mental health

Importance: Increasing child and adolescent use of social media, video games, and mobile phones has raised concerns about potential links to youth mental health problems. Prior research has largely focused on total screen time rather than longitudinal addictive use trajectories.

Objectives: To identify trajectories of addictive use of social media, mobile phones, and video games and to examine their associations with suicidal behaviors and ideation and mental health outcomes among youths.

Design, setting, and participants: Cohort study analyzing data from baseline through year 4 follow-up in the Adolescent Brain Cognitive Development Study (2016-2022), with population-based samples from 21 US sites.

Exposures: Addictive use of social media, mobile phones, and video games using validated child-reported measures from year 2, year 3, and year 4 follow-up surveys.

Main outcomes and measures: Suicidal behaviors and ideation assessed using child- and parent-reported information via the Kiddie Schedule for Affective Disorders and Schizophrenia. Internalizing and externalizing symptoms were assessed using the parent-reported Child Behavior Checklist.

Results: The analytic sample (n = 4285) had a mean age of 10.0 (SD, 0.6) years; 47.9% were female; and 9.9% were Black, 19.4% Hispanic, and 58.7% White. Latent class linear mixed models identified 3 addictive use trajectories for social media and mobile phones and 2 for video games. Nearly one-third of participants had an increasing addictive use trajectory for social media or mobile phones beginning at age 11 years. In adjusted models, increasing addictive use trajectories were associated with higher risks of suicide-related outcomes than low addictive use trajectories (eg, increasing addictive use of social media had a risk ratio of 2.14 [95% CI, 1.61-2.85] for suicidal behaviors). High addictive use trajectories for all screen types were associated with suicide-related outcomes (eg, high-peaking addictive use of social media had a risk ratio of 2.39 [95% CI, 1.66-3.43] for suicidal behaviors). The high video game addictive use trajectory showed the largest relative difference in internalizing symptoms (T score difference, 2.03 [95% CI, 1.45-2.61]), and the increasing social media addictive use trajectory for externalizing symptoms (T score difference, 1.05 [95% CI, 0.54-1.56]), compared with low addictive use trajectories. Total screen time at baseline was not associated with outcomes.

Conclusions and relevance: High or increasing trajectories of addictive use of social media, mobile phones, or video games were common in early adolescents. Both high and increasing addictive screen use trajectories were associated with suicidal behaviors and ideation and worse mental health.

Author/s:

Yunyu Xiao, PhD, Yuan Meng, PhD, Timothy T. Brown, PhD

Autistic patients

Megan George — Mon, 14 Jul 2025 17:16:22 +0000

Date Added:

July 14, 2025

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

July 13, 2025

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Poster

DOI (1):

https://doi.org/10.1503/cmaj.250152

Keywords

autism

sensory

delivery of health care

MeSH

delivery of health care

communication

Treatment access

health services accessibility

gender identity

Evidence-based recommendations for ways that primary care clinicians can be helpful to autistic patients. James W. Mold, MD, MPH

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Ensuring accessibility helps reduce missed health care for autistic people. Health care delivery should be adapted in light of autism-related sensory profiles. Tailored accommodations should be implemented for each autistic patient’s unique communication profiles and preferences. Health care encounters should be as predictable, clear, and unrushed as possible. Autistic people with intersectional (e.g., cultural, gender) identities often experience discrimination in health care settings, which should be mitigated.

Author/s:

Louisa Lok Yee Man, Adeline Lacroix, Meng-Chuan Lai

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Alex Haga — Tue, 20 Aug 2024 19:53:30 +0000

Date Added:

August 20, 2024

Journal/Publication:

Agency for Healthcare Research and Quality

Publication Date:

July 31, 2024

URL:

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

Cognitive Behavioral Therapy

counseling

Postpartum period

An evidence-based review of non-pharmocologic treatments for maternal mental health conditions. James W. Mold, MD, MPH

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Objectives. This systematic review evaluates nonpharmacologic treatments for mental health conditions during the perinatal period (pregnancy and up to 12 months postpartum). We evaluated nonpharmacologic treatments for perinatal individuals with depressive disorders, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).

