Pub Date : 2024-01-01Epub Date: 2023-05-24DOI: 10.1177/07067437231176905
Samreen Shafiq, Paul Everett Ronksley, Tayler Dawn Scory, Meghan Jessica Elliott, Andrew Gabriel McKay Bulloch, Scott Burton Patten
Aims: Despite lithium's clinical efficacy, it is commonly thought that its use is declining. The objective of this study is to describe the new and prevalent lithium users as well as rates of discontinuation of lithium use over a 10-year period.
Methods: This study used provincial administrative health data from Alberta, Canada between January 1, 2009 and December 31, 2018. Lithium prescriptions were identified within the Pharmaceutical Information Network database. Total and subgroup specific frequencies of new and prevalent lithium use were determined over the 10-year study period. Lithium discontinuation was also estimated through survival analysis.
Results: Between the calendar years of 2009 and 2018, 580,873 lithium prescriptions were dispensed in Alberta to 14,008 patients. The total number of new and prevalent lithium users appears to be decreasing over the 10-year timeframe, although the decline may have stopped or reversed in the latter years of the study period. Prevalent use of lithium was lowest among individuals between the ages of 18-24 years while the highest number of prevalent users were in the 50-64 age group, particularly among females. New lithium use was lowest amongst those 65 years and older. More than 60% (8,636) of patients prescribed lithium, discontinued use during the study timeframe. Lithium users between ages of 18-24 years were at the highest risk of discontinuations.
Conclusions: Rather than a general decline in prescribing, trends in lithium use are dependent on age and sex. Further, the period soon after lithium initiation appears to be a key time period in which many lithium trials are abandoned. Detailed studies using primary data collection are needed to confirm and further explore these findings. These population-based results not only confirm a decline in lithium use, but also suggest that this may have stopped or even reversed. Population-based data on discontinuation pinpoint the period soon after initiation as the time when trials are most often discontinued.
{"title":"Ten-Year Trends in Lithium Prescribing in Alberta, Canada.","authors":"Samreen Shafiq, Paul Everett Ronksley, Tayler Dawn Scory, Meghan Jessica Elliott, Andrew Gabriel McKay Bulloch, Scott Burton Patten","doi":"10.1177/07067437231176905","DOIUrl":"10.1177/07067437231176905","url":null,"abstract":"<p><strong>Aims: </strong>Despite lithium's clinical efficacy, it is commonly thought that its use is declining. The objective of this study is to describe the new and prevalent lithium users as well as rates of discontinuation of lithium use over a 10-year period.</p><p><strong>Methods: </strong>This study used provincial administrative health data from Alberta, Canada between January 1, 2009 and December 31, 2018. Lithium prescriptions were identified within the Pharmaceutical Information Network database. Total and subgroup specific frequencies of new and prevalent lithium use were determined over the 10-year study period. Lithium discontinuation was also estimated through survival analysis.</p><p><strong>Results: </strong>Between the calendar years of 2009 and 2018, 580,873 lithium prescriptions were dispensed in Alberta to 14,008 patients. The total number of new and prevalent lithium users appears to be decreasing over the 10-year timeframe, although the decline may have stopped or reversed in the latter years of the study period. Prevalent use of lithium was lowest among individuals between the ages of 18-24 years while the highest number of prevalent users were in the 50-64 age group, particularly among females. New lithium use was lowest amongst those 65 years and older. More than 60% (8,636) of patients prescribed lithium, discontinued use during the study timeframe. Lithium users between ages of 18-24 years were at the highest risk of discontinuations.</p><p><strong>Conclusions: </strong>Rather than a general decline in prescribing, trends in lithium use are dependent on age and sex. Further, the period soon after lithium initiation appears to be a key time period in which many lithium trials are abandoned. Detailed studies using primary data collection are needed to confirm and further explore these findings. These population-based results not only confirm a decline in lithium use, but also suggest that this may have stopped or even reversed. Population-based data on discontinuation pinpoint the period soon after initiation as the time when trials are most often discontinued.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9516767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-07-18DOI: 10.1177/07067437231187459
Helen-Maria Vasiliadis, Catherine Lamoureux-Lamarche, Alexandra Chapdelaine, Martin D Provencher, Peter J Norton, Djamal Berbiche, Pasquale Roberge
Aim: To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon.
Methods: Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method.
Results: The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%.
Conclusion: tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.
