Cystic fibrosis (CF) is an illness associated with high healthcare utilization and healthcare costs, even when compared to other chronic illnesses. In a variety of medical populations, depression has been found to be associated with lower adherence and poorer medical outcomes. The current study is a retrospective chart review of a matched set of 40 patients with CF, half with and half without a depressive disorder diagnosis. Participants were matched on the basis of their age, gender and lung function, and compared in terms of their illness severity (lung function and weight), medical adherence, and healthcare utilization during the year prior to and following diagnosis of depression and a comparable time period for the non-depressed group. Results show an association between depression and BMI, with only the depressed group showing significant decreases in the year following their depressive disorder diagnosis (from a mean BMI z-score of -0.48 to -1.04). Depression was also strongly associated with greater healthcare utilization and healthcare costs relative to those of comparably medically ill controls, in that depressed youth were hospitalized at over three times the rate of non-depressed youth, and their healthcare costs were more than four times higher (mean number of admissions per year for the depressed group of 4.00 vs. 1.20 for the non-depressed group; mean annual costs of $280,000 for the depressed vs. $60,116 for the non-depressed). These findings highlight the importance of addressing the mental health needs of chronically ill patients as a path to better health outcomes and decreasing need for medical services.

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Introduction Pediatric delirium assessment is complicated by variations in baseline language and cognitive skills, regression of skills during illness, and absence of pediatric-specific modifiers within the Diagnostic and Statistical Manual of Mental Disorders (DSM) delirium criterion. Objective To develop a standardized approach to pediatric delirium assessment by psychiatrists. Methods A multidisciplinary group of clinicians used DSM criterion as the foundation for the Vanderbilt Assessment for Delirium in Infants and Children (VADIC). Pediatric-specific modifiers were integrated into the delirium criterion, including key developmental and assessment variations for children. The VADIC was used in clinical practice to prospectively assess critically ill infants and children. The VADIC was assessed for content validity by the American Academy of Child and Adolescent Psychiatry (AACAP) Delirium Special Interest Group (SIG). Results The AACAP-Delirium SIG determined that the VADIC demonstrated high content validity. The VADIC 1) preserved the core DSM delirium criterion; 2) appropriately paired interactive assessments with key criterion based on development, and 3) addressed confounders for delirium. A cohort of 300-patients with a median age of 20 months was assessed for delirium using the VADIC. Delirium prevalence was 47%. Conclusion The VADIC provides a comprehensive framework to standardize pediatric delirium assessment by psychiatrists. The need for consistency in both delirium education and diagnosis is highlighted given the high prevalence of pediatric delirium.

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