JAACAP openPub Date : 2023-12-01DOI: 10.1016/j.jaacop.2023.08.006
Petya D. Radoeva MD, PhD , Victor T. Milev BS , Jeffrey I. Hunt MD , Christopher H. Legere AB , Sean C.L. Deoni PhD , Stephen J. Sheinkopf PhD , Carla A. Mazefsky PhD , Noah S. Philip MD , Daniel P. Dickstein MD
{"title":"Systematic Review: White Matter Microstructural Organization in Adolescents With Depression","authors":"Petya D. Radoeva MD, PhD , Victor T. Milev BS , Jeffrey I. Hunt MD , Christopher H. Legere AB , Sean C.L. Deoni PhD , Stephen J. Sheinkopf PhD , Carla A. Mazefsky PhD , Noah S. Philip MD , Daniel P. Dickstein MD","doi":"10.1016/j.jaacop.2023.08.006","DOIUrl":"10.1016/j.jaacop.2023.08.006","url":null,"abstract":"<div><h3>Objective</h3><p>A growing body of literature has focused on the neural mechanisms of depression. Our goal was to conduct a systematic review on the white matter microstructural differences in adolescents with depressive disorders vs adolescents without depressive disorders.</p></div><div><h3>Method</h3><p>We searched PubMed and PsycINFO for publications on August 3, 2022 (original search conducted in July 2021). The review was registered on PROSPERO (registration number: CRD42021268200), and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligible studies were original research papers comparing diffusion tensor/spectrum imaging findings in adolescents with vs without depression (originally ages 12-19 years, later expanded to 11-21 years). Studies were excluded if they focused on depression exclusively in the context of another condition, used only dimensional depressive symptom assessment(s), or used the same dataset as another included publication.</p></div><div><h3>Results</h3><p>The search yielded 575 unique records, of which 14 full-text papers were included (824 adolescents with depression and 686 without depression). The following white matter regions showed significant differences in fractional anisotropy in at least 3 studies: uncinate fasciculus, cingulum, anterior corona radiata, inferior fronto-occipital fasciculus, and corpus callosum (genu and body). Most studies reported decreased, rather than increased, fractional anisotropy in adolescents with depression. Limitations include the possibility for selective reporting bias and risk of imprecision, given the small sample sizes in some studies.</p></div><div><h3>Conclusion</h3><p>Our systematic review suggests aberrant white matter microstructure in limbic-cortical-striatal-thalamic circuits, and the corpus callosum, in adolescents with depression. Future research should focus on developmental trajectories in depression, identifying sources of heterogeneity and integrating findings across imaging modalities.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 4","pages":"Pages 233-245"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949732923000352/pdfft?md5=52b14d2dad4c4a1eb8dfae52dde3e94d&pid=1-s2.0-S2949732923000352-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135098787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAACAP openPub Date : 2023-12-01DOI: 10.1016/j.jaacop.2023.08.004
Xinshu She MD, MPH , Lian Tong PhD , Huan Wang PhD , Luwan Lan MPH , Min Wang PhD , Cody Abbey MS , Manpreet Kaur Singh MD, MS , Scott Rozelle PhD
{"title":"Community Mindfulness and Mentorship Preventive Intervention in Migrant Chinese Children: A Randomized Controlled Trial","authors":"Xinshu She MD, MPH , Lian Tong PhD , Huan Wang PhD , Luwan Lan MPH , Min Wang PhD , Cody Abbey MS , Manpreet Kaur Singh MD, MS , Scott Rozelle PhD","doi":"10.1016/j.jaacop.2023.08.004","DOIUrl":"10.1016/j.jaacop.2023.08.004","url":null,"abstract":"<div><h3>Objective</h3><p>To test the feasibility and effectiveness of a mindfulness-based intervention in rural-to-urban migrant Chinese children using trained community volunteers.</p></div><div><h3>Method</h3><p>Migrant students ages 9 to 16 from 5 schools in Shanghai (N = 653) were randomly assigned to a mindfulness only group (n = 167), a mindfulness plus life skills group (n = 118), or a waitlist control group (n = 368). The first 2 groups received an 8-week mindfulness intervention delivered 1 hour weekly by trained community volunteers. The mindfulness plus life skills group received 8 additional hours of skills-based mentorship. Measurements on mindfulness, resilience, and anxiety and depression symptoms were collected before and after intervention. Multivariable regression analyses compared the intervention vs control groups.