Data sources and review methods. We searched MEDLINE®, PsycINFO®, Embase®, CINAHL®, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from January 1, 2000, to January 17, 2024, to identify relevant randomized controlled trials (RCTs). Nonpharmacologic interventions of interest included, among others, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), exercise, non-directive counseling, behavioral activation, bright light therapy, eye movement desensitization and reprocessing (EMDR), and acupuncture. Outcomes of interest were improvement in scores on psychological assessment tools, cure or resolution of symptoms, suicide-related outcomes, and adherence to treatment. PROSPERO registration number: CRD42023440650.

Results. We identified 103 RCTs. Nonpharmacologic treatments were compared to control or each other in 101 RCTs and to pharmacologic treatments in 2 RCTs. The risk of bias was moderate for the majority of included studies, mostly related to lack of blinding. For perinatal individuals with depressive disorders, CBT was more effective than treatment as usual (TAU) to reduce depressive and anxiety symptoms (both moderate strength of evidence [SoE]); IPT was more effective than TAU to treat depressive symptoms (moderate SoE) and anxiety symptoms (low SoE); and both behavioral activation (a CBT technique, with low SoE) and exercise interventions (moderate SoE) were more effective than TAU to reduce depressive symptoms. Remission rates for depressive symptoms were higher with CBT and IPT compared to TAU (both low SoE) and higher with specific acupuncture than nonspecific or sham acupuncture (low SoE). There were no differences between CBT and non-directive counseling (an active patient-led intervention), between counseling and TAU, and between bright light and placebo light therapy (all low SoE). CBT was more effective than TAU to reduce anxiety and depressive symptoms for individuals with combined depressive and anxiety disorders (low SoE). Few (or no) eligible studies evaluated individuals with anxiety disorder, PTSD, OCD, or bipolar disorders, precluding conclusions for these conditions. There was also insufficient evidence for suicide-related outcomes, potential harms of treatment, and adherence to treatment, and for comparisons of nonpharmacologic with pharmacologic treatments.

Conclusion. Several nonpharmacologic treatments are more effective than TAU for perinatal mental health conditions, with the strongest evidence for CBT and IPT to reduce depressive symptoms among perinatal individuals with depressive disorders or combined depressive and anxiety disorders. Future research is needed to evaluate the comparative effectiveness of lesser studied nonpharmacologic interventions and lesser studied perinatal mental health conditions.

Marijuana and Youth: The Impact of Marijuana Use on Teen Health and Wellbeing

Erin Blanchette — Thu, 07 Mar 2024 02:26:51 +0000

Date Added:

March 6, 2024

Publisher:

Centers for Disease Control and Prevention

URL:

Marijuana and Youth: The Impact of Marijuana Use on Teen Health and Wellbeing

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

marijuana

recreational marijuana

MeSH

A concise summary of what is known about use and abuse of marijuana by teenagers. James W. Mold, MD, MPH

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National Cannabis Awareness Month is observed in April to increase awareness and education about marijuana. While scientists are still learning about the risks and benefits of using marijuana, we know that marijuana use can harm a teen’s health and wellbeing.

What Is Bipolar Disorder?

Erin Blanchette — Thu, 07 Mar 2024 02:18:46 +0000

Date Added:

March 6, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 16, 2024

URL:

What Is Bipolar Disorder?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.24844

Keywords

PMID (1):

38363576

MeSH

Information for patients on bipolar disorder(s). James W. Mold, MD, MPH

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Bipolar disorder is characterized by mood swings ranging from depressive lows to manic highs.

Bipolar disorder affects about 8 million people in the US and an estimated 40 million individuals worldwide. Symptoms of bipolar disorder typically start between age 15 to 25 years, often with an initial episode of depression.

Author/s:

Rebecca Voelker

Postpartum Depression-New Screening Recommendations and Treatments

Erin Blanchette — Tue, 05 Dec 2023 20:35:41 +0000

Date Added:

December 5, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 27, 2023

URL:

Postpartum Depression-New Screening Recommendations and Treatments

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.21311

Keywords

Depressive Disorders

Pregnancy

Obstetrics and Gynecology

Women's Health

Postpartum Depression

PMID (1):

38010647

MeSH

A summary of current recommendations regarding detection and treatment of postpartum depression. James W. Mold, MD, MPH

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Perinatal mental health conditions are those that occur during pregnancy and the year following childbirth, whether onset of the condition(s) predates pregnancy or occurs in the perinatal period. Perinatal mental health conditions are the leading cause of overall and preventable maternal mortality and include a wide array of mental health conditions including anxiety, depression, and substance use disorders. Perinatal depression specifically affects 1 in 7 perinatal individuals. While commonly referred to as postpartum depression, it is more accurately called perinatal depression because its onset corresponds with prepregnancy (27%), pregnancy (33%), and postpartum (40%) time frames.

