Associations Between Documented Depressive Descriptors and Timing of Mental Health Interventions in Pediatric Leukemia Patients Restricted; Files Only
Hunt, Amy (Spring 2026)
Abstract
Background: Depression is a significant comorbidity among pediatric leukemia patients, with potential to compromise treatment adherence, prolong hospitalization, and diminish psychological well-being and survival outcomes. Despite this, depression documentation varies across providers, and little is known about how documentation patterns relate to the timeliness of mental health intervention. The language used in patient charts may reflect clinical priorities as well as provider bias, cultural contexts, and institutional practices that impact equitable care delivery.
Purpose: This study examined associations between the frequency and type of depressive descriptors documented in patient charts and time to mental health intervention among pediatric leukemia patients, as well as the relationship between descriptor counts and depression severity measured by CTCAE v5 grade.
Methods: A retrospective chart review was conducted using data from 834 pediatric leukemia patients at a large hospital in Atlanta, GA, of whom 107 (12.8%) had at least one documented case of depression. Somatic and affective descriptor counts were derived from structured chart abstraction. Sequential linear regression models assessed associations between descriptor counts and time to psychological and medication intervention. Secondary analyses used sequential ordinal logistic regression to examine associations between descriptor counts and CTCAE depression grade.
Results: Descriptor counts were largely not associated with time to psychological or medication intervention. One exception was observed in the fully adjusted medication intervention model, where higher somatic descriptor counts were significantly associated with shorter time to medication intervention (β = -8.76, p = 0.031). Secondary analyses revealed consistent significant associations between all descriptor types and depression grade, such that higher descriptor counts were associated with lower odds of more severe grades across all models (p < 0.05). Race was the only covariate to reach statistical significance across all three adjusted grade models.
Conclusions: The quantity of depressive language documented in charts does not consistently predict how quickly mental health interventions are initiated. The inverse relationship between descriptor counts and depression grade likely reflects variability in provider documentation practices rather than true differences in symptom burden. These findings highlight the need for standardized depression screening tools and improved documentation training in pediatric oncology to promote consistent, equitable, and timely care.
Table of Contents
Chapter 1
Introduction, Theoretical Framework, Purpose Statement, and Identification of Problem
Background
Theoretical Framework
Purpose Statement
Research Question
Significance of Thesis Project (to expand as paper develops)
Definition of Terms (to expand as paper develops)
Chapter 2
Literature Review
Assessment for Depression
Language, Bias, and Documentation
Depression Treatment
Chapter 3
Methodology
Study Design, Participants, and Sampling
Procedures
Measures
Data Analysis
Chapter 4
Results
Sample Characteristics
Associations Between Descriptor Counts and Time to Psychological Intervention
Associations Between Descriptor Counts and Time to Medication Intervention
Chapter 5
Discussion
Introduction
Discussion of Key Results
Strengths and Limitations
Implications for Public Health Research and Practice
Conclusions
References
Appendix A
Figure A.1 – Conceptual Model
Figure A.2 – Analytic Model
Appendix B
Table B.1 – Demographic and Cancer Diagnosis Characteristics of Pediatric Leukemia Patients Included in the Study (N = 834)
Table B.2. – Treatment and Documentation Characteristics Among Pediatric Leukemia Patients with Documented Depression (N = 107)
Table B.3 – Association Between Somatic Descriptor Counts and Time to Psychological Intervention Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.4 – Association Between Affective Descriptor Counts and Time to Psychological Intervention Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.5 – Association Between Total Descriptor Counts and Time to Psychological Intervention Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.6 – Association Between Somatic Descriptor Counts and Time to Medication Intervention Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.7 – Association Between Affective Descriptor Counts and Time to Medication Intervention Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.8 – Association Between Total Descriptor Counts and Time to Medication Intervention Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.9 – Association Between Somatic Descriptor Counts and Depression Severity (CTCAE Grade) Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.10 – Association Between Affective Descriptor Counts and Depression Severity (CTCAE Grade) Among Pediatric Patients with Leukemia and Depression (N = 107)
Table B.11 – Association Between Total Descriptor Counts and Depression Severity (CTCAE Grade) Among Pediatric Patients with Leukemia and Depression (N = 107)
About this Master's Thesis
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File download under embargo until 21 May 2027 | 2026-04-23 12:20:03 -0400 | File download under embargo until 21 May 2027 |
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