Representativeness of clinical samples of youths with mental disorders: A preliminary population-based study.

In a household community sample of 1,285, 9–17 year-olds with mental disorders who had received outpatient specialty mental health services in the past year were compared with youths with mental disorders who had not received those services to determine if samples drawn from clinical settings are representative of youths with mental disorders in the general population. Those who had used services were more impaired, less competent, more likely to have comorbid disorders, more likely to belong to non-Hispanic White relative to other ethnic groups, and less likely to be prepubertal girls. Their parents were more educated, but less satisfied with family life, engaged in less monitoring of their children, and more likely to have used mental health services themselves. These findings suggest the hypothesis that samples of youths with mental disorders drawn from outpatient clinical settings are not representative of all youths with mental disorders. If confirmed, this would indicate the importance of population-based samples for the study of psychopathology in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of a children's health insurance program on newly enrolled children

CONTEXT: Although there is considerable interest in decreasing the number of US children who do not have health insurance, there is little information on the effect that health insurance has on children and their families. OBJECTIVE: To determine the impact of children's health insurance programs on access to health care and on other aspects of the lives of the children and their families. DESIGN: A before-after design with a control group. The families of newly enrolled children were interviewed by telephone using an identical survey instrument at baseline, at 6 months, and at 12 months after enrollment into the program. A second group of families of newly enrolled children were interviewed 12 months after the initial interviews to form a comparison sample. SETTING: The 29 counties of western Pennsylvania, an area with a population of 4.1 million people. SUBJECTS: A total of 887 families of newly enrolled children were randomly selected to be interviewed; 88.3% agreed to participate. Of these, 659 (84%) responded to all 3 interviews. The study population consists of 1031 newly enrolled children. The children were further classified into those who were continuously enrolled in the programs. The 330 comparison families had 460 newly enrolled children. MAIN OUTCOME MEASURES: The following access measures were examined: whether the child had a usual source of medical or dental care; the number of physician visits, emergency department visits, and dentist visits; and whether the child had experienced unmet need, delayed care, or both for 6 types of care. Other indicators were restrictions on the child's usual activities and the impact of being insured or uninsured on the families. RESULTS: Access to health care services after enrollment in the program improved: at 12 months after enrollment, 99% of the children had a regular source of medical care, and 85% had a regular dentist, up from 89% and 60%, respectively, at baseline. The proportion of children reporting any unmet need or delayed care in the past 6 months decreased from 57% at baseline to 16% at 12 months. The proportion of children seeing a physician increased from 59% to 64%, while the proportion visiting an emergency department decreased from 22% to 17%. Since the comparison children were similar to the newly enrolled children at enrollment into the insurance programs, these findings can be attributed to the program. Restrictions on childhood activities because of lack of health insurance were eliminated. Parents reported that having health insurance reduced the amount of family stress, enabled children to get the care they needed, and eased family burdens. CONCLUSIONS: Extending health insurance to uninsured children had a major positive impact on children and their families. In western Pennsylvania, health insurance did not lead to excessive utilization but to more appropriate utilization.     

Are you treating youngsters who are or should be receiving mental health services?

Psychiatrists now recognize that the disorders of children are serious, treatable conditions and as precursors of adult psychopathology. These conditions can seriously influence the patient's behavior when undergoing dental treatment. The dentist will probably assume that the behavior problems are directly related to the nature of the dental service, rather than particular underlying personality characteristics of preschool and school-age children. It is important that practitioners recognize and understand these conditions as they attempt to provide adequate treatment. No national epidemiological studies have been conducted in this country that would provide valid indicators of either the prevalence or incidence of mental disorders among children. Local studies, however, have been done that diagnosable disorders in children range from 17.6 percent to 22 percent, including 3 percent to 5 percent who have severe emotional or behavioral problems. The prevalence of many mental disorders is greater in males than in females, ranging from a ratio of 2:1 to 9:1. Lifetime prevalence of mental disorders, first diagnosed in infancy, childhood, and adolescence range as high as 15,000 cases per 100,000 persons. It is important for the dentist to recognize that (1) even the youngest of children seen in a dental practice may be in need of mental health services, (2) management problems may stem from mental health problems, and (3) families are unaware or unwilling to admit that a child may need help.     

Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health service use among young children receiving pediatric primary care

OBJECTIVE: To investigate the factors associated with mental health service use among young children. METHOD: Five hundred ten preschool children aged 2 through 5 years were enrolled through 68 primary care physicians, with 388 (76% of the original sample) participating in a second wave of data collection, 12 to 40 months later. Consensus DSM-III-R diagnoses were assigned using best-estimate procedures. The test battery included the Child Behavior Checklist, a developmental evaluation, the Rochester Adaptive Behavior Inventory, and a videotaped play session (preschool children) or structured interviews (older children). At wave 2, mothers completed a survey of mental health services their child had received. RESULTS: In logistic regression models, older children, children with a wave 1 DSM-III-R diagnosis, children with more total behavior problems and family conflict, and children receiving a pediatric referral were more likely to receive mental health services. Among children with a DSM-III-R diagnosis, more mental health services were received by children who were older, white, more impaired, experiencing more family conflict, and referred by a pediatrician. CONCLUSIONS: Young children with more impairment and family conflict are more likely to enter into treatment. Services among young children of different races with diagnoses are not equally distributed. Pediatric referral is an important predictor of service use.     

Improving Mental Health Service Utilization for Children and Adolescents.

Approximately 10% of children and adolescents have mental health problems necessitating intervention, but well below 50% of these children receive needed services, and far fewer receive the quality of care required to effectively reduce their impairments. Although system reform is needed to improve service utilization and quality of care for all children, preschoolers, girls, individuals of minority status, and the uninsured are most at risk for being underserved. Factors contributing to poor service utilization can be classified into two broad sets: sociopolitical factors referring to issues related to funding and access, and cultural/familial factors including beliefs about mental health services, providers, and treatments. This article describes the help-seeking process and focuses on cultural and familial factors that contribute to movement through these stages, with a particular focus on variables that are amenable to change by practitioners in the school and community, including school psychologists. Guidelines for understanding and changing the help-seeking behavior of families, including suggestions for creating service options, providing family education, and offering individualized family services, are described. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Three-year course of behavior/emotional problems in a national sample of 4- to 16-year-olds: III. Predictors of signs of disturbance.

Tested parent-reported family variables, problems, competencies, and stress as predictors of (1) academic problems, (2) school behavior problems, (3) receipt of mental health services, (4) child's need for additional help, (5) suicidal behavior, (6) police contacts, and (7) the sum of these 6 outcomes. Included in the study were 995 cases manifesting at least 1 sign of disturbance (from Outcomes 1–6) and 995 matched controls from a national sample of 2,479 children assessed twice over a 3-yr interval. Path analyses identified predictors that were significant across age and sex plus those specific to particular groups. The predictive models accounted for medium to large effects in Time 2 signs of disturbance. Time 2 Child Behavior Checklist scores were significantly associated with all Time 2 disturbance scores. The multiple significant risk factors associated with signs of disturbance indicated variations in pathways leading to particular signs of disturbance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blood flow through the ductus venosus in human fetus: calculation using Doppler velocimetry and computational findings

The associations of the mutual mother-child, father-child, and mother-father relationship and various patterns of family relations with child psychopathology were investigated in a sample of 137 families referred to outpatient mental health services. Assessment of the relative association of the different family dyads showed that both the mother-child and the mother-father relationship were related to child problem behaviour. However, whereas the mother-child relationship was consistently more related to externalising behaviour, the mother-father relationship was particularly related to internalising behaviour. Our findings gave clear support for the cumulative risk model: having more negatively qualified relationships was associated with more problem behaviour. Furthermore, our results suggested a protective influence of the parent-child relationship: having one or two positive parent-child relationships was associated with less problem behaviour. No support was found for the cross-generational coalition hypothesis. Implications for future research are discussed.     

Help seeking for mental health care among poor Puerto Ricans: problem recognition, service use, and type of provider

OBJECTIVES: This study examines the effects of health, predisposing, and enabling factors on recognition of a mental health problem, use of formal mental health care, and contact with a specialized mental health provider. METHODS: Interviews were conducted with a probability sample of 3,435 adults. The variables examined include measures of mental health; social and demographic factors; and enabling factors relevant to the help-seeking process. RESULTS: Subjective and objective measures of mental health were associated with the recognition of a mental health problem. The objective assessment of definite need for services was relevant for the use of formal services. However, the subjects' perception of poor mental health was strongly related to receiving care from a mental health specialist. Although interaction with social networks is associated with use of formal services, low economic strain is related to receiving care from the specialty sector. CONCLUSIONS: The results support the importance of using multiple measures of mental health problems. The finding that individuals' perceived economic strain increases the likelihood of receiving specialized care suggests that studies of economic barriers to the use of mental health services might benefit from the adoption of measures that assess perceived economic circumstances.     

