{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:02:59Z","timestamp":1789653779690,"version":"4.0.0"},"reference-count":51,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R21AI148849"],"award-info":[{"award-number":["R21AI148849"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study examined the associations between mental health diagnoses, medication nonadherence, and healthcare utilization among pediatric solid organ transplant (SOT) recipients using a large, multistate electronic health record dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were drawn from 2037 pediatric SOT recipients (ages 0\u201325\u2009years) within the OneFlorida+ Data Trust (2012\u20132018). Mental health conditions (depression, anxiety, post\u2010traumatic stress disorder [PTSD], and attention\u2010deficit\/hyperactivity disorder [ADHD]), clinician\u2010documented nonadherence, and healthcare utilization outcomes, emergency department (ED) and inpatient (IP) visits, were identified using ICD\u20109\/10\u2010CM codes. Logistic regression estimated predictors of nonadherence, while negative binomial regression models with log\u2010offsets for follow\u2010up time produced incidence rate ratios (IRRs) for utilization outcomes. Models adjusted for demographic and clinical covariates including age, sex, race, ethnicity, and organ type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mental health diagnoses were common: anxiety (21.6%), depression (15.3%), ADHD (13.7%), and PTSD (13.1%). Clinician\u2010documented nonadherence occurred in 13.3% of patients and was associated with older age, non\u2010White race, depression (OR\u2009=\u20092.85, 95% CI 1.75\u20134.62), and anxiety (OR\u2009=\u20092.29, 95% CI 1.62\u20133.23). Nonadherence independently predicted increased healthcare utilization, with approximately twice the rate of ED (IRR\u2009=\u20092.02, 95% CI 1.68\u20132.43) and IP (IRR\u2009=\u20092.00, 95% CI 1.67\u20132.40) visits. Anxiety and PTSD also remained significant predictors of elevated utilization across models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mental health conditions and medication nonadherence are common and independently associated with higher acute care utilization among pediatric SOT recipients. Integrating standardized psychosocial assessment and adherence interventions into routine post\u2010transplant care may help mitigate preventable hospitalizations and improve long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70291","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:24:30Z","timestamp":1773289470000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mental Health, Nonadherence, and Healthcare Utilization in Pediatric Solid Organ Transplantation: Evidence From a Multistate Cohort"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5719-5193","authenticated-orcid":false,"given":"Sonnie E.","family":"Mayewski","sequence":"first","affiliation":[{"name":"College of Social Work Florida State University  Tallahassee Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4974-7044","authenticated-orcid":false,"given":"Zhe","family":"Yang","sequence":"additional","affiliation":[{"name":"College of Social Work Florida State University  Tallahassee Florida USA"},{"name":"Florida Institute for Child Welfare Florida State University  Tallahassee Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2287-9007","authenticated-orcid":false,"given":"Michael O.","family":"Killian","sequence":"additional","affiliation":[{"name":"College of Social Work Florida State University  Tallahassee Florida USA"},{"name":"College of Medicine Florida State University  Tallahassee Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/25.8.567"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20103046.2005.00382.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10880\u2010021\u201009770\u20108"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14151"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13647"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004\u20100118"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14030"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsj054"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/15269248241305018"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13518"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13188"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181b2a0e0"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhlto.2025.100293"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20103046.2005.00356.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12479"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10880\u2010023\u201009970\u20104"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12899"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2013.03.008"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12117"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.21582"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20103046.2007.00791.x"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14276"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1037\/cpp0000233"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002553"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/jpn3.12234"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000586"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2018.11.014"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.70012"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12936"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17096"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsv107"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383\u2010016\u20103881\u20106"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13842"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14841"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.2196\/56812"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13847"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2019.10.022"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2022.2057582"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.5863\/1551\u20106776\u201029.2.107"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhlto.2025.100319"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2017.01.997"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12260"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2024.11.028"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13217"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14361"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14577"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.21037\/tp\u20102025\u201066"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.15442"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010\u20101466D"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo\u20102019\u2010000503"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020\u2010003657"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70291","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70291","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70291","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T13:12:28Z","timestamp":1789650748000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":51,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/petr.70291"],"URL":"https:\/\/doi.org\/10.1111\/petr.70291","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-10-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70291"}}