First name
Barbara
Middle name
H
Last name
Chaiyachati

Title

Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study.

Year of Publication

2022

Date Published

08/2022

ISSN Number

1098-4275

Abstract

BACKGROUND AND OBJECTIVE: The reported impacts of the COVID-19 pandemic on child maltreatment in the United States have been mixed. Encounter trends for child physical abuse within pediatric emergency departments may provide insights. Thus, this study sought to determine the change in the rate of emergency department encounters related to child physical abuse.

METHODS: A retrospective study within the Pediatric Emergency Care Applied Research Network Registry. Encounters related to child physical abuse were identified by 3 methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, or age-restricted skeletal survey completion. The primary outcomes were encounter rates per day and clinical severity before (January 2018-March 2020) and during the COVID-19 pandemic (April 2020-March 2021). Multivariable Poisson regression models were fit to estimate rate ratios with marginal estimation methods.

RESULTS: Encounter rates decreased significantly during the pandemic for 2 of 3 identification methods. In fully adjusted models, encounter rates were reduced by 19% in the diagnosis-code cohort (adjusted rate ratio: 0.81 [99% confidence interval: 0.75-0.88], P <.001), with the greatest reduction among preschool and school-aged children. Encounter rates decreased 10% in the injury cohort (adjusted rate ratio: 0.90 [confidence interval: 0.82-0.98], P = .002). For all 3 methods, rates for lower-severity encounters were significantly reduced whereas higher-severity encounters were not.

CONCLUSIONS: Encounter rates for child physical abuse were reduced or unchanged. Reductions were greatest for lower-severity encounters and preschool and school-aged children. This pattern calls for critical assessment to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.

DOI

10.1542/peds.2022-056284

Alternate Title

Pediatrics

PMID

35707943

Title

Clinician-reported childbirth outcomes, patient-reported childbirth trauma, and risk for postpartum depression.

Year of Publication

2022

Number of Pages

985-993

Date Published

10/2022

ISSN Number

1435-1102

Abstract

Childbirth trauma is common and increases risk for postpartum depression (PPD). However, we lack brief measures to reliably identify individuals who experience childbirth trauma and who may be at greater prospective risk for PPD. To address this gap, we used data from a racially diverse prospective cohort (n=1082). We collected survey data during pregnancy and at 12 weeks postpartum, as well as clinician-reported data from medical records. A new three-item measure of patient-reported childbirth trauma was a robust and independent risk factor for PPD, above and beyond other known risk factors for PPD, including prenatal anxiety and depression. Cesarean birth, greater blood loss, and preterm birth were each associated with greater patient-reported childbirth trauma. Finally, there were prospective indirect pathways whereby cesarean birth and higher blood loss were related to higher patient-reported childbirth trauma, in turn predicting greater risk for PPD. Early universal postpartum screening for childbirth trauma, targeted attention to individuals with childbirth complications, and continued screening for depression and anxiety can identify individuals at risk for PPD. Such efforts can inform targeted interventions to improve maternal mental health, which plays a vital role in infant development.

DOI

10.1007/s00737-022-01263-3

Alternate Title

Arch Womens Ment Health

PMID

36030417

Title

Association of COVID-19 and Endemic Systemic Racism With Postpartum Anxiety and Depression Among Black Birthing Individuals.

Year of Publication

2022

Date Published

2022 Apr 13

ISSN Number

2168-6238

Abstract

<p><strong>Importance: </strong>The intersection of endemic structural racism and the global health crisis secondary to the COVID-19 pandemic represents a syndemic, defined as the aggregation of 2 or more endemic and epidemic conditions leading to adverse repercussions for health. Long-standing inequities have placed Black individuals at disproportionate risk for negative postpartum mental health outcomes. Studies are urgently needed to understand how the COVID-19 pandemic has added to this risk (eg, syndemic associations).</p>

<p><strong>Objective: </strong>To examine the association between the syndemic and the postpartum mental health of Black birthing individuals.</p>

<p><strong>Design, Setting, and Participants: </strong>A longitudinal cohort of Black birthing individuals were followed up from pregnancy (April 17 to July 8, 2020) through the early postpartum period (August 11, 2020, to March 2, 2021) from urban university medical center prenatal clinics. Pregnant Black participants were recruited via email and completed 2 online surveys.</p>

<p><strong>Main Outcomes and Measures: </strong>Composite variables capturing negative experiences of the COVID-19 pandemic and racism (structural racism [general], structural racism [neighborhood], and interpersonal racism) were created. Logistic regressions examined main and interactive associations between these variables and postpartum depression (Edinburgh Postnatal Depression Scale) and anxiety (Generalized Anxiety Disorder 7-item scale).</p>

