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

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).

Objective: This study seeks to understand the characteristics of individuals with addictions and other mental health (AMH) conditions who had a history of homelessness compared to those who did not experience homelessness.

Method: This cross-sectional analysis used linked administrative data from Alberta, Canada on April 1, 2018. People with AMH who experienced homelessness in the year prior to index were identified using hospitalisations and emergency department (ED) visits. We used multivariable logistic regression to evaluate the association between a set of descriptive variables and homelessness, adjusted for age and sex.

Results: Among the 622,614 individuals with AMH conditions, 3,390 (0.54%) had an indicator of homelessness. People experiencing homelessness (PEH) were younger (mean = 39 vs. 42 years, p < .001) and more frequently male (66% vs. 41%, p < .001) than individuals not experiencing homelessness. PEH were also more likely to be diagnosed with multiple AMH disorders (44.8% diagnosed with ≥ 4 AMH conditions vs. 3.8% of individuals without homelessness). PEH were more likely to have a history of visiting a psychiatrist (adjusted odds ratio (AOR) = 8.11, 95% CI [7.47-8.80], having an ED visit for AMH reasons (AOR = 25.44, 95% CI [22.94-28.21], and to have been hospitalised for AMH reasons (AOR = 13.53, 95%CI [12.61-14.52]).

Conclusions: Within the population of individuals with diagnosed AMH conditions, PEH demonstrated increased AMH complexity, greater healthcare utilisation and a greater likelihood of almost all AMH disorders. Given the complex mental health needs of this group, they will require more intensive mental health and general medical services that must be integrated with housing and additional social support systems.

BackgroundInfectious disease outbreaks have been associated with significant psychological distress and trauma. In Canada, the COVID-19 pandemic's social disruptions have heightened mental health risks. While global studies report elevated posttraumatic stress disorder (PTSD) symptoms, Canadian findings remain limited and inconsistent. This meta-analysis estimated pooled prevalence of PTSD symptoms in Canada during the COVID-19 pandemic and examined potential moderators.MethodsA comprehensive search strategy was executed by research librarians across five databases (APA PsycInfo, CINAHL, Embase, MEDLINE and Web of Science) and on LitCovid. The PRISMA guidelines were used for data extraction and reporting. Random-effects meta-analyses were conducted to estimate pooled PTSD symptoms prevalence and explore potential moderators using the metaprop command in STATA/SE 19.5.ResultsThirty studies conducted between 2020 and 2022, with 52,565 participants aged 18 and older were included (65% weighted women). The pooled prevalence of PTSD symptoms was 22.2% (95% CI, 15.7% to 29.4%; I²=99.69). Prevalence was 32.1% in women, 26.1% in men (p = 0.399) and ranged from 16.1% in Quebec to 29.7% in Ontario (p = 0.091). Meta-regressions showed lower PTSD symptoms prevalence in Quebec (B=-0.16, p = 0.029). No significant differences in PTSD symptoms were found according to sex, healthcare worker status, assessment tool used, or data collection year.ConclusionsThis meta-analysis reveals a concerning prevalence of PTSD symptoms in the Canadian population during the COVID-19 pandemic. Contrary to expectations, no significant differences were found by sex or healthcare worker status, suggesting widespread psychological distress across the population. However, the substantial heterogeneity across studies limits the interpretation of these findings in the context of the COVID-19 pandemic. The results emphasize the need for inclusive and accessible mental health responses and further research on post-pandemic Canadians' mental health. Future studies should better disaggregate data by sex, age and race to address disparities and inform targeted public health policies and interventions.

