Transgender and gender diverse (TGD) adolescents
experience 4-18 times higher rates of anxiety, 4-23 times higher rates of
depression, 11-54 times higher rates of suicidal ideation, and 2-5 times higher
rates of suicide attempts compared to their cisgender peers. Importantly, parents/guardians
(i.e., caregivers) can have a significant impact on TGD adolescent mental
health, with recent research suggesting that caregiver support and acceptance are
associated with a 30-40% reduction in these mental health concerns.
Community-based support groups are common practice
with TGD adolescents and families. However, group intervention programs that
work specifically with caregivers are rare, and existing programs have not been
formally evaluated. Therefore, the goal of this project is to evaluate TRANSforming
Families: Embracing Change with Teens, a virtual,
multi-family program that was developed by mental health providers in the
Seattle Children’s Gender Clinic (SCGC), to understand its impact on caregiver support
and acceptance and adolescent mental health. This partnership between SCGC
mental health providers and researchers will represent one of the first formal
evaluations of a group intervention program for caregivers of TGD adolescents, the
results of which can inform future implementation and evaluation of this
program in pediatric gender clinics across the United States.
Though the focus of most research on dementia is the pathogenesis of cognitive deficits, neuropsychiatric symptoms (NPS) are identified in >90% of those afflicted, resulting in hastened cognitive decline, worsened general health, reduced patient and caregiver quality of life, sooner institutionalization, and increased mortality. Affective symptoms, including depression, are the most common NPS in Alzheimer’s Disease (AD), and are present in over half of patients. Using the in-depth clinical phenotyping of participants in the National Alzheimer’s Coordinating Center (NACC) with matched plasma samples, we propose to determine the correlation between select cytokines/chemokines and T-cell differentiation with depression in dementia.
As rates of pediatric mental health emergencies have
skyrocketed over the last decade – and even more so since the Covid-19 pandemic
– the number of youth staying in emergency departments (EDs) and medical units
while awaiting inpatient psychiatric care or stabilization (i.e., “boarding”)
has reached unprecedented levels. The massive surges in patient volume, coupled
with widespread staff shortages and lack of staff expertise in treating mental
health, are overwhelming ED and hospital resources. This causes dangerous or
even life-threatening delays in care for youth populations in greatest need of
medical and psychiatric treatment. Prolonged ED stays not only delay necessary
mental health care, but they can cause additional trauma and distress for youth
already in crisis. While the boarding crisis affects all hospitals and EDs, it
poses an even greater challenge to community EDs that lack on-site mental
health specialists and/or pediatric providers.
To address the boarding crisis, this project will pilot a
model in which a multidisciplinary team of mental health clinicians at Seattle
Children’s Hospital provides telebehavioral health consultation to community
EDs in Western Washington to guide care for youth who are boarding. The primary
goals of this model are (1) to improve timeliness of mental health care and
reduce length of stay for youth boarding in community EDs, and (2) to support
ED staff in providing more developmentally appropriate and evidence-informed
mental healthcare. The Seattle Children’s team will provide case consultation
to ED providers and staff, including support with decisions about
hospitalization, medication treatment, behavioral interventions and case
management services. The team will also deliver practical trainings to
community ED staff to build their internal capacity to care for boarding youth.
If this initiative is successful, additional funding could expand ED
telebehavioral health consultation services statewide, with a focus on rural
communities.
Adolescent depression is one of the most common mental
health concerns during adolescence and can be a cause of significant impairment
across the lifespan, particularly if untreated. Access to evidence-based
psychotherapy is poor and pandemic-related increased demand for services has
greatly worsened access issues, leaving many adolescents without effective and
critically needed treatment. Adolescent depression is often first identified in
primary care, making it the ideal setting for improving early access to
treatment. While treatment by mental health specialists within primary care is
effective, the workforce is not adequate to meet the high demand for services.
Online depression treatment has been shown to be effective and has the added potential to expand
access, particularly given adolescent’s comfort with digital technology.
Importantly, the addition of human coaching alongside online treatments has
been shown to boost engagement and treatment outcomes.
The goal of
this project is to increase early access to evidence-based depression treatment
in primary care settings. The project team will work with adolescents, caregivers
and providers to develop an accessible and engaging online treatment for
delivery in primary care. To support integration and enhance engagement, the
project will also develop a coaching toolkit that can be utilized by a range of
non-mental health specialists, including nurses, medical providers, social
workers and bachelor’s level staff.
The
ages of 18-25 years are ‘peak onset’ times of major depression and bipolar
disorder. These disorders have different courses and treatments, but diagnosing
bipolar disorder is difficult because manic symptoms occur less often than
depressive symptoms and many individuals do not recall manic symptoms. A
‘misdiagnosis lag’ of 8-10 years can contribute to prolonged periods of
potentially ineffective treatments and suboptimal outcomes such as high symptom
burden, relationship problems, educational attainment and occupational
functioning.
This project will use remote prospective assessment and monitoring of depressive and manic symptoms in at-risk patients in-between patient visits to increase the ‘data points’ clinicians have when assessing a bipolar disorder diagnosis. This is especially important for people at risk for bipolar disorder (for example those with a family history of bipolar disorder) because manic symptoms can be provoked by first-line medication treatments for major depression. The project will use a new manic symptom measure (the Patient Mania Questionnaire-9) and a commonly used depressive symptom measure (the Patient Health Questionnaire-9) to monitor symptoms, and learn how clinicians and patients use this information clinically.
Cognitive therapies help patients by providing ways to modify habitual but unproductive thought patterns, known as maladaptive thinking styles. Cognitive therapies are effective in treating depression, amongst other conditions, and are increasingly delivered remotely as text-based interventions. This trend toward digital delivery has accelerated on account of physical isolation and psychological stressors during the global pandemic. While this means cognitive therapy can potentially reach more patients, the effectiveness of this therapy depends on the ability of a skilled practitioner to recognize types of maladaptive thinking, and there is a critical shortage of mental health practitioners with this expertise.
In radiology, computer-aided diagnosis systems driven by artificial intelligence are used to help physicians detect signs of illness they may otherwise miss. In this project, we will develop a computer-aided detection system to support text-based cognitive therapy. To do so, we will identify indicators of maladaptive thinking styles within a set of text messages exchanged between clients and their therapists, and train neural networks to detect these indicators automatically. The resulting tools will provide a basis for an artificial intelligence-based decision support system to help clinicians recognize and manage maladaptive thinking styles that will enhance the quality and effectiveness of text-based cognitive therapy.
