Tag Archives: Depression In School Age Children and Adolescents

University of California, San Francisco study identifies most common reasons for children’s mental health hospitalizations

23 Mar

Moi wrote about troubled children in Schools have to deal with depressed and troubled children: Both the culture and the economy are experiencing turmoil. For some communities, the unsettled environment is a new phenomenon, for other communities, children have been stressed for generations. According to the article, Understanding Depression which was posted at the Kids Health site:

Depression is the most common mental health problem in the United States. Each year it affects 17 million people of all age groups, races, and economic backgrounds.
As many as 1 in every 33 children may have depression; in teens, that number may be as high as 1 in 8.
Schools are developing strategies to deal with troubled kids…. http://kidshealth.org/parent/emotions/feelings/understanding_depression.html

One strategy in helping children to succeed is to recognize and treat depression.

How Common Is Depression In Children?

According to Mary H. Sarafolean, PhD in the article, Depression In School Age Children and Adolescents

In general, depression affects a person’s physical, cognitive, emotional/affective, and motivational well-being, no matter their age. For example, a child with depression between the ages of 6 and 12 may exhibit fatigue, difficulty with schoolwork, apathy and/or a lack of motivation. An adolescent or teen may be oversleeping, socially isolated, acting out in self-destructive ways and/or have a sense of hopelessness.
Prevalence and Risk Factors
While only 2 percent of pre-teen school-age children and 3-5 percent of teenagers have clinical depression, it is the most common diagnosis of children in a clinical setting (40-50 percent of diagnoses). The lifetime risk of depression in females is 10-25 percent and in males, 5-12 percent. Children and teens who are considered at high risk for depression disorders include:
* children referred to a mental health provider for school problems
* children with medical problems
* gay and lesbian adolescents
* rural vs. urban adolescents
* incarcerated adolescents
* pregnant adolescents
* children with a family history of depression http://www.healthyplace.com/depression/children/recognizing-symptoms-of-depression-in-teens-and-children/

If you or your child has one or more of the risk factors and your child is exhibiting symptoms of prolonged sadness, it might be wise to have your child evaluated for depression.

How to Recognize Depression In Your Child?

MedNet has an excellent article about Depression In Children and how to recognize signs of depression in your child.
Signs and symptoms of depression in children include:

* Irritability or anger
* Continuous feelings of sadness, hopelessness
* Social withdrawal
* Increased sensitivity to rejection
* Changes in appetite — either increased or decreased
* Changes in sleep — sleeplessness or excessive sleep
* Vocal outbursts or crying
* Difficulty concentrating
* Fatigue and low energy
* Physical complaints (such as stomachaches, headaches) that do not respond to
treatment
* Reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
* Feelings of worthlessness or guilt
* Impaired thinking or concentration
* Thoughts of death or suicide
Not all children have all of these symptoms. In fact, most will display different symptoms at different times and in different settings. Although some children may continue to function reasonably well in structured environments, most kids with significant depression will suffer a noticeable change in social activities, loss of interest in school and poor academic performance, or a change in appearance. Children may also begin using drugs or alcohol,
especially if they are over the age of 12. http://www.onhealth.com/depression_in_children/article.htm

The best defense for parents is a good awareness of what is going on with their child. As a parent you need to know what is going on in your child’s world. https://drwilda.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

Science Daily reported in the article, Study identifies most common, costly reasons for mental health hospitalizations for kids:

Nearly one in 10 hospitalized children have a primary diagnosis of a mental health condition, and depression alone accounts for $1.33 billion in hospital charges annually, according to a new analysis led by UCSF Benioff Children’s Hospital.
The study is the first to examine frequency and costs associated with specific inpatient mental health diagnoses for children, and is a step towards creating meaningful measures of the quality of pediatric hospital care.
“This is the first paper to give a clear picture of the mental health reasons kids are admitted to hospitals nationally,” said Naomi Bardach, MD, an assistant professor of pediatrics at UCSF Benioff Children’s Hospital and lead author. “Mental health hospitalizations have been increasing in kids, up 24% from 2007-2010. Mental health is a priority topic for national quality measures, which are intended to help improve care for all kids.”
The study will be published in the April issue of the journal Pediatrics.
More than 14 million children and adolescents in the United States have a diagnosable mental health disorder, yet little is known about which specific mental health diagnoses are causing children to be hospitalized. In the study, researchers found that depression, bipolar disorder and psychosis are the most common and expensive primary diagnoses for pediatric admissions.
“We now know through our analysis of cost and frequency which diagnoses are the most relevant,” said Bardach. “Next, we need to define what the optimal care is for children with these conditions so that hospitals can consistently deliver the best care for every child, every time.”
Using two national databases — Kids’ Inpatient Database and Pediatric Health Information System — the researchers looked at all hospital discharges in 2009 for patients aged three to 20 years old to determine the frequency of hospitalizations for primary mental health diagnoses. They compared the mental health hospitalizations between free-standing children’s hospitals and hospitals that treat both adults and children, to assess if there was a difference in frequency of diagnoses.
The study found that hospitalizations for children with primary mental health diagnoses were more than three times more frequent at general hospitals than free standing children’s hospitals, which the researchers say could indicate that general hospitals have a greater capacity to deliver inpatient psychiatric care than free-standing children’s hospitals…. http://www.sciencedaily.com/releases/2014/03/140317084531.htm

