Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Scenario:

BK is a 16-year-old Caucasian female who comes in with her grandmother for an annual exam. The grandmother reports BK has been “acting strange, staying in her room all the time and refusing to do all the things she used to enjoy like singing in the youth choir”. Grandmother shares that BK’s mother is a drug addict is currently incarcerated so she is worried BK is using drugs and wants her tested for drugs. BK is not on any medications. She is obese and does not make eye contact when you enter the room.

Socioeconomic, Spiritual, and Lifestyle Factors

Socioeconomic factors that may affect this patient include the patient’s age, the primary guardian of the patient being her grandmother and the imprisonment of her mother with an addiction to drugs. The patient is at an age where she is unable to provide for and care for herself and relies on her grandmother for her care and needs. Depending on the financial security of the grandmother, it is highly likely that the grandmother has a difficult time meeting the needs of the child while also meeting her own needs as well. In families that experience drug addiction, there is a financial burden placed on the family as well as the addict. It is highly likely that this family has suffered the effects of financial strain due to the mother’s illness. Teens that are raised in a household that experiences addiction have a higher risk of leaving the home at an early age and are then vulnerable to sexual, economical and emotional exploitation. (Sachan, Tiwari, Kurnwar, 2019)

Lifestyle factors that may be relevant in this case include diet and socialization habits. This patient, according to the grandmother was previously a very social child, that has become withdrawn from social activities such as choir that she used to enjoy. Increase in weight for young women can often times lead to feelings of isolation, depression and anxiety which in turn can develop into the use of drugs to cope. (Hussong et al, 2018) With this patient’s family history of drug use, the use of drugs in this patient is not out of the question.

Sensitive Issues

Sensitive Issues with this patient include the patient’s weight, the incarceration of her mother, and her recent withdrawal from social activities that she used to enjoy. This sequel of behaviors may indicate drug use, however at this point it may be a greater sign of psychological issues that this teenager is experiencing such as depression or anxiety. Child and adolescent obesity is associated with increased risk of emotional problem, low self-esteem, depression, anxiety and obsessive compulsive disorders. (Ten Hoor et al, 2016)

Targeted Questions

I believe this patient is at high risk for depression or may be experiencing depressive like symptoms, so in this assessment I would use questions from the PHQ-9 pediatric depression assessment tool. However, due to the family history of drug use, I believe this to be a serious consideration in this patient’s case as well. Because of this, I have chosen to ask targeted questions from the DAST- 20 drug assessment tool. It would be most important in this assessment to have the grandmother leave the room and allow the patient privacy during this health assessment.

Questions

1. In the past 3 months, have you felt depressed or sad most days, even If you felt okay sometimes?
2. Has there been a time in the past month where you had serious thoughts about ending your life?
3. Have you ever tried to kill yourself or made a suicide attempt?
4. Have you ever used drugs other than those required for medical reasons?
5. Have you abused prescription drugs?

References

Sachan, P., Tiwari, P., & Kunwar, N. (2019). Factors responsible for increasing drug addiction

practices and consequences for teenagers.

Hussong, A. M., Ennett, S. T., McNeish, D., Rothenberg, W. A., Cole, V., Gottfredson, N. C., &

Faris, R. W. (2018). Teen social networks and depressive symptoms-substance use associations: developmental and demographic variation. Journal of studies on alcohol and drugs, 79(5), 770-780.

Ten Hoor, G. A., Plasqui, G., Ruiter, R. A., Kremers, S. P., Rutten, G. M., Schols, A. M., & Kok,

G. (2016). A new direction in psychology and health: resistance exercise training for obese children and adolescents.

response

Great post. I found it of good interest that you chose to ask about depression and suicide pertaining to BK. A recent article that I read stated that  if your child stops doing things that he or she usually enjoy, doesn’t seem to be enjoying the things that he or she is doing, isn’t doing well in school, or is taking more risks than he or she usually takes then this could be a sign that your child is feeling anxious, stressed or depressed (Pre-teen and teenage depression, 2019). Due to BK locking herself in her room and not enjoying the things that she normally does it would be good for the provider to touch on the subject of depression to find out more information about what is going on with BK.

I feel that when dialoguing and having communication with BK it would be better if the provider spoke with her without her grandmother in the room. Sometimes, a better health history can be obtained from a teenage without the company of their guardian. The communication has proven to be more effective when seeing the patient alone and tailoring the conversation to be geared toward the patient being seen. The provider must also ensure that whatever topics come up that confidentiality will be maintained (Ham & Allen, 2012)

References:

Ham, P., & Allen, C., W., (2012). Adolescent Health Screening and Counseling. Retrieved June 9, 2020 from https://www.aafp.org/afp/2012/1215/p1109.html

Pre-teen and teenage depression. (2019). Retrieved June 9, 2020, from the raising children website: https://raisingchildren.net.au/pre-teens/mental-health-physical-health/stress-anxiety-depression/depression

response 2

I have enjoyed reading your post this week. I agree that this patient’s lifestyle factors include her diet and socialization habits. It is important to consider that the grandmother is reporting that the child was recently socially active, and she has now become more withdrawn. I really like your questions consider her situational issues to assess for mental health issues and substance abuse issues. Many primary care providers struggle to treat patients with substance abuse issues and research has found that many PCP’s feel unprepared to treat these patients (Shapiro, Coffa, & McCance-Katz, 2013).

The targeted questions you chose were fantastic. I would have, however, asked the patient about her eating and diet habits. This of course a sensitive issue for a sixteen-year-old female but it is important that she become educated on the negative health impacts of obesity. Obesity can negatively affect adolescents in many ways including both their psychological and cardiovascular health (Sanyaolu, Okorie, Qi, Locke, & Rehman, 2019).

The targeted questions you asked your patient also to relate to my patient. My patient was homeless and has a history of alcohol and cocaine use. As the case study you were assigned, it was also important for me to interview my patient about his substance use history.

References

Sanyaolu, A., Okorie, C., Qi, X., Locke, J., & Rehman, S. (2019). Childhood and adolescent obesity in the United States: A public health concern. Global pediatric health, 6, 2333794X19891305. http://dx.doi.org/10.1177/2333794X19891305

Shapiro, B., Coffa, D., & McCance-Katz, E. (2013). A primary care approach to substance misuse. American Family Physician, 88(2), 113-121. Retrieved from https://www.aafp.org/afp/2013/0715/p113.html