</p></div><div><h3>Results</h3><p>Before intervention, there were no significant demographic or outcome measure differences between groups except that students in the intervention groups were slightly older. Students had relatively low levels of mindfulness and prosociality difficulties and similar degrees of depression and anxiety symptoms compared with prior studies. After intervention, no statistically significant differences were found in mean scores for mindfulness, resilience, anxiety, or depression in the intervention vs control groups.</p></div><div><h3>Conclusion</h3><p>A volunteer-led mindfulness intervention did not significantly benefit migrant Chinese children after 8 weeks. More implementation research is needed for low-cost, scalable, and contextually effective mental health prevention programs.</p></div><div><h3>Clinical trial registration information</h3><p>Planting Seeds for Resilience—a Pilot Mindfulness and Mentorship Program in Migrant Chinese Children; <span>http://www.chictr.org.cn</span><svg><path></path></svg>; ChiCTR2100012027.</p></div><div><h3>Diversity & Inclusion Statement</h3><p>We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 4","pages":"Pages 295-305"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949732923000339/pdfft?md5=cda7d570529b2dfe3071ff0fe472e23a&pid=1-s2.0-S2949732923000339-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43540421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAACAP openPub Date : 2023-12-01DOI: 10.1016/j.jaacop.2023.10.002
Robert L. Findling MD, MBA (Deputy Editor), Manpreet K. Singh MD, MS (Editor), Joseph C. Blader PhD (Guest Editor)
{"title":"Introduction to a Special Series on Aggressive Behavior as a Focus of Psychiatric Attention","authors":"Robert L. Findling MD, MBA (Deputy Editor), Manpreet K. Singh MD, MS (Editor), Joseph C. Blader PhD (Guest Editor)","doi":"10.1016/j.jaacop.2023.10.002","DOIUrl":"10.1016/j.jaacop.2023.10.002","url":null,"abstract":"","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 4","pages":"Pages 231-232"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949732923000534/pdfft?md5=9f72138701b5f72e233fba06d50a5c13&pid=1-s2.0-S2949732923000534-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAACAP openPub Date : 2023-12-01DOI: 10.1016/j.jaacop.2023.08.001
Caroline P. Martin PhD , Eric A. Youngstrom PhD , Joshua A. Langfus MA , Robert L. Findling MD, MBA , Jennifer K. Youngstrom PhD , Kathryn Van Eck PhD , Ekaterina Stepanova MD, PhD , Andrea S. Young PhD
{"title":"Examining Behavioral Approach and Inhibition to Further Characterize Youth With Impulsive Aggression","authors":"Caroline P. Martin PhD , Eric A. Youngstrom PhD , Joshua A. Langfus MA , Robert L. Findling MD, MBA , Jennifer K. Youngstrom PhD , Kathryn Van Eck PhD , Ekaterina Stepanova MD, PhD , Andrea S. Young PhD","doi":"10.1016/j.jaacop.2023.08.001","DOIUrl":"10.1016/j.jaacop.2023.08.001","url":null,"abstract":"<div><h3>Objective</h3><p>Impulsive aggression in youth is a significant clinical and public health concern, spanning multiple diagnostic categories and causing significant psychosocial impairment. To advance its assessment and treatment, recent research has focused on developing an empirically derived nosology that can distinguish impulsive aggression from other common childhood problems. The current study is a secondary analysis examining the associations between this empirically defined form of impulsive aggression, other psychiatric symptom dimensions, and behavioral approach and inhibition motivation of youth.</p></div><div><h3>Method</h3><p>Participants were 636 youth (61% male; 69% Black/African American; mean age = 11.10) who presented for treatment to a community mental health center or an academic medical center. Dimensions of psychopathology were based on a prior principal component analysis that yielded 5 components: aggression-impulsive/reactive (AIR), mania, depression, self-harm, and rule-breaking. All parents and a subset of youth (<em>n</em> = 363) rated behavioral approach and inhibition motivation of youth.