Faculty Bibliography

Trauma exposure in children and adolescents is a significant public health concern due to its profound impact on mental health and development. This study explores the complexities of trauma in youth, including the differentiation between trauma exposure and posttraumatic stress disorder, and the long-term effects of adverse childhood experiences. The study discusses the risks and benefits of polypharmacy in treating complex trauma and comorbid conditions in youth. Given the current gaps in research, the study emphasizes the need for comprehensive, individualized treatment plans that integrate psychotherapy, pharmacologic interventions, and psychosocial support to foster resilience and improve outcomes for trauma-exposed youth.

Currently, the identification of individuals experiencing suicidal thoughts and behaviours (STBs) rely predominantly on self-report. Previous research on children and young people highlighted an association between difficulties in arousal regulation (reflected, for example, in reduced heart rate variability and altered electrodermal activity patterns) and STBs, but this has not been meta-analytically explored in adults. This systematic review and meta-analysis aimed to quantify the association between STBs and markers of autonomic functioning/regulation in adults. Based on a pre-registered protocol (PROSPERO CRD42024596886), we searched PubMed/MEDLINE, Embase, PsycINFO and Web of Science until 2^nd August 2025 for empirical studies assessing the association between measures of autonomic functioning and/or regulation and STBs in adults. Quality of cross-sectional and cohort studies was assessed through the Newcastle-Ottawa Scale. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models in R. Out of 2,726 articles screened, 40 studies were included in the systematic review, and 22 in the meta-analyses (6,290 individuals, 28% with STBs). We found reduced heart rate variability in adults with STBs (g = -0.2469, p = 0.0069) but no significant associations between electrodermal activity patterns and STBs (g = -0.2563, p = 0.3953). Our results highlight the connection between reduced cardiac regulation and STBs, providing a rationale for further exploration of cardiac regulation as a potential objective marker for assessing and monitoring STBs in adults. Further research is warranted to understand how these markers can be used in clinical practice to assess and support the management of suicide risk in adults.

OBJECTIVE:To identify optimal strategies to integrate early relational health (ERH) programs in pediatric primary care (PPC) and to describe the development of a best practices toolkit to provide guidance and useful tools that clinicians can use to navigate this process. METHODS:A two-phased approach to develop, assess, and refine a best practices toolkit for the integration of multiple ERH programs in PPC through a modified Delphi process. Phase One included identification and assessment around barriers to ERH program integration and strategies to address them through surveys and focus groups of PPC clinics nationwide. Phase Two then utilized the identified barriers and strategies from Phase One to create a toolkit of best practices on integrating ERH programs in PPC that included two rounds of revision for a final version. RESULTS:126 PPC personnel from 44 clinics nationwide completed the Phase One survey, with respondents reporting many notable strengths and challenges to ERH program integration. 18 survey participants also participated in follow-up focus groups, which reiterated the strengths and challenges found in the surveys. An initial toolkit was then drafted, and experts provided qualitative, free-response feedback around clarity and presentation. Further improvement was made to create the final toolkit, which was rated highly useful and important, though slightly less feasible, by practitioners using formal feedback questions. CONCLUSION/CONCLUSIONS:This study employed a modified Delphi process to create a consensus-based best practices toolkit for integrating multiple ERH programs in PPC to help meet the heterogeneous needs of families to promote optimal child development.

OBJECTIVE/UNASSIGNED:Assessing suicide risk among children is complex, in part due to their developmental differences in identifying, recalling, and verbally describing internal states, alongside cultural differences in how distress is experienced. This study aimed to identify expressions of distress around suicide ideation or attempts through body mapping, a qualitative technique that facilitates both visual and verbal expressions. METHOD/UNASSIGNED: = 16). Children completed the Childhood Suicide Ideation Interview, which included semi-structured questions about their suicide ideation and/or attempt and a body mapping activity, where children illustrated and described their thoughts, feelings, body sensations, and social connections surrounding their suicidal crisis on a printed body silhouette. RESULTS/UNASSIGNED:Analyses conducted with Anthropac yielded 94 expressions of distress. The congruence in overall experiences across children was low (24%), yet specific somatic experiences like "shaking" (70%), "pain" (43%), and "dizziness" (39%) were prevalent. Other frequent experiences included "sad" (48%), "passive suicide ideation" (43%), and "thoughts about family" (39%). CONCLUSIONS/UNASSIGNED:Body mapping was a valuable tool for uncovering unique expressions of distress among ethnoracially diverse children. Somatic expressions, often overlooked in risk assessments, were prominent. Ours and similar studies have the potential to inform the design of culturally and developmentally responsive risk assessment tools and safety planning protocols.

