The Workforce Shortage of Child and Adolescent Psychiatrists: Is It Time for a Different Approach?

Findling, Robert L.; Stepanova, Ekaterina

doi:10.1016/j.jaac.2018.02.008

Cited by 80 publications

(38 citation statements)

References 7 publications

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“…Unfortunately, the approximately 8000 child and adolescent psychiatrists in the USA are not equitably distributed, and rural populations areas are among the most underserved. Since early intervention is the most important means for prevention of chronic mental illness, the consequences of workforce shortages in these areas will have the greatest impact on the trajectory of morbidity and mortality [9][10][11] (see). Nguyen et al [3] found that rural counties and areas in Nebraska with high proportions of children and elderly face significant challenges in recruiting and retaining behavioral healthcare professionals.…”

mentioning

confidence: 99%

Rural Mental Health Training: an Emerging Imperative to Address Health Disparities

et al. 2018

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confidence: 99%

Rural Mental Health Training: an Emerging Imperative to Address Health Disparities

et al. 2018

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“…Given the increasing utilization of VAD support as a bridge to HTx in children and adolescents, 41 addressing psychiatric comorbidities will continue to be an important aspect of care in this unique population and further research in this area is critical. However, there is an ongoing shortage of providers trained in child and adolescent psychiatry 42 . While this presents a challenge, the results of our analysis highlight the importance of routine psychiatric evaluation and treatment to optimize the outcomes of children and adolescents following HTx.…”

Section: Discussionmentioning

confidence: 94%

The impact of psychiatric disorders on outcomes following heart transplantation in children

Quinlan

Auerbach

Bearl

et al. 2020

Pediatric Transplantation

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Psychiatric disorders are common in pediatric HTx recipients. However, the impact of psychiatric comorbidities on patient outcomes is unknown. We aimed to assess the impact of disorders of adjustment, depression, and anxiety on HTx outcomes in children; hypothesizing that the presence of psychiatric disorders during or preceding HTx would negatively impact outcomes. All pediatric HTx recipients ≥8 years of age who survived to hospital discharge were identified from a novel linkage between the PHIS and SRTR databases (2002-2016). Psychiatric disorders were identified using ICD codes during or preceding the HTx admission. Post-transplant graft survival, freedom from readmission, and freedom from rejection were analyzed using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to adjust for covariates. A total of 1192 patients were included, of which 133 (11.2%) had depression, 197 (16.5%) had anxiety, and 218 (18.3%) had adjustment disorders. The presence of depression was independently associated with higher rates of readmission (60.9% vs 54.1% at 6 months) (AHR 1.63, 95% CI 1.22-2.18, P = .001) and inferior graft survival (70.2% vs 83.4% at 5 years) (AHR 1.62, 95% CI 1.14-2.3, P = .007). Anxiety was independently associated with higher rates of readmission (60.4% vs 53.9% at 6 months) (AHR 1.46, 95% CI 1.09-1.94, P = .01). Anxiety and depression in the pretransplant period are independently associated with outcomes following HTx in children. Evaluation and management of psychiatric comorbidities represents an important component of care in this vulnerable population.

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“…The variation shown in Table 2 raises the question of what is driving these area-level variations? A hypothesis raised in the literature is that shortages of qualified mental health professionals are an important determinant of treatment (16,17). Shortages may leave primary care physicians providing mental health care, even though many pediatricians report that they are uncomfortable in this role (18).…”

Section: Resultsmentioning

confidence: 99%

Treatment of mental illness in American adolescents varies widely within and across areas

Cuddy

Currie

2020

Proc. Natl. Acad. Sci. U.S.A.

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Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episode of mental illness. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes. We also found large variations in the probability that children receive drug treatments that raise a red flag when viewed through the lens of treatment guidelines: Overall, in the first 3 mo after their initial claim for mental illness, 44.85% of children who receive drug treatment receive benzodiazepines, tricyclic antidepressants, or a drug that is not Food and Drug Administration-approved for their age. On average, these children are 12 y old. While the supply of mental health professionals impacts treatment choices, little of the overall variation is explained by supply-side variables, and at least half of the variation in treatment outcomes occurs within zip codes. These results suggest that other factors, such as physician practice style, may play an important role in the types of treatment that children receive.

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The Workforce Shortage of Child and Adolescent Psychiatrists: Is It Time for a Different Approach?

Cited by 80 publications

References 7 publications

Rural Mental Health Training: an Emerging Imperative to Address Health Disparities

Rural Mental Health Training: an Emerging Imperative to Address Health Disparities

The impact of psychiatric disorders on outcomes following heart transplantation in children

Treatment of mental illness in American adolescents varies widely within and across areas

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