</p></div><div><h3>Results</h3><p>After controlling for demographic factors (age, sex, race) and other dimensions of psychopathology (mania, depression, self-harm, rule-breaking behavior), AIR was uniquely and positively associated with parent- and adolescent-reported behavioral approach motivation and negatively associated with parent-reported behavioral inhibition.</p></div><div><h3>Conclusion</h3><p>The results help to further characterize AIR, a clinically relevant and empirically defined construct of impulsive aggression, by showing that AIR is associated with high approach and low inhibition motivational dispositions above and beyond the effects of rule-breaking behavior and mood symptoms. These findings add to a growing literature that shows promise in improving assessment and treatment outcomes for this highly impairing clinical concern.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 4","pages":"Pages 263-273"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949732923000303/pdfft?md5=6ab9cf45190eb4b57964dfaecba6edc8&pid=1-s2.0-S2949732923000303-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43148671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Population-Based Analysis of the Temporal Association of Screen Time and Aggressive Behaviors in Adolescents","authors":"Jasmina Wallace PhD , Elroy Boers PhD , Julien Ouellet MSc , Patricia Conrod PhD","doi":"10.1016/j.jaacop.2023.08.002","DOIUrl":"10.1016/j.jaacop.2023.08.002","url":null,"abstract":"<div><h3>Objective</h3><p>The recent widespread diffusion of screen-based devices among adolescents has raised questions about the effects of screen time on adolescent behavior, including aggressive behaviors. However, previous studies have been methodologically limited in their ability to distinguish between common vulnerability, concurrency, and lasting associations between screen time and aggression among adolescents, and findings are still inconsistent. To address this gap in the literature, time-varying direct and indirect associations between screen time and aggression were investigated.</p></div><div><h3>Method</h3><p>The sample included nearly 4,000 Canadian adolescents who participated in annual surveys for 5 consecutive years. Multilevel statistical models were applied to study between-person effects (common vulnerability), within-person effects (concurrency explaining a priming effect), and lagged-within-person effects (lasting effects explaining a learning process) of screen time (ie, social media use, television viewing, video game playing, computer use) on aggressive behaviors (ie, fighting, conduct problems, hostile thoughts). Screen time effects on aggression through hostility were further studied.</p></div><div><h3>Results</h3><p>Short-lived concurrent relations between different forms of screen time and aggressive behaviors suggested a priming effect. Social media use was further associated with longer lasting increases in conduct problems, suggesting a social learning process, while television viewing showed significant negative lagged-within-person association with hostility, showing a protective effect. Hostile thoughts mediated screen time and aggression associations mainly at between-person levels.</p></div><div><h3>Conclusion</h3><p>The results suggest that the nature of the relation between screen time and aggressive behaviors depends on the type of digital platform through which such content is presented and suggest the need for policies focusing on protecting young users of digital media.</p></div><div><h3>Clinical trial registration information</h3><p>Does Delaying Adolescent Substance Use Lead to Improved Cognitive Function and Reduce Risk for Addiction?; <span>https://www.clinicaltrials.gov/</span><svg><path></path></svg>: NCT01655615</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 4","pages":"Pages 284-294"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949732923000315/pdfft?md5=e3b09380aacdff9752ae811d2ab19e63&pid=1-s2.0-S2949732923000315-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46307226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAACAP openPub Date : 2023-12-01DOI: 10.1016/j.jaacop.2023.08.005