Citation:

Study identifies most common, costly reasons for mental health hospitalization

Date: March 17, 2014

Source: University of California, San Francisco

Summary:
Nearly one in 10 hospitalized children have a primary diagnosis of a mental health condition, and depression alone accounts for $1.33 billion in hospital charges annually, according to a new analysis. The study is the first to examine frequency and costs associated with specific inpatient mental health diagnoses for children, and is a step towards creating meaningful measures of the quality of pediatric hospital care.
Journal Reference:
1.Naomi S. Bardach, Tumaini R. Coker, Bonnie T. Zima, J. Michael Murphy, Penelope Knapp, Laura P. Richardson, Glenace Edwall, and Rita Mangione-Smith. Common and Costly Hospitalizations for Pediatric Mental Health Disorders. Pediatrics, March 2014 DOI: 10.1542/peds.2013-3165

Here is the press release from the University of San Francisco:

Study Identifies Most Common, Costly Reasons for Mental Health Hospitalizations for Kids
By Juliana Bunim on March 13, 2014
Nearly one in 10 hospitalized children have a primary diagnosis of a mental health condition, and depression alone accounts for $1.33 billion in hospital charges annually, according to a new analysis led by UCSF Benioff Children’s Hospital.
The study is the first to examine frequency and costs associated with specific inpatient mental health diagnoses for children, and is a step towards creating meaningful measures of the quality of pediatric hospital care.
“This is the first paper to give a clear picture of the mental health reasons kids are admitted to hospitals nationally,” said Naomi Bardach, MD, an assistant professor of pediatrics at UCSF Benioff Children’s Hospital and lead author. “Mental health hospitalizations have been increasing in kids, up 24% from 2007-2010. Mental health is a priority topic for national quality measures, which are intended to help improve care for all kids.”
The study will be published in the April issue of the journal Pediatrics.
More than 4 million children and adolescents in the United States have a diagnosable mental health disorder, yet little is known about which specific mental health diagnoses are causing children to be hospitalized. In the study, researchers found that depression, bipolar disorder and psychosis are the most common and expensive primary diagnoses for pediatric admissions.
“We now know through our analysis of cost and frequency which diagnoses are the most relevant,” said Bardach. “Next, we need to define what the optimal care is for children with these conditions so that hospitals can consistently deliver the best care for every child, every time.”
Using two national databases – Kids’ Inpatient Database and Pediatric Health Information System – the researchers looked at all hospital discharges in 2009 for patients aged three to 20 years old to determine the frequency of hospitalizations for primary mental health diagnoses. They compared the mental health hospitalizations between free-standing children’s hospitals and hospitals that treat both adults and children, to assess if there was a difference in frequency of diagnoses.
The study found that hospitalizations for children with primary mental health diagnoses were more than three times more frequent at general hospitals than free standing children’s hospitals, which the researchers say could indicate that general hospitals have a greater capacity to deliver inpatient psychiatric care than free-standing children’s hospitals.
At both kinds of hospitals, the most common mental health diagnoses were similar (depression, bipolar disorder, and psychosis), which the researchers say supports the creation of diagnosis-specific quality measures for all hospitals that admit children.
Depression accounted for 44.1 percent of all pediatric primary mental health admissions, with charges of $1.33 billion dollars, based on the billing databases used in the study. Bipolar was the second most common diagnosis accounting for 18.1 percent and $702 million, followed by psychosis at 12.1 percent and $540 million.
“These are costly hospitalizations, and being hospitalized is a heavy burden for families and patients. Prevention and wellness is a huge part of the Affordable Care Act, along with controlling costs by delivering great care,” said Bardach. “This study helps us understand that mental health is a key priority. The long term goal is not only to improve hospital care for these kids, but also to understand how to effectively optimize mental health resources in the outpatient world.”
Co-authors include Tumaini Coker, MD, MBA and Bonnie Zima, MD, MPH, both of UCLA; J. Michael Murphy, EdD, Massachusetts General Hospital Boston; Penelope Knapp, MD, UC Davis; Laura Richardson, MD, MPH and Rita Mangione-Smith, MD, MPH, both of the University of Washington School of Medicine, Seattle; and Glenace Edwall, PsyD, PhD, MPP, Minnesota State Health Access Data Assistance Center.
The study was supported by the Agency for Healthcare Research and Quality and the National Institute for Children’s Health and Human Development.
UCSF Benioff Children’s Hospital creates an environment where children and their families find compassionate care at the forefront of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.

