Literature Collection

Background Youth with type 1 diabetes (T1D) experience substantially higher rates of depression, anxiety, diabetes distress, attention-deficit/hyperactivity disorder (ADHD), and disordered eating behaviors (DEB) than peers. These conditions may impair self-management and contribute to worsened glycemic outcomes.ContentWe synthesize prevalence and consequences of common comorbidities; summarize International Society for Pediatric and Adolescent Diabetes (ISPAD) and American Diabetes Association (ADA) guidance on psychosocial assessment; and appraise integrated models: co-located behavioral health, stepped care, and telehealth integration. We map barriers (workforce, workflow, stigma, fragmented communication, digital inequities) to concrete actions.SummaryPsychological morbidity and glycemic outcomes may be connected through behavioral and neuroendocrine pathways and family dynamics. Programs embedding behavioral health in pediatric diabetes care facilitate routine psychosocial screening and are associated with improved engagement and quality of life, and in some models, improved glycemic outcomes.OutlookTo close the implementation gap, teams should standardize routine psychosocial screening, embed trained mental-health professionals, use stepped-care models matching interventions to symptom severity, track referral follow-through, and leverage hybrid telehealth. Policy levers include reimbursement for integrated visits and investment in the behavioral-health workforce. The consistent associations between psychological and glycemic outcomes in youth with T1D support integrating psychosocial care as a core component of comprehensive diabetes management.

RATIONALE: Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized. OBJECTIVES AND METHODS: We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine-naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study. RESULTS: Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use. CONCLUSIONS: People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.

Collaborative Care is well accepted as an evidence-based model to manage depression and anxiety in pediatric primary care. However, symptoms of attention-deficit hyperactivity disorder (ADHD), traumatic stress, and grief are common in primary care and can also be identified by pediatricians and treated within this model. Attention-deficit hyperactivity disorder (ADHD) is the most common childhood-onset neurodevelopmental disorder with a prevalence of 10.2 %.(1) Trauma-spectrum disorders are another cluster of disorders that will often be seen first by the pediatrician, and, potentially, only by the pediatrician. In some urban pediatric centers, the rate of children who have been exposed to traumatic events is as high as 90 %.(2) Similarly, symptoms of grief are often first identified by the pediatrician. Considering that the COVID-19 pandemic alone has claimed >760,000 parents, custodial grandparents, and other caregivers to children in the US, the number of children and teenagers affected by trauma and loss overwhelms the mental health care system's capacity. In light of the shortage of child and adolescent psychiatrists in the United States and the increased demand for mental health services, it is essential to broaden the scope of what collaborative care initiatives can accomplish in pediatrics. This paper shares insights from a collaborative care model implemented in a New York City safety net hospital center to illustrate how ADHD, traumatic stress, and grief can be identified and managed in pediatric primary care. Lastly, we will discuss the potential for collaborative care models to increase access to care for immigrant families.

Conventional outpatient diabetes management, which focuses mainly on biomedical measures like glycemic control, may be inadequate for achieving sustainable long-term health outcomes, especially among patients with co-occurring psychosocial challenges. Although these methods are physiologically important, they often ignore key psychosocial factors that greatly affect self-management, treatment adherence, and clinical results. Based on the biopsychosocial model, this article proposes a comprehensive care framework that includes structured psychosocial support as a core part of diabetes management. Strong evidence shows that psychosocial factors-such as diabetes-related distress, mental health conditions, and social determinants-directly influence glycemic control, quality of life, and complication rates. The article also points out structural weaknesses in current healthcare systems that prevent integrated care. In response, a coordinated, multi-level strategy is introduced. This includes systematic psychosocial screening, communication methods supported by evidence, digital health technologies, and personalized stepped-care interventions. Finally, we recommend systemic reforms in clinical practice, payment policies, and medical education to support a shift toward person-centered, biopsychosocial diabetes care. These changes are necessary to address the complex nature of diabetes and improve both health outcomes and patient well-being.

Integrating healthcare through team collaboration has many benefits, including more efficient, cost-effective services and improved client outcomes. However, in primary care, allied health professionals treating people with stroke often work in parallel, discipline-specific silos, which limits communication and leads to fragmented and/or duplicated care. Strengthening patient care after stroke requires moving beyond multidisciplinary collaboration toward transdisciplinary collaboration. Transdisciplinary collaboration is a form of skill-sharing, where one professional completes additional competency training to safely work beyond their usual scope of practice. In this perspectives paper, we present the view that transdisciplinary allied health collaboration has a role in primary care, using stroke as our case example. We explore the potential benefits and feasibility of transdisciplinary collaboration and provide clinical examples and insights to illustrate the concepts. We propose five considerations when embarking on transdisciplinary collaboration: (1) healthcare settings and jurisdiction, (2) consumer needs, (3) workforce availability, (4) clinician attributes and skills, and (5) team collaboration rules. This paper challenges allied health professionals, leaders and managers working in primary care, as well as policy makers, to review current practice and explore avenues for transdisciplinary collaboration.

PURPOSE: To examine the prevalence and association of mental health symptoms, social factors, and healthcare experiences in individuals diagnosed with Scheuermann's disease (SD). METHODS: We analyzed self-reported data from the Scheuermann's Disease Fund (SDF) CoRDS registry from September 2021 to March 2025, which included 168 patients. Of these patients, 106 self-reported a Cobb angle. Participants completed a 196-item questionnaire covering demographics, curve severity, mental health domains of anxiety, depression, PTSD, and social isolation, healthcare experiences, and social factors. Statistical analyses, including descriptives and chi-square tests (α = 0.05), were conducted with IBM SPSS Statistics v30. RESULTS: Patients diagnosed with SD in these specific cohort were between the ages of 11-20 (59.5%), 21-40 (28.0%), and > 41 (12.5%) years, with thoracic kyphosis Cobb angle < 60º (15.1%), 61-80° (40.6%) or 81° and above (44.3%). Patients often reported pain (73.2%), with 37.3% reporting severe pain or worse. In total, 46.1% reported anxiety, 45.2% reported depression, 9.6% reported PTSD, and 63.0% reported social isolation. Depression was associated with chronic pain (r = 0.27, p < 0.001), and anxiety was correlated with social isolation (r = 0.26, p = 0.001). Over 72.0% of the patients felt misunderstood, and 65.1% lacked mental health referrals to receive appropriate counseling. Patients expressed that they did not believe their physician could understand or treat their condition, with 52.6% visiting at least two to four doctors before finding adequate care that met their unique needs. CONCLUSIONS: SD imposes substantial mental health burden, with many patients experiencing anxiety, depression, or feelings of social isolation. Many patients reported challenges in finding specialty care. These findings suggest the need for further research to determine whether earlier diagnosis and integrated care could improve outcomes.