Joshua A. Langfus PhD Candidate , Eric A. Youngstrom PhD , Chase M. DuBois BA , Robert L. Findling MD, MBA , Ekaterina Stepanova MD, PhD
{"title":"Scoping Review: Evidence-Based Assessment of Reactive Aggression in Children","authors":"Joshua A. Langfus PhD Candidate , Eric A. Youngstrom PhD , Chase M. DuBois BA , Robert L. Findling MD, MBA , Ekaterina Stepanova MD, PhD","doi":"10.1016/j.jaacop.2023.08.005","DOIUrl":"10.1016/j.jaacop.2023.08.005","url":null,"abstract":"<div><h3>Objective</h3><p>Severe reactive aggression poses a major mental health challenge for many families. A lack of validated instrumentation for assessing young children may present a barrier to more effective clinical assessment and treatment. This scoping review evaluates tools currently used in clinical research to assess aggressive behavior, and identifies gaps in the evidence base for their use in children under the age of 12 years. Measures were evaluated through an evidence-based assessment framework to support clinical decision making.</p></div><div><h3>Method</h3><p>A comprehensive review of registered clinical trials targeting childhood aggression in the US identified relevant instruments; tools cited in 3 recent reviews of related constructs were also coded. Measures included were available in English, contained at least 3 items measuring aggressive behavior, and had at least 1 validation study in children under 12 years of age. Validation studies were identified through structured queries, and information was extracted from full text review of these studies as well as published manuals.</p></div><div><h3>Results</h3><p>Of 173 candidate measures, 17 met inclusion criteria: 3 broadband and 14 narrow-band. Compared to commercially distributed measures, free instruments that were more targeted to assess aggression nevertheless had poorer norms and fewer validation studies in children under 12 years of age.</p></div><div><h3>Conclusion</h3><p>Improving instrumentation for assessing reactive aggression would address an urgent clinical need and a gap in current research. More work is needed to validate measures of reactive aggression in children under 12 years of age, especially studies that include non-clinical comparison samples. Here we recommend broad and narrow measures for providers to use in clinical care, emphasizing tools with good psychometric properties and no cost barrier.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 4","pages":"Pages 246-262"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949732923000340/pdfft?md5=8c38850ba87b31278d2aeb53bee59ab7&pid=1-s2.0-S2949732923000340-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAACAP openPub Date : 2023-11-01DOI: 10.1016/j.jaacop.2023.07.002
Wenna Xi PhD , Samprit Banerjee PhD , Bonnie T. Zima MD, MPH , George S. Alexopoulos MD , Mark Olfson MD, MPH , Yunyu Xiao PhD , Jyotishman Pathak PhD
{"title":"Effects of Geography on Risk for Future Suicidal Ideation and Attempts Among Children and Youth","authors":"Wenna Xi PhD , Samprit Banerjee PhD , Bonnie T. Zima MD, MPH , George S. Alexopoulos MD , Mark Olfson MD, MPH , Yunyu Xiao PhD , Jyotishman Pathak PhD","doi":"10.1016/j.jaacop.2023.07.002","DOIUrl":"10.1016/j.jaacop.2023.07.002","url":null,"abstract":"<div><h3>Objective</h3><p>Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth.</p></div><div><h3>Method</h3><p>This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011-2015) from the Health Care Cost Institute. Outcomes were time to SI or SA within 3 months after the indexed mental health or substance use disorder (MH/SUD) outpatient visit. Predictors included sociodemographic and clinical characteristics up to 3 years before the index event.