A comparison of psychiatric inpatient admissions in youth before and during the COVID-19 pandemic.

Background: The current understanding of the effect of COVID-19 on child and youth admissions to psychiatric inpatient units over time is limited, with conflicting findings and many studies focusing on the initial wave of the pandemic. Objectives: This study identified changes in psychiatric inpatient admissions, and reasons for admission, including suicidality and self-harm, before and during the COVID-19 pandemic. Method: This time series study analyzed 3,723 admissions of youth (ages 0-18.88 years) admitted to four major psychiatry inpatient units in a large Canadian city between January 1st, 2016 and December 31st, 2021. Pre-pandemic (before March 11, 2020) and during-pandemic (after March 11, 2020) trends of admissions were explored using a Bayesian structural time series model (BSTS). Results: The model revealed that overall admissions during the pandemic period exceeded what would have been predicted in the absence of a pandemic, a relative increase of 29%. Additionally, a rise in the total number of admissions due to self-harm and suicidality (29% increase), externalizing/behavioral issues (69% increase), and internalizing/emotional issues (28% increase) provided strong evidence of increased admissions compared to what might have been expected from pre-pandemic numbers. Conclusions: There was strong evidence of increases in psychiatric inpatient admissions during the COVID-19 pandemic compared to expected trends based on pre-pandemic data. To ensure accessible and continuous mental health supports and services for youth and their families during future pandemics, these findings highlight the need for rapid expanse of inpatient mental health services, similar to what occurred in many intensive care units across Canada.

Contexte: La compréhension actuelle de l'effet de la COVID-19 sur les enfants et jeunes patients admis aux unités d'hospitalisation psychiatrique avec le temps est limitée, avec des conclusions contradictoires et des études portant sur la vague initiale de la pandémie. Objectifs: La présente étude a identifié les changements dans les admissions de patients hospitalisés en psychiatrie, et les raisons de l'admission, notamment la suicidabilité et l'automutilation, avant et durant la pandémie de la COVID-19. Méthode: Cette étude de séries chronologiques a analysé 3 723 admissions de jeunes (de 0 à 18,88 ans) admis à quatre grandes unités d'hospitalisation en psychiatrie dans une grande ville canadienne entre le 1er janvier 2016 et le 31 décembre 2021. Les tendances des admissions pré-pandémiques (avant le 11 mars 2020) et pendant la pandémie (après le 11 mars 2020) ont été explorées à l'aide d'un Modèle bayésien de séries chronologiques structurelles (BSTS). Résultats: Le modèle a révélé que globalement, les admissions durant la période pandémique excédaient ce qui aurait été prédit en l'absence d'une pandémie, une hausse relative de 29%. En outre, une hausse du nombre total d'admissions attribuables à l'automutilation et à la suicidabilité (hausse de 29%), à des problèmes de comportement/d'externalisation (hausse de 69%), et à des problèmes d'internalisation/émotionnels (hausse de 28%) a fourni des preuves solides des admissions accrues comparé à ce qu'on aurait pu attendre des chiffres pré-pandémiques. Conclusions: Il y avait des preuves solides des augmentations des admissions de patients hospitalisés en psychiatrie durant la pandémie de la COVID19 comparé aux tendances prévues selon les données pré-pandémiques. Afin d'assurer des soutiens et des services de santé mentale accessibles et continus pour les jeunes et leur famille durant les futures pandémies, ces résultats soulignent la nécessité d'une expansion rapide des services de santé mentale pour patients hospitalisés, pareillement à ce qui s'est produit dans de nombreuses unités de soins intensifs du Canada.

COVID-19 and Neurodevelopmental Disabilities: Examining the Impact of the First 2 Years of the Pandemic on the Demand for Pediatric Inpatient Care.

The COVID-19 pandemic has strained the resources of the world's healthcare systems. Most individuals with neurodevelopmental disabilities (NDDs) experience significant mental health issues and face substantial barriers in accessing appropriate supports which have been exacerbated during the pandemic. It is unknown the extent to which COVID-19 impacted the demand for and effectiveness of inpatient care for those with NDDs. The impact of COVID-19 on the number of admissions of youth with NDDs to pediatric inpatient psychiatry units, as well as their functioning and length of stay during the first two years of the pandemic was analyzed using Bayesian structural time series models. Admission data of youth with NDDs from four pediatric inpatient units in Alberta, Canada (n = 2144) was examined. Inpatient admissions of youth with NDDs significantly increased following the onset of the pandemic. Compared to the period prior to the pandemic, patients with NDDs had significantly worse overall functioning and received fewer days of treatment. These findings highlight the need for increased resources to support the mental health needs of this vulnerable population and are consistent with other studies in the general population examining the utilization of inpatient psychiatric units during the pandemic.

