Screening Accuracy of the Parent-Report Preschool Strengths and Difficulties Questionnaire in Primary Care.

OBJECTIVE: To evaluate the screening test accuracy and reliability of the parent-report preschool Strengths and Difficulties Questionnaire (P-SDQ) in primary care settings. METHODS: Children 24 to 48 months were recruited at scheduled primary care visits in Toronto, Canada. Parents completed the P-SDQ at baseline, 2, and 12 weeks. At 12 weeks, parents were invited to a semistructured diagnostic phone interview, the Preschool Age Psychiatric Assessment (PAPA). Criterion validity between baseline P-SDQ scores (Total Difficulties Score [TDS], internalizing and externalizing subscale) and Diagnostic and Statistical Manual, 5th edition diagnoses on PAPA was evaluated using area under the curve (AUC) and calculating screening test properties (sensitivity and specificity). Test-retest reliability at baseline and 2 weeks was evaluated using intraclass correlation coefficient. RESULTS: A total of 183 children were enrolled, mean age 39.3 (SD 7.4) months, 46.4% male, 120 (66%) completed P-SDQ at 2 weeks, 107 (58%) completed PAPA at 12 weeks. Of those with a PAPA, 26 (24%) had any psychiatric diagnosis, 17 (16%) had internalizing disorders and 4 (4%) had externalizing disorders. TDS identified any diagnosis with AUC = 0.67 (95% confidence intervals (CI): 0.55, 0.79); internalizing subscale identified internalizing disorders with AUC = 0.61 (95% CI: 0.47, 0.74); externalizing subscale identified externalizing disorders with AUC = 0.77 (95% CI: 0.60, 0.94). Sensitivity and specificity, and test-retest reliability were satisfactory for TDS and externalizing subscale, and less satisfactory for the internalizing subscale. CONCLUSIONS: The externalizing subscale has sufficient accuracy and reliability to identify children aged 2 to 4 years at risk for attention deficit/hyperactivity disorder and disruptive behavior disorders in primary care.

Sleep Duration and Internalizing Symptoms in Children.

Objective: Emotional problems such as anxiety and low mood have been associated with sleep problems in children. The study's objectives were to 1) assess the association between sleep duration and internalizing symptoms (anxiety and low mood) in children aged 5-12 years (y), and 2) evaluate whether insufficient sleep according to the National Sleep Foundation (NSF) guidelines is associated with internalizing symptoms. Methods: A cross-sectional study of N =796 children aged 5-12y, recruited from primary care physicians' offices in Toronto, Canada was conducted through the TARGet Kids! research network. Using linear regression, we investigated 1) the cross-sectional association between parent reported 24-hour sleep duration (hours) and parent reported symptoms using the Strengths and Difficulties Questionnaire (SDQ), controlling for child age, sex, family income, maternal education, family composition, and standardized body-mass index (zBMI). The analysis was repeated using insufficient sleep per NSF guideline as the independent variable. Results: Sleep duration was inversely associated with internalizing symptoms, B estimate = -0.33 (95%CI -0.57, -0.07), p=0.012. Twenty-eight (14%) children aged 5 y, and 36 (6%) of those aged 6-12y, experienced insufficient sleep. There was a trend toward association between insufficient sleep and internalizing symptoms, B estimate = 0.64 (-0.09, 1.38), p=0.086. Conclusion: The relationship between insufficient sleep and internalizing symptoms among children requires further elucidation. Children who show internalizing symptoms may benefit from interventions supporting sleep.

