Early Childcare Precarity and Subsequent Maternal Health.

PURPOSE: We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health. STUDY DESIGN: We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes. RESULTS: Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11-2.41). All early childcare precarity measures were associated with higher odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23-2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13-2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22-2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B -0.45; 95% CI, -0.80 to -0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences. CONCLUSION: Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.

Material Hardship, Protective Factors, Children's Special Health Care Needs, and the Health of Mothers and Fathers.

BACKGROUND: Parents of children with special health care needs (CSHCN) are at risk of poorer health outcomes. Material hardships also pose significant health risks to parents. Little is known about how protective factors may mitigate these risks and if effects are similar between mothers and fathers. METHODS: This was a cross-sectional survey study conducted using the US 2018/2019 National Survey of Children's Health, including parents of children 0 to 17 with income <200% of the federal poverty level. Separately, for parents of children with and without special health care needs (N-CSHCN), weighted logistic regression measured associations between material hardship, protective factors (family resilience, neighborhood cohesion, and receipt of family-centered care), and 2 outcomes: mental and physical health of mothers and fathers. Interactions were assessed between special health care needs status, material hardship, and protective factors. RESULTS: Sample consisted of parents of 16,777 children; 4440 were parents of CSHCN. Most outcomes showed similar associations for both mothers and fathers of CSHCN and N-CSHCN: material hardship was associated with poorer health outcomes, and family resilience and neighborhood cohesion associated with better parental health outcomes. Family-centered care was associated with better health of mothers but not fathers. Interaction testing showed that the protective effects of family resilience were lower among fathers of CSHCN experiencing material hardship. CONCLUSIONS: Family resilience and neighborhood cohesion are associated with better health outcomes for all parents, though these effects may vary by experience of special health care needs, parent gender, and material hardship.

Validation of Parent-reported Gestational Age Categories for Children Less Than 6 Years of Age.

BACKGROUND: Preterm birth is an important outcome or exposure in epidemiologic research. When administrative data on measured gestational age is not available, parent-reported gestational age can be obtained from questionnaires, which is subject to potential bias. To our knowledge, few studies have assessed the validity of parent-reported gestational age categories, including commonly defined categories of preterm birth. METHODS: We used linked data from primarily healthy children <6 years of age in TARGet Kids! in Toronto, Canada, and ICES administrative healthcare data from April 2011 to March 2020. We assessed the criterion validity of questionnaire-based parent-reported gestational age by calculating sensitivity and specificity for term (≥37 weeks), late preterm (34-36 weeks), and moderately preterm (32-33 weeks) gestational age categories, using administrative healthcare records of gestational age as the criterion standard. We conducted subgroup analyses for various parent and socioeconomic factors that may influence recall. RESULTS: Of the 4684 participants, 97.3% correctly classified the gestational age category according to administrative healthcare data. Parent-reported gestational age sensitivity ranged from 83.7% to 98.5% and specificity ranged from 88.3% to 99.8%, depending on category. For each subgroup characteristic, sensitivity and specificity were all ≥70%. Lower educational attainment, lower family income, father reporting, ≥1 year since birth, ≥2 children, lower parent age, and reported gestational diabetes and/or hypertension were associated with slightly lower sensitivity and/or specificity. CONCLUSIONS: In this linked cohort, parent-reported gestational age categories had high accuracy. Criterion validity varied minimally among some parent and socioeconomic factors. Our findings can inform future quantitative bias analyses.

Comparing youth with vs without outpatient mental health services on subsequent acute mental health care visits.