Perception of stress by mothers of children with language development disorders

Subject of this study is the maternal stress as a result of the disabilities of language impaired children. The report concentrates on the influence of the children disabilities and the maternal coping strategies on the stress in the families. The study is based on an inquiry of 98 mothers with speech and language impaired children. Nearly 50% of the mothers suffer from stress because of their children' disabilities. Special caregiving demands, family conflicts, anxiety about the child future, depressive mood, aggressive feeling or deception were often experienced by the mothers as a direct consequence of their child's problems. The correlation of this specific maternal stress with general stress factors was insignificant. The maternal stress was more due to the attention deficits and the behavioural problems of the children than to the language delay. An increased level of stress was hardly related to the severity of the impairment, but to the maternal coping strategies. Mothers applying emotion focused coping strategies experienced more stress than those who predominantly used problem focused strategies. The results prove that mothers of children with even minor disabilities feel overstrained by their children' disorders. During counseling experts should attach more importance to deal with the needs and wishes of mothers and families of language impaired children. Reduction of family stress can be achieved by intervention programs helping the mothers to improve their psychological resources.     

Facilitating the care of terminally Ill children

Life-threatening illness is fortunately rare in children. Some children, however, will need palliative care for symptom control; psychological support may be needed by the child and the child's family; and families may require help with decisions about life-prolonging treatment. Providing consistent high-quality care for a relatively uncommon problem is difficult. Adult palliative care services, liaison with pediatricians can help provide this care.     

Everyday problems and stress faced by parents of children with cochlear implants.

Objectives: To explore everyday problems associated with parenting children who undergo cochlear implantation (CI), to investigate parents' interpersonal relationships as a resource for collaborative problem solving, and to examine links among parents' everyday problems, stress, and life satisfaction. Method: 31 parents of deaf children with CI responded to open-ended questions regarding types of everyday problems encountered within the specific context of parenting those children. Parents also completed the Parental Stress Index/Short Form and the Life Satisfaction Scale. Results: Problems were categorized in 9 domains: implant drawbacks, communication difficulties, child's behavior and character, socialization, habilitation demands and parenting role, financial difficulties, services, educating others and/or advocacy, and academic concerns. Professionals, spouses, and other parents of deaf children were frequently nominated partners for collaborative everyday problem solving and coping. Significant correlations emerged among parents' everyday problems, stress, and life satisfaction. Conclusions: Findings enhance understanding regarding the contextual specificity of everyday problems associated with raising deaf children with CI, beyond that obtained from a general measure of parental stress. This, in turn, can guide habilitation teams in working with families of implanted children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of melatonin on metabolic changes in female rats induced by continuous irradiation and/or administration of 7,12-dimethylbenz/a/anthracene

OBJECTIVE: To investigate the influence of social deprivation upon the diet, dental health behaviours and dental health status of five-year-old children in Northern Ireland. DESIGN: Cross-sectional study. SETTING: Fifty-eight primary schools in North and West Belfast. SUBJECTS: A nine per cent (240) random sample of 2,666 five-year-old children resident and attending school in North and West Belfast. MAIN OUTCOME MEASURES: Dental health status measured by dmft index; parental assessments of the child's dental health behaviours: parental dental attendance patterns and attitudes towards dental health; parental assessments of the child's diet and snacking behaviours: parental attitudes towards snack foods; and demographic profile of child's family. RESULTS: One hundred and sixty-three children were examined, a 68 per cent response. The majority of the families were either in low income employment or unemployed. Sixty-eight per cent of children had experience of dental caries. Dental decay was unrelated to parental employment status but more children from unemployed families attended when in pain. The diet of the children was related to both employment status and parental attitude and was reflected in their caries experience. Caries experience was dependent upon parental dental attendance, the consumption of carbonated drinks and sugar containing bedtime drinks. CONCLUSIONS: The results suggest that unemployment and parental attitudes are important as determinants of dental caries in five-year-old children from North and West Belfast. These factors may influence the child's dental health care as well as type of diet.     

Maternal depression, paternal psychopathology, and adolescent diagnostic outcomes.

