ingest cdrApp 2017-08-15T23:19:45.661Z d91e81c8-5a8a-4e8a-976c-cad4e396e5ee modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T23:20:24.095Z Setting exclusive relation modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T23:20:33.342Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2017-08-15T23:20:42.577Z Adding technical metadata derived by FITS modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T23:20:53.243Z Setting exclusive relation addDatastream MD_FULL_TEXT fedoraAdmin 2017-08-15T23:21:03.753Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T23:21:22.092Z Setting exclusive relation modifyDatastreamByValue RELS-EXT cdrApp 2017-08-22T13:58:27.665Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-25T02:34:12.348Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-27T03:15:23.931Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-03-13T22:59:25.789Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-05-16T20:31:46.415Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-10T21:29:06.049Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-17T17:40:03.610Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-08T17:06:46.932Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-14T21:44:37.701Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-16T17:16:29.088Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-21T14:50:07.693Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-26T17:51:57.855Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-10T18:12:27.263Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-11T18:37:29.970Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-02-28T01:56:59.424Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-19T21:15:31.533Z Greta Bushnell Author Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. Summer 2017 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. Summer 2017 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. Summer 2017 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017-08 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 University of North Carolina at Chapel Hill Degree granting institution Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence; anxiety disorder; children; healthcare utilization; pharmacotherapy; psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 University of North Carolina at Chapel Hill Degree granting institution Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Pediatric Anxiety: Initial Pharmacotherapy, Adherence Prediction, and Burden of Events Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence, anxiety disorder, children, healthcare utilization, pharmacotherapy, psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence; anxiety disorder; children; healthcare utilization; pharmacotherapy; psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Greta Bushnell Creator Department of Epidemiology Gillings School of Global Public Health Anxiety disorders are one of the most common mental illnesses in children. Multiple pharmacotherapies for treating anxiety exist; selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacotherapy for pediatric anxiety. SSRI adherence is important to consider during care and parent adherence may help predict child SSRI adherence. The burden of serious events following an anxiety diagnosis has not been well characterized in children. In children with anxiety, we aimed to: 1) describe the initial anti-anxiety medication prescribed and psychotherapy utilization, 2) estimate SSRI adherence and determine if parental medication adherence predicts child SSRI adherence, and 3) estimate the incidence of emergency room (ER) visits, mental health related hospitalizations, and treated self-harm events after a new anxiety diagnosis. The research was completed in a large commercial claims database (2004-2014) in children (3-17 years) with diagnosed anxiety (ICD-9-CM code). We estimated the proportion of children initiating each medication class and factors independently associated with non-SSRI initiation. For adherence we measured the 6-month proportion of days covered; parent SSRI, statin, and antihypertensive adherence was evaluated prior to child SSRI initiation. We estimated the cumulative incidence of each event following the new anxiety diagnosis. Among children initiating anti-anxiety medication (n=84,500), 70% initiated an SSRI followed by benzodiazepines (8%) and non-SSRI antidepressants (7%). Anxiety disorder, age, provider type, and co-morbid diagnoses were associated with the initial medication; less than a third had psychotherapy claims before medication initiation. In children initiating an SSRI, parent high adherence (risk ratio=1.16) independently predicted high child adherence compared to parents with low adherence. One-year after a new anxiety diagnosis, 2.0% of children had a mental health related hospitalization, 8 per 10,000 an inpatient, treated self-harm event, and 1.4% an anxiety-related ER visit, with higher incidence in older children with co-morbid depression. SSRIs are the most commonly used first-line medication for pediatric anxiety; yet, a third initiated a medication with limited evidence of effectiveness for pediatric anxiety. Parental adherence may help predict child SSRI adherence. Following a new anxiety diagnosis, a significant proportion of children experience a serious event, adding to understanding the burden of pediatric anxiety disorders. 2017 Epidemiology Public health adherence; anxiety disorder; children; healthcare utilization; pharmacotherapy; psychotherapy eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Til Stürmer Thesis advisor M. Alan Brookhart Thesis advisor Scott Compton Thesis advisor Stacie Dusetzina Thesis advisor Bradley Gaynes Thesis advisor text 2017-08 Bushnell_unc_0153D_17207.pdf uuid:14765502-4ce8-4e6d-b538-b636998df615 proquest 2017-07-26T18:32:52Z 2019-08-15T00:00:00 application/pdf 2566644 yes