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Association between child psychiatric emergency room outcomes and dimensions of psychopathology.

ABSTRACT: OBJECTIVE:To determine the degree to which dimensional psychopathology predicts length of stay in an emergency department (ED) and need for hospital admission among children with psychiatric complaints. METHOD:Electronic health records of children age 4-17?years who presented to the ED of a large academic medical center were analyzed using a natural language processing tool to estimate Research Domain Criteria (RDoC) symptom scores. These scores' association with length of stay and probability of admission versus discharge to home were evaluated. RESULTS:We identified 3061 children and adolescents who presented to the ED and were evaluated by the psychiatry service between November 2008 and March 2015. Median length of stay was 7.8?h (interquartile range 5.2-14.3?h) and 1696 (55.4%) were admitted to the hospital. Higher estimated RDoC arousal, cognitive, positive, and social domain scores were associated with increased length of stay in multiple regression models, adjusted for age, sex, race, private insurance, voluntary admission, and diagnostic categories. In similarly adjusted models, odds of hospital admission were increased by higher RDoC arousal and cognitive domain scores and decreased by higher negative domain scores. CONCLUSIONS:A natural language processing tool to characterize dimensional psychopathology identified features associated with differential outcomes in children in the psychiatric ED, most notably symptoms reflecting arousal and cognitive function. Methodologically, this in silico approach to risk stratification should facilitate precision psychiatry in children within the emergency setting.

SUBMITTER: McCoy TH

PROVIDER: S-EPMC7392621 | biostudies-literature | 2019 Jul - Aug

REPOSITORIES: biostudies-literature

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Association between child psychiatric emergency room outcomes and dimensions of psychopathology.

McCoy Thomas H TH Wiste Anna K AK Doyle Alysa E AE Pellegrini Amelia M AM Perlis Roy H RH

General hospital psychiatry 20190416

<h4>Objective</h4>To determine the degree to which dimensional psychopathology predicts length of stay in an emergency department (ED) and need for hospital admission among children with psychiatric complaints.<h4>Method</h4>Electronic health records of children age 4-17 years who presented to the ED of a large academic medical center were analyzed using a natural language processing tool to estimate Research Domain Criteria (RDoC) symptom scores. These scores' association with length of stay an ...[more]

PMID: 31034963

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Project description:PurposeThe association between atmospheric particulate matter and emergency room visits for cerebrovascular disease were evaluated in Beijing.MethodsA generalized additive model was used to evaluate the associations between particulate matter and cerebrovascular disease, based on the daily data of meteorological elements, PM concentrations, and emergency room (ER) visits for cerebrovascular disease in Beijing from 2009 to 2012. Long-term trends and the effects of holidays, the day of the week, and confounding factors were controlled to determine the lag effect at 0-6 days. Single- and double-pollutant models were employed for different age and sex groups.ResultsThe effect of PM2.5 concentration on the number of daily ER visits for cerebrovascular disease was much stronger than that of PM10 concentration. PM2.5 and PM10 had maximum RR values of 1.096 and 1.054 at lag 6 for patients aged 61-75 years. For each inter-quartile range (IQR) increase in PM10 concentration, the maximum RR values for the total, males, females, aged 15-60 years, aged 61-75 years, and aged > 75 years were 1.024, 1.044, 1.043, 1.038, 1.054, and 1.032, respectively. For each IQR increase in PM2.5 concentration, the maximum RR values for the total, males, females, aged 15-60 years, aged 61-75 years, and aged > 75 years were 1.038, 1.064, 1.076, 1.054, 1.096, and 1.049, respectively. The RR values of the double-pollutant models were lower than those of the single-pollutant models.ConclusionThis study showed that the effects of PM pollution on cerebrovascular disease were different among different gender and age groups, and aged 61-75 years were mostly sensitive to particulate matters. The effects of PM2.5 on cerebrovascular disease were stronger than those of PM10. Our results can provide scientific evidence for the local government to take effective measures to improve air quality and the health of residents.Supplementary informationThe online version contains supplementary material available at 10.1007/s40201-021-00776-w.

Project description:BackgroundComorbidity between psychopathologies may be attributed to genetic and environmental differences between people as well as causal processes within individuals, where one pathology increases risk for another. Disentangling between-person (co)variance from within-person processes of psychopathology dimensions across childhood may shed light on developmental causes of comorbid mental health problems. Here, we aim to determine whether and to what extent directional relationships between psychopathology dimensions within-person, and between individuals within families, play a role in comorbidity.MethodsWe conducted random intercepts cross-lagged panel model (RI-CLPM) analyses to unravel the longitudinal co-occurrence of child psychopathology dimensions, jointly estimating between-person and within-person processes from childhood to early adolescence (age 7-12). We further developed an extension of the model to estimate sibling effects within-family (wf-RI-CLPM). Analyses were separately conducted in two large population-based cohorts, TEDS and NTR, including parent-rated measures of child problem behaviours based on the SDQ and CBCL scales respectively.ResultsWe found evidence for strong between-person effects underlying the positive intercorrelation between problem behaviours across time. Beyond these time-varying within-person processes accounted for an increasing amount of trait variance, within- and cross-trait, overtime in both cohorts. Lastly, by accommodating family level data, we found evidence for reciprocal directional influences within sib-pairs longitudinally.ConclusionsOur results indicate that within-person processes partly explain the co-occurrence of psychopathology dimensions across childhood, and within sib-pairs. Analyses provided substantive results on developmental processes underlying comorbidity in behavioural problems. Future studies should consider different developmental timeframes to shed more light on the processes contributing to developmental comorbidity.

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Association between child psychiatric emergency room outcomes and dimensions of psychopathology.

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Association between child psychiatric emergency room outcomes and dimensions of psychopathology.

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