<p><strong>Results: </strong>The mean (SD) age of 151 Black participants was 30.18 (5.65) years. The association between higher negative COVID-19 pandemic experiences and postpartum depression may be influenced by experiences of interpersonal racism and general systemic racism. Negative COVID-19 pandemic experiences were associated with greater likelihood of screening positive for depression only at higher levels of systemic racism (odds ratio, 2.52; 95% CI, 1.38-4.60) and interpersonal racism (odds ratio, 1.90; 95% CI, 1.04-3.48) but not at lower levels of systemic or interpersonal racism. Similarly, negative COVID-19 experiences were associated with anxiety only at higher levels of interpersonal racism (odds ratio, 1.85; 95% CI, 0.86-4.01) but not at lower levels of interpersonal racism. Overall, 44 (29%) met screening criteria for postpartum depression and 20 (13%) for postpartum anxiety.</p>

<p><strong>Conclusions and Relevance: </strong>In this longitudinal cohort study of Black birthing individuals, the experience of the syndemic was associated with negative postpartum mental health. Associations between interpersonal racism, structural racism, and negative COVID-19 pandemic experiences were associated with greater risk for postpartum depression and anxiety. Research is needed to address how systemic racism perturbs biobehavioral pathways to magnify associations between acute stressors and mental health. Such research can inform the creation of effective, culturally informed preventive interventions to improve the postpartum mental health of Black individuals.</p>

DOI

10.1001/jamapsychiatry.2022.0597

Alternate Title

JAMA Psychiatry

PMID

35416928

Title

Child Abuse Imaging and Findings in the Time of COVID-19.

Year of Publication

2022

Number of Pages

65-69

Date Published

2022 Feb 01

ISSN Number

1535-1815

Abstract

<p><strong>OBJECTIVE: </strong>To assess the impact of the COVID-19 pandemic on physical abuse in young children, we compared the following before and during the pandemic: (1) skeletal survey volume, (2) percent of skeletal surveys revealing clinically unsuspected (occult) fractures, and (3) clinical severity of presentation. We hypothesized that during the pandemic, children with minor abusive injuries would be less likely to present for care, but severely injured children would present at a comparable rate to prepandemic times. We expected that during the pandemic, the volume of skeletal surveys would decrease but the percentage revealing occult fractures would increase and that injury severity would increase.</p>

<p><strong>METHODS: </strong>We conducted a retrospective study of children younger than 2 years undergoing skeletal surveys because of concern for physical abuse at a tertiary children's hospital. Subjects were identified by querying a radiology database during the March 15, 2019-October 15, 2019 (pre-COVID-19) period and the March 15, 2020-October 15, 2020 (COVID-19) period, followed by chart review to refine our population and abstract clinical and imaging data.</p>

<p><strong>RESULTS: </strong>Pre-COVID-19, 160 skeletal surveys were performed meeting the inclusion criteria, compared with 125 during COVID-19, representing a 22% decrease. No change was observed in identification of occult fractures (6.9% pre-COVID vs 6.4% COVID, P = 0.87). Clinical severity of presentation did not change, and child protective services involvement/referral decreased during COVID.</p>

<p><strong>CONCLUSIONS: </strong>Despite a &gt;20% decrease in skeletal survey performance early in the pandemic, the percent of skeletal surveys revealing occult fractures did not increase. Our results suggest that decreases in medical evaluations for abuse did not stem from decreased presentation of less severely injured children.</p>

DOI

10.1097/PEC.0000000000002630

Alternate Title

Pediatr Emerg Care

PMID

35100743

Title

Brief resolved unexplained events vs. child maltreatment: a review of clinical overlap and evaluation.

Year of Publication

2021

Number of Pages

866-871

Date Published

2021 May

ISSN Number

1432-1998

Abstract

<p>Within their first year, a number of infants present for medical evaluation because of unexplained changes in color, tone, breathing, or level of responsiveness. This broad collection of symptoms has an accordingly large differential diagnosis that includes both brief resolved unexplained event (BRUE) and child maltreatment. The overlap between clinical presentation for BRUE and maltreatment can present a diagnostic challenge - especially given the significant consequences for infants and families for diagnostic error at that juncture. In this review, we provide overviews of the presenting features and findings in cases of BRUE and child maltreatment with a focus on areas of overlap and differentiation.</p>

DOI

10.1007/s00247-020-04793-z

Alternate Title

Pediatr Radiol

PMID

33999231

Title

Trends in Pediatric Emergency Department Utilization after Institution of COVID-19 Mandatory Social Distancing.

Year of Publication

2020

Date Published

2020 Jul 20

ISSN Number

1097-6833

DOI

10.1016/j.jpeds.2020.07.048

Alternate Title

J. Pediatr.

PMID

32702427

Title

All-Cause Mortality Among Children in the US Foster Care System, 2003-2016.

Year of Publication

2020

Date Published

2020 Apr 20

ISSN Number

2168-6211

Abstract

<p>Children in foster care have worse medical and behavioral health than children in the general population. This is influenced by multiple factors, including a high incidence of poverty, exposure to trauma, and chronic medical conditions. Despite known differences in health, less is known regarding differences in mortality. In this cross-sectional study, we compared mortality rates and trends for children in the US foster care system with those in the general population for the 2003-2016 time period.</p>

DOI

10.1001/jamapediatrics.2020.0715

Alternate Title

JAMA Pediatr

PMID

32310278

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