Psychiatry Consultation in Primary Care: Examining Treatment Access for Adolescent Depression.

Purpose: Youth in the United States are experiencing mental health concerns at an unprecedented level. Child Psychiatry Access Programs offer an innovative approach to close the gap between the need for care and insufficient mental health workforce. This study examined whether primary care provider consultation with a Child Psychiatry Access Program, Michigan Clinical Consultation & Care (MC3), was associated with greater access to treatment for adolescents with moderate to severe depression symptoms.

The integration of behavioral health consultants within a state-wide psychiatry consultation program: a community case study.

This paper describes the integration and role of masters-prepared behavioral health consultants (BHCs) within a state-wide psychiatry consultation program for children, adolescents, and perinatal women. Data from the Michigan Clinical Consultation and Care (MC3) program are reviewed, with attention to the role that BHCs play in the consultation process, integrated care, screening, and their dual roles with Community Mental Health Services Programs (CMHSPs) in Michigan. Approximately 82% of MC3 services are provided by the BHCs and involve resources or integrated care.

A Review of Telepsychiatry for Pediatric Patients in the Emergency Setting.

Purpose Of Review: The purpose of this review is to summarize factors contributing to the current state of pediatric mental health access in ED settings and synthesize the existing literature on the use of telepsychiatry to extend access to care, with particular focus on feasibility and sustainability.

Recent Findings: Children are presenting to emergency departments (EDs) with mental health concerns at an increasing rate, while ED capacity to treat psychiatric needs in children remains insufficient. This growing problem is compounded by decreased access to outpatient care and inpatient psychiatric beds, resulting in exorbitantly long waiting times, or "boarding," of children in crisis.

The Michigan Child Collaborative Care Program: Building a Telepsychiatry Consultation Service.

This column describes the establishment of the Michigan Child Collaborative Care (MC3), a statewide telepsychiatry consultation program that provides support to primary care providers (PCPs) in meeting the mental health needs of youths and perinatal women. The MC3 program provides cost-effective, timely, remote consultation to primary care providers in an effort to address the lack of access and scarcity of resources in child, adolescent, and perinatal psychiatry. Data from 10,445 service requests are summarized.

Exploring the Telepsychiatry Experience: Primary Care Provider Perception of the Michigan Child Collaborative Care (MC3) Program.

Background: Pediatric mental healthcare is a growing component of primary care practice. However, there is a lack of access to mental health services, particularly those provided by Child and Adolescent Psychiatrists. The Michigan Child Collaborative Care (MC3) Program is a telepsychiatry service that offers embedded behavioral health consultants within primary care practices, telephonic consultation, video consultation and embedded care.

Partnerships with Primary Care for the Treatment of Preschoolers.

This article reviews mental health access issues relevant to preschool children and data on this population obtained through the Michigan Child Collaborative Care Program (MC3). The MC3 program provides telephonic consultation to primary care physicians (PCPs) in 40 counties in Michigan and video telepsychiatric consultation to patients and families. Attention-deficit/hyperactivity disorder and disruptive behavioral disorders are frequent initial presenting diagnoses, but autism spectrum disorders, parent-child relational issues, trauma, and posttraumatic stress disorder should also be considered.

Executive Functioning at Baseline Prospectively Predicts Depression Treatment Response.

Objective: Existing cognitive and clinical predictors of treatment response to date are not of sufficient strength to meaningfully impact treatment decision making and are not readily employed in clinical settings. This study investigated whether clinical and cognitive markers used in a tertiary care clinic could predict response to usual treatment over a period of 4 to 6 months in a sample of 75 depressed adults.

Methods: Patients (N = 384) were sequentially tested in 2 half-day clinics as part of a quality improvement project at an outpatient tertiary care center between August 2003 and September 2007; additional subjects evaluated in the clinic between 2007 and 2009 were also included.

Vitamin D levels and perinatal depressive symptoms in women at risk: a secondary analysis of the mothers, omega-3, and mental health study.

Background: Vitamin D insufficiency may be associated with depressive symptoms in non-pregnant adults. We performed this study to evaluate whether low maternal vitamin D levels are associated with depressive symptoms in pregnancy.

Methods: This study was a secondary analysis of a randomized trial designed to assess whether prenatal omega-3 fatty acid supplementation would prevent depressive symptoms.

Contraception and mental health: a commentary on the evidence and principles for practice.

Among the most prevalent and disabling chronic diseases affecting reproductive-aged women worldwide, depression and anxiety can contribute to adverse reproductive health outcomes, including an increased risk of unintended pregnancy and its health and social consequences. For women with these common mental health conditions who want to avoid an unintended pregnancy, effective contraception can be an important strategy to maintain and even improve health and well-being. Reproductive health clinicians play a critical role in providing and managing contraception to help women with mental health considerations achieve their desired fertility.

Development of a screening and recruitment registry to facilitate perinatal depression research in obstetrics settings in the USA.

Objective: To create a multi-site registry to enable future large-scale studies of perinatal depression among women attending obstetrics clinics in the USA.

Methods: A screening and recruitment registry was developed that included women aged at least 18 years who attended seven obstetric clinics in the University of Michigan Health System (Ann Arbor, MI, USA) for prenatal care between September 8, 2008, and June 9, 2011. Participants completed depression screening and research recruitment materials.

Parenting stress and depressive symptoms in postpartum mothers: bidirectional or unidirectional effects?

Despite the consistent link between parenting stress and postpartum depressive symptoms, few studies have explored the relationships longitudinally. The purpose of this study was to test bidirectional and unidirectional models of depressive symptoms and parenting stress. Uniquely, three specific domains of parenting stress were examined: parental distress, difficult child stress, and parent-child dysfunctional interaction (PCDI).