If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.

Related:

GAO report: Children’s mental health services are lacking
https://drwilda.com/2013/01/12/gao-report-childrens-mental-health-services-are-lacking/

Schools have to deal with depressed and troubled children:
https://drwilda.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews © http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

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Yale University study: Left-handed people more likely to have psychotic disorders such as schizophrenia

3 Nov

Science Daily reported in the article, Lefties More Likely to Have Psychotic Disorders Such as Schizophrenia:

Being left-handed has been linked to many mental disorders, but Yale researcher Jadon Webb and his colleagues have found that among those with mental illnesses, people with psychotic disorders like schizophrenia are much more likely to be left-handed than those with mood disorders like depression or bipolar syndrome. 1 The new study is published in the October-December 2013 issue of the journal SAGE Open. About 10% of the U.S. population is left-handed. When comparing all patients with mental disorders, the research team found that 11% of those diagnosed with mood disorders such as depression and bipolar disorder are left-handed, which is similar to the rate in the general population. But according to Webb, a child and adolescent psychiatry fellow at the Yale Child Study Center with a particular interest in biomarkers of psychosis, “a striking of 40% of those with schizophrenia or schizoaffective disorder are left-handed….” Webb and his colleagues studied 107 individuals from a public outpatient psychiatric clinic seeking treatment in an urban, low-income community. The research team determined the frequency of left-handedness within the group of patients identified with different types of mental disorders. The study showed that white patients with psychotic illness were more likely to be left-handed than black patients. “Even after controlling for this, however, a large difference between psychotic and mood disorder patients remained,” said Webb. What sets this study apart from other handedness research is the simplicity of the questionnaire and analysis, said Webb. Patients who were attending their usual check-ups at the mental health facility were simply asked “What hand do you write with?” “This told us much of what we needed to know in a very simple, practical way,” said Webb. “Doing a simple analysis meant that there were no obstacles to participating and we had a very high participation rate of 97%. Patients dealing with serious symptoms of psychosis might have had a harder time participating in a more complicated set of questions or tests. By keeping the survey simple, we were able to get an accurate snapshot of a hard-to-study subgroup of mentally ill people — those who are often poverty-stricken with very poor family and community support.” http://www.sciencedaily.com/releases/2013/10/131031125319.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29

Citation:

Journal Reference:
1. J. R. Webb, M. I. Schroeder, C. Chee, D. Dial, R. Hana, H. Jefee, J. Mays, P. Molitor. Left-Handedness Among a Community Sample of Psychiatric Outpatients Suffering From Mood and Psychotic Disorders. SAGE Open, 2013; 3 (4) DOI: 10.1177/2158244013503166

Here is the Yale University press release:

By Karen N. Peart
October 31, 2013
Being left-handed has been linked to many mental disorders, but Yale researcher Jadon Webb and his colleagues have found that among those with mental illnesses, people with psychotic disorders like schizophrenia are much more likely to be left-handed than those with mood disorders like depression or bipolar syndrome.
The new study is published in the October-December 2013 issue of the journal SAGE Open. About 10% of the U.S. population is left-handed. When comparing all patients with mental disorders, the research team found that 11% of those diagnosed with mood disorders such as depression and bipolar disorder are left-handed, which is similar to the rate in the general population. But according to Webb, a child and adolescent psychiatry fellow at the Yale Child Study Center with a particular interest in biomarkers of psychosis, “a striking of 40% of those with schizophrenia or schizoaffective disorder are left-handed.”
“In general, people with psychosis are those who have lost touch with reality in some way, through hallucinations, delusions, or false beliefs, and it is notable that this symptom constellation seems to correlate with being left-handed,” said Webb. “Finding biomarkers such as this can hopefully enable us to identify and differentiate mental disorders earlier, and perhaps one day tailor treatment in more effective ways.” Webb and his colleagues studied 107 individuals from a public outpatient psychiatric clinic seeking treatment in an urban, low-income community. The research team determined the frequency of left-handedness within the group of patients identified with different types of mental disorders.
The study showed that white patients with psychotic illness were more likely to be left-handed than black patients. “Even after controlling for this, however, a large difference between psychotic and mood disorder patients remained,” said Webb. What sets this study apart from other handedness research is the simplicity of the questionnaire and analysis, said Webb. Patients who were attending their usual check-ups at the mental health facility were simply asked “What hand do you write with?” “This told us much of what we needed to know in a very simple, practical way,” said Webb. “Doing a simple analysis meant that there were no obstacles to participating and we had a very high participation rate of 97%.
Patients dealing with serious symptoms of psychosis might have had a harder time participating in a more complicated set of questions or tests. By keeping the survey simple, we were able to get an accurate snapshot of a hard-to-study subgroup of mentally ill people — those who are often poverty-stricken with very poor family and community support.”
Other authors on the study include Mary I. Schroeder, Christopher Chee, Deanna Dial, Rebecca Hana, Hussam Jefee, Jacob Mays, and Patrick Molitor. Citation: Sage Open vol. 3 no. 4 2158244013503166 (October-December 2013)

