Faculty Bibliography

Early childhood is a critical period for overall development and well-being, yet children from low-income and low-resourced families, such as Chinese American immigrant families, often have unmet mental health needs as they face additional barriers like limited English proficiency and health literacy. Cultural and linguistic adaptation is essential for equitable access to resources and care. Despite the need, early childhood mental health among Chinese American families remains significantly understudied. A digital mental health solution may pose greater access and convenience to address the mental health needs of this community. Thus, this study aims to collaboratively develop a web-based app called OurChild, which provides culturally and linguistically adapted early childhood mental health and development resources for Chinese American immigrant families in New York City. Using the Participatory Cultural Adaptation Framework for Implementation Research (PCAFIR), the project involves a multiphased participatory co-design process: 1. understanding community needs through formative research and engagement; 2. building a digital library with evidence-based and culturally tailored content; 3. designing a culturally tailored web-based app using a participatory approach; and 4. refining and validating the design through user testing. Informed by formative data from existing studies and programs; focus groups and interviews with community experts (n = 6) and parents (n = 11); user testing with parents (n = 11), and through an iterative re-design process, the app was designed to be user-friendly, culturally relevant, and evidence-based. This study described the co-design process and highlighted the lessons learned in developing culturally tailored digital health tools to promote digital health equity for underserved communities.

OBJECTIVE:Autism spectrum disorder (ASD) is a neurodevelopmental condition with early-life origins. Maternal health conditions during pregnancy have been linked to autism risk, but most studies focus on single populations, limiting generalizability. We examined whether associations previously reported in a Danish registry-based study hold in a U.S. METHOD/METHODS:We analyzed electronic health records of children born between 2010 and 2017 at Kaiser Permanente Northern California (KPNC) and their mothers. Maternal diagnoses were classified as chronic or non-chronic, and associations with ASD in the child were assessed using Cox models, adjusting for sociodemographic factors, healthcare utilization, and comorbid maternal diagnoses. Methods were aligned with the Danish study for comparability. RESULTS:Among 224,353 children in the KPNC cohort, 5,448 (2.4%) were diagnosed with autism. Of the 42 maternal diagnoses significantly associated with autism in Denmark, 38 were evaluable in KPNC, and 18 remained statistically significant after adjustment. Most associations had point estimates consistent with the Danish study, particularly psychiatric and cardiometabolic conditions. CONCLUSION/CONCLUSIONS:Despite demographic and healthcare differences, 35 of the 38 associations found in the Danish study replicated qualitatively (direction of effect) in the U.S. cohort, suggesting robust cross-setting relevance. Further research is needed to explore underlying mechanisms and effect modifiers.

BACKGROUND:Depression rates are higher in women, especially during periods of hormonal fluctuation. Reproductive system disorders (RSDs), which often disrupt hormonal balance, may contribute to this mental health burden. Despite their prevalence and significant health implications, the link between RSDs and depression remains underexplored, leaving a gap in understanding these women's mental health risks. METHODS:Using Danish nationwide health registers (2005-2018), we conducted a cohort study of 2,295,824 women aged 15-49, examining depression outcomes in 265,891 women diagnosed with 24 RSDs, including endometriosis, polycystic ovary syndrome, and pain-related diagnoses. For each RSD, age-matched controls were selected. We calculated incidence rates, incidence rate ratios, and prevalence proportions of depression diagnoses or antidepressant use around RSD diagnosis. RESULTS:Across all RSD subtypes, women demonstrated higher rates of depression both before and after diagnosis, with a peak within the year following diagnosis. Incidence rate ratios within 1 year of RSD diagnosis ranged from 1.15 (95% confidence interval [CI] 1.06-1.25) to 2.09 (95% CI 1.98-2.21), depending on RSD subtype. Elevated depression prevalence was observed 3 years before diagnosis, suggesting mental health impacts may have preceded clinical RSD identification. CONCLUSIONS:This study reveals a striking association between RSDs and depression. Women with RSDs are more likely to suffer from depression, before and after RSD diagnosis, highlighting the need for integrated mental health screening and intervention. With over 10% of women affected by RSDs, addressing this overlooked mental health burden is imperative for improving well-being in a significant portion of the population.

