Back to the basics: Addressing our individual and societal despair.

It started with a simple question on social media, "How is everybody doing?" (Elmo [@elmo], 2024). With this basic check-in from one of our most beloved Sesame Street characters, Elmo was able to reach millions of people and elicit responses that gave words to the feelings that the authors have been personally experiencing and noticing within my behavioral health (BH) colleagues and patients for some time now. Quite simply, we are struggling. Responses to Elmo's collective check-in demonstrated the depths of the current human experience, ranging from individual sadness, trauma, existential crises, despondence, mere survival, disbelief, and societal despair. Resilience for BH providers is possible if we return to the basics, what we are foundationally trained to do, and what Elmo reminded us works so well: facilitate human connection within ourselves, with our colleagues, with our patients, and to continue to advocate for this connection at a systemic level. Exploring fundamental questions about our well-being, showing empathy for each other's pain, and openly acknowledging our shared struggles allows for a way through this, together. As we practice these efforts at the individual level, broader policies to support the BH system must follow to offer an effective, resilient, and enduring BH system necessary for the world we live in. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Addressing Adolescent Suicidality in Pediatric Primary Care.

OBJECTIVE: This study examines prevalence rates of reported suicidal ideation (SI) in 2107 adolescents, characterizes recommendations and interventions given by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to SI on the Patient Health Questionnaire 9-Item Modified for Adolescents (PHQ-9A) for 140 adolescents, and identifies factors associated with a decrease in the frequency of SI at follow-up visits for 85 adolescents. METHODS: A retrospective mixed-method approach was taken. Clinical informatics was used to extract visit data, demographics, and PHQ-9A scores for all visits between January 3, 2017, and August 31, 2018. Conventional content analysis of electronic medical records was used to examine qualitative results, and qualitative codes were then analyzed using point-biserial correlations. The setting includes a fully integrated behavioral health team within the primary care clinic. RESULTS: Of the 2107 adolescents, 140 (7%) endorsed SI within the past 2 weeks. Content analysis yielded 40 actions (17 PCP codes and 23 BHC codes) used in response to SI. Significant correlations were found between decreased SI frequency and the PCP referring to integrated behavioral health ( r = 0.24) and family navigators ( r = 0.26) and BHCs conducting a risk assessment ( r = 0.24), completing a safety plan ( r = 0.21), involving caregivers ( r = 0.29), sending the adolescent to the emergency department ( r = 0.28), and referring to family navigators ( r = 0.21; all p values < 0.05). CONCLUSION: The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.

Child, Parent, and Family Adjustment for Patients Followed in a Multidisciplinary Spina Bifida Clinic.

Objectives: To characterize child, parent, and family adjustment for patients followed in a multidisciplinary spina bifida (SB) clinic. Methods: Participants were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2017 and 2019. Participants included 209 youth under 19 years old who were diagnosed with SB and their parents. Self-reported internalizing symptoms were measured in youth in grade 3 through 12 using the 25-item Revised Children's Anxiety and Depression Scale-25 (RCADS-25). Self- and parent-reported quality of life and family functioning were obtained using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and Family Impact Modules. Results: A total of 45.7% of children and adolescents reported at-risk psychosocial functioning on the PedsQL. In contrast, only 5% of patients reported clinically elevated internalizing symptoms on the RCADS. Parents' quality of life and family functioning in the study were higher than in most studies of parents of children with other chronic health conditions, children with attention deficit-hyperactivity disorder, and healthy control samples. Conclusion: Our findings indicate that children and adolescents with SB are at risk for poor health-related quality of life (HRQOL); however, poorer HRQOL may not necessarily be associated with more severe psychiatric symptoms in this population. Examining resilience factors that may help to buffer against challenges to HRQOL will be important in informing future interventions.

A Low-Cost Method for Understanding How Nature-Based Early Learning and Childcare Impacts Children's Health and Wellbeing.

Nature-based play and learning provision is becoming increasingly popular across the early learning and childcare (ELC) sector in Scotland. However, there remains a lack of understanding of how the program is expected to function. This has implications for program learning and may affect wider rollout of the program. Secondary data analysis of parent interviews (n = 22) and observations (n = 7) in Scottish ELC settings, and review of internationally published studies (n = 33) were triangulated to develop a program theory using the Theory of Change approach. This approach makes a program's underlying assumptions explicit by systematically demonstrating the relationship between each component: inputs, activities, outcomes, impact, and the contexts of the program. Findings suggested that location of outdoor nature space, affordances, availability of trained practitioners, and transport to location lead to activities such as free play, educator-led activities, and interactions with nature, resulting in longer durations of physical activity, interactions with peers and educators, and increased engagement with the natural environment. These activities are vital for supporting children's physical, cognitive, social, and emotional development. Our results demonstrate the value of using secondary data analysis to improve our understanding of the underlying theory of nature-based ELC which can support future evaluation designs. These findings will be of interest to program evaluators, researchers, practitioners, and funders, who find themselves with limited resources and want to better understand their program before investing in an evaluation. We encourage researchers and evaluators in the field of early years and outdoor play in other countries to refine this logic model in their own context-specific setting.