The authors examined the relationship between maternal depression, paternal psychopathology, and adolescent diagnostic outcomes in a community sample of 522 Australian families. They also examined whether chronic family stress, father's expressed emotion, and parents' marital satisfaction mediated the relationship between parental psychopathology and adolescent outcomes. Mother's education, child's gender, and family income were covaried in all analyses. Results revealed that maternal depression and paternal depression had an additive effect on youth externalizing disorders. In addition, maternal depression interacted with both paternal depression and paternal substance abuse in predicting youth depression but not youth nondepressive disorders. Chronic family stress and father's expressed emotion appeared to mediate the relationship between parental psychopathology and youth depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health problems of homeless children and families: longitudinal study

OBJECTIVE: To establish the mental health needs of homeless children and families before and after rehousing. DESIGN: Cross sectional, longitudinal study. SETTING: City of Birmingham. SUBJECTS: 58 rehoused families with 103 children aged 2-16 years and 21 comparison families of low socioeconomic status in stable housing, with 54 children. MAIN OUTCOME MEASURES: Children's mental health problems and level of communication; mothers' mental health problems and social support one year after rehousing. RESULTS: Mental health problems remained significantly higher in rehoused mothers and their children than in the comparison group (mothers 26% v 5%, P = 0.04; children 39% v 11%, P = 0.0003). Homeless mothers continued to have significantly less social support at follow up. Mothers with a history of abuse and poor social integration were more likely to have children with persistent mental health problems. CONCLUSIONS: Homeless families have a high level of complex needs that cannot be met by conventional health services and arrangements. Local strategies for rapid rehousing into permanent accommodation, effective social support and health care for parents and children, and protection from violence and intimidation should be developed and implemented.     

Respite-care needs--met and unmet: assessment of needs for children with disability

The study aimed to ascertain the current use of respite-care services by families with children with a learning and/or a physical disability in a South London, UK, health authority, to estimate the type and extent of the unmet need, and to set standards for the provision of such services. Over 1200 families were sent an 11-page questionnaire. The results indicated that the child's level of dependency and the presence of behaviour and communication problems led to significantly higher levels of experienced stress among carers. This was also associated with a significantly greater use of respite care except by families of children with behavioural problems. The results showed that respite care was generally perceived as an inadequate service, though 88% of respondents had no knowledge of the existence of respite-care services. Recommendations are made in relation to information provision, choice, and flexibility for carers and for quality standards in general.     

Community-based systems of care for children's mental health services

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.     

Children in low-income, urban settings: Interventions to promote mental health and well-being.

Urbanization provides unique political, cultural, economic, and educational opportunities for children and families. However, it may also have a negative impact on the mental health and well-being of children and adolescents, particularly when they are exposed to settings with high rates of crime, violence, delinquency, substance use, abuse, and poverty. Psychologists are well suited to intervene in problems associated with urbanization. However, most psychological services have been directed toward children who are experiencing problems, and there has been less focus on population-based or preemptive interventions that prevent problems before they occur. This review presents 11 recommendations for urban interventions that build on individual, family, and community strengths to promote the mental health and well-being of urban children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomised, prospective study comparing cemented and cementless total knee replacement: results of press-fit condylar total knee replacement at five years

OBJECTIVE: The objective of this study was to examine the effect of family and neighborhood income on health care use of young children born prematurely and of low birth weight (N = 619). DESIGN: A birth cohort was enrolled in a clinical randomized trial of early childhood educational and family services. SETTINGS/PARTICIPANTS: Infant Health and Development Program provided a sample of low birth weight premature infants stratified by clinical site, birth weight, and treatment group. Maternal reports of health care use, family income, and heath insurance were obtained at 12, 24, and 36 months of corrected age. Neighborhood income was based on census tract residence at birth. MAIN OUTCOME MEASURES: Maternal reports of hospitalizations, doctor visits, and emergency department visits were used; data were averaged over the child's first 3 years of life. RESULTS: Children from poorer families were more likely to be hospitalized and to have more emergency department visits than were children from more affluent families. Residence in poor and middle-income neighborhoods was associated with more emergency department visits than residence in affluent neighborhoods. Families in middle-income neighborhoods reported more doctor visits than families in poor or affluent neighborhoods. CONCLUSION: Neighborhood residence influences health care use by poor and nonpoor families and by insured and uninsured families. The use of the emergency department for low birth weight premature children in middle-income and poor neighborhoods is discussed.