{"title":"Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon.","authors":"Helen-Maria Vasiliadis, Catherine Lamoureux-Lamarche, Alexandra Chapdelaine, Martin D Provencher, Peter J Norton, Djamal Berbiche, Pasquale Roberge","doi":"10.1177/07067437231187459","DOIUrl":"10.1177/07067437231187459","url":null,"abstract":"<p><strong>Aim: </strong>To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon.</p><p><strong>Methods: </strong>Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (<i>n</i> = 117) or TAU (<i>n</i> = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method.</p><p><strong>Results: </strong>The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%.</p><p><strong>Conclusion: </strong>tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10185839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-07-14DOI: 10.1177/07067437231187460
Lucy C Barker, Juveria Zaheer, Zakia Hussain, Julia France, Ananka Rodriguez, Shakked Lubotzky-Gete, Suze Berkhout, Robert Dmytryshyn, Sheila Dunn, Renu Gupta, Fardous Hosseiny, Frank Sirotich, Sophie Soklaridis, Aristotle N Voineskos, Simone N Vigod
Objective: Individuals with psychosis are at elevated risk of adverse sexual and reproductive health (SRH) outcomes, and not receiving adequate SRH care. SRH is important for youth, yet little is known about SRH care access and experiences among those with early psychosis. This study explored SRH care experiences among women and nonbinary individuals with early psychosis.
Method: We conducted semistructured qualitative interviews with 19 service users (cisgender and transgender women, nonbinary individuals) receiving care in 2 early psychosis programs in Ontario, Canada. We also conducted semistructured interviews and focus groups with 36 clinicians providing SRH or mental health care to this population. Participants were asked about SRH care access/provision experiences and the interplay with psychosis. Using a social interactionist orientation, a thematic analysis described and explained service user and clinician perspectives regarding SRH care.
Results: Amongst both service users and clinician groups, common themes developed: (a) diversity of settings: SRH services are accessed in a large range of spaces across the health care system, (b) barriers in nonpsychiatric SRH care settings: psychosis impacts the ability to engage with existing SRH services, (c) invisibility of SRH in psychiatric settings: SRH is rarely addressed in psychiatric care, (d) variability of informal SRH-related conversations and supports, and cutting across all of the above themes, (e) intersecting social and cultural factors impacted SRH services access.
Conclusions: SRH is important for health and wellbeing; improvements are urgently needed across the healthcare system and within early psychosis programs to meet this population's multifaceted SRH needs.
{"title":"Experiences of Sexual and Reproductive Health Care Access for Women and Nonbinary People With Early Psychosis: Towards an Integrated Perspective of Service Users and Clinicians.","authors":"Lucy C Barker, Juveria Zaheer, Zakia Hussain, Julia France, Ananka Rodriguez, Shakked Lubotzky-Gete, Suze Berkhout, Robert Dmytryshyn, Sheila Dunn, Renu Gupta, Fardous Hosseiny, Frank Sirotich, Sophie Soklaridis, Aristotle N Voineskos, Simone N Vigod","doi":"10.1177/07067437231187460","DOIUrl":"10.1177/07067437231187460","url":null,"abstract":"<p><strong>Objective: </strong>Individuals with psychosis are at elevated risk of adverse sexual and reproductive health (SRH) outcomes, and not receiving adequate SRH care. SRH is important for youth, yet little is known about SRH care access and experiences among those with early psychosis. This study explored SRH care experiences among women and nonbinary individuals with early psychosis.</p><p><strong>Method: </strong>We conducted semistructured qualitative interviews with 19 service users (cisgender and transgender women, nonbinary individuals) receiving care in 2 early psychosis programs in Ontario, Canada. We also conducted semistructured interviews and focus groups with 36 clinicians providing SRH or mental health care to this population. Participants were asked about SRH care access/provision experiences and the interplay with psychosis. Using a social interactionist orientation, a thematic analysis described and explained service user and clinician perspectives regarding SRH care.</p><p><strong>Results: </strong>Amongst both service users and clinician groups, common themes developed: (a) diversity of settings: SRH services are accessed in a large range of spaces across the health care system, (b) barriers in nonpsychiatric SRH care settings: psychosis impacts the ability to engage with existing SRH services, (c) invisibility of SRH in psychiatric settings: SRH is rarely addressed in psychiatric care, (d) variability of informal SRH-related conversations and supports, and cutting across all of the above themes, (e) intersecting social and cultural factors impacted SRH services access.</p><p><strong>Conclusions: </strong>SRH is important for health and wellbeing; improvements are urgently needed across the healthcare system and within early psychosis programs to meet this population's multifaceted SRH needs.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-08-27DOI: 10.1177/07067437231197263
Jude Mary Cénat, Myrna Lashley, G Eric Jarvis, Monnica T Williams, Emmanuelle Bernheim, Daniel Derivois, Cécile Rousseau
{"title":"The Burden of Psychosis in Black Communities in Canada: More than a Feeling, a Black Family Experience.","authors":"Jude Mary Cénat, Myrna Lashley, G Eric Jarvis, Monnica T Williams, Emmanuelle Bernheim, Daniel Derivois, Cécile Rousseau","doi":"10.1177/07067437231197263","DOIUrl":"10.1177/07067437231197263","url":null,"abstract":"","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2023-06-27DOI: 10.1177/07067437231178958
Farooq Naeem, Nagina Khan, Nazia Sohani, Farhana Safa, Mehreen Masud, Sarah Ahmed, Gary Thandi, Baldev Mutta, Azaad Kasaam, Kamlesh Tello, Muhammad Ishrat Husain, Muhammad Omair Husain, Sean A Kidd, Kwame McKenzie
Background: South Asian (SA) Canadians are disproportionately affected by higher rates of mood and anxiety disorders. SA Canadians with depression report significant barriers to accessing mental health care and the highest proportion of unmet mental health needs. The Mental Health Commission of Canada (MHCC) advocates for culturally and linguistically relevant services for SA Canadians. Culturally adapted cognitive behavior therapy (CaCBT) has shown to be more effective than standard cognitive behavior therapy (CBT). Adapting CBT for the growing SA population in Canada will ensure equitable access to effective, culturally-appropriate mental health interventions.
