What is the burden of chronic cough for families?

BACKGROUND: The burden of children's chronic cough to parents is largely unknown. The objectives of this study were as follows: (1) to determine the burden of chronic cough using a purposely designed questionnaire, and (2) to evaluate psychological (child's anxiety and parental emotional distress) and other influences on the reported burden of cough. METHODS: Parents of children newly referred for chronic cough completed three questionnaires (Spence anxiety scale; depression, anxiety, and stress 21-item scale [DASS]; and burden of cough questionnaire) at enrollment. The last 79 parents also completed these questionnaires at follow-up. RESULTS: Median age of the 190 children recruited was 2.6 years. The number of medical consultations for coughing illness in the last 12 months was high: > 80% of children had > or = 5 doctor visits and 53% had > 10 visits. At presentation, burden scores correlated to parental DASS scores when their child was coughing. Stress was the largest contributor to parents' emotional distress. Parental anxiety and depression scores were within published norms. Scores on all three DASS subscales reduced significantly when the children ceased coughing. At follow-up, the reduction in burden scores was significantly higher in the "ceased coughing" group (n = 49) compared to the "still coughing" group (n = 32). CONCLUSIONS: Chronic cough in children is associated with a high burden of recurrent doctor visits, parental stress, and worries that resolve when cough ceases. Parents of children with chronic cough did not have above-average anxiety or depression levels. This study highlights the need to improve the management of children with chronic cough, including clinicians being cognizant of the emotional distress of the parents.

Developing an integrated substance use and mental health service in the specialised setting of a youth detention centre.

This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.