For interesting facts about left-handed people http://facts.randomhistory.com/facts-about-left-handedness.html

A 2011 Wall Street Journal article, The Health Risks of Being Left-Handed, highlighted some of the potential challenges faced by lefties:

On average there is no significant difference in IQ between righties and lefties, studies show, belying popular perceptions. There is some evidence that lefties are better at divergent thinking, or starting from existing knowledge to develop new concepts, which is considered an element of creativity. And left-handed people have salaries that on average are about 10% lower than righties, according to recent research performed at Harvard University that analyzed large income data bases, although findings of some earlier studies were mixed.
Left-handedness appears to be associated with a greater risk for a number of psychiatric and developmental disorders. While lefties make up about 10% of the overall population, about 20% of people with schizophrenia are lefties, for example. Links between left-handedness and dyslexia, ADHD and some mood disorders have also been reported in research studies. The reasons for this aren’t clear. Scientists speculate it could be related to a concept known as brain lateralization.
The brain has two halves. Each performs primarily separate, specialized functions, such as language processing, which mainly takes place in the left hemisphere. There is lots of communication between the hemispheres. Typically in right-handers, the brain’s left side is dominant. But this tendency doesn’t hold up with lefties, as scientists previously believed. Some 70% of lefties rely on the left hemisphere for their language centers, a key brain function, says Metten Somers, a psychiatrist and researcher who studies brain lateralization at Utrecht University Medical Center in the Netherlands. This doesn’t appear to present problems, scientists say. The other 30% of lefties appear to exhibit either a right-dominant or distributed pattern, Dr. Somers says. They may be more prone to impaired learning or functioning, and at greater risk for brain disorders, he says. Hemisphere dominance is typical and more efficient. Symmetry, in which neither side is dominant, is believed linked to disorders, researchers say. People with schizophrenia, for instance, exhibit more symmetrical activation of their brain hemispheres than those without the disorder, studies show.
In a 2008 study, Alina Rodriguez, a psychology professor at Mid Sweden University in Östersund who studies handedness, brain development and ADHD, found that left- or mixed-handedness in children was linked to a greater risk of difficulty with language as well as ADHD symptoms. In another study published last year in Pediatrics, involving nearly 8,000 Finnish children, Dr. Rodriguez found that mixed-handedness rather than left-handedness was linked to ADHD symptoms. And knowing that a child was mixed-handed and had ADHD symptoms at age 8 helped predict much more accurately than just knowing they had symptoms at that age whether the child would continue to have symptoms at age 16. (What happens when people are forced to switch from writing with their dominant hand to the other isn’t well known, experts say.) Research that suggests that there is a link between favoring the left hand and an increased risk of bipolar disorder and ADHD, among other conditions. Emily Nelson has details on Lunch Break.
One reason that not more is known about lefties is that many studies of how the brain works prohibit left-handers from participating because their brain wiring is known to be different, says Robin Nusslock, a psychology professor at Northwestern University in Evanston, Ill., who uses neuroimaging to study mood disorders.
Lefties have an advantage in sports such as tennis, fencing and baseball, when up against a righthanded competitor, but not in noninteractive sports such as gymnastics. A potential pathway between prenatal stress and brain wiring could be cortisol, the body’s main stress hormone, which can interfere with brain development, says Carsten Obel, a professor at the public-health department at Aarhus University in Denmark who has conducted research on the prenatal environment and risk of disease. Cortisol is able to pass over the placenta barrier to influence the baby.
Several studies show that stressful life events, such as the death of a loved one or job loss, during pregnancy increase the risk of having non-right-handed children. In one study of 834 Danish mothers and their 3-year-old children, Dr. Obel and his colleagues found that mothers who reported multiple stressful events during their third trimester of pregnancy and experienced distress were more than three times as likely to have a mixed-handed child, 17% compared with 5%, according to the 2003 paper published in Developmental Medicine & Child Neurology. Another large study followed 1,700 Swedish mothers and children until the kids were 5 years old. It found that mothers with depressive symptoms or who underwent stressful life events while pregnant were more likely to have left- or mixed-handed children. The work was published by Dr. Rodriguez and her colleagues in 2008 in the Journal of Child Psychology and Psychiatry. Experts suggest that left- and mixed-handedness could be used as a risk factor for possible psychiatric or developmental conditions, along with behavioral difficulties, such as having a hard time in school. The presence of such risk factors could prompt early evaluation for those conditions, they say. http://online.wsj.com/news/articles/SB10001424052970204083204577080562692452538