Author/s:

Tiffany A Moore Simas, Anna Whelan, Nancy Byatt

Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement

Aubrey Delammermore — Sat, 24 Jun 2023 22:55:19 +0000

Date Added:

June 24, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

June 20, 2023

URL:

Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.9301

Keywords

PMID (1):

37338866

MeSH

The USPSTF recommends screening all adults under 65 for anxiety disorders. James W. Mold, MD, MPH

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Importance: Anxiety disorders are commonly occurring mental health conditions. They are often unrecognized in primary care settings and substantial delays in treatment initiation occur.

Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults.

Population: Asymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older.

Evidence assessment: The USPSTF concludes with moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum persons, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety disorders in older adults.

Recommendation: The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement).

Author/s:

US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Li, L., Ogedegbe, G., Pbert, L., Roa, G., Ruiz, J. M., Stevermer, J., Tsevat, J., Underwood, S. M., Wong, J. B.

Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder

Aubrey Delammermore — Sun, 06 Nov 2022 05:00:00 +0000

Date Added:

November 6, 2022

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

October 24, 2022

URL:

Pharmacologic and Nonpharmacologic Treatments for Posttraumatic Stress Disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.23970/AHRQEPCPTSD2022

Keywords

PTSD

Sample Size

Health Policy

referral and consultation

MEDLINE

PMID (1):

33252890

MeSH

stress disorders, post-traumatic

An evidence-based review of our current knowledge of both pharmacologic and non-pharmacologic treatments for people suffering from PTSD. James W. Mold, MD, MPH

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Objectives: Identify and abstract data from posttraumatic stress disorder (PTSD) treatment randomized controlled trials (RCTs) to update the PTSD Trials Standardized Data Repository (PTSD-Repository) with data on PTSD and mental health, including suicide-related outcomes and substance use.

Data sources: We searched PTSDpubs, Ovid® MEDLINE®, Cochrane CENTRAL, PsycINFO®, Embase®, CINAHL®, and Scopus® for eligible RCTs published from 1980 to May 22, 2020.

Review methods: In consultation with the National Center for PTSD (NCPTSD), we updated the PTSD-Repository by expanding inclusion criteria to RCTs targeting comorbid PTSD/substance use disorder (SUD) and adding data elements. The primary publication for each RCT was abstracted; data and citations from secondary publications (i.e., companion papers) appear in the same record. We assessed risk of bias (ROB) for all studies in the PTSD-Repository. We undertook an exploratory assessment of an expanded ROB system developed with guidance from a Technical Expert Panel and NCPTSD, which was pilot tested on a small subset of studies.

Results: We identified 47 new RCTs of interventions for PTSD and 21 RCTs for comorbid PTSD/SUD, resulting in 389 included studies published from 1988 to 2020. Psychotherapy interventions were the most common (63%), followed by pharmacologic interventions (25%). Most studies were conducted in the United States (62%) and had sample sizes ranging from 25 to 99 participants (60%). Approximately half of studies enrolled community participants (55%), and most were conducted in the outpatient setting (72%). Studies typically enrolled participants with a mix of trauma types (53%). Most RCTs (60%) were rated as having a medium ROB, and only 6 percent were rated as having a low ROB. Our pilot testing of an expanded ROB assessment tool emphasized more detailed assessment of elements, including: (1) methods for managing missing data, including both dropout from treatment and missing measurements (i.e., loss to followup); (2) differential assessment of subjective and objective outcomes; and (3) consideration of a five-category overall rating system.

Conclusions: The PTSD-Repository is a comprehensive database of data from PTSD trials. The PTSD-Repository allows clinical, research, education, and policy stakeholders to understand current research on treatment effectiveness and harms, and enable informed decisions about future research, mental health policy, and clinical care priorities. This report updates the studies and variables included in the PTSD-Repository to include recently published trials, interventions targeting comorbid PTSD/SUD, variables related to comorbidities such as suicide and SUDs, and ROB assessment.