Social support and childhood cancer survivors: A systematic review (2006-2022).

OBJECTIVE: Research has indicated that social support may play a protective role in the face of stress and help children and adolescents cope with the demands and challenges they face on a daily basis during their cancer journey. However, social support tends to reduce over time as survivors overcome their illness despite its ongoing importance even years after treatment has finished. The current review aimed to systematically examine existing evidence on social support in child and adolescent cancer survivors. METHODS: Five databases (PsychINFO, CINAHL, EMBASE, PubMed and Web of Science) were searched systematically to identify quantitative studies which explored social support from the perspective of child and adolescent cancer survivors aged 18 years or younger. RESULTS: A total of 10 studies met the eligibility criteria for inclusion. Findings from the review indicate that family and friends, particularly parents, are important sources of social support for survivors. Social support was positively related to posttraumatic growth, school re-entry and physical activity, and negatively related to psychological stress, depression, anxiety and stress. Furthermore, findings relating to gender, age and group differences were mixed. A number of methodological concerns were identified in the reviewed studies including small sample sizes, as well as a lack of consistency in the measurement of social support. CONCLUSIONS: Future studies of social support for child and adolescent cancer survivors need to address these shortcomings to help inform care and support interventions promoting social support in survivors.

A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer.

This review aimed to examine and synthesise literature on spirituality as experienced by individuals living with terminal cancer. Six databases were systematically searched for studies with qualitative findings relevant to spirituality and terminal cancer. Thirty-seven studies were included and thematic synthesis was used to identify themes. Analytical themes included: making sense of dying; living with dying; feeling connected; and being reflective. This review highlights how the experience of spirituality can positively impact the lives of terminal cancer patients. Further, these findings suggest that spirituality can be a transformative experience that allows individuals to experience peace at end of life.

An investigation into the relationship between social support, stress, and psychological well-being in farmers.

This study investigated the stress-buffering effect of social support on psychological well-being and impact of demographic factors on stress in a sample of farmers. One-hundred and ninety-six farmers completed an online questionnaire including measures of social support, stress, psychological well-being, and demographics. Overall, after controlling for stress, increased social support was associated with higher psychological well-being. Family support had a significant relationship with financial and farm-related factors of stress but not with psychological well-being, while friend and significant other support had a much greater impact on psychological well-being than family support. Membership of a farming organisation was found to be protective against social stress while working on one type of farm only (e.g., dairy) was protective against financial stress. The findings highlight the potential utility of the stress-buffering model in understanding stress among farmers. Future interventions which facilitate social support, reduce stress, and boost psychological well-being among farmers are needed.

On Becoming Trauma-Informed: Role of the Adverse Childhood Experiences Survey in Tertiary Child and Adolescent Mental Health Services and the Association with Standard Measures of Impairment and Severity.

CONTEXT: There is a movement toward trauma-informed, trauma-focused psychiatric treatment. OBJECTIVE: To examine Adverse Childhood Experiences (ACE) survey items by sex and by total scores by sex vs clinical measures of impairment to examine the clinical utility of the ACE survey as an index of trauma in a child and adolescent mental health care setting. DESIGN: Descriptive, polychoric factor analysis and regression analyses were employed to analyze cross-sectional ACE surveys (N = 2833) and registration-linked data using past admissions (N = 10,400) collected from November 2016 to March 2017 related to clinical data (28 independent variables), taking into account multicollinearity. RESULTS: Distinct ACE items emerged for males, females, and those with self-identified sex and for ACE total scores in regression analysis. In hierarchical regression analysis, the final models consisting of standard clinical measures and demographic and system variables (eg, repeated admissions) were associated with substantial ACE total score variance for females (44%) and males (38%). Inadequate sample size foreclosed on developing a reduced multivariable model for the self-identified sex group. CONCLUSION: The ACE scores relate to independent clinical measures and system and demographic variables. There are implications for clinical practice. For example, a child presenting with anxiety and a high ACE score likely requires treatment that is different from a child presenting with anxiety and an ACE score of zero. The ACE survey score is an important index of presenting clinical status that guides patient care planning and intervention in the progress toward a trauma-focused system of care.

ERRATUM TO: On Becoming Trauma-Informed: Role of the Adverse Childhood Experiences Survey in Tertiary Child and Adolescent Mental Health Services and the Association with Standard Measures of Impairment and Severity.

[This corrects the article DOI: 10.7812/TPP/17-054.].