The best defense for parents is a good awareness of what is going on with their child. As a parent you need to know what is going on in your child’s world

Related:

GAO report: Children’s mental health services are lacking https://drwilda.com/2013/01/12/gao-report-childrens-mental-health-services-are-lacking/

Schools have to deal with depressed and troubled children: https://drwilda.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda © https://drwilda.com/

Tags: , , , , , , , , , , , , , , , , , ,

GAO report: Children’s mental health services are lacking

12 Jan

Moi wrote about troubled children in Schools have to deal with depressed and troubled children:

Both the culture and the economy are experiencing turmoil. For some communities, the unsettled environment is a new phenomenon, for other communities, children have been stressed for generations. According to the article, Understanding Depression which was posted at the Kids Health site:

Depression is the most common mental health problem in the United States. Each year it affects 17 million people of all age groups, races, and economic backgrounds.

As many as 1 in every 33 children may have depression; in teens, that number may be as high as 1 in 8. http://kidshealth.org/parent/emotions/feelings/understanding_depression.html

Schools are developing strategies to deal with troubled kids….

One strategy in helping children to succeed is to recognize and treat depression.

How Common Is Depression In Children?      

According to Mary H. Sarafolean, PhD in the article, Depression In School Age Children and Adolescents

In general, depression affects a person’s physical,  cognitive, emotional/affective, and motivational well-being, no matter  their age. For example, a child with depression between the ages of 6 and 12 may exhibit fatigue, difficulty with schoolwork, apathy and/or a lack of motivation. An adolescent or teen may be oversleeping, socially isolated, acting out in self-destructive ways and/or have a sense of hopelessness.

Prevalence and Risk Factors

While only 2 percent of pre-teen school-age children and 3-5 percent of teenagers have clinical depression, it is the most common diagnosis of children in a clinical setting (40-50 percent of diagnoses). The lifetime risk  of depression in females is 10-25 percent and in males, 5-12 percent. Children and teens who are considered at high risk for depression disorders include:

* children referred to a mental health provider for school problems
* children with medical problems
* gay and lesbian adolescents
* rural vs. urban adolescents
* incarcerated adolescents
* pregnant adolescents
* children with a family history of depression    

If you or your child has one or more of the risk factors and your child is exhibiting symptoms of prolonged sadness, it might be wise to have your child evaluated for depression. 

How to Recognize Depression In Your Child?     

MedNet has an excellent article about Depression In Children and how to recognize signs of depression in your child.

Signs and symptoms of depression in children include:       

* Irritability or anger
* Continuous feelings of sadness, hopelessness
* Social withdrawal
* Increased sensitivity to rejection
* Changes in appetite — either increased or decreased
* Changes in sleep — sleeplessness or excessive sleep
* Vocal outbursts or crying
* Difficulty concentrating
* Fatigue and low energy
* Physical complaints (such as stomachaches, headaches) that do not respond to
treatment
* Reduced  ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or  interests

* Feelings of worthlessness or guilt
* Impaired thinking or concentration
* Thoughts of death or suicide        

Not all children have all of these symptoms. In fact, most will  display different symptoms at different times and in different settings.  Although some children may continue to function reasonably well in  structured environments, most kids with significant depression will  suffer a noticeable change in social activities, loss of interest in  school and poor academic performance, or a change in appearance.  Children may also begin using drugs or alcohol,
especially if they are  over the age of 12.

