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With growing numbers of pediatric cancer survivors, it is becoming increasingly important to investigate the psychosocial sequelae of surviving cancer diagnosed during childhood or adolescence. It is particularly important to study the psychosocial needs of adolescent survivors of pediatric cancer because adolescence is a critical time during psychosocial development. Although there is existent literature about the general psychosocial adjustment of this population, the literature regarding anxiety is scant. This brief review aimed to assesses currently available literature that addresses anxiety in adolescent cancer survivors.
Articles assessing psychosocial adjustment in adolescent survivors of pediatric cancer were reviewed for information regarding anxiety symptoms.
To the authors' knowledge, there is no literature that focuses specifically on anxiety in this population. However, many articles reported results that indicated the possibility of increased anxiety in this group.
Significance of results:
It is critical to further investigate anxiety in this group and develop appropriate interventions if necessary. Doing so will aid the process of enhancing psychosocial care for adolescent cancer survivors.
This chapter reviews the developmental epidemiology, and determinants of course and outcome of pediatric depression. Early-onset depression conveys significantly increased risk, compared to later-onset depression for the development of bipolar spectrum disorder. Parents have a right to know the goals and progress of treatment. A high proportion of clinically referred youth with mood disorders have clinically significant suicidal ideation or behavior. Multi-family psychoeducation and family-based attachment therapy show promise in randomized clinical trials. Two selective serotonin reuptake inhibitors, fluoxetine and escitalopram are approved for use in adolescent depression by the Federal Drug Administration (FDA); fluoxetine is also approved for use in preadolescent patients. Patients with co-morbid anxiety or obsessive compulsive disorder (OCD) can usually be treated with the same antidepressant as that used for the depression, although higher dosages may be needed to treat anxiety or OCD.
Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare.
To test the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders.
Twenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinicaltrials.gov (NCT00446407).
A total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53–0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59–0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR = 0.64, 95% CI 0.42–0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities.
Trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
A randomised controlled trial comparing group interpersonal psychotherapy with treatment as usual among rural Ugandans meeting symptom and functional impairment criteria for DSM–IV major depressive disorder or sub-threshold disorder showed evidence of effectiveness immediately following the intervention.
To assess the long-term effectiveness of this therapy over a subsequent 6-month period.
A follow-up study of trial participants was conducted in which the primary outcomes were depression diagnosis, depressive symptoms and functional impairment.
At 6 months, participants receiving the group interpersonal psychotherapy had mean depression symptom and functional impairment scores respectively 14.0 points (95% CI 12.2–15.8; P < 0.0001) and 5.0 points (95% CI 3.6–6.4; P < 0.0001) lower than the control group. Similarly, the rate of major depression among those in the treatment arm (11.7%) was significantly lower than that in the control arm (54.9%) (P < 0.0001).
Participation in a 16-week group interpersonal psychotherapy intervention continued to confer a substantial mental health benefit 6 months after conclusion of the formal intervention.
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