Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention

Abstract

This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well‐being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence‐based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention‐deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.

Evaluating Differences in the Disease Experiences of Minority Adults With Cystic Fibrosis

“…Along these lines, some minority participants acknowledged that their personal life experiences deeply influenced their experience with CF. “I am from a family that has suffered a lot in this country, cycles of poverty, violence and abuse are all parts of my lineage … Food shelters, homelessness, and turmoil formed my childhood … My life is different now, I am a high earner and live in a very stable environment but, it took me getting here to really see how bad it was.” Intergenerational and personal trauma are more prevalent in minority individuals, and can influence mental health concerns to which individuals with chronic illnesses like CF may already be prone ( 20 , 21 ). Both minority and NHC participants expressed a sense of lack of control they feel over their CF: “I feel like no matter what I do far as taking my meds I have no control with the outcome of my condition.…”

National integration of mental health screening and treatment into specialized care for cystic fibrosis: What predicts success?

“…Given the recent recommendation of the US Preventative Task Force to implement anxiety screening in preadolescent children, 22,23 a consideration of mental health screening in this age group of children with CF is timely and appropriate. [24][25][26] Lastly, elevated rates of depression and anxiety have been consistently reported in other chronic respiratory diseases (e.g., non-CF bronchiectasis, primary ciliary dyskinesia, NTM). [3][4][5] This model of mental health screening and intervention implemented in CF could serve as a model for the integration of mental and physical health in other respiratory conditions.…”

National integration of mental health screening and treatment into specialized care for cystic fibrosis: What predicts success?

“…Given the recent recommendation of the US Preventative Task Force to implement anxiety screening in preadolescent children, [20][21] a consideration of mental health screening in this age group of children with CF is timely and appropriate. 22,23 Lastly, elevated rates of depression and anxiety have been consistently reported in other chronic respiratory diseases (e.g., non-CF bronchiectasis, primary ciliary dyskinesia, NTM). [3][4][5] This model of mental health screening and intervention implemented in CF could serve as a model for the integration of mental and physical health in other respiratory conditions.…”