The best defense for parents is a good awareness of what is going on with their child. As a parent you need to know what is going on in your child’s world. https://drwilda.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

Joy Resmovits reported in the article, Mental Health Care For Kids Severely Lacking, Says GAO which was posted at Huffington Post:

“Most children whose emotions or behavior, as reported by their parent or guardian, indicated a potential need for a mental health service did not receive any services within the same year,” the GAO wrote.

The report comes after Sen. Tom Harkin (D-Iowa), Rep. Rosa DeLauro (Conn.), and Rep. Lucille Roybal-Allard (Calif.) requested that the GAO look into how psychotropic drugs affect the long-term development of kids who grow up in foster care. While the report is very specific in its scope, it’s sure to be a relevant piece of evidence as the Obama administration formulates policy to deal with the ramifications of the Newtown, Conn. elementary school shooting. The shooting has sparked a nationwide debate on gun control, but it has also directed America’s attention to the state of its mental health care system.

Here are some findings:

  • On average, 6.2 percent of noninstitutionalized children in Medicaid and 4.8 percent of privately insured kids received psychotropic medications.

  • 30 percent of foster children who might have required mental health care didn’t receive them over the last year.

  • Most kids outside the foster care system whose behavior displayed red flags didn’t receive mental care services.

  • Many kids who got psychotropic medication didn’t get counseling or therapy to complete the care.

  • While the National Institutes of Health spent1.2 billion on children’s mental health care research between 2008 and 2011, most of the funding focused on research studying therapy, rather than the effects of such medication. http://www.huffingtonpost.com/joy-resmovits/mental-health-care-for-ki_b_2449205.html?utm_hp_ref=education

Here is the GAO press release:

What GAO Found

An annual average of 6.2 percent of noninstitutionalized children in Medicaid nationwide and 4.8 percent of privately insured children took one or more psychotropic medications, according to GAO’s analysis of 2007-2009 data from the Department of Health and Human Services’ (HHS) Medical Expenditure Panel Survey (MEPS). MEPS data also showed that children in Medicaid took antipsychotic medications (a type of psychotropic medication that can help some children but has a risk of serious side effects) at a relatively low rate–1.3 percent of children–but that the rate for children in Medicaid was over twice the rate for privately insured children, which was 0.5 percent. In addition, MEPS data showed that most children whose emotions or behavior, as reported by their parent or guardian, indicated a potential need for a mental health service did not receive any services within the same year. The Centers for Medicare & Medicaid Services (CMS) and many states have initiatives under way to help ensure that children receive appropriate mental health treatments. However, CMS’s ability to monitor children’s receipt of mental health services is limited because CMS does not collect information from states on whether children in Medicaid have received services for which they were referred. GAO recommended in 2011 that CMS identify options for collecting such data from state Medicaid programs. Findings in this report underscore the continued importance of CMS’s monitoring of children’s receipt of mental health services.

HHS’s Administration for Children and Families (ACF) reported that 18 percent of foster children were taking psychotropic medications at the time they were surveyed, although utilization varied widely by the child’s living arrangement. ACF also reported that 30 percent of foster children who may have needed mental health services did not receive them in the previous 12 months. HHS agencies are taking steps to promote appropriate mental health treatments for foster children, such as by sending information to states on psychotropic medication oversight practices.

HHS’s National Institutes of Health spent an estimated $1.2 billion on over 1,200 children’s mental health research projects during fiscal years 2008 through 2011. Most of the funding–$956 million–was awarded by the National Institute of Mental Health, with more research projects studying psychosocial therapies than psychotropic medications. Other HHS agencies spent about $16 million combined on children’s mental health research during this period.

HHS reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.

Why GAO Did This Study

Experts have concerns that children with mental health conditions do not always receive appropriate treatment, including concerns about appropriate use of psychotropic medications (which affect mood, thought, or behavior) and about access to psychosocial therapies (sessions with a mental health provider). These concerns may be compounded for low-income children in Medicaid and children in foster care (most of whom are covered by Medicaid)–populations who may be at higher risk of mental health conditions. Within HHS, CMS oversees Medicaid, and ACF supports state child welfare agencies that coordinate health care for foster children.

GAO was asked to provide information on children’s mental health. This report examines (1) the use of psychotropic medications and other mental health services for children in Medicaid nationwide, and related CMS initiatives; (2) HHS information on the use of psychotropic medications and other mental health services for children in foster care nationwide, and related HHS initiatives; and (3) the amount HHS has invested in research on children’s mental health.

GAO analyzed data from HHS’s MEPS –a national household survey on use of medical services–from 2007 through 2009 for children covered by Medicaid and private insurance. GAO reviewed two recent ACF foster care reports with data from a national survey conducted during 2008 through 2011. GAO analyzed data from HHS agencies that conduct or fund research and interviewed HHS officials and children’s mental health providers, researchers, and advocates.

