Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie最新文献

ObjectiveThis study explored the importance of various aspects of Rapid Access Addiction Medicine (RAAM) based care for alcohol use health from the perspectives of people across Canada, including those who had and had not accessed RAAM services.DesignParticipants (n = 160) responded to items in rounds of an eDelphi survey, with each progressive round aiming to reach a consensus on the most important components of care at a RAAM clinic. Thirty-eight evidence-informed components were organized into five domains of healthcare accessibility. Ranking was conducted on a 5-point scale, with options ranging from "not at all important" to "critical". Consensus was defined a priori as 75% or greater ranking agreement. The survey was designed to close after 10 components reached consensus or following four rounds.ResultsEighty-nine participants (mean AUDIT = 13.9, SD = 5.4; mean age = 53.1, SD = 16.1; women = 43%) completed three rounds of the eDelphi. Seven per cent of participants reported having visited a RAAM clinic. The top ten components of care included compassionate care, RAAM team collaboration and effective communication, prompt care, low costs, easy contact, accessible clinic information, strength-focused care, shared decision making and availability of services for individuals across the substance use health spectrum.ConclusionsFindings highlight client-prioritized features of alcohol use health services and offer actionable insights that can help enhance care across care settings. Future research should focus on under-represented populations to ensure that their specific needs are addressed and incorporated into service planning and policy development.

ObjectivesUnacceptable experiences (UEs) during undergraduate studies and the associated emotional and academic impact have not been rigorously evaluated in the Canadian context. This study aimed to estimate the prevalence of UEs and examine their associations with mental health and academic outcomes in a diverse sample of Canadian undergraduate students.MethodsUndergraduates attending Queen's University completed the U-Flourish Student Well-Being Survey at the beginning and end of each academic year from 2021/2022 to 2023/2024. Validated self-report measures included the GAD-7 (anxiety), PHQ-9 (depression), C-SSRS (suicidal thoughts and behaviours) and WEMWBS-7 (well-being). UEs reported over the academic year included: discrimination, sexual violence/harassment, bullying, hate crimes and physical assault. Multivariable regression analyses examined associations between UEs and student mental health outcomes and cumulative grade-point average (GPA) abstracted from the university database.ResultsNearly one-third (28.9%; range = 27.0-30.1% across years) of students (n = 2,948) reported experiencing at least one UE over the academic year. Discrimination (14.6%) and sexual violence/harassment (14.4%) was reported most frequently, followed by bullying/harassment (10.6%), hate crimes (5.0%) and physical assault (3.2%). UEs were highest in students who identified as non-binary gender (51.6%), 2SLGBTQIA + (39.9%) and as having a lifetime mental illness (41.2%). Each UE increased the risk of screening positive for anxiety and depression over the academic year by 10-19% and 14-40%, respectively. Students reporting UEs were also more likely (13-72%) to report having suicidal thoughts and/or behaviours over the academic year, particularly those reporting sexual violence (RR:1.72; 95% CI:1.45-2.05). Sexual violence, bullying, and hate crimes were associated with lower average cumulative GPA in first year.ConclusionUEs were commonly reported by undergraduate students, especially in minoritised subgroups, and associated with mental health concerns and academic difficulties. These findings highlight the need for further research to inform universal and targeted prevention and early intervention initiatives.

ObjectiveGrowing efforts to transform youth mental health (YMH) services rest on the assumption that they will produce superior outcomes to those of traditional services. We therefore aimed to determine whether implementation of a broad YMH service model in Edmonton, Alberta (the largest site in the pan-Canadian ACCESS Open Minds [AOM] network) resulted in greater improvements in individual-level outcomes compared to a matched control group seen at non-AOM community mental health services.MethodThis retrospective cohort study used data on the Health of Nation Outcomes Scale (HoNOS) collected by trained clinicians, in youth aged 15-25 attending AOM or comparator services for any mental health problem between April 2016 and September 2019. A difference-in-differences approach compared HoNOS outcomes pre- versus post-exposure to the AOM service over a 1-year time horizon, in relation to youth attending a non-transformed service. Propensity score matching and sensitivity analyses were conducted to ensure bias reduction and robustness of observations, respectively.ResultsThe number of referrals to AOM Edmonton increased over time (36.3% [95%CI = 11.0%-68.0%] per month), and the site met benchmarks for rapid assessment (within 72 hours) and time to appropriate care (within 30 days). Of 1,078 youth (344 in the intervention [AOM] group and 734 in the control [non-AOM] group) aged 15-25 visiting community mental health centres, the intervention group had statistically greater improvements (7.4% absolute improvement or 1.2× relative improvement) in total HoNOS scores and its behavioural and symptom subscales.ConclusionsIn addition to improving the reach and timeliness of YMH services, AOM Edmonton produced greater improvements in HoNOS total scores (and two of four subscale scores) compared to a matched control group. Comparative evaluations such as these are essential to demonstrating the value of such services and generating continuous cycles of learning and improvement.