All Hands on Deck: Addressing Adolescent Depression in Pediatric Primary Care.

OBJECTIVE: This study examines prevalence rates of elevated depression symptoms utilizing the Patient Health Questionnaire-9 Item Modified for Adolescents (PHQ-9A), characterizes recommendations and interventions by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to elevated PHQ-9As, and identifies factors associated with improved PHQ-9A scores at follow-up pediatric primary care visits. METHODS: A mixed methods approach was taken. Visit data, demographics, and PHQ-9A scores for 2,107 adolescents aged 11-18 were extracted using clinical informatics between January 3, 2017 and August 31, 2018. Descriptive statistics and chi-square analyses were conducted, followed by conventional content analysis of electronic medical records to examine qualitative results. Qualitative analyses were transformed into quantitative results and analyzed using point biserial correlations. RESULTS: Of the 2,107 adolescents, 277 (13%) had an elevated PHQ-9A. Content analysis resulted in 40 actions (17 PCP codes, 23 BHC codes) in response to an elevated PHQ-9A. Significant correlations were found between an improved PHQ-9A at a follow-up visit and the PCP referring to integrated behavioral health (r = .20, p < .01), and BHCs recommending and checking in at a follow-up visit (r = .20, p < .05), conducting a risk assessment (r = .15, p < .05), and providing psychoeducation about mood symptoms (r = .15, p < .05). CONCLUSIONS: Primary care is an ideal setting to address the public health crisis of untreated adolescent depression. Implications for screening processes, practice implications for PCPs and BHCs, future directions, and limitations are discussed.

Emotional numbing symptoms partially mediate the association between exposure to potentially morally injurious experiences and sexual anxiety for male service members.

Service members (SMs) returning from deployment are at risk of a range of sexual problems, some of which are thought to be related to psychological issues that may arise during deployment or combat. The current study sought to examine whether exposure to potentially morally injurious events (PMIEs) was associated with sexual anxiety (SA) above and beyond combat exposure and whether any such association was mediated by post-traumatic stress disorder (PTSD) symptom clusters. These questions were tested using data from self-report surveys collected from 221 partnered male Army (Active Duty, National Guard, or Reserve) SMs at three separate time points. Findings showed that exposure to PMIEs was significantly related to greater SA, with transgressions by self and perceived betrayal demonstrating unique associations when controlling for all factors of PMIEs. Moreover, total exposure to PMIEs was associated with SA above and beyond general combat exposure. PTSD symptoms partially mediated the association between exposure to PMIEs and SA, with emotional numbing accounting for significant unique indirect effects after controlling for other PTSD symptom clusters. The findings suggest that exposure to PMIEs is associated with SA, even when accounting for either combat exposure or PTSD symptoms, emphasizing the importance of this issue in understanding post-deployment problems in sexual intimacy.

Pitch perception and frequency-following responses elicited by lexical-tone chimeras.

OBJECTIVE: Previous research has shown the usefulness of utilizing auditory chimeras in assessing a listener's perception of the envelope and fine structure for an acoustic stimulus. However, research comparing and contrasting behavioral and electrophysiological responses to this stimulus type is scarce. DESIGN: Two sets of chimeric stimuli were constructed by interchanging the envelopes and fine-structures of the rising/yi(2)/and falling/yi(4)/Mandarin pitch contours that were filtered through 1, 2, 4, 8, 16, 32, and 64 frequency banks. Behavioral pitch-perception tasks were administered through a two-alternative, forced-choice paradigm. Electrophysiological responses were measured through scalp-recorded frequency-following responses (FFRs) to the lexical-tone chimeras. STUDY SAMPLE: Twenty American and twenty Chinese adults were recruited. RESULTS: A two-way analysis of variance showed significance (p < 0.05) within and across the filter bank and language background factors for the behavioral measurements, while the frequency-following response demonstrated a significance only across the filter banks. CONCLUSIONS: Perceptual importance of envelope cues increases starting from 16 filter banks, while the FFR accuracy and magnitude decreases with increasing number of filter banks. These results can be useful in assessing experience-dependent neuroplasticity and in designing speech processing strategies for cochlear-implant users who speak tonal or non-tonal languages around the globe.