When thoroughly assessed, the prevalence of attention-deficit hyperactivity disorder (ADHD) in children/adolescents is estimated at 5%. There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis, even though rigorous updated post-COVID-19 pandemic data are not available. Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance or inappropriate differential diagnosis. Beyond the controversy around over- or under-diagnosis and over-medicalisation of ordinary behaviours or emotions, the main issue is that UK clinical services cannot adequately support individuals with ADHD who need help. There is a risk that the narrative claiming 'ADHD is over-diagnosed' could be used to deny people with properly-diagnosed ADHD the care they deserve.

IMPORTANCE/UNASSIGNED:Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID. OBJECTIVE/UNASSIGNED:To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024. EXPOSURE/UNASSIGNED:Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices. RESULTS/UNASSIGNED:The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVE:Due to proximity of the surgical site to important respiratory structures, patients may undergo delayed extubation after adult cervical deformity (ACD) surgery to manage postoperative airway edema/obstruction. Herein, we evaluate relevant relationships with delayed extubation. SUMMARY OF BACKGROUND DATA/BACKGROUND:Delayed extubation is an underreported perioperative occurrence, with only a few studies conducting case-by-case reviews of prolonged intubation. METHODS:Operative ACD patients with baseline (BL) were grouped based on whether they experienced delayed extubation (DE), or leaving the OR while still intubated, versus those who were extubated successfully in the OR (non-DE). Means comparison and regression analyses identified predictors of delayed extubation and associations with peri-operative complications and outcomes. RESULTS:82 patients met inclusion criteria (mean age 62.4±13.0 y, 52.4% female, Edmonton frailty score: 5.10±2.97, ACFI score: 0.30±0.16, CCI: 1.41±1.73). 14 patients left the OR intubated, and 1(1.2%) required reintubation. DE cohort demonstrated greater Edmonton frailty scores (P=0.017) and smoking histories (P=0.031). Intraoperatively, there was a significant difference EBL (P=0.021) and rate of transfusions (DE: 27.3% v non-DE: 4.8%, P=0.12). Upper instrumented vertebra (UIV) was not associated with DE, while lower LIV increased the likelihood of DE (OR 1.1, P=0.029). Post-operatively, as expected, there was a significant difference in rate of SICU admissions (DE: 90.9% v. non-DE: 49.2%, P=0.01), although no significant differences in LOS. Greater cSVA and MGS correction from baseline was associated with increased likelihood of delayed extubation (OR 1.1, CI 95% 1.05-1.17, P<.001; OR 1.14, CI 95% 1.05-1.24, P=0.003). Furthermore, delayed extubation was a significant predictor of increased VR-Physical Component Scores (P=0.013) at 6W, and DE cohort demonstrated significantly higher VR-PCS and VR-MCS Scores at 6W (P=0.01, both). CONCLUSIONS:Baseline frailty and larger radiographic correction can be associated with delayed extubation, which can impact quality of life perioperatively. Considerations like minimizing intraoperative blood loss and degree of correction could minimize delayed extubation.

BACKGROUND:Research demonstrates the effectiveness of evidence-based psychological treatment adjunctive to pharmacotherapy for reducing mood symptoms in bipolar disorder. However, access to these treatments is limited, and innovative strategies are needed to ensure that more patients with bipolar disorder receive the gold-standard treatments that may help them achieve wellness. "Stepped care" models of psychological service delivery represent one potential solution to this problem of treatment access. Under a stepped care model, patients are assigned the minimum necessary psychological treatment for symptom improvement. This typically means that patients who are experiencing more symptoms are assigned to a treatment of greater intensity (e.g., weekly individual therapy) whereas patients who are experiencing fewer symptoms are assigned to a treatment of relatively lesser intensity (e.g., biweekly group therapy). Stepped care models are dynamic, meaning that the level of treatment can be modified depending on the patient's response. Stepped care models have been explored in other clinical populations but require further exploration in bipolar disorder. METHODS:Members of the Psychological Interventions Task Force for the International Society of Bipolar Disorders conducted a narrative review of stepped care models and their application to bipolar disorder. RESULTS:We found evidence that stepped care models are useful approaches to delivering psychosocial treatments for bipolar disorder. We discuss several contextual factors in executing stepped care models in this population (i.e., cultural and pediatric applications), as well as share an example of a stepped care model-Focused Integrated Team-based Treatment for Bipolar Disorder (FITT-BD)-that is currently being evaluated in an academic medical center. CONCLUSION/CONCLUSIONS:Further research is warranted to develop and assess robust stepped care models to determine whether they can improve access to treatment of bipolar disorder while not sacrificing outcomes.