Objectif: Les problèmes émotionnels comme l'anxiété et l'humeur sombre ont été associés à des problèmes de sommeil chez les enfants. Les objectifs de la présente étude étaient de 1) évaluer l'association entre la durée du sommeil et les symptômes d'internalisation (anxiété et humeur sombre) chez les enfants de 5 à 12 ans (a), et 2) évaluer si le sommeil insuffisant selon les lignes directrices de la Fondation nationale du sommeil (FNS) est associé aux symptômes internalisants. Méthodes: Une étude transversale de N =796 enfants de 5 à 12 ans recrutés dans les bureaux de médecins de soins de première ligne à Toronto, Canada, a été menée dans le réseau de recherche TARGet Kids! À l'aide de la régression linéaire, nous avons investigué 1) l'association transversale entre la durée du sommeil (en heures) sur 24 heures rapportée par les parents et les symptômes rapportés par les parents à l'aide du questionnaire des forces et difficultés (QFD), en contrôlant pour l'âge de l'enfant, le sexe, le revenu familial, l'éducation maternelle, la composition de la famille et l'indice de masse corporelle normalisé (IMCn). L'analyse a été répétée avec le sommeil insuffisant selon les lignes directrices de la (FNS) comme variable indépendante. Résultats: La durée du sommeil était inversement associée à des symptômes d'internalisation, estimation B = −0,33 (IC à 95 % −0,57 à-0,07), p = 0,012. Vingt-huit (14 %) enfants âgés de 5 ans, et 36 (6 %) de ceux âgés de 6 à 12 ans avaient un sommeil insuffisant. Il y avait une tendance à l'association entre le sommeil insuffisant et les symptômes d'internalisation; estimation B = 0,64 (−0,09, 1,38), p = 0,086. Conclusion: La relation entre le sommeil insuffisant et les symptômes d'internalisation chez les enfants nécessite des éclaircissements. Les enfants souffrant de symptômes d'internalisation peuvent bénéficier d'interventions favorisant le sommeil.

Parenting stress during infancy is a risk factor for mental health problems in 3-year-old children.

BACKGROUND: Although research on the relationship between parent and child mental health is growing, the impact of early parenting stress on preschool-aged children's mental health remains unclear. The objective was to evaluate the association between parenting stress during infancy and mental health problems in 3-year-old children. METHODS: A prospective cohort study of healthy preschool-aged children recruited from 9 primary care practices in Toronto, Canada was conducted through the TARGet Kids! primary care practice-based research network. Parenting stress was measured when children were between 0 to 16 months of age, using the Parent Stress Index Short Form, PSI-SF. Parent-reported child mental health problems were measured at 36 to 47 months using the preschool Strengths and Difficulties Questionnaire, total difficulties score (TDS). Hierarchical linear regression analysis was used to investigate the association between standardized PSI-SF and TDS, adjusted for child age, sex, temperament, sleep duration and household income. To strengthen clinical interpretation, analysis was repeated using adjusted multivariable logistic regression (TDS dichotomized at top 20%). RESULTS: A total of 148 children (mean ± SD age, 37.2 ± 1.7 months, 49% male) were included in the analysis. Parenting stress during infancy (11.4 ± 3.1 months of age) was significantly associated with mental health problems in 3-year-old children (ß = 0.35; 95% CI = 0.20-0.49, p < 0.001). Higher parenting stress was also associated with increased odds of higher TDS (OR = 2.26, 95% CI = 1.69-2.83, p < 0.01). CONCLUSION: Healthy preschool-aged children with parents reporting parenting stress during infancy had a 2 times higher odds of mental health problems at 3 years.

Goals of care or goals of life? A qualitative study of clinicians' and patients' experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS).

BACKGROUND: Recognizing the need for improved communication with patients at the point of hospital discharge, a group of clinicians, patients, and designers in Toronto, Canada collaborated to develop a standardized tool known as the Patient-Oriented Discharge Summary (PODS). Although quantitative results suggest PODS helps mitigate gaps in knowledge, a qualitative inquiry from the clinician and patient perspective of psychiatric hospital discharge using PODS has not been widely explored. Our aim was to explore clinicians' and patients' experiences with PODS. METHODS: We used a qualitative thematic analysis to explore clinicians' (n = 10) and patients' (n = 6) experiences with PODS. We used convenience sampling to identify and invite potential participants at the Center for Addiction and Mental Health in Toronto, Canada to participate in semi-structured interviews between February 2019 and September 2019. Data were analyzed using a thematic analysis approach to develop descriptive themes. RESULTS: Emerging themes from the data between clinicians and patients were both different and complementary. Clinicians described PODS using the concept of "goals of care." They relayed their experiences with PODS as a discrete event and emphasized its role in meeting their "goals of care" for discharge planning. Patients provided more of a "goals of life" perspective on recovery. They characterized PODS as only one facet of their recovery journey and not necessarily as a discrete or memorable event. Patients focused on their outcomes post-discharge and situated their experiences with PODS through its relation to their overall recovery. CONCLUSIONS: PODS was experienced differently by clinicians and patients. Clinicians experienced PODS as helpful in orienting them to the fulfillment of goals of care. Patients did not experience PODS as a particularly memorable intervention. Due to the information advantage that clinicians have about PODS, it is not surprising that clinicians and patients experienced the PODS differently. This study expanded our understanding of hospital discharge from clinicians and patients perspectives, and suggests that there are additional areas that need improvement.