Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11507
Food Insecurity, Associated Health Behaviors, and Academic Performance Among Urban University Undergraduate Students
OBJECTIVE:To explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university. METHODS:A cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance. RESULTS:Of the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14-3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23-4.25). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Increased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.
PMID: 34758921
ISSN: 1878-2620
CID: 5050612
The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study
BACKGROUND:Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS:Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. RESULTS:As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS:This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.
PMCID:8782684
PMID: 35064280
ISSN: 1433-9285
CID: 5262542
Journal of the American Academy of Child and Adolescent Psychiatry. 2022:61(3):362-363.DOI: 10.1016/j.jaac.2021.07.007
Editorial: Race-Based Traumatic Stress and Vicarious Racism Within the Parent-Child Dyad: Opportunities for Intervention [Editorial]
With every disaster, there are fault lines that deepen our understanding of what has happened and what needs to come. The events over the past 18 months including the coronavirus disease 2019 (COVID-19) pandemic as well as the murder of George Floyd and the associated protests throughout the United States brought those fault lines into stark relief by highlighting the history of systemic racism that has fostered marginalization and discrimination against Black Americans. These clouds of systemic racism and discrimination-encompassing 250 years of slavery, 100 years of Jim Crow, police brutality, redlining, and the resulting high rates of poverty and poorer health outcomes-have created systems in which Black Americans face unequal and unequitable stressful situations. The medical community is now beginning to take notice of this race-based traumatic stress, a term coined by Carter in 2007,1 to describe how social determinants of health impacted by racial discrimination can "get under the skin" through the accumulative effects of ongoing exposure to toxic stress.2.
PMID: 34311037
ISSN: 1527-5418
CID: 5005832
Maternal caregiving representations of the infant in the first year of life: Associations with prenatal and concurrent reflective functioning
Few studies have examined whether maternal caregiving representations are associated with maternal reflective functioning (MRF), especially when MRF is evaluated longitudinally beginning in pregnancy. This study addresses this gap by evaluating whether prenatal and postnatal MRF are associated with mothers' caregiving representations assessed at 7 months postpartum, and by exploring theoretically unexpected MRF scores in each of the representational categories. Forty-seven mothers were recruited during their last trimester of pregnancy from an obstetrics clinic at a university hospital located in a large mid-western city in the United States. During pregnancy, mothers completed the Pregnancy Interview, and at 7 months postpartum they completed the Parent Development Interview (PDI) and the Working Model of the Child Interview. Results indicate that higher prenatal and postnatal MRF increased the odds of being classified as balanced versus disengaged. At 7 months, MRF also increased the odds of being balanced vs. distorted. Ten mothers who were classified as balanced or distorted had unexpected prenatal MRF scores, and six mothers had unexpected MRF scores when representations were assessed concurrently. Mothers classified as balanced with low MRF scores tended to have a low level of education, whereas mothers classified as distorted with high MRF scores had responses that were hostile, helpless, and role-reversed.
PMID: 34879170
ISSN: 1097-0355
CID: 5082892
Mothers talk about infants' actions: How verbs correspond to infants' real-time behavior
Infants learn nouns during object-naming events-moments when caregivers name the object of infants' play (e.g., ball as infant holds a ball). Do caregivers also label the actions of infants' play (e.g., roll as infant rolls a ball)? We investigated connections between mothers' verb inputs and infants' actions. We video-recorded 32 infant-mother dyads for 2 hr at home (13 month olds, n = 16; 18 month olds, n = 16; girls, n = 16; White, n = 23; Asian, n = 2; Black, n = 1; other, n = 1; multiple races, n = 5; Hispanic/Latinx, n = 2). Dyads were predominantly from middle-class to upper middle-class households. We identified each manual verb (e.g., press, shake) and whole-body verb (e.g., kick, go) that mothers directed to infants. We coded whether infants displayed manual and/or whole-body actions during a 6-s window surrounding the verb (i.e., 3 s prior and 3 s after the named verb). Mothers' verbs and infant actions were largely congruent: Whole-body verbs co-occurred with whole-body actions, and manual verbs co-occurred with manual actions. Moreover, half of mothers' verbs corresponded precisely to infants' concurrent action (e.g., infant pressed button as mother said, "Press the button"). In most instances, mothers commented on rather than instigated infants' actions. Findings suggest that verb learning is embodied, such that infants' motor actions offer powerful cues to verb meanings. Furthermore, our approach highlights the value of cross-domain research integrating infants' developing motor and language skills to understand word learning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMID: 35286106
ISSN: 1939-0599
CID: 5181442
Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial
BACKGROUND:Implementation facilitation is an effective strategy to support the implementation of evidence-based practices (EBPs), but our understanding of multilevel strategies and the mechanisms of change within the "black box" of implementation facilitation is limited. This implementation trial seeks to disentangle and evaluate the effects of facilitation strategies that separately target the care team and leadership levels on implementation of a collaborative care model in pediatric primary care. Strategies targeting the provider care team (TEAM) should engage team-level mechanisms, and strategies targeting leaders (LEAD) should engage organizational mechanisms. METHODS:We will conduct a hybrid type 3 effectiveness-implementation trial in a 2 × 2 factorial design to evaluate the main and interactive effects of TEAM and LEAD and test for mediation and moderation of effects. Twenty-four pediatric primary care practices will receive standard REP training to implement Doctor-Office Collaborative Care (DOCC) and then be randomized to (1) Standard REP only, (2) TEAM, (3) LEAD, or (4) TEAM + LEAD. Implementation outcomes are DOCC service delivery and change in practice-level care management competencies. Clinical outcomes are child symptom severity and quality of life. DISCUSSION/CONCLUSIONS:This statewide trial is one of the first to test the unique and synergistic effects of implementation strategies targeting care teams and practice leadership. It will advance our knowledge of effective care team and practice-level implementation strategies and mechanisms of change. Findings will support efforts to improve common child behavioral health conditions by optimizing scale-up and sustainment of CCMs in a pediatric patient-centered medical home. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov, NCT04946253 . Registered June 30, 2021.