For more information, contact Katherine Iritani at (202) 512-7114 or iritanik@gao.gov.

Concerns Remain about Appropriate Services for Children in Medicaid and Foster Care GAO-13-15, Dec 10, 2012

If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.

Resources:

Counselors, School Support Staff Toil Amid Scant Resources http://www.edweek.org/ew/articles/2013/01/10/16staffing.h32.html?tkn=VPLFw6EYbOz23lTzoeSKlVNGV4SNwasebCry&cmp=clp-edweek&intc=EW-QC13-EWH

About.Com’s Depression In Young Children

  1. Psych Central’s Depression In Young Children
  2. Psychiatric News’ Study Helps Pinpoint Children With Depression
  3. Family Doctor’s What Is Depression?
  4. WebMD’s Depression In Children
  5. Healthline’s Is Your Child Depressed?
  6. Medicine.Net’s Depression In Children
Where information leads to Hope. ©                 Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©                         http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©                                               http://drwildareviews.wordpress.com/

Dr. Wilda ©                                                                                    https://drwilda.com/

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School psychologists are needed to treat troubled children

27 Feb

Pamela Paul has a fascinating article in the New York Times about preschoolers and depression. In the article, Can Preschoolers Be Depressed? Paul does a great job of describing what depression looks like in small children and reporting about nascent research efforts by various universities.     

How Common Is Depression In Children?  

According to Mary H. Sarafolean, PhD in the article, Depression In School Age Children and Adolescents

In general, depression affects a person’s physical,  cognitive, emotional/affective, and motivational well-being, no matter  their age. For example, a child with depression between the ages of 6 and 12 may exhibit fatigue, difficulty with schoolwork, apathy and/or a lack of motivation. An adolescent or teen may be oversleeping, socially isolated, acting out in
self-destructive ways and/or have a sense of hopelessness. (See table 1.)    

Prevalence and Risk Factors             

While only 2 percent of pre-teen school-age children and 3-5 percent of teenagers have clinical depression, it is the most common diagnosis of children in a clinical setting (40-50 percent of diagnoses). The lifetime risk  of depression in females is 10-25 percent and in males, 5-12 percent. Children and teens who are considered at high risk for depression disorders include:

* children referred to a mental health provider for school problems
* children with medical problems
* gay and lesbian adolescents
* rural vs. urban adolescents
* incarcerated adolescents
* pregnant adolescents
* children with a family history of depression          

If you or your child has one or more of the risk factors and your child is exhibiting symptoms of prolonged sadness, it might be wise to have your child evaluated for depression. Because many children exhibit symptoms of depression, schools are increasingly forced to deal with depressed children.

Mark Phillips, professor emeritus of secondary education at San Francisco State University wrote the article, School psychologists: Shortage amid increased need which discusses the need for psychological support in schools.

The adolescent suicide rate continues to rise, with each suicide a dramatic reminder that the lives of a significant number of adolescents are filled with anxiety and stress. Most schools have more than a handful of kids wrestling with significant emotional problems, and schools at all levels face an ongoing challenge related to school violence and bullying, both physical and emotional.

Yet in many schools there is inadequate professional psychological support for students.

Although statistics indicate that there is a significant variation from state to state (between 2005- and 2011 the ratio of students per school psychologist in New Mexico increased by 180%, while in the same period the ratio decreased in Utah by 34%), the overall ratio is 457:1. That is almost twice that recommended by the National Association of School Psychologists (NASP).

THE NASP noted a shortage of almost 9,000 school psychologists in 2010 and projected a cumulative shortage of close to 15,000 by 2020. Mental Health America estimates that only 1 in 5 children in need of mental health services actually receive the needed services. These gross statistics also omit the special need of under funded schools and the increased roles school psychologists are being asked to play.

This problem, for the most part, is not one of commitment or values. Most school leaders recognize the problem and want to effectively address it, but they report that most of the counseling support services they have are for testing and helping kids with special emotional and/or learning problems. Even this is inadequate, with the psychologist available only a day or two each week.

In the best-funded districts, there is more full-time psychological counseling available for students. Yet, even in these districts, principals indicate that they have more students who need help with stress management than the existing counseling services can provide.

The problems extend beyond inadequate support services. School advisories — when a group of students meet with a teacher for advisory help — are supposed to provide psychological support but rarely do. Most students I’ve spoken with perceive advisories as a time for academic help but not a place they can go to deal with personal problems. Few schools are able to offer the training that teachers need to be able to provide that kind of support. Even those schools that have sponsored a program like Challenge Day, which provides an opportunity for students to openly discuss their individual struggles, rarely have a sustained follow-up program in place.

