- Email: [email protected]
2.34 Impairment of Quality of Life in Childhood Cancer Survivors and Parenting Stress
NEW RESEARCH POSTERS 2.34 — 2.36
assessments capture some of the children with delirium, both the screeners and psychiatry are still missing a significant proportion of children who have ongoing cognitive dysfunction. Pediatric healthcare needs to improve its evaluation of delirium to minimize ongoing cognitive deficits after admission to the PICU.
COG, CON, DIAG Supported by a Society of Critical Care Medicine-Weil Research Grant http://dx.doi.org/10.1016/j.jaac.2017.09.113
2.34 IMPAIRMENT OF QUALITY OF LIFE IN CHILDHOOD CANCER SURVIVORS AND PARENTING STRESS Yunhye Oh, National Center Mental Health, nunnerine@ gmail.com; Yoo-Sook Joung, MD, PhD, Samsung Medical Center, Sungkyunkwan Univ Medical School, yschoung@ skku.edu Objectives: This study investigated and compared psychological functioning, quality of life, and parenting stress of caretakers among childhood survivors with brain tumor and neuroblastoma and healthy control subjects. Methods: A total of 304 children were within the age range of 8–15 years, and their parent participated in this study. Psychosocial functioning among survivors of brain tumor (n ¼ 100) and neuroblastoma (n ¼ 51) was assessed using Childhood Behavior Checklist (CBCL). Parenting stress and quality of life among brain tumor group, neuroblastoma group, and healthy control group (n ¼ 151) were assessed using the Parenting Stress Index and the Pediatric Quality of Life Inventory (PedsQLTM). Results: The group with brain tumor had lower intelligence and higher CBCL scores (more problems) on somatic complaints compared with the group with neuroblastoma. The group with brain tumor had lower quality of life compared with the group with neuroblastoma and the healthy control group (all P < 0.05). No differences between cancer groups were found for parenting stress, with the exception of the scale measuring parenting competence. Conclusions: These findings will inform our understanding of childhood cancer survivors and hence suggest that patients with childhood cancer are likely to have higher levels of psychosocial stress and poor quality of life.
IMP, STRESS, PAT http://dx.doi.org/10.1016/j.jaac.2017.09.114
2.35 ADDRESSING MENTAL HEALTH NEEDS OF LATINO IMMIGRANT PARENTS IN PEDIATRIC PRIMARY CARE Rheanna Platt, MD, MPH, Johns Hopkins University, rplatt1@ jhmi.edu; Elisabet Arribas-Ibar, PhD, Barcelona Biomedical Research Park/Hospital Del Mar Research Institute, [email protected] Objectives: Few studies have examined the prevalence of depressive symptoms and comorbid conditions in Latino parents whose children are presenting for well-child care. Methods: Spanish-speaking parents (n ¼ 100) of children (ages 0–5 years) attending well visits at a general pediatric clinic were surveyed between October 2015 and February 2016. The verbally administered survey included the Personal Health Questionnaire Depression Scale-8 (PHQ-8), Generalized Anxiety Disorder 2-item (GAD-2), Primary Care-PTSD screener, and Alcohol Use Disorders Identification Test (AUDIT-C) and psychosocial/demographic measures used in large regional/national surveys. From the sample group of 100 parents, 11 were recruited to participate in in-depth interviews, further exploring sources of parental distress and acceptability of screening and intervention for parental mental health symptoms in the pediatric primary care settings. Results: A total of 96 percent of approached parents agreed to participate. Participants were predominantly female (ages <35 years), lived in the United States a mean of eight years (range 1–17 years), and reported limited English proficiency (75%). Respondents (35%) had a
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
“positive” PHQ-8 score (>5; 95% CI: 25.8–44.6%); 82.8 percent of these fell within the mild range. Of those who screened positive for depression, 50 percent also screened positive for PTSD symptoms (95% CI: 33– 67%), 25 percent for anxiety symptoms (95% CI: 11.7–41.5%), and 29.4 percent for problematic alcohol use (95% CI: 16.1–47.5%). Among parents with a positive PHQ-8, 94 percent did not identify a primary care physician and 73 percent were uninsured in the preceding 12 months. In qualitative interviews, parents were generally supportive of screening for and addressing parental psychosocial stressors within the pediatric primary care setting. Most felt that a group-based intervention would be beneficial and would allow them to share experiences with other parents. Parents cited finances, immigration-related difficulties (including family separation, fear of deportation, and limited English proficiency), and interpersonal and community violence as significant sources of stress. Conclusions: Parents screening positive for depression reported a relatively high prevalence of comorbid anxiety, PTSD, and alcohol use symptoms and limited access to their own source of healthcare. In interviews, parents generally perceived a pediatric clinic-based intervention as acceptable. Resultsfrom this study will be used to inform the development of a groupbased intervention for recently immigrated parents in pediatric primary care.