PMCID:8862323
PMID: 35193619
ISSN: 1748-5908
CID: 5172152
Association between autism spectrum disorder and diabetes: systematic review and meta-analysis
There is mixed evidence on the link between autism spectrum disorder (ASD) and diabetes. We conducted the first systematic review/meta-analysis on their association. Based on a pre-registered protocol (PROSPERO: CRD42021261114), we searched Pubmed, Ovid, and Web of Science databases up to 6 December 2021, with no language/type of document restrictions. We assessed study quality using the Newcastle-Ottawa Scale (NOS). We included 24 studies (total: 3,427,773 individuals; 237,529 with ASD and 92,832 with diabetes) in the systematic review and 20 in the meta-analysis (mean stars number on the NOS: 5.89/10). There was a significant association, albeit characterized by significant heterogeneity, when pooling unadjusted OR (1.535, 95%CI = 1.109-2.126), which remained significant when restricting the analysis to children and type 2 diabetes, but became non-significant when considering adjusted ORs (OR: 1.528, 95%CI = 0.954-2.448). No significant prospective association was found (n=2) on diabetes predicting ASD (HR: 1.232, 0.826-11.837). Therefore, the association between ASD and diabetes is likely confounded by demographic and clinical factors that should be systematically investigated in future studies.
PMID: 35217107
ISSN: 1873-7528
CID: 5172562
Costing of a Multiple Family Group Strengthening Intervention (SMART-Africa) to Improve Child and Adolescent Behavioral Health in Uganda
Reliable cost estimates are key to assessing the feasibility, affordability, and cost-effectiveness of interventions. We estimated the economic costs of a multiple family group (MFG) intervention-child and adolescent mental health evidence-based practices (CAMH-EBP) implemented under the SMART-Africa study, seeking to improve family functioning and reduce child and adolescent behavior problems-delivered through task-shifting by community health workers (CHWs) or parent peers (PPs) in school settings in Uganda. This prospective microcosting analysis was conducted from a provider perspective as part of a three-armed randomized controlled trial of the MFG intervention involving 2,391 participants aged 8-13 years and their caregivers in 26 primary schools. Activity-specific costs were estimated and summed, and divided by actual participant numbers in each study arm to conservatively calculate total per-child costs by arm. Total per-child costs of the MFG-PP and MFG-CHW arms were estimated at US$346 and US$328, respectively. The higher per-child cost of the MFG-PP arm was driven by lower than anticipated attendance by participants recruited to this arm. Personnel costs were the key cost driver, accounting for approximately 70% of total costs because of intensive supervision and support provided to MFG facilitators and intervention quality assurance efforts. This is the first study estimating the economic costs of an evidence-based MFG intervention provided through task-shifting strategies in a low-resource setting. Compared with the costs of other family-based interventions ranging between US$500 and US$900 in similar settings, the MFG intervention had a lower per-participant cost; however, few comparisons are available in the literature. More costing studies on CAMH-EBPs in low-resource settings are needed.
PMID: 35189589
ISSN: 1476-1645
CID: 5175022
International review of psychiatry (Abingdon, UK). 2022:34(2):101-117.DOI: 10.1080/09540261.2022.2059346
International perspective on integrated care models in child and adult mental health
The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.
PMID: 35699101
ISSN: 1369-1627
CID: 5353642
The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health effects of the COVID-19 pandemic
BACKGROUND:. High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed. METHODS:. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others. RESULTS:. Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive. LIMITATIONS:. Cross-sectional survey, preponderance of non-representative participants. CONCLUSIONS:. Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics.
PMCID:8288233
PMID: 34949568
ISSN: 1573-2517
CID: 5185182