Serious workforce shortages in youth mental health widen the gap between demand and use, and exacerbate health disparities. A strategy to address this is training and integrating youth and young adult (Y/YA) peers to deliver services. This paper reviews international scientific studies on Y/YA services targeting mental health conditions or health promotion. We applied systematic criteria including controlled designs (RCTs or quasi-experimental), active intervention delivered by a young person, key search terms, and peer-reviewed publication between 2012 and 2023. The review yielded 32 studies meeting criteria, encompassing six domains: eating disorders, health promotion, depression/anxiety, suicidal risk, serious mental illness (SMI) and "other." The most consistent evidence for effectiveness was for eating disorders; findings in the other domains were mixed. Training manuals, fidelity measurement, reporting of demographic data, and consistency in outcome measurement were largely absent, limiting both replicability and generalizability. The acceleration of scientific attention to youth/young adult peer services over the past decade and emerging support for its effectiveness is encouraging, however, and it bodes well for mitigating workforce shortages and, more importantly, for improving the quality of services for young people.

OBJECTIVE:To evaluate the association between attention-deficit/hyperactivity disorder (ADHD) and atypical sensory processing patterns. METHOD/METHODS:For this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from their inception until June 30, 2024. Studies examining sensory processing patterns using questionnaires in participants with a diagnosis of ADHD compared with healthy controls were included. The study risk of bias was assessed using a modified Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted using R Version 4.3.1 software, considering sensory modulation severity atypicities as the primary outcome. The risk of publication bias was explored, and sensitivity analyses were conducted to test the robustness of findings. RESULTS:= 97%). Heterogeneity was high in all analyses. Only 9 studies were deemed at overall low risk of bias. CONCLUSION/CONCLUSIONS:Even though available ADHD clinical guidelines do not specifically mention the need to assess sensory processing in ADHD, this meta-analysis suggests that this should be systematically explored in the evaluation of children and adults referred for ADHD. PLAIN LANGUAGE SUMMARY/CONCLUSIONS:This systematic review and meta-analysis examined 30 studies including over 5,000 participants to assess the link between attention-deficit/hyperactivity disorder (ADHD) and atypical sensory processing. Findings show that individuals with ADHD experience significantly higher sensory sensitivity, sensory avoidance, sensory seeking, and low sensory registration compared to controls. Given their impact on daily functioning, assessing sensory processing could improve clinical evaluations for both children and adults with ADHD. STUDY REGISTRATION INFORMATION/UNASSIGNED:Association between ADHD and sensory processing disorder: A systematic review and meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022325271. DIVERSITY & INCLUSION STATEMENT/UNASSIGNED:We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.

BACKGROUND:Children from migrant families with absent parents are more likely to have poorer physical and mental health than children from non-migrant families. The impact of labor migration on left-behind family members in South Asian countries is not well-known. This study aimed to examine the patterns of labor migration and its impact on the health and development of children and their caregivers in rural Nepal. METHODS:Baseline family data collected from a school-based violence prevention program were utilized. Parents/caregivers (N = 346) with school-aged children (aged 3 to 15 years attending nursery to primary grades) from the rural Arghakhanchi district of Nepal were included in the study. A series of descriptive and chi-square analyses were carried out to explore the pattern of labor migration and differences between labor-migrant and non-labor-migrant families. Multivariate linear and logistic regression analyses were applied to explore the correlates and moderators involved. RESULTS:Labor migration has been a common practice in rural Nepal, with an estimated 49% of families having parents working overseas, mostly in India (57%) and Gulf countries (39%) on low-skill labor jobs. Labor migration was significantly associated with left-behind caregivers' and children's mental health. Left-behind caregivers in father-only labor-migrant families reported higher levels of depression than did parents in non-labor migrant families and left-behind children from labor-migrant families reported greater anger than did children from non-labor migrant families. The impact of labor migration on families was moderated by social class. For low social-class father migrant families, left-behind children were at greater risk for developmental delay and behavioral problems, but there seems to be a protective effect for high social-class father migrant families (with lower risk of developmental delay and problem behaviors compared to all other groups). CONCLUSIONS:Labor migration has a substantial impact on the mental health of left-behind families and children. The impact of labor migration may vary by living social-cultural context. Understanding the complex dynamics of labor migration has important implications for local and global migration-related health service planning.