BACKGROUND: Use of acute care for mental health concerns has been increasing among youth in recent years. Improving access to outpatient mental health services may prevent downstream acute care visits. PURPOSE: To examine differences in rates of acute mental health care visits among youth with- versus without prior outpatient mental health services. METHODOLOGY: A total of 2,442 youth ages 14-17 years participated in a provincially representative cross-sectional epidemiological survey, the 2014 Ontario Child Health Study. This sample was individually linked to health administrative databases, with nearly universal coverage of all medically necessary physician and acute care visits. Our exposure was parent and youth reported outpatient mental health service use in the six-month period prior to completing the survey. Exposed youth (n=691) were matched with unexposed youth using a propensity score informed by a range of clinical and socio-demographic factors. Our outcome was acute mental health care visits in the 18-month period following completion of the survey, ascertained though the linked health administrative data. RESULTS: In our propensity score matched sample, we found no difference in rates of subsequent acute mental health care visits (HR= 1.14, 95%CI 0.44, 2.98) between youth with- versus without prior outpatient mental health services. CONCLUSIONS: There is a need to further understand the types of services youth are receiving in outpatient settings to determine if, and for whom, outpatient mental health services reduces the likelihood of future acute mental health care visits.

Social Capital and Sleep Outcomes Across Childhood in United States Families.

OBJECTIVE: To examine whether aspects of social capital, or benefits received from social relationships, are associated with regular bedtime and sleep duration across childhood in US families with lower income. METHODS: Cross-sectional study using the 2018-19 National Survey of Children's Health in participants with incomes <400% federal poverty level. Separately for early childhood (0-5 years), school-age (6-12 years), and adolescence (13-17 years), we used weighted logistic regression to examine associations between social capital (measured by family social cohesion, parent social support, child social support) and sleep (measured by regular bedtime, sleep duration, adequate sleep per American of Academy of Sleep guidelines). Path analysis tested whether regular bedtime mediated associations between social capital and sleep duration. RESULTS: In our sample (N = 35,438), 84.9% had a regular bedtime, 60.2% had adequate sleep. Family social cohesion was associated with sleep duration and adequate sleep (infancy: adjusted odds ratio [aOR] 2.18 [95% confidence interval [CI], 1.32, 3.60]; school age: aOR 2.03 [95% CI, 1.57, 2.63]; adolescence: aOR 2.44 [95% CI, 1.94, 3.09]). In toddlerhood, parent social support was associated with adequate sleep (aOR 1.44 [95% CI, 1.06, 1.96]). In adolescence, child social support was associated with regular bedtime (aOR 1.70 [95% CI, 1.25, 2.32]. Across childhood, associations between family social cohesion and sleep duration were partially mediated by regular bedtime. CONCLUSIONS: Family social cohesion was associated with adequate sleep across childhood, this was partially mediated by regular bedtime. Associations between social support and sleep outcomes varied by development stage. Future work should consider how supportive relationships may influence child sleep outcomes.

Youth Aware of Mental Health (YAM) Program With Texas Adolescents: Depression, Anxiety, and Substance Use Outcomes.

Objective: To determine the state of mental health problems among a general youth population and assess whether the Youth Aware of Mental Health (YAM) intervention can improve symptoms of depression and anxiety.Methods: We implemented YAM with a cluster quasi-experimental study design from August 2017 through June 2019 in 29 middle schools and high schools in North Texas. Students completed the Quick Inventory of Depressive Symptomatology, Adolescent version; the Generalized Anxiety Disorder Screener; and additional substance use questionnaires before YAM delivery and 3-6 months after implementation. Multilevel models, with students nested within schools, were used to model difference scores of depression and anxiety, controlling for various student-level and school-level characteristics. Missing data were imputed during analysis. Sensitivity analyses were performed on non-imputed data.Results: Among 3,302 adolescents at pre-test, 27% had moderate-to-severe depression, 22% had moderate-to-severe anxiety, and 4% expressed suicidal ideation. We found that on average, compared to those who had no depression at pre-test, depression decreased at post-test by (a) 4.62 units (P < .05) for those who had severe to very severe depression at pre-test, (b) 2.92 units (P < .0001) for those who had moderate depression at pre-test, and (c) 1.5 units (P < .001) for those who had mild depression at pre-test, controlling for all other factors in the model. Similar significant decreases were observed in anxiety, controlling for student-level characteristics.Conclusions: These findings demonstrate the effectiveness of YAM in reducing symptoms of depression and anxiety among adolescents in North Texas.