ETHN, CC, PAT Supported by the Johns Hopkins Institute for Clinical and Translational Research and National Center for Advancing Translational Sciences Grant KL2TR001077 http://dx.doi.org/10.1016/j.jaac.2017.09.115
2.36 THE TWO-YEAR NATIONWIDE SURVEY OF COMMUNITY MENTAL HEALTH OUTREACH SERVICE COMBINED OUTPATIENT PSYCHIATRIC TREATMENT FOR CHILDREN AND ADOLESCENTS WITH MENTAL DISABILITY IN TAIWAN Chao-Wei Hsu, MD, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, [email protected] Objectives: Since June 2015, Ministry of Health and Welfare in Taiwan started a project of providing community mental health outreach services and outpatient psychiatric treatment for children and adolescents with mental disability from schools and institutions within the community. The primary goal of this project was promotion of medical service quality by early detection and management for children and adolescents with mental disability and psychiatric disorder. Methods: Service team members from seven hospitals in Taiwan, including psychiatrists, psychologists, and case managers, provided both outreach services and outpatient psychiatric treatment and collected all of the outpatient’s basic data and assessment scales from June 2015 to December 2016 (N ¼ 772). In this retrospective study, the study team of this project analyzed outpatient’s basic data and assessment scales, including Clinical Global Impression (CGI)—Schizophrenia (S), CGI-Global Improvement (CGI-I), Global Assessment of Functioning (GAF), Personal and Social Performance (PSP), rehospitalization rate, length of hospital stay, and satisfaction survey from their family members and caregivers. Results: The study findings revealed significant improvement in CGI-S, CGI-I, GAF, and PSP (P < 0.01); lower rehospitalization rate; and shorter length of hospital stay. Majority of these outpatients presented less mood or behavioral symptoms, better adaptation and academic performance at schools and institutions, and higher scores of satisfaction survey provided from their family members and caregivers. Conclusions: From the study’s findings, community mental health outreach service combined with outpatient psychiatric treatment allowed for early detection and intervention of children and adolescents with mental disability and psychiatric disorder. This service model can help children and adolescents alleviate their symptoms at early stages of psychiatric disorder, reduce hospitalization and medical cost, and avoid
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assessments capture some of the children with delirium, both the screeners and psychiatry are still missing a significant proportion of children who have ongoing cognitive dysfunction. Pediatric healthcare needs to improve its evaluation of delirium to minimize ongoing cognitive deficits after admission to the PICU.
COG, CON, DIAG Supported by a Society of Critical Care Medicine-Weil Research Grant http://dx.doi.org/10.1016/j.jaac.2017.09.113
2.34 IMPAIRMENT OF QUALITY OF LIFE IN CHILDHOOD CANCER SURVIVORS AND PARENTING STRESS Yunhye Oh, National Center Mental Health, nunnerine@ gmail.com; Yoo-Sook Joung, MD, PhD, Samsung Medical Center, Sungkyunkwan Univ Medical School, yschoung@ skku.edu Objectives: This study investigated and compared psychological functioning, quality of life, and parenting stress of caretakers among childhood survivors with brain tumor and neuroblastoma and healthy control subjects. Methods: A total of 304 children were within the age range of 8–15 years, and their parent participated in this study. Psychosocial functioning among survivors of brain tumor (n ¼ 100) and neuroblastoma (n ¼ 51) was assessed using Childhood Behavior Checklist (CBCL). Parenting stress and quality of life among brain tumor group, neuroblastoma group, and healthy control group (n ¼ 151) were assessed using the Parenting Stress Index and the Pediatric Quality of Life Inventory (PedsQLTM). Results: The group with brain tumor had lower intelligence and higher CBCL scores (more problems) on somatic complaints compared with the group with neuroblastoma. The group with brain tumor had lower quality of life compared with the group with neuroblastoma and the healthy control group (all P < 0.05). No differences between cancer groups were found for parenting stress, with the exception of the scale measuring parenting competence. Conclusions: These findings will inform our understanding of childhood cancer survivors and hence suggest that patients with childhood cancer are likely to have higher levels of psychosocial stress and poor quality of life.