Author/s:

O'Neil, M. E., Cheney, T. P., Hsu, F. C., Carlson, K. F., Hart, E. L., Holmes, R. S., Murphy, K. M., Graham, E., Cameron, D. C., Kahler, J., Lewis, M., Kaplan, J., McDonagh, M. S.

Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review

Bethie Seay — Sun, 07 Nov 2021 05:00:00 +0000

Date Added:

November 7, 2021

Journal/Publication:

JAMA Network Open

Publication Date:

October 13, 2021

Issue:

Volume:

Pages:

e2128568

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jamanetworkopen.2021.28568

A summary of post-COVID symptoms and their duration based upon studies involving more than 250,000 cases.

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Importance
Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region.

Objective
To estimate organ system–specific frequency and evolution of PASC.

Evidence Review
PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility.

Findings
From a total of 2100 studies identified, 57 studies with 250 351 survivors of COVID-19 met inclusion criteria. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC was 54.0% (45.0%-69.0%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term). Most prevalent pulmonary sequelae, neurologic disorders, mental health disorders, functional mobility impairments, and general and constitutional symptoms were chest imaging abnormality (median [IQR], 62.2% [45.8%-76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), general functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]), respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders.

Conclusions and Relevance
In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.

Author/s:

Groff, D., Sun, A., Ssentongo, A. E., Ba, D. M., Parsons, N., Poudel, G. R., Lekoubou, A., Oh, J. S., Ericson, J. E., Ssentongo, P., Chinchilli, V. M.

Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care

Bethie Seay — Tue, 25 May 2021 05:00:00 +0000

Date Added:

May 25, 2021

Type:

Notifications and Opportunities

MeSH

Humans

United States

Information Technology

Adaptation, physiological

Quality of Health Care

This is a summary of recommendations from a National Academy of Medicine panel on Implementing High Quality Primary Care.

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High-quality primary care is the foundation of a high-functioning health care system. When it is high-quality, primary care provides continuous, personcentered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.

Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country’s primary care services a public concern.

The National Academies of Sciences, Engineering, and Medicine formed the Committee on Implementing High-Quality Primary Care in 2019. Building on the recommendations of the 1996 Institute of Medicine report Primary Care: America’s Health in a New Era, the committee was tasked to develop an implementation plan for high-quality primary care in the United States.

The committee’s definition of high-quality primary care (see Box 1) describes what it should be, not what most people in the United States experience today. To rebuild a strong foundation for the U.S. health care system, the committee’s implementation plan includes objectives and actions targeting primary care stakeholders and balancing national needs for scalable solutions while allowing for adaptations to meet local needs.

The committee set five implementation objectives to make high-quality primary care available to all people living in the United States:

1. Pay for primary care teams to care for people, not doctors to deliver services.

2.Ensure that high-quality primary care is available to every individual and family in every community.

3.Train primary care teams where people live and work.

4.Design information technology that serves the patient, family, and the interprofessional care team.

5.Ensure that high-quality primary care is implemented in the United States.

Author/s:

The National Academy of Sciences

Responding to Unsafe Opioid Use: Abandon the Drug, Not the Patient

Devin Evans — Wed, 24 Mar 2021 05:00:00 +0000

Date Added:

March 24, 2021

Journal/Publication:

Journal of General Internal Medicine

Publication Date:

October 9, 2020

Issue:

Volume:

Pages:

790-791

URL:

Responding to Unsafe Opioid Use: Abandon the Drug, Not the Patient

Type:

Best Local Practices

Format:

Article

DOI (1):

10.1007/s11606-020-06281-4

Keywords

Opioid Use

opioids

RISEOK

Opioid-Related Disorders

2019-nCOV

PMID (1):

33037590

MeSH

opioid-related disorders

Prejudice

An argument for not firing patients for opioid misuse. James W. Mold, MD, MPH

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Physicians have a legal and ethical duty to protect their patients and support them during times of clinical need; the decision to end a doctor-patient relationship should not be made lightly. However, in a recent survey of 794 primary care practices, 90% reported discharging patients in the previous two years, often for opioid-related issues.1 Disruptive or inappropriate behavior was the most common reason for discharge (81%), but 78% reported dismissing patients for violations of a chronic pain or controlled substance agreement. We find this practice worrisome, particularly since many controlled substance agreements use coercive and stigmatizing language that patients may reluctantly sign or have trouble understanding.2 Although violent, threatening, or disruptive behavior may be a valid reason to discharge patients in certain circumstances, opioid misuse should rarely rise to this threshold

Author/s:

Tobin, Daniel G., Holt, Stephen R., Doolittle, Benjamin R.