OBJECTIVES/OBJECTIVE:To assess the effects of and related evidence certainty of interventions for attention deficit/hyperactivity disorder (ADHD) across an individual's lifespan, and to develop a continuously updated web platform for people with lived experience of ADHD as a method to disseminate living evidence synthesis for shared decision making. DESIGN/METHODS:Umbrella review and platform for shared decision making. DATA SOURCES/METHODS:Six databases from inception to 19 January 2025. Study authors were contacted for additional information when necessary. ELIGIBILITY CRITERIA FOR SELECTING STUDIES/METHODS:Systematic reviews that used meta-analyses of randomised controlled trials were eligible if they compared a drug or non-drug intervention with a passive control in individuals with a diagnosis of ADHD. Primary outcomes were severity of ADHD symptoms, analysed by rater type (clinician-rated, parent-rated, teacher-rated, or self-rated) and time point (short term (12 weeks, or study endpoint), medium term (26 weeks), and long term (52 weeks)),acceptability (participants dropping out for any reason), and tolerability (participants dropping out owing to any side effects). Secondary outcomes included daily functioning, quality of life, comorbid symptoms, and key side effects (decreased sleep and appetite). DATA SYNTHESIS/RESULTS:Eligible meta-analyses were re-estimated with a standardised statistical approach. Methodological quality was assessed using AMSTAR-2. Evidence certainty was evaluated using an algorithmic version of the GRADE framework, adapted for drug and non-drug interventions. RESULTS:115 of 414 full text articles were deemed eligible and 299 were excluded; the eligible articles comprised 221 unique combinations of participants, interventions, comparators, and outcomes. For each combination, the most recent and methodologically robust meta-analysis was selected for re-estimation, which gave 221 re-estimated meta-analyses in total, derived from 47 meta-analytic reports. In the short term, alpha-2 agonists, amphetamines, atomoxetine, methylphenidate, and viloxazine showed medium to large effect sizes in reducing the severity of ADHD symptoms in children and adolescents, with moderate to high certainty evidence. Methylphenidate showed consistent benefits across raters (standardised mean difference >0.75, 95% confidence interval (CI) 0.56 to 1.03; moderate or high certainty evidence). These interventions showed lower tolerability than the placebo, but this effect was not significant for methylphenidate and atomoxetine. In adults, atomoxetine, cognitive behavioural therapy, methylphenidate (and, when restricting analyses to high quality trials, amphetamines) showed at least moderate certainty evidence of efficacy on ADHD symptoms, with medium effect sizes. Methylphenidate, amphetamines, and atomoxetine had worse tolerability than placebo (methylphenidate, risk ratio 0.50, 95% CI 0.36 to 0.69; amphetamines, 0.40, 0.22 to 0.72; atomoxetine, 0.45, 0.35 to 0.58). Some non-drug interventions (acupuncture and cognitive behavioural therapy in children and adolescents, and mindfulness in adults) showed large effect sizes for ADHD symptoms, but with low certainty evidence. No high certainty, long term evidence was found for any intervention. An online platform showing effects and evidence certainty of each intervention across age groups, time points, and outcomes (https://ebiadhd-database.org/) was developed. CONCLUSIONS:This review provides updated evidence to inform patients, practitioners, and guideline developers how best to manage ADHD symptoms. The online platform should facilitate the implementation of shared decision making in daily practice. TRIAL REGISTRATION/BACKGROUND:Open Science Framework https://osf.io/ugqy6/.

Suicide remains a leading cause of death among US youth. The emergency department (ED) is a critical access point for identifying suicide risk and initiating interventions to reduce that risk. Key strategies include developing individualized safety plans and counseling on reducing access to lethal means. This article reviews the current evidence supporting ED safety planning for youth at risk of suicide and presents a practical framework for its delivery. It also explores strategies to enhance the implementation of safety planning and lethal means counseling, including using clinical pathways, training of staff, optimizing reimbursement, and integrating resources into the electronic medical record system. Finally, the article highlights emerging innovations aimed at improving the reach of safety plan interventions in the ED setting.