Experiencing bullying's impact on adolescent depression and anxiety: Mediating role of adolescent resilience.

Youth who experience bullying are at risk for psychopathology, indicating the necessity of identifying factors that may protect against the deleterious effects of being bullied. The present study expands upon prior research by examining resilience as a mediator of the effects of experiencing bullying on depression and anxiety within a sample of 2155 adolescents. Results indicated that youth who experienced bullying were more likely to have higher symptoms of depression and anxiety and lower resilience, while higher levels of resilience were associated with fewer symptoms of depression and anxiety. Resilience partially mediated the associations of experiencing bullying with depression and anxiety symptoms, suggesting that resilience may serve as a protective factor for adolescents who experience bullying. These findings have implications for programming that seeks to address bullying, peer victimization, and promotion of adolescent mental health.

Food insecurity during COVID-19 in a Canadian academic pediatric hospital: a cross-sectional survey.

BACKGROUND: Hospital-based food insecurity is defined as the inability of caregivers to obtain adequate food during their child's hospital admission. We aimed to measure the prevalence of household and hospital-based food insecurity, and to explore the associations with caregiver distress in an academic pediatric hospital setting. METHODS: We conducted a cross-sectional survey of caregivers of children admitted to the general pediatric ward of an academic pediatric hospital in Toronto, Ontario, from April to October 2020. We measured household food insecurity using the 18-item Household Food Security Survey Module, and included 3 adapted questions about hospital-based food insecurity. We measured caregiver distress with the Distress Thermometer for Parents. We used descriptive statistics to assess the proportion of respondents with food insecurity, and linear regression models to explore the relation of household (adult and child) and hospital-based food insecurity with caregiver distress. We used thematic analysis to explore caregivers' feedback. RESULTS: We contacted 851 caregivers, and 775 (91.1%) provided consent to participate. Overall, 430 (50.5%) caregivers completed at least part of the survey. Caregivers described a high prevalence of household (34.2%) and hospital-based (38.1%) food insecurity. Adult (ß = 0.21, 95% confidence interval [CI] 0.07-0.36), child (ß = 0.38, 95% CI 0.10-0.66) and hospital-based (ß = 0.56, 95% CI 0.30-0.83) food insecurity were significantly associated with caregiver distress, independent of covariates. We identified financial burden, emotional and practical barriers, stress obtaining food and advocacy for food as important themes in caregiver feedback. INTERPRETATION: Both household and hospital-based food insecurity were highly prevalent among caregivers. To reduce caregiver distress, hospitals need to consider reducing barriers for caregivers in obtaining food for themselves during their child's admission.

Understanding income-related differences in distribution of child growth, behaviour and development using a cross-sectional sample of a clinical cohort study.

OBJECTIVES: Children from low-income households are at an increased risk of social, behavioural and physical health problems. Prior studies have generally relied on dichotomous outcome measures. However, inequities may exist along the range of outcome distribution. Our objective was to examine differences in distribution of three child health outcomes by income categories (high vs low): body mass index (BMI), behaviour difficulties and development. DESIGN AND SETTING: This was a cross-sectional study using data from a primary care-based research network with sites in three Canadian cities, and 15 practices enrolling participants. PARTICIPANTS, INDEPENDENT VARIABLE AND OUTCOMES: The independent variable was annual household income, dichotomised at the median income for Toronto (<$C80 000 or ≥$C80 000). Outcomes were: (1) growth (BMI z-score (zBMI) at 5 years, 1628 participants); (2) behaviour (Strengths and Difficulties Questionnaire (SDQ) at 3-5 years, 649 participants); (3) development (Infant Toddler Checklist (ITC) at 18 months, 1405 participants). We used distributional decomposition to compare distributions of these outcomes for each income group, and then to construct a counterfactual distribution that describes the hypothetical distribution of the low-income group with the predictor profile of the higher-income group. RESULTS: We included data from 1628 (zBMI), 649 (SDQ) and 1405 (ITC) children. Children with lower family income had a higher risk distribution for all outcomes. For all outcomes, thecounterfactual distribution, which represented the distribution of children with lower-income who were assigned the predictor profile of the higher-income group, was more favourable than their observed distributions. CONCLUSION: Comparing the distributions of child health outcomes and understanding different risk profiles for children from higher-income and lower-income groups can offer a deeper understanding of inequities in child health outcomes. These methods may offer an approach that can be implemented in larger datasets to inform future interventions.