Method: The study used a qualitative design to elicit stakeholder consultation via in-depth interviews. This study is reported using the criteria included in Consolidated Criteria for Reporting Qualitative Studies (COREQ). The analysis follows an ethnographic approach and was informed by the principles of emergent design.
Results: Five themes were identified from the analysis, (i) Awareness and preparation: factors that impact the individual's understanding of therapy and mental illness. (ii) Access and provision: SA Canadians' perception of barriers, facilitators, and access to treatment. (iii) Assessment and engagement: experiences of receiving helpful treatment. (iv) Adjustments to therapy: modifications and suggestions to standard CBT. (v) Ideology and ambiguity: racism, immigration, discrimination, and other socio-political factors.
Conclusions: Mainstream mental health services need to be culturally appropriate to better serve SA Canadians experiencing depression and anxiety. Services must understand the family dynamics, cultural values and socio-political factors that impact SA Canadians to reduce attrition rates in therapy.
{"title":"Culturally Adapted Cognitive Behaviour Therapy (CaCBT) to Improve Community Mental Health Services for Canadians of South Asian Origin: A Qualitative Study.","authors":"Farooq Naeem, Nagina Khan, Nazia Sohani, Farhana Safa, Mehreen Masud, Sarah Ahmed, Gary Thandi, Baldev Mutta, Azaad Kasaam, Kamlesh Tello, Muhammad Ishrat Husain, Muhammad Omair Husain, Sean A Kidd, Kwame McKenzie","doi":"10.1177/07067437231178958","DOIUrl":"10.1177/07067437231178958","url":null,"abstract":"<p><strong>Background: </strong>South Asian (SA) Canadians are disproportionately affected by higher rates of mood and anxiety disorders. SA Canadians with depression report significant barriers to accessing mental health care and the highest proportion of unmet mental health needs. The Mental Health Commission of Canada (MHCC) advocates for culturally and linguistically relevant services for SA Canadians. Culturally adapted cognitive behavior therapy (CaCBT) has shown to be more effective than standard cognitive behavior therapy (CBT). Adapting CBT for the growing SA population in Canada will ensure equitable access to effective, culturally-appropriate mental health interventions.</p><p><strong>Method: </strong>The study used a qualitative design to elicit stakeholder consultation via in-depth interviews. This study is reported using the criteria included in Consolidated Criteria for Reporting Qualitative Studies (COREQ). The analysis follows an ethnographic approach and was informed by the principles of emergent design.</p><p><strong>Results: </strong>Five themes were identified from the analysis, (i) Awareness and preparation: factors that impact the individual's understanding of therapy and mental illness. (ii) Access and provision: SA Canadians' perception of barriers, facilitators, and access to treatment. (iii) Assessment and engagement: experiences of receiving helpful treatment. (iv) Adjustments to therapy: modifications and suggestions to standard CBT. (v) Ideology and ambiguity: racism, immigration, discrimination, and other socio-political factors.</p><p><strong>Conclusions: </strong>Mainstream mental health services need to be culturally appropriate to better serve SA Canadians experiencing depression and anxiety. Services must understand the family dynamics, cultural values and socio-political factors that impact SA Canadians to reduce attrition rates in therapy.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01Epub Date: 2022-12-14DOI: 10.1177/07067437221140385
Michael Lebenbaum, Fiona Kouyoumdjian, Anjie Huang, Paul Kurdyak
Background: There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use.
Methods: We conducted a population-based cohort study linking individuals held in provincial correctional institutions in 2010 to health administrative databases. Prior MHA service use was assigned hierarchically in order of hospitalization, emergency department visit and outpatient visit. We followed up individuals post-release for up to 5 years for the first occurrence of recidivism and MHA hospitalization, emergency department visit and outpatient visit. We use Cox-proportional hazards models to examine the association between prior MHA service use and each outcome adjusting for prior correctional involvement and demographic characteristics.
Results: Among a sample consisting