A bill was introduced in Congress last November that would provide some alleviation of this problem in lower income areas. H.R. 3405 is the Increased Student Achievement Through Increased Student Support Act. It would provide grants to partnerships between schools and low- income local educational agencies to improve the ratio of school counselors, social workers, and psychologists. Although limited in focus, it is at least a start. The bill was sent to the House Committee on Education and the Workforce and has still not been acted on by the Committee.

Even with the psychological services that should be provided and often aren’t, schools can’t fully prevent suicides, acts of violence, bullying, or the daily stresses that weigh on kids shoulders. The malaise runs deeper and broader.

Still schools need more resources than they receive in order to provide more programs that actively identify and counsel those kids that need help. At the very least, they need to alleviate some of the stress these kids are experiencing and to help improve the quality of their daily lives.

http://www.washingtonpost.com/blogs/answer-sheet/post/school-psychologists-shortage-amid-increased-need/2012/02/26/gIQAU7psdR_blog.html

It is important to deal with the psychological needs of children because untreated depression can lead to suicide.

Why Do Teens Attempt Suicide? 

The American Academy of Adolescent Psychiatry has some excellent suicide resources 

Suicides among young people continue to be a serious problem. Each year in the U.S., thousands of teenagers commit suicide. Suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds.

Teenagers experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. For some teenagers, divorce, the formation of a new family with step-parents and step-siblings, or moving to a new community can be very unsettling and can intensify self-doubts. For some teens, suicide may appear to be a solution to their problems and stress.  

Sometimes, people see suicide as an answer to their problems. All of us must stress that suicide is always the WRONG answer to what in all likelihood is a transitory situation.  

What are the Warning Signs of Suicide? 

According to Teen’s Health there are some suicide warning signs 

Warning Signs

There are often signs that someone may be thinking about or planning a suicide attempt. Here are some of them:

talking about suicide or death in general

talking about “going away”

referring to things they “won’t be needing,” and giving away possessions

talking about feeling hopeless or feeling guilty

pulling away from friends or family and losing the desire to go out

having no desire to take part in favorite things or activities

having trouble concentrating or thinking clearly

experiencing changes in eating or sleeping habits

engaging in self-destructive behavior (drinking alcohol, taking drugs, or cutting, for example) 

These are signs that indicate a person may be depressed. 

According to Jared Story.com the primary cause of suicide is depression. 

# 1 CAUSE OF SUICIDE:  UNTREATED DEPRESSION

It can be very hard to diagnose depression.  There are many different kinds of depression and not all people will have the same symptoms, or have them to the same degree.  Here are some symptoms to watch for and if they last more than a few weeks, a doctor or psychiatrist should be consulted. 

Persistent sad or “empty” mood

Feeling hopeless, helpless, worthless

pessimistic and or guilty

Substance abuse

Fatigued or loss of interest in ordinary activities

Disturbances in eating and sleeping patterns

Irritability, increased crying, anxiety and panic attacks, (Post Traumatic Stress Disorder)

Difficulty concentrating, remembering or making decisions

Thoughts of suicide; suicide plans or attempts

Persistent physical symptoms or pains that do not respond to treatment 

The site also lists events that might trigger depression in a person. 

A death of a family member or close friend – which could include a fellow student from school

An assault, car accident or painful physical event – which could include physical bullying

Mental, or emotional event – which could include non-physical bullying

Marriage breakup, or love lost suddenly – which could include “breaking up” with a girlfriend or boyfriend

Constant physical, mental, or emotional pain that goes on for a length of time – which includes constant bullying that is not intervened, resolved or stopped entirely

Major Financial setback – which includes a teenager who may have lost a job

Something “embarrassing” happens – as an example; getting kicked off a football team or a public insult by a teacher or popular student; bullying

Failing an important exam a school – not a normal trigger unless the exam was life changing and the individual is under a lot of stress

A best friend moves out of town – especially true for teenagers who are being bullied and have very few friends as it is 

If you notice these signs, the key is to get help for yourself or a friend. 

What Should You Do if You Know Someone Who Thinking About Suicide? 

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center has some excellent advice about suicide prevention If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.” That statement should be clarified to make it perfectly clear that appropriate medical care may include a second, third or more medical opinions if necessary.

Resources:

Teen’s Health’s Suicide

American Academy of Adolescent Psychiatry

Suicide Prevention Resource Center

Teen Depression

Jared Story.Com

CNN Report about suicide

Dr. Wilda says this about ©

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