Cash transfer programs and child health and family economic outcomes: a systematic review.

OBJECTIVES: Family income is an important determinant of child and parental health. In Canada, cash transfer programs to families with children have existed since 1945. This systematic review aimed to examine the association between cash transfer programs to families with children and health outcomes in Canadian children (ages 0 to 18) as well as family economic outcomes. METHODS: We reviewed academic and grey literature published up to November 2021. Additional studies were identified through reference review. We included any study that examined children 0-18 years old and/or their parents, took place in Canada and reported Canada-specific data, and reported child, youth and/or parental health outcomes, as well as family economic outcomes. Risk of bias was assessed by two reviewers using a modified Newcastle-Ottawa Scale. SYNTHESIS: Our search yielded 23 studies meeting the inclusion criteria out of 7052 identified. Eight studies in total measured child health outcomes, including birth outcomes, child overall health, and developmental and behavioural outcomes, and four directly addressed parental health, including mental health, injuries, and obesity. Most studies reported generally positive associations, though some findings were specific to certain subgroups. Some studies also examined fertility and labour force participation outcomes, which described varying effects. CONCLUSION: Cash transfer programs to families with children in Canada are associated with better child and parental health outcomes. Additional research is needed to evaluate the mechanisms of effects, and to identify which types and levels of government transfers are most effective, and target populations, to optimize the positive effects of these benefits.

RéSUMé: OBJECTIFS: Le revenu familial est un important déterminant de la santé infantile et parentale. Au Canada, des programmes de transferts monétaires aux familles avec enfants existent depuis 1945. Notre revue systématique visait à examiner l'association entre les programmes de transferts monétaires aux familles avec enfants et les résultats cliniques chez les enfants canadiens (0 à 18 ans), ainsi que les résultats économiques familiaux. MéTHODE: Nous avons passé en revue la littérature spécialisée et la littérature grise publiées jusqu'en novembre 2021. D'autres études ont été répertoriées par une revue des références. Nous avons inclus toute étude portant sur les enfants de 0 à 18 ans et/ou leurs parents, menée au Canada, rapportant des données propres au Canada et rapportant les résultats cliniques d'enfants, de jeunes et/ou de parents, ainsi que les résultats économiques de familles. Le risque de biais a été évalué par deux évaluateurs à l'aide d'une échelle de Newcastle-Ottawa modifiée. SYNTHèSE: Sur les 7 052 études repérées dans notre recherche, 23 répondaient aux critères d'inclusion. En tout, huit études mesuraient les résultats cliniques d'enfants, dont les issues de la grossesse, la santé globale des enfants et les résultats développementaux et comportementaux, et quatre études portaient directement sur la santé parentale, dont la santé mentale, les blessures et l'obésité. La plupart des études faisaient généralement état d'associations positives, mais certaines constatations étaient spécifiques à certains sous-groupes. Quelques études portaient aussi sur la fécondité et la participation à la population active et décrivaient une diversité d'effets. CONCLUSION: Les programmes de transferts monétaires aux familles avec enfants au Canada sont associés à de meilleurs résultats cliniques infantiles et parentaux. Il faudrait pousser la recherche pour évaluer les mécanismes des effets constatés et pour déterminer quels sont les types et les niveaux de transferts gouvernementaux qui sont les plus efficaces, ainsi que les populations cibles, pour optimiser les effets positifs de ces prestations.

Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0-12 years of age: a cross-sectional study from 2013 to 2019.

BACKGROUND: Childhood obesity is a major public health concern. This study evaluated the independent and joint associations of family-level income, neighbourhood-level income and neighbourhood deprivation, in relation to child obesity. METHODS: A cross-sectional study was conducted in children ≤12 years of age from TARGet Kids! primary care network (Greater Toronto Area, 2013-2019). Parent-reported family income was compared with median neighbourhood income and neighbourhood deprivation measured using the Ontario Marginalization Index. Children's height and weight were measured and body mass index (BMI) z-scores (zBMI) were calculated. ORs and 95% CIs were estimated for the three exposure variables separately using multilevel multinomial logistic regression models with zBMI categories as the outcome, adjusting in model 1 for age, sex, ethnicity and number of family members and in model 2 adding family income. A joint measure was derived combining income and deprivation measures. RESULTS: A total of 5962 children were included. Low family income (Q1 vs Q5: OR=4.69, 95% CI 2.65 to 8.29), low neighbourhood income (Q1 vs Q5: OR=2.18, 95% CI 1.33 to 3.58) and high neighbourhood deprivation (Q1 vs Q5: OR=2.45, 95% CI 1.52 to 3.95) were each associated with increased OR of child obesity. However, after adjustment for family income, the association for both neighbourhood income (OR=1.39, 95% CI 0.82 to 2.34) and deprivation (OR=1.56, 95% CI 0.94 to 2.58) and obesity was attenuated. Children from low-income families living in low-income or high deprivation neighbourhoods had higher OR of obesity. CONCLUSION: Child obesity was independently associated with low family-level income and a joint measure suggests that neighbourhood also matters. Socioeconomic inequalities at both individual and neighbourhood levels should be addressed in childhood obesity interventions.

Psychometric Evaluation of the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire in a General Youth Population.

Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire is a brief 15-item self-report measure of quality of life and life satisfaction originally developed for clinical populations (6 to 17 years old). The current paper examines the initial factor structure proposed by the developers and underlying psychometric properties of the measure in a non-clinical population of teens. A cross-sectional adolescent sample (N = 3222) completed self-report measures as part of mental health promotion program. A confirmatory factor analysis was conducted with construct validity analyses. The original factor structure was replicated with strong internal consistency (Cronbach α = .912). Strong construct validity (e.g. resilience, well-being, depression, and anxiety) was found. Minimal differences were found based on gender, race, and ethnicity. PQ-LES-Q has strong, replicable psychometric properties, which makes it a generally reliable and valid assessment tool to evaluate the quality of life and life satisfaction in adolescents.

Psychometric properties of the Generalized Anxiety Disorder 7-item scale in youth: Screening in a primary care sample.

BACKGROUND: Anxiety disorders in youth are frequently underdiagnosed and untreated, partly due to a lack of screening in primary care. The Generalized Anxiety Disorder 7-item (GAD-7) scale is a brief self-report measure designed to screen for anxiety in primary care settings. However, little is known about the psychometrics of this scale with adolescents. METHODS: Participants included 579 youth age 11 to 17 years who received screening for depression in a primary care setting through a web-based application, VitalSign6, over a 4-year period. Psychometric analyses were completed based on classical test theory (CTT) and item response theory (IRT). RESULTS: Using CTT and IRT methods, the GAD-7 has a unidimensional structure with good psychometric properties. In addition, the IRT analysis demonstrates that items 1 and 2 are strongly associated with the total score, and thus are good choices as a 2-item screening tool. Convergent validity was demonstrated, with high correlations between the GAD-7 and other measures of anxiety, and discriminant validity was also demonstrated, with low correlations to measures of other psychological states. CONCLUSIONS: This psychometric evaluation of the GAD-7 provides support for the utility of this measure with adolescents. The GAD-2 is a good estimate of GAD-7 total score.

