Universal Suicide Risk Screening for Youths in the Emergency Department: A Systematic Review
OBJECTIVES/UNASSIGNED:To address escalating youth suicide rates, universal suicide risk screening has been recommended in pediatric care settings. The emergency department (ED) is a particularly important setting for screening. However, EDs often fail to identify and treat mental health symptoms among youths, and data on implementation of suicide risk screening in EDs are limited. A systematic review was conducted to describe the current literature on universal suicide risk screening in EDs, identify important gaps in available studies, and develop recommendations for strategies to improve youth screening efforts. METHODS/UNASSIGNED:A systematic literature search of PubMed, MEDLINE, CINAHL, PsycINFO, and Web of Science was conducted. Studies focused on universal suicide risk screening of youths served in U.S. EDs that presented screening results were coded, analyzed, and evaluated for reporting quality. Eleven studies were included. RESULTS/UNASSIGNED:All screening efforts occurred in teaching or children's hospitals, and research staff administered suicide screens in eight studies. Thus scant information was available on universal screening in pediatric community ED settings. Large variation was noted across studies in participation rates (17%-86%) and in positive screen rates (4.1%-50.8%), although positive screen rates were influenced by type of presenting concern (psychiatric versus nonpsychiatric). Only three studies concurrently examined barriers to screening, providing little direction for effective implementation. STROBE guidelines were used to rate reporting quality, which ranged from 51.9% to 87.1%, with three studies having ratings over 80%. CONCLUSIONS/UNASSIGNED:Research is needed to better inform practice guidelines and clinical pathways and to establish sustainable screening programs for youths presenting for care in EDs.
Just Let Me Sleep in: Identifying and Treating Delayed Sleep Phase Disorder in Adolescents
Individuals with delayed sleep phase disorder (DSPD) are unable to naturally fall asleep and awake at conventional times; for this reason, DSPD is often mistaken for insomnia. However, unlike many patients with insomnia, those with DSPD struggle to get up at appropriate times. DSPD is associated with school refusal, academic difficulties, and lower employment rate. DSPD in youth has prevalence as high as 16%, and is often comorbid with other psychiatric disorders. Treatments include appropriate light exposure during the day, melatonin use, developing an evening routine that minimizes arousal-increasing activities, and gradually shifting sleep-wake times toward more functional ones.
Pediatric Sleep Disorders: A Unique Opportunity for Child and Adolescent Psychiatry [Editorial]
When Night Falls Fast: Sleep and Suicidal Behavior Among Adolescents and Young Adults
Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.
Restless Legs Syndrome in Children and Adolescents
Children with psychiatric comorbidities frequently are referred for evaluation of sleep complaints. Common sleep symptoms can include difficulty falling asleep, frequent nocturnal awakening, restless sleep, and symptoms of restless legs syndrome (RLS). The understanding of the sleep condition in relation to the psychiatric comorbidity often is a challenge to the physician and often sleep disorders remain undiagnosed, untreated, or undertreated. Restless legs syndrome has been associated with psychiatric comorbidities and with certain medications, such as antidepressants, antihistamines, and antipsychotics. This article reviews the presentation of RLS and restless sleep, the association with psychiatric comorbidities, and treatment options.
COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA [Meeting Abstract]
THE RHYTHMS OF WELL-BEING: TREATMENT OF INSOMNIA AND CIRCADIAN RHYTHM DISTURBANCES IN YOUTH WITH MENTAL HEALTH DISORDERS [Meeting Abstract]
SLEEP AND CIRCADIAN RHYTHMS ACROSS DEVELOPMENT [Meeting Abstract]
Emerging Insights Into the Association Between Nature Exposure and Healthy Neuronal Development
Teens Who Can't Sleep: Insomnia or Circadian Rhythm Disorder? [Editorial]
Maggie is a 16-year-old girl who came to see me because she wanted help with her longstanding difficulties falling asleep at night and waking up in the morning. She goes to bed between midnight and 3Â am and usually lies awake worrying until falling asleep at 3Â to 4 am. She often video-calls or texts her boyfriend before sleep. Her wakeup time is 8 am; she typically wakes exhausted, having slept 4 to 5 hours. Although a good student, she is often late for classes. On weekends, she wakes around noon. She is tired, anxious, and demoralized. She cannot concentrate as well as she did prior to the onset of her sleep symptoms at age 10 to 11 years. Her psychiatric history includes a diagnosis of anxiety and depression, both in remission, treated with fluoxetine 30 mg daily for several years. Difficulties falling asleep and waking in the morning are common complaints among adolescents and young adults. Before my additional year of training in sleep medicine, I would have misdiagnosed Maggie as having insomnia rather than delayed sleep phase disorder (DSPD), a circadian rhythm disorder.