There has been a renewed interest in the use of various psychedelic agents as potential therapies for multiple psychiatric conditions, including post-traumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), to name a few. This follows the recent accumulation of evidence for ketamine pharmacotherapy and a rapid proliferation of clinics/programs offering a variety of ketamine based treatments. A quick glance at the existing evidence, however, reveals a confusing scenario for patients, healthcare providers, and regulators. Overall, there are no standard definitions of what constitutes a psychotherapeutic intervention within a psychedelic-based or a ketamine-based treatment. More specifically, studies have not always distinguished between using a well-known, manualized psychotherapy, providing psychoeducation and psychological support, or providing a therapy specifically to integrate the drug experience in psychedelic trials. Also, it is difficult to determine the role of the psychedelic agent as a stand-alone treatment, and the relative importance (if any) of the psychedelic experience for the desired therapeutic effect. In this perspective, we discuss the evolving landscape of psychedelic-based and ketamine-based treatments, highlighting different therapeutic models, their methodologies, and the need for clearer definitions and rigorous clinical trials. The document proposes three new definitions to improve clarity in evaluating the effects of these agents and the role of psychotherapies. We suggest language that will distinguish: (1) when the drug is used for its pharmacologic effects as a stand-alone treatment, without requiring the psychedelic experience or combined psychotherapy; (2) when the treatment requires the acute psychological effects of the drug to assist psychotherapy and (3) When ketamine or a psychedelic agent is used in combination with a structured, manualized psychotherapy that could be implemented even in the absence of these agents. We hope that this new terminology and definitions will help distinguish the various therapeutic roles of these agents (as stand-alone treatments or in combination with psychotherapies), and facilitate study designs, regulatory pathways, and more informed patient care.Plain Language Summary TitleKetamine, Psychedelics, and Psychotherapy: Understanding treatment models to better inform practice.

ObjectivesThe objectives of this study were to quantify the associations between preterm birth and adolescent-to-adult psychiatric disorders in the Quebec (Canada) population and to determine whether sex and socioeconomic status (SES) modified this relationship.MethodsThis was an observational cohort study using administrative data from the province of Quebec, Canada. All eligible children born preterm between 1976 and 1995 were identified (N = 100,040) and matched 1:2 with term-born children. Individuals were followed from age 11 years until either incident diagnosis of a psychiatric disorder (attention-deficit/hyperactivity disorder [ADHD], psychosis, bipolar disorder, anxiety, or depression), death, or December 2019. Preterm birth was considered as a binary (<37 weeks gestational age) and categorical exposure (extreme, <28; very, 28-31; moderate-to-late, 32-36 weeks gestational age), in addition to continuous gestational age in weeks. Cox proportional hazard models were applied. Effect-modifying roles of sex and SES were investigated in interaction analyses.ResultsCompared to term-born children, those born preterm had a higher risk of all outcomes, with magnitudes ranging from HR 1.16 for ADHD (95% confidence interval 1.13, 1.19) to 1.05 for anxiety (1.04, 1.07). A dose-response relationship was observed, with increasing risks of ADHD, psychosis, and anxiety as the degree of preterm birth increased. Despite some statistically significant associations, there was no clinically significant evidence of effect modification by sex or SES.ConclusionsChildren born preterm had an increased risk of psychiatric disorders in adolescence-to-adulthood, with similar risks across sexes and socioeconomic strata of the population. Policies for early and continued mental health surveillance in this susceptible group are important to initiate appropriate interventions.

ObjectiveTo describe demographic and practice characteristics of psychiatrists in British Columbia (BC), Manitoba (MB) and Ontario (ON) and explore how practice characteristics change by psychiatrist sex/gender and years since medical school graduation.MethodWe conducted a repeated cross-sectional study of all practising psychiatrists who had patient interactions and submitted billings from the fiscal years (FY) 2012/2013 to 2021/2022 using linked administrative data in BC, MB and ON. Psychiatrist demographic variables included age, sex/gender, years since medical school graduation and their practice location. Psychiatrist practice characteristics included visit and patient volume, service settings and patient diagnoses. We used measures of central tendency to describe demographic and practice characteristics and quantify change over time using percentage change.ResultsThe number of psychiatrists increased from 2012/2013 to 2021/2022 (percentage change, BC: 15.4%, MB: 20.0%, ON: 11.8%) and kept up with population increases, shown by stable per-capita supply of psychiatrists. The median age of psychiatrists in all provinces decreased over the study period. The percentage of female psychiatrists in practice increased in all provinces, but more in BC and ON than in MB. On average, psychiatrists are seeing a greater number of patients per year in 2021/2022 than in 2012/2013 (percentage change, BC: 14.6%, MB: 6.5%, ON: 11.1%), and more than half of patients are seen, on average, for one or two visits in all three provinces. More patients receive substance use and psychosis diagnoses over the 10-year study.ConclusionsDuring the past decade, psychiatric practice characteristics show modest changes despite changing psychiatrist demographics and subtle shift towards more consultative practices. While provinces demonstrated similar trends, differences underscore the importance of conducting pan-Canadian analyses to highlight particularities in workforce patterns.Plain Language Summary TitleDescribing 10-year change in psychiatrists' demographics and practice characteristics in British Columbia, Manitoba and Ontario.

ObjectiveUnderstanding differences in outpatient care before and after mental health hospitalization for adolescents from diverse backgrounds is critical to ensuring effective and responsive care. The objective of the current study was to examine outpatient mental health care in the two years before and 30 days after a mental health hospitalization for adolescents from immigrant, refugee and non-immigrant backgrounds.MethodThis retrospective, population-based cohort study, conducted in British Columbia (BC), Canada, analyzed linked health service utilization data (practitioner billings, hospitalizations) and migration records to track outpatient care before and after mental health hospitalization. The study included adolescents (ages 10-18) with an unscheduled/urgent mental health hospitalization between January 1, 2008 and December 31, 2016 (n = 5,314) from a cohort of adolescents in 10 of the largest school districts in BC (between 1996 and 2016). The main analyses examined outpatient mental health visits (e.g., general practitioner/psychiatrist) (i) in the two years before hospitalization and (ii) in the 30 days after discharge. Sub-analyses focused on outpatient visits with psychiatrists.ResultsOverall, 30.4% had no outpatient mental health visit in the two years before hospitalization and 45.1% had none in the 30 days following discharge. First-generation immigrants and refugees and second-generation immigrant adolescents were significantly less likely than non-immigrants to have had an outpatient mental health visit in the two years before mental health hospitalization (aOR_{1st_gen_immg} = 0.79, 95% CI, 0.63 to 0.98; aOR_{2nd_gen_immg} = 0.75, 95% CI, 0.61 to 0.93; aOR_{1st_gen_ref} = 0.40, 95% CI, 0.26 to 0.64). Second-generation immigrant adolescents were significantly more likely than non-immigrants to have had any outpatient mental health visit in the 30 days following hospitalization (aOR_{2nd_gen_immg} = 1.34, 95% CI, 1.09 to 1.65).ConclusionsResults suggest outpatient care before and after mental health hospitalizations is limited for many adolescents in BC and differed by migration background. Implications for meeting standards of care are discussed.Plain Language Summary TitleMental health-related care from a doctor/psychiatrist before and after mental health hospitalization for adolescents from immigrant, refugee, and non-immigrant backgrounds in British Columbia.

ObjectiveTo identify long-term trajectories of incarceration, impact of Housing First intervention, and associated predictor factors among people with mental illness and experiences of homelessness who participated in a randomized trial of Housing First in Toronto, Canada.MethodsParticipants in the Toronto site of the At Home/Chez Soi study (n = 559) were followed from 2009 to 2017. The primary outcome of interest was incarceration trajectories, analyzed using group-based trajectory modelling. Multinomial logistic regression was used to examine the association between Housing First intervention, baseline socio-demographic and health characteristics, and trajectories of incarceration.ResultsThree group-based incarceration trajectories were identified: Low (66.3%), decreasing (23.1%), and high (10.6%). Younger age, early onset of homelessness, longer duration of homelessness, male gender, drug and alcohol dependence or abuse disorders, and history of traumatic brain injury were significant predictors of high and decreasing incarceration trajectories compared to low trajectory. Receiving Housing First was not significantly associated with incarceration trajectory group.ConclusionsA small subgroup of individuals with mental illness and experiences of homelessness demonstrated a persistently high and long-term incarceration trajectory. Multi-disciplinary collaborations with mental health, housing and the criminal justice systems are needed, especially for individuals at increased risk of future incarceration.The trial is registered in the ISRCTN registry (ISRCTN42520374).