Mortality Among Parents of Children With Major Congenital Anomalies.

BACKGROUND: A mother whose child has a chronic condition, such as a major congenital anomaly, often experiences poorer long-term health, including earlier mortality. Little is known about the long-term health of fathers of infants with a major congenital anomaly. METHODS: In this population-based prospective cohort study, we used individual-linked Danish registry data. Included were all mothers and fathers with a singleton infant born January 1, 1986, to December 31, 2015. Cox proportional hazards regression was used to generate hazard ratios for all-cause and cause-specific mortality among mothers and fathers whose infant had an anomaly and fathers of unaffected infants, relative to mothers of unaffected infants (referent), adjusted for child's year of birth, parity, parental age at birth, parental comorbidities, and sociodemographic characteristics. RESULTS: In total, 20 952 of 965 310 mothers (2.2%) and 20 655 of 951 022 fathers (2.2%) had an infant with a major anomaly. Median (interquartile range) of parental follow-up was 17.9 (9.5 to 25.5) years. Relative to mothers of unaffected infants, mothers of affected infants had adjusted hazard ratios (aHRs) of death of 1.20 (95% confidence interval [CI]: 1.09 to 1.32), fathers of unaffected infants had intermediate aHR (1.62, 95% CI: 1.59 to 1.66), and fathers of affected infants had the highest aHR (1.76, 95% CI: 1.64 to 1.88). Heightened mortality was primarily due to cardiovascular and endocrine/metabolic diseases. CONCLUSIONS: Mothers and fathers of infants with a major congenital anomaly experience an increased risk of mortality, often from preventable causes. These findings support including fathers in interventions to support the health of parental caregivers.

Identification of retinal ganglion cell types and brain nuclei expressing the transcription factor Brn3c/Pou4f3 using a Cre recombinase knock-in allele.

Members of the POU4F/Brn3 transcription factor family have an established role in the development of retinal ganglion cell (RGCs) types, the main transducers of visual information from the mammalian eye to the brain. Our previous work using sparse random recombination of a conditional knock-in reporter allele expressing alkaline phosphatase (AP) and intersectional genetics had identified three types of Brn3c positive (Brn3c+ ) RGCs. Here, we describe a novel Brn3cCre mouse allele generated by serial Dre to Cre recombination and use it to explore the expression overlap of Brn3c with Brn3a and Brn3b and the dendritic arbor morphologies and visual stimulus response properties of Brn3c+ RGC types. Furthermore, we explore brain nuclei that express Brn3c or receive input from Brn3c+ neurons. Our analysis reveals a much larger number of Brn3c+ RGCs and more diverse set of RGC types than previously reported. Most RGCs expressing Brn3c during development are still Brn3c positive in the adult, and all express Brn3a while only about half express Brn3b. Genetic Brn3c-Brn3b intersection reveals an area of increased RGC density, extending from dorsotemporal to ventrolateral across the retina and overlapping with the mouse binocular field of view. In addition, we report a Brn3c+ RGC projection to the thalamic reticular nucleus, a visual nucleus that was not previously shown to receive retinal input. Furthermore, Brn3c+ neurons highlight a previously unknown subdivision of the deep mesencephalic nucleus. Thus, our newly generated allele provides novel biological insights into RGC type classification, brain connectivity, and cytoarchitectonic.

Associations between Adverse Childhood Experiences and Need and Unmet Need for Care Coordination.

