Predicting Mental Health Treatment Access Among Adolescents With Elevated Depressive Symptoms: Machine Learning Approaches

A large proportion of adolescents experiencing depression never access treatment. To increase access to effective mental health care, it is critical to understand factors associated with increased versus decreased odds of adolescent treatment access. This study used individual depression symptoms and sociodemographic variables to predict whether and where adolescents with depression accessed mental health treatments. We performed a pre-registered, secondary analysis of data from the 2017 National Survey of Drug Use and Health (NSDUH), a nationally representative sample of non-institutionalized civilians in the United States. Using four cross-validated random forest models, we predicted whether adolescents with elevated past-year depressive symptoms (N?=?1,671; ages 12–17 years) accessed specific mental health treatments in the previous 12 months (“yes/no” for inpatient, outpatient, school, any). 53.38% of adolescents with elevated depressive symptoms accessed treatment of any kind. Even with depressive symptoms and sociodemographic factors included as predictors, pre-registered random forests explained?<?0.00% of pseudo out-of-sample deviance in adolescent access to inpatient, outpatient, school, or overall treatments. Exploratory elastic net models explained 0.80–2.50% of pseudo out-of-sample deviance in adolescent treatment access across all four treatment types. Neither individual depressive symptoms nor any socioeconomic variables meaningfully predicted specific or overall mental health treatment access in adolescents with elevated past-year symptoms. This study highlights substantial limitations in our capacity to predict whether and where adolescents access mental health treatment and underscores the broader need for more accessible, scalable adolescent depression treatments.

     

Frequency of stroke and embolism in left ventricular hypertrabeculation/noncompaction

Left ventricular hypertrabeculation/noncompaction (LVHT/NC) is associated with stroke or embolism (S/E). The aim of this retrospective study was to assess the rate, risk factors, and cause of S/E in patients with LVHT/NC. The medical records of patients with LVHT/NC were retrospectively screened for S/E. For stroke classification, the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria were applied, and for peripheral embolism, angiographic findings were used. Baseline clinical, echocardiographic, and electrocardiographic data were compared between patients with and without S/E. In 22 of 144 patients (15%), stroke (n = 21) or peripheral embolism (n = 1) had occurred. The cause of S/E was cardioembolic (n = 14), atherosclerotic (n = 5), or undetermined (n = 3). S/E occurred before (n = 14) and after (n = 8) the diagnosis of LVHT/NC. Only mean age (60 vs 53 years, p <0.05) and the prevalence of hypertension (32% vs 59%, p <0.05) were higher in patients with S/E than in those without S/E. Among patients with cardioembolic S/E, 13 of 14 had either atrial fibrillation (AF) or systolic dysfunction, and AF as well as systolic dysfunction were found in 4 of 14 patients. In conclusion, S/E in patients with LVHT/NC is not always cardioembolic but may also have an atherosclerotic cause. In the absence of AF or left ventricular systolic dysfunction, cardioembolic S/E is rare in patients with LVHT/NC. These findings suggest that patients with LVHT/NC with systolic dysfunction or AF should receive oral anticoagulation as primary prophylaxis against S/E.     

Growth, health, and development after neonatal gut surgery: a long-term follow-up.

Growth and development data on 19 children who survived gut surgery in the immediate newborn period are presented. The follow-up period ranges from seven months to seven years six months, with a mean of three years eight months. Neonates who undergo gut resection are at a higher risk for delay in height and weight gain compared to those who have gut surgery without resection. Six of the 12 children who had gut resection showed delay in height gain and seven showed delay in weight gain. Of the seven children who had gut surgery but no resection, only one showed delay in height and weight gain after the age of 1 year. An individual approach and careful serial follow-ups are recommended for all children undergoing gut resection in the newborn period. Of the eight children who had psychometric testing in the gut-resected group, only two are normal. Three of the four older children in this group show signs of perceptuomotor defects, suggesting the need for subtesting such children at about 6 years of age so that remedial help, if necessary, may be provided when formal schooling begins.