IMP, STRESS, PAT http://dx.doi.org/10.1016/j.jaac.2017.09.114
2.35 ADDRESSING MENTAL HEALTH NEEDS OF LATINO IMMIGRANT PARENTS IN PEDIATRIC PRIMARY CARE Rheanna Platt, MD, MPH, Johns Hopkins University, rplatt1@ jhmi.edu; Elisabet Arribas-Ibar, PhD, Barcelona Biomedical Research Park/Hospital Del Mar Research Institute, [email protected] Objectives: Few studies have examined the prevalence of depressive symptoms and comorbid conditions in Latino parents whose children are presenting for well-child care. Methods: Spanish-speaking parents (n ¼ 100) of children (ages 0–5 years) attending well visits at a general pediatric clinic were surveyed between October 2015 and February 2016. The verbally administered survey included the Personal Health Questionnaire Depression Scale-8 (PHQ-8), Generalized Anxiety Disorder 2-item (GAD-2), Primary Care-PTSD screener, and Alcohol Use Disorders Identification Test (AUDIT-C) and psychosocial/demographic measures used in large regional/national surveys. From the sample group of 100 parents, 11 were recruited to participate in in-depth interviews, further exploring sources of parental distress and acceptability of screening and intervention for parental mental health symptoms in the pediatric primary care settings. Results: A total of 96 percent of approached parents agreed to participate. Participants were predominantly female (ages <35 years), lived in the United States a mean of eight years (range 1–17 years), and reported limited English proficiency (75%). Respondents (35%) had a
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
“positive” PHQ-8 score (>5; 95% CI: 25.8–44.6%); 82.8 percent of these fell within the mild range. Of those who screened positive for depression, 50 percent also screened positive for PTSD symptoms (95% CI: 33– 67%), 25 percent for anxiety symptoms (95% CI: 11.7–41.5%), and 29.4 percent for problematic alcohol use (95% CI: 16.1–47.5%). Among parents with a positive PHQ-8, 94 percent did not identify a primary care physician and 73 percent were uninsured in the preceding 12 months. In qualitative interviews, parents were generally supportive of screening for and addressing parental psychosocial stressors within the pediatric primary care setting. Most felt that a group-based intervention would be beneficial and would allow them to share experiences with other parents. Parents cited finances, immigration-related difficulties (including family separation, fear of deportation, and limited English proficiency), and interpersonal and community violence as significant sources of stress. Conclusions: Parents screening positive for depression reported a relatively high prevalence of comorbid anxiety, PTSD, and alcohol use symptoms and limited access to their own source of healthcare. In interviews, parents generally perceived a pediatric clinic-based intervention as acceptable. Resultsfrom this study will be used to inform the development of a groupbased intervention for recently immigrated parents in pediatric primary care.
ETHN, CC, PAT Supported by the Johns Hopkins Institute for Clinical and Translational Research and National Center for Advancing Translational Sciences Grant KL2TR001077 http://dx.doi.org/10.1016/j.jaac.2017.09.115
2.36 THE TWO-YEAR NATIONWIDE SURVEY OF COMMUNITY MENTAL HEALTH OUTREACH SERVICE COMBINED OUTPATIENT PSYCHIATRIC TREATMENT FOR CHILDREN AND ADOLESCENTS WITH MENTAL DISABILITY IN TAIWAN Chao-Wei Hsu, MD, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, [email protected] Objectives: Since June 2015, Ministry of Health and Welfare in Taiwan started a project of providing community mental health outreach services and outpatient psychiatric treatment for children and adolescents with mental disability from schools and institutions within the community. The primary goal of this project was promotion of medical service quality by early detection and management for children and adolescents with mental disability and psychiatric disorder. Methods: Service team members from seven hospitals in Taiwan, including psychiatrists, psychologists, and case managers, provided both outreach services and outpatient psychiatric treatment and collected all of the outpatient’s basic data and assessment scales from June 2015 to December 2016 (N ¼ 772). In this retrospective study, the study team of this project analyzed outpatient’s basic data and assessment scales, including Clinical Global Impression (CGI)—Schizophrenia (S), CGI-Global Improvement (CGI-I), Global Assessment of Functioning (GAF), Personal and Social Performance (PSP), rehospitalization rate, length of hospital stay, and satisfaction survey from their family members and caregivers. Results: The study findings revealed significant improvement in CGI-S, CGI-I, GAF, and PSP (P < 0.01); lower rehospitalization rate; and shorter length of hospital stay. Majority of these outpatients presented less mood or behavioral symptoms, better adaptation and academic performance at schools and institutions, and higher scores of satisfaction survey provided from their family members and caregivers. Conclusions: From the study’s findings, community mental health outreach service combined with outpatient psychiatric treatment allowed for early detection and intervention of children and adolescents with mental disability and psychiatric disorder. This service model can help children and adolescents alleviate their symptoms at early stages of psychiatric disorder, reduce hospitalization and medical cost, and avoid
www.jaacap.org
S189