Introduction: Children exposed to adverse childhood experiences (ACEs) may access multiple systems of care to address medical and social complexities. Care coordination (CC) optimizes health outcomes for children with special health care needs who often use multiple systems of care. Little is known about whether ACEs are associated with need and unmet need for CC. Methods: Use of the 2016-2017 National Survey of Children's Health to identify children who saw ≥1 health care provider in the last 12 months. The study team used weighted logistic regression analyses to examine associations between 9 ACE types, ACE score and need and unmet need for CC. Results: In the sample (N=39,219, representing 38,316,004 US children), material hardship (aOR, 1.50; 95% CI, 1.29-1.75), parental mental illness (aOR, 1.31; 95% CI, 1.07-1.60), and neighborhood violence (aOR, 1.33; 95% CI, 1.01-1.74) were significantly associated with an increased need for CC. Material hardship was also associated with unmet need for CC (aOR, 2.37; 95% CI, 1.80 - 3.11). Children with ACE scores of 1, 2, 3, and ≥4 had higher odds of need and unmet need for CC than children with 0 ACEs. Discussion: Specific ACE types and higher ACE scores were associated with need and unmet need for CC. Evaluating the unique needs of children who endured ACEs should be considered in the design and implementation of CC processes in the pediatric healthcare system.

Comprehensive phenotyping of depression disease trajectory and risk: Rationale and design of Texas Resilience Against Depression study (T-RAD).

Depression has a chronic and recurrent course often with early onset and is the leading cause of disability worldwide. In contrast to diagnoses for other conditions which rely on precise medical tests, the diagnosis of depression still focuses exclusively on symptom reports. As a result, heterogeneous patient groups are included under broad categories. Furthermore, in the absence of companion diagnostic tests, choosing specific treatments for patients remains imprecise with only one-third of patients entering remission with initial treatment, with others requiring multiple intervention steps to achieve remission. In addition to improving treatment outcomes, disease prevention is essential to reduce overall disease burden. Adolescence is a critical window where complex emotional, social, familial, and biological shifts may predispose to lifelong depression. Thus, personalized medicine, integrating individual variability in genes, brain function, and clinical phenotypes, can offer a comprehensive approach to provide precise diagnosis, novel drug development, optimal treatment assignment, and prevention of illness and its associated burden. Texas Resilience Against Depression study (T-RAD) encompasses two natural history, longitudinal (10 + years), prospective studies (D2K and RAD), each enrolling 2500 participants. The D2K study follows participants (ages 10 years and older) who have a current or past diagnosis of depression or bipolar disorder. The RAD study follows participants aged 10-24 years who are at risk for depression but not yet suffering from the disease. The T-RAD study will help to uncover the socio-demographic, lifestyle, clinical, psychological, and neurobiological factors that contribute to mood disorder onset, recurrence, progression, and differential treatment response.

Relationships Between Material Hardship, Resilience, and Health Care Use.

BACKGROUND: Material hardship has been associated with adverse health care use patterns for children with special health care needs (CSHCN). In this study, we assessed if resilience factors were associated with lower emergency department (ED) visits and unmet health care needs and if they buffered associations between material hardship and health care use for CSHCN and children without special health care needs. METHODS: A cross-sectional study using the 2016 National Survey of Children's Health, restricted to low-income participants (<200% federal poverty level). Separately, for CSHCN and children without special health care needs, weighted logistic regression was used to measure associations between material hardship, 2 resilience factors (family resilience and neighborhood cohesion), and 2 measures of use. Moderation was assessed using interaction terms. Mediation was assessed using structural equation models. RESULTS: The sample consisted of 11 543 children (weighted: n = 28 465 581); 26% were CSHCN. Material hardship was associated with higher odds of ED visits and unmet health care needs for all children. Resilience factors were associated with lower odds of unmet health care needs for CSHCN (family resilience adjusted odds ratio: 0.58; 95% confidence interval: 0.36-0.94; neighborhood cohesion adjusted odds ratio: 0.53; 95% confidence interval: 0.32-0.88). For CSHCN, lower material hardship mediated associations between resilience factors and unmet health care needs. Neighborhood cohesion moderated the association between material hardship and ED visits (interaction term: P = .02). CONCLUSIONS: Among low-income CSHCN, resilience factors may buffer the effects of material hardship on health care use. Future research should evaluate how resilience factors can be incorporated into programs to support CSHCN.