Hazardous drinking and family functioning in National Guard veterans and spouses postdeployment.

The current study examined rates of alcohol misuse among National Guard (NG) service members and their spouses/partners, concordance of drinking behaviors among couples, and the effects of alcohol misuse, depression, and posttraumatic stress disorder (PTSD) on three measures of family functioning. This study is important because it addresses the topics of heavy drinking and family functioning in an at-risk population-NG service members returning from a combat zone deployment. We surveyed NG service members (1,143) and their partners (674) 45-90 days after returning from a military deployment.

The Mothers, Omega-3, and Mental Health Study: a double-blind, randomized controlled trial.

Objectives: Maternal deficiency of the omega-3 fatty acid, docosahexaenoic acid (DHA), has been associated with perinatal depression, but there is evidence that supplementation with eicosapentaenoic acid (EPA) may be more effective than DHA in treating depressive symptoms. This trial tested the relative effects of EPA- and DHA-rich fish oils on prevention of depressive symptoms among pregnant women at an increased risk of depression.

Study Design: We enrolled 126 pregnant women at risk for depression (Edinburgh Postnatal Depression Scale score 9-19 or a history of depression) in early pregnancy and randomly assigned them to receive EPA-rich fish oil (1060 mg EPA plus 274 mg DHA), DHA-rich fish oil (900 mg DHA plus 180 mg EPA), or soy oil placebo.

Predictors of recovery from prenatal depressive symptoms from pregnancy through postpartum.

Background: Identifying predictors of the course of depressive symptoms from pregnancy through postpartum is important to inform clinical interventions.

Methods: This longitudinal study investigated predictors of recovery from prenatal elevated depressive symptoms in the postpartum period. Forty-one pregnant women completed demographic, interpersonal, and psychosocial self-report assessment measures at 32 weeks of gestation and again 12 weeks postpartum.

The mothers, Omega-3 and mental health study.

Background: Major depressive disorder (MDD) during pregnancy and postpartum depression are associated with significant maternal and neonatal morbidity. While antidepressants are readily used in pregnancy, studies have raised concerns regarding neurobehavioral outcomes in exposed infants. Omega-3 fatty acid supplementation, most frequently from fish oil, has emerged as a possible treatment or prevention strategy for MDD in non-pregnant individuals, and may have beneficial effects in pregnant women.

Lengthened predelivery stay and antepartum complications in women with depressive symptoms during pregnancy.

Unlabelled: Abstract Background: It is crucial to understand the timing and mechanisms behind depression's effect on peripartum stay because attempts to intervene will vary based on the time period involved. We designed this study to compare predelivery and postdelivery length of stay in women with and without elevated depressive symptoms during pregnancy.

Methods: This study involved secondary data analysis of a larger study exploring antepartum depression.

Public-academic partnerships: working together to meet the needs of Army National Guard soldiers: an academic-military partnership.

The conflicts in Afghanistan and Iraq have greatly increased the number of veterans returning home with combat exposure, reintegration issues, and psychiatric symptoms. National Guard soldiers face additional challenges. Unlike active duty soldiers, they do not return to military installations with access to military health services or peers.

Depressive symptoms during pregnancy: impact on neuroendocrine and neonatal outcomes.

Objective: To explore the interplay of maternal depressive symptoms on the infant limbic-hypothalamic-pituitary axis (LHPA) and neurological development.

Design: Pregnant women were monitored for depressive symptoms using the Beck Depression Inventory (BDI) at 28, 32, and 37 weeks of gestation and at delivery. A mixture growth curve analysis divided the women into three risk groups: low/stable, intermediate, and high/increasing depression based on BDI scores.

Maternal mood and sleep in children of women at risk for perinatal depression.

Few studies have examined relationships between perinatal depression and sleep in offspring beyond very early childhood. Eighty-five women classified as high risk for major depressive disorder during pregnancy completed measures of mood and their child's sleep 4-7 years postpartum. Mothers with Beck Depression Inventory-II (BDI-II) scores ≥20 reported more sleep problems in their child, and child sleep disruption was a reasonable predictor of maternal BDI-II.

Risk factors for depressive symptoms during pregnancy: a systematic review.

The purpose of this study was to evaluate risk factors for antepartum depressive symptoms that can be assessed in routine obstetric care. We evaluated articles in the English-language literature from 1980 through 2008. Studies were selected if they evaluated the association between antepartum depressive symptoms and > or =1 risk factors.

Peripartum length of stay for women with depressive symptoms during pregnancy.

Background: Approximately 1 in 10 women suffers from depression during pregnancy. Little is known about whether antepartum depression affects a mother's length of stay at delivery. We aimed to compare peripartum length of stay in women with and without depressive symptoms during pregnancy.

When depression complicates childbearing: guidelines for screening and treatment during antenatal and postpartum obstetric care.

Prevalence studies show that 1 in 5 women experience an episode of major depressive disorder during their lifetime. The peripartum period is a prime time for symptom exacerbation and relapse of depressive episodes. Health care providers, specifically those in obstetric care, should be aware of: (1) the frequency of depression in pregnant and postpartum women; (2) signs, symptoms, and appropriate screening methods; and (3) the health risks for the mother and growing fetus if depression is undetected or untreated.

The relationship between obstetrical outcomes and alcohol use in the year prior to pregnancy.

Objectives: The purpose of this study was to examine problems related to alcohol use as reported covering the year prior to pregnancy in a general prenatal care seeking sample. The relationship of alcohol use to a number of pregnancy and birth complications (premature rupture of membrane, birthweight, weeks gestation and APGAR) was examined.

Methods: A total of 940 prenatal care-seeking women completed the TWEAK, a brief measure of alcohol use problems during the previous year.