</p></div><div><h3>Results</h3><p>At each follow-up time period, rates of SI and SA varied by the US geographic division (<em>p</em> < .001), and the Mountain Division consistently had the highest rates for both SI and SA (5.44%-10.26% for SI; 0.70%-2.82% for SA). Having MH emergency department (ED) visits in the past year increased the risk of SI by 28% to 65% for individuals residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p<0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (hazard ratios = 0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (hazard ratio = 1.46).</p></div><div><h3>Conclusion</h3><p>To understand the underlying mechanisms driving the high prevalence of SI and SA in the Mountain Division and the elevated risk of SI after having MH ED visits, future research examining regional differences in risks for SI and SA should include indicators of access to MH ED care and other social determinants of health.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 3","pages":"Pages 206-217"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49355595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAACAP openPub Date : 2023-11-01DOI: 10.1016/j.jaacop.2023.08.003
Rachel Oblath PhD , Eileen Twohy PhD , Claudine Higdon MD , Alison Duncan MD , Johanna B. Folk PhD , Marissa A. Schiel MD, PhD , Seena Grewal MD, FRCP(C) , Jessica L. Hawks PhD , William Martinez PhD, ABPP , Kelly Coble MSW, LCSW-C , Sarah Edwards DO , Amy Goetz PhD , Ujjwal Ramtekkar MD, MBA , Chetana A. Kulkarni MD, FRCPC , Shabana Khan MD , Bridget T. Doan MN, NP , Kishan Nallapula MD , Victor M. Fornari MD, MS , Lisa R. Fortuna MD, MPH, MDiv , Kathleen Myers MD, MPH, MS, DLFAACAP, DLFAPA, FATA
{"title":"The Provision and Utilization of Telehealth Within Academic Mental Health Clinics in North America During the COVID-19 Pandemic","authors":"Rachel Oblath PhD , Eileen Twohy PhD , Claudine Higdon MD , Alison Duncan MD , Johanna B. Folk PhD , Marissa A. Schiel MD, PhD , Seena Grewal MD, FRCP(C) , Jessica L. Hawks PhD , William Martinez PhD, ABPP , Kelly Coble MSW, LCSW-C , Sarah Edwards DO , Amy Goetz PhD , Ujjwal Ramtekkar MD, MBA , Chetana A. Kulkarni MD, FRCPC , Shabana Khan MD , Bridget T. Doan MN, NP , Kishan Nallapula MD , Victor M. Fornari MD, MS , Lisa R. Fortuna MD, MPH, MDiv , Kathleen Myers MD, MPH, MS, DLFAACAP, DLFAPA, FATA","doi":"10.1016/j.jaacop.2023.08.003","DOIUrl":"10.1016/j.jaacop.2023.08.003","url":null,"abstract":"<div><h3>Objective</h3><p>To document the experience of 14 academic child and adolescent psychiatry programs in transitioning to and managing telehealth services during the COVID-19 pandemic. The goal was to understand how programs adopted and sustained telehealth during the pandemic. Telehealth was defined as services delivered via videoconferencing and telephony.</p></div><div><h3>Method</h3><p>In this descriptive study, faculty from 14 programs completed online surveys about the use of both telehealth and in-person services from February 2020 to June 2021. Survey questions addressed telehealth practices (eg, policies, support resources), monthly service utilization, telehealth modality (videoconferencing vs telephony), and missed appointments.</p></div><div><h3>Results</h3><p>Programs varied in the proportion of appointments delivered by telehealth before the pandemic (February 2020; 0%-27%). By May 2020, all programs were providing a majority of visits via telehealth (64%-100%). In June 2021, all programs continued to provide services via telehealth (41%-100%) and reported that they would continue to do so moving forward. Programs addressed many challenges to telehealth provision during the study period, including adding interpreter services, technological support for providers and patients, and formalizing safety and training requirements.</p></div><div><h3>Conclusion</h3><p>Academic child and adolescent psychiatry programs provided outpatient services primarily via telehealth throughout the COVID-19 pandemic and reported that they planned to continue using telehealth in combination with in-person services moving forward. Academic programs should address logistical, technological, and financial barriers to the sustained use of telehealth.</p></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"1 3","pages":"Pages 218-229"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41926751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}