Understanding Suicide Risk And Prevention

Devin Evans — Fri, 19 Mar 2021 05:00:00 +0000

Date Added:

March 19, 2021

Journal/Publication:

Health Affairs

Publication Date:

January 29, 2021

URL:

Understanding Suicide Risk And Prevention

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.1377/hpb20201228.198475

Keywords

MeSH

Self-Injurious Behavior

A review of suicide risk and prevention by a psychologist who works with primary care practices. James W. Mold, MD, MPH

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KEY POINTS:

Suicide rates have been rising during the past several years, but suicide is preventable.
There are many known risk factors for suicide, but the predictive utility of any single risk factor is low, requiring a focus on population-level rather than individual-level prevention.
There are proven processes for identifying suicide risk and intervening in health care, criminal justice, and education settings.
There is also a need for an enhanced data infrastructure to support suicide and self-harm surveillance systems.
Additional policy intervention is needed to scale and spread successful prevention approaches and to identify others. For example, policies should support removal of lethal means, increased funding for help lines and school-based programs, and integration of mental health care into routine health care.

Author/s:

Miller, Benjamin F., Coffey, M. J.

Health Policy Brief: Understanding Suicide Risk and Prevention

Devin Evans — Wed, 03 Feb 2021 06:00:00 +0000

Date Added:

February 3, 2021

Publisher:

Health Affairs

Publication Date:

January 29, 2021

URL:

Health Policy Brief: Understanding Suicide Risk and Prevention

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.1377/hpb20201228.198475

Keywords

MeSH

A summary of what we know about prevention of suicide written by someone who has been working hard to integrate primary and mental health care for years. James WE. Mold, MD, MPH

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Suicide rates have been rising during the past several years, but suicide is preventable.
There are many known risk factors for suicide, but the predictive utility of any single risk factor is low, requiring a focus on population-level rather than individual-level prevention.
There are proven processes for identifying suicide risk and intervening in health care, criminal justice, and education settings.
There is also a need for an enhanced data infrastructure to support suicide and self-harm surveillance systems.
Additional policy intervention is needed to scale and spread successful prevention approaches and to identify others. For example, policies should support removal of lethal means, increased funding for help lines and school-based programs, and integration of mental health care into routine health care.

Author/s:

Miller, Benjamin F., Coffery, M. J.

Behavioral Health Integration Compendium

Carly Hughes — Sat, 16 Jan 2021 19:20:20 +0000

Date Added:

January 16, 2021

Publication Date:

December 1, 2020

URL:

Behavioral Health Integration Compendium

Type:

Practice Management Reviews and Guidelines

Keywords

behavioral health

MeSH

mental health

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This Compendium has been developed by the Behavioral Health Integration (BHI) Collaborative, led by several of the nation’s leading physician organizations, as a tool for physicians and their practices to learn about and implement behavioral health integration (BHI) in order to achieve the goal of optimal whole person care.

Author/s:

American Medical Association

Medical Care of Adults With Down Syndrome: A Clinical Guideline

Brian Desmarais — Thu, 22 Oct 2020 14:30:11 +0000

Date Added:

October 22, 2020

Journal/Publication:

Journal of the American Medical Association

Publication Date:

October 20, 2020

Issue:

Volume:

324

Pages:

1543-1556

URL:

Medical Care of Adults With Down Syndrome: A Clinical Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1001/jama.2020.17024

MeSH

cardiovascular diseases

Patient Advocacy

comorbidity

Abstracting and Indexing

A guideline for the medical care of adults with Down’s Syndrome (see Results section). James W. Mold,. MD, MPH

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Abstract

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients.

Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome.

Evidence review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence.

Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome.

Conclusions and relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.

Author/s:

Tsou, Amy Y., Bulova, Peter, Capone, George, Chicoine, Brian, Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup