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Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.
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Children and youth in the United States are experiencing a mental health crisis that predates the COVID-19 pandemic. Child and adolescent psychiatrists have the knowledge and skillset to advocate for improving the pediatric mental health care system at the local, state, and federal levels. Child psychiatrists can use their knowledge and expertise to advocate legislatively or through regulatory advocacy to improve access to mental health care for youth. Further, including advocacy education in psychiatry and child psychiatry graduate medical education would help empower child psychiatrists to make an impact through their advocacy efforts.
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Psiquiatría Infantil , Servicios de Salud Mental , Humanos , Niño , Adolescente , Estados Unidos , COVID-19/prevención & control , Psiquiatría del Adolescente , Salud Mental , Defensa del Niño , Defensa del Paciente , Trastornos Mentales/terapiaRESUMEN
Background: Several studies have demonstrated that individuals with autism spectrum disorder (ASD) are at a significantly higher risk of suicide, with over 7.5 times increased likelihood of dying by suicide and higher rates of suicidal ideation. The present study aimed to examine the perspectives and awareness of psychiatrists regarding suicidal behavior in individuals with ASD. Methods: To achieve this, an online survey was developed to assess clinicians' practices in evaluating suicidal thoughts and behaviors in individuals with ASD. Results: A total of 143 psychiatrists, including 55 general adult psychiatrists and 88 child and adolescent psychiatrists, completed the cross-sectional survey. The results of the study revealed that clinicians reported lower rates of suicidal ideation and behavior in individuals with ASD compared to those without ASD (P < .05). Furthermore, it was found that the usage of screening tools for assessing suicidal behavior was significantly lower in the ASD group (P < .05). Conclusion: The study aimed to investigate psychiatrists' knowledge and screening practices regarding ASD and emphasize the importance of increasing knowledge and implementing effective screening and intervention practices to address the risk of suicidality in individuals with ASD.
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BACKGROUND: Several genetic testing techniques have been recommended as a first-tier diagnostic tool in clinical practice for diagnosing autism spectrum disorder (ASD). However, the actual usage rate varies dramatically. This is due to various reasons, including knowledge and attitudes of caregivers, patients, and health providers toward genetic testing. Several studies have therefore been conducted worldwide to investigate the knowledge, experiences, and attitudes toward genetic testing among caregivers of children with ASD, adolescent and adult ASD patients, and health providers who provide medical services for them. However, no systematic review has been done. AIM: To systematically review research on knowledge, experiences, and attitudes towards genetic testing among caregivers of children with ASD, adolescent and adult ASD patients, and health providers. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and searched the literature in three English language databases (PubMed, Web of Science, and PsychInfo) and two Chinese databases (CNKI and Wanfang). Searched literature was screened independently by two reviewers and discussed when inconsistency existed. Information on characteristics of the study, characteristics of participants, and main findings regarding knowledge, experience, and attitudes of caregivers of children with ASD, adolescent and adult ASD patients, and health providers concerning ASD genetic testing were extracted from included papers into a charting form for analysis. RESULTS: We included 30 studies published between 2012 and 2022 and conducted in 9 countries. Most of the studies (n = 29) investigated caregivers of children with ASD, one study also included adolescent and adult patients, and two covered health providers. Most (51.0%-100%) of the caregivers/patients knew there was a genetic cause for ASD and 17.0% to 78.1% were aware of ASD genetic testing. However, they lacked full understanding of genetic testing. They acquired relevant and necessary information from physicians, the internet, ASD organizations, and other caregivers. Between 9.1% to 72.7% of caregivers in different studies were referred for genetic testing, and between 17.4% to 61.7% actually obtained genetic testing. Most caregivers agreed there are potential benefits following genetic testing, including benefits for children, families, and others. However, two studies compared perceived pre-test and post-test benefits with conflicting findings. Caregivers concerns included high costs, unhelpful results, negative influences (e.g., causing family conflicts, causing stress/risk/pain to children etc.) prevented some caregivers from using genetic testing. Nevertheless, 46.7% to 95.0% caregivers without previous genetic testing experience intended to obtain it in the future, and 50.5% to 59.6% of parents previously obtaining genetic testing would recommend it to other parents. In a single study of child and adolescent psychiatrists, 54.9% of respondents had ordered ASD genetic testing for their patients in the prior 12 mo, which was associated with greater knowledge of genetic testing. CONCLUSION: Most caregivers are willing to learn about and use genetic testing. However, the review showed their current knowledge is limited and usage rates varied widely in different studies.
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Psiquiatría Infantil , Psiquiatría , Humanos , Niño , Adolescente , Psiquiatría del Adolescente , ChinaRESUMEN
OBJECTIVE: This study sought to examine career satisfaction among United States of America child and adolescent psychiatrists (CAPs) across career stages, identifying predictive factors for their career satisfaction. METHODS: A total of 526 CAPs responded to a national career satisfaction survey. Satisfaction was assessed via responses to statements about their career on a Likert scale. Career satisfaction was defined as the sum of the scores for satisfaction with their choice of career, career advancement, and career recognition. Responses were disaggregated by the number of years post child and adolescent psychiatry residency training (early career: 0-10 years; midcareer: 11-20 years; and late career: 21 + years post-training). Stepwise linear regression analyses identified predictive factors of career satisfaction. RESULTS: CAPs' career satisfaction was high (3.95) and increased with career stage. It was most positively correlated with advancement opportunities, job enjoyment, and control of assigned tasks, and most negatively correlated with workload. Job enjoyment was the leading predictive factor of career satisfaction for early career and late career CAPs, with midcareer CAPs identifying task assignment control as the leading contributor to their career satisfaction (all p = .000). CONCLUSIONS: Career satisfaction in Child and Adolescent Psychiatry is high, increases with career stage, and is most predicted by advancement opportunities. Further study of the predictive factors of CAPs' career satisfaction is warranted as we focus on increasing the workforce in child and adolescent psychiatry.
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Internado y Residencia , Psiquiatría , Adolescente , Psiquiatría del Adolescente/educación , Selección de Profesión , Niño , Humanos , Satisfacción en el Trabajo , Satisfacción Personal , Psiquiatría/educación , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Abstract Introduction In 2016, there were 4,393 psychiatrists in Mexico, with an estimated rate of 3.68 per 100,000 inhabitants. It is essential to keep this information updated in order to achieve the overall objectives of mental health care. Objective Estimate the total number of psychiatrists and paidopsychiatrists in Mexico in 2018; identify their geographical distribution, and compare the results with those obtained in 2011 and 2016. Method Comparative, longitudinal study. Various sources were consulted to update the number of psychiatrists and paidopsychiatrists in 2018 and to determine their sociodemographic characteristics. These characteristics were compared with those found in 2011 and 2016. Results A total of 4,999 specialists in psychiatry practiced their specialty in Mexico in 2018, 365 of whom are child and adolescent psychiatrists. A rate of 3.71 psychiatrists per 100,000 inhabitants was obtained for a population of 124,737,789. Regarding pedopsychiatric specialists, if we consider a population of 37,714,991 inhabitants under 16, the corresponding rate is .96 child and adolescent psychiatrists per 100,000 minors. These specialists are unevenly distributed throughout the country. Approximately 60% of all psychiatrists and child and adolescent psychiatrists practice in the three largest cities in Mexico. Discussion and conclusion Although the national rate of psychiatrists was increased in comparison with 2016, it is still lower than that recommended by the World Health Organization (WHO). The geographical distribution of psychiatrists is uneven due to centralization and economic factors as happens in many countries in the world.
Resumen Introducción En 2016 se contabilizaron en México 4,393 psiquiatras, con una tasa estimada de 3.68 por cada 100,000 habitantes. Es necesario mantener actualizada esta información para alcanzar los objetivos globales de atención a la salud mental. Objetivo Estimar el número total de psiquiatras y paidopsiquiatras en México en 2018; determinar su distribución geográfica y comparar los resultados con los obtenidos en 2011 y 2016. Método Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el número de psiquiatras y paidopsiquiatras en 2018 y conocer sus características sociodemográficas. Se compararon estas características con las encontradas en 2011 y 2016. Resultados Un total de 4,999 especialistas en psiquiatría ejercen su especialidad en México en 2018 y de estos 365 son paidopsiquiatras. En una población de 124,737,789 habitantes, se obtuvo una tasa de 3.71 psiquiatras por cada 100,000 habitantes. Respecto a los especialistas en paidopsiquiatría, si consideramos una población de 37,714,991 habitantes menores de 16 años, la tasa correspondiente es de .96 paidopsiquiatras por cada 100,000 menores. Existe una distribución desigual de estos especialistas en el país. Alrededor del 60% de todos los psiquiatras y paidopsiquiatras ejercen en las tres mayores ciudades de México. Discusión y conclusión Aunque la tasa nacional de psiquiatras se incrementó en comparación con la obtenida en 2016, sigue siendo todavía menor a la recomendada por la Organización Mundial de la Salud. La distribución geográfica de los psiquiatras es inequitativa debido a la centralización y a factores económicos como sucede en muchos países del mundo.
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There are few available and reliable data regarding the number and geographic location of psychiatrists in Mexico. It is important to have these data in order to know if the mental health needs of the country are being met. This study is an attempt to update both the current data on this subject by locating the most psychiatrists possible, and also to learn more about how they manage their medical practice. Methods Descriptive and cross-sectional study. Several sources available in Mexico were consulted such as Mexican Psychiatry Associations, health care institutions, universities, telephone directories among several others, to locate psychiatrists and to identify where and what kind of practice they have. Results According to our several data bases, 3823 psychiatrists were counted in Mexico, 225 of these being child and adolescent psychiatrists. The rate of psychiatrists obtained was 3.47 psychiatrists per 100 000 inhabitants and 0.69 child and adolescent psychiatrists per 100 000 inhabitants under 15 years. 56% of psychiatrists practiced in the Federal District. There are 1.8 male psychiatrists for every female psychiatrist. Discussion The number of psychiatrists in Mexico is still below the rate that the World Health Organization recomends. The distribution by gender is shifting towards more equality. Psychiatrists were found to be grouped in urban areas of the country. The number of psychiatrists and child and adolescent psychiatrists seems to be insufficient to cover the needs of the country.
Existe poca información disponible y actualizada acerca del número de psiquiatras en México y sobre su localización geográfica. Es importante conocer estos datos para saber si se cubren las necesidades de salud mental del país. Este estudio busca actualizar tanto los datos disponibles sobre este tema al localizar el mayor número de psiquiatras posibles, como el tipo de práctica en su especialidad y si cuentan con la certificación correspondiente. Metodología Se trata de un estudio descriptivo y transversal. Se consultaron múltiples fuentes disponibles en México, como las asociaciones psiquiátricas mexicanas, las instituciones hospitalarias, las universidades, los directorios telefónicos y otros, para localizar a los psiquiatras, identificar dónde ejercen y conocer el tipo de su práctica profesional. Resultados Considerando nuestras diversas fuentes de búsqueda, se contabilizó un total de 3 823 psiquiatras para una población total de 112 000 000 de habitantes. Del número total de psiquiatras, 225 tienen la subespecialidad de paidopsiquiatría. Se obtuvo una tasa de 3.47 psiquiatras por cada 100 000 habitantes y de 0.69 paidopsiquiatras sobre una población de 100 000 habitantes menores de 15 años. El 56% se encuentra en el Distrito Federal. Hay 1.8 psiquiatras varones por cada mujer en esa especialidad. Discusión El número de psiquiatras en México aún está por debajo de la tasa recomendada por la Organización Mundial de la Salud. La distribución por género está cambiando hacia una más equitativa. Se encontró que los psiquiatras están agrupados en las zonas urbanas del país. El número de psiquiatras y paidopsiquiatras es insuficiente para cubrir las necesidades de salud mental del país.
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El presente estudio se basa en la Encuesta de Calidad de Vida de la Organización Mundial de la Salud (WHOQOL-BREF), que se utilizó para analizar la calidad de vida y los factores que contribuyen a su calidad de vida en Psiquiatras Infanto-Juveniles y Neuropediatras, además de residentes de ambas especialidades en Chile. Se realizaron entrevistas electrónicas a 79 profesionales, asociados a la Sociedad de Psiquiatría y Neurología de la Infancia y de la Adolescencia. Los resultados mostraron que las puntuaciones medias en cada dominio del WHOQOL-BREF de los profesionales son las siguientes: la capacidad física (CF) es de 15,11 +/- 2.55, el bienestar psicológico (BP) fue de 15,22 +/- 2.08, relaciones sociales (RS) fue 14,63 +/- 2.75 y el medio ambiente (MA) 15,04 +/- 2.39. Estas puntuaciones medias fueron inferiores a las de la población general. Por último, se realizaron regresiones múltiples por pasos para examinar las características del Psiquiatra Infanto-Juvenil, Neurólogo Infantil y residentes de la especialidad. El estudio encontró que los siguientes tres factores: la percepción subjetiva del estado de salud, los hogares, los ingresos y el estrés de apoyo familiar insuficiente, fueron significativamente correlacionados con los cuatro dominios de regresión múltiple análisis. Los resultados destacan que los cuidadores de los niños y adolescentes con discapacidad intelectual parecen mostrar una menor WHOQOL-BREF puntuación media que la población general, probablemente por una combinación de estrés, la salud y los factores de ingreso de los hogares. Estas conclusiones deben tenerse en cuenta en la formulación de políticas para proporcionar medidas de mayor apoyo e intervenciones más específicas para los psiquiatras infanto-juveniles y Neuropediatras.
The present study is based on World Health Organization´s quality of life (WHOQOL-BREF) scale to examine quality of life of child and adolescent psychiatrists and child neurologists in Chile, and the factors contributing to their quality of life. Structured interviews were conducted with 79 practitioners. Self-evaluation of their quality of life revealed that 72 percent considered it good or very good, while 58 percent were pleased of very pleased with regards to health satisfaction. The mean scores obtained in each domain of WHOQOL-BREF were: physical capacity (PC) 15.11 +- 2.55, psychological well-being (PW) 15.22 +-2.08, social relationship (SR) 14.63 +- 2.75 and environment (EN) 15.04 +- 2.39. Finally, multiple stepwise regressions were conducted to examine the characteristics of the practitioners which more likely explained the WHOQOL-BREF mean scores. The study found that marital status was significantly correlated to psychological well-being and environment; religion was significantly correlated to the environment; and the number of work places with physical capacity and quality of life score. The results highlights that child and adolescent psychiatrists and child neurologists display a higher WHOQOL-BREF mean score than the general population however, in certain domains the scores are lower, probably due to a combination of stress and health factors. These finding must be taken into account in policy making to provide better and more specific supports and interventions for the child and adolescent psychiatrists and child neurologists.