ObjectiveAccess to cognitive behavioural therapy (CBT) in Canada is limited by long wait times. Our objective was to determine the optimal dose of CBT sessions for patients to maximize recovery and minimize treatment time.MethodOutpatient data from electronic medical records at a specialized mental health centre between 1 January 2017 and 31 May 2024 was used. The primary outcome was having experienced a reliable and clinically significant improvement (RCSI) in symptoms since start of treatment. Kaplan-Meier estimators were used to determine the percentile who had achieved RCSI after a given number of CBT sessions. Adjusted Cox regression determined predictors of treatment response.ResultsAmong patients (n = 1,853) receiving treatment, 50% showed response in Patient Health Questionnaire-9 (PHQ-9) scores at 7 sessions of low-intensity CBT (LiCBT) and 95% showed response at 23 sessions. For high-intensity CBT (HiCBT), treatment response occurred between 14 and 36 sessions for 50-95% of patients. In Generalized Anxiety Disorder Assessment-7 (GAD-7) scores, treatment response occurred between 8 and 30 sessions in LiCBT and 15 and 37 sessions in HiCBT for 50-95% of patients. Cox regression results found that neighbourhood dependency [PHQ-9: hazard ratio (HR) (95% confidence interval (CI)) = 1.32 (1.08 to 1.63), GAD-7: HR (95% CI) = 1.36 (1.12 to 1.65)] and sex (male) [PHQ-9: HR (95% CI) = 0.83 (0.70 to 0.99), GAD-7: HR (95% CI) = 0.80 (0.66 to 0.96)] were significant predictors of non-response in HiCBT. Older age at admission was a significant predictor of non-response to LiCBT [PHQ-9: HR (95% CI = 0.99 (0.98 to 1.00), GAD-7: HR (95% CI) = 0.99 (0.98 to 1.00)].ConclusionsThere are differences in the dose and the predictors of patients' responses to LiCBT and HiCBT. These results provide insight into potential check-in points for clinicians to assess CBT treatment plans. These results may inform treatment planning, reducing longer than necessary length of stays, allowing for more patients to access mental healthcare services.

ObjectiveThe objective of this systematic review is to synthesize and evaluate the evidence involving creatine monohydrate supplementation (CrM) across mental disorders.MethodsMEDLINE, Embase, Cochrane, and PsycINFO were searched up to 09/30/2025 for randomized controlled trials (RCTs) investigating the effect of CrM on psychiatric symptoms and safety in participants with a mental disorder. Risk of bias was assessed.ResultsSix articles from five RCTs were included (CrM: n = 126, placebo: n = 112; mean age=36 ± 14 years; male sex = 26%). Four RCTs reported on major depressive disorder (MDD), one bipolar depression. No other mental disorders were investigated. Two RCTs were low risk of bias and three had some concerns. CrM dosing ranged from 2 to 10 g/day for 4-8 weeks as adjunct treatment. In the treatment of MDD, CrM was tested as combination with escitalopram (k = 1, outperforming selective serotonin reuptake inhibitor (SSRI) + placebo; Cohen's d = 1.13 at 8 weeks), pharmacotherapy augmentation in adults (k = 1) and female adolescents (k = 1, no difference vs placebo), psychotherapy augmentation (k = 1, cognitive behavioural therapy (CBT) + CrM outperforming CBT + placebo) in MDD, and as pharmacotherapy augmentation in bipolar depression (k = 1, no difference vs placebo augmentation). Two trials in MDD found a correlation between CrM brain N-acetylaspartate and phosphocreatine, which was associated with larger improvement. CrM was generally well-tolerated. Two CrM out of 17 participants experienced hypomania/mania.ConclusionCrM shows promise as a combination treatment with SSRIs or for augmenting psychotherapy in MDD in adults. Double-blind, large-scale RCTs investigating the efficacy of CrM, with and without first-line therapies, are needed across mental disorders.

BackgroundIn 2023/2024, there were 15 psychiatrists/100,000 Canadians with inequitable distribution across Canada and unprecedented demand for mental health and addiction services. Psychiatry human resource planning in Canada has not occurred for more than a decade. The objectives of this study were to understand the current state and future directions related to Psychiatry Human Resources in the Canadian mental health care system.MethodsUsing Delphi methods, we surveyed the 17 chairs of the academic departments of psychiatry in Canada and held focus groups. The Royal College and subspecialty programs were also engaged. Themes were extracted, summarized and refined. The refined themes were distributed via an online survey to all 17 chairs for final review and input, ensuring alignment and consensus across institutions.ResultsCommon themes focused on: the role of psychiatrists working in teams to provide care for complex mental disorders and addictions; need for innovative models of care including use of physician extenders, technology to reach the larger population of patients with mild to moderate disorders, working closely with primary care in collaborative care models. Due to the large proportion of Canadian psychiatrists being 35 years or more in practice (26%) and close to retirement, the chairs supported the need to expand the number of residency positions for psychiatry and continue strong recruitment efforts for international medical graduates. Although the majority of chairs supported shortening the general psychiatry residency program from 5 to 4 years, the Association of Chairs of Psychiatry of Canada (ACPC) could not reach a consensus on this issue. Pan-Canadian licensing for psychiatrists should be considered due to inequitable distribution of psychiatrists in Canada and advances in virtual care post-COVID-19 pandemic.ConclusionsThis study will contribute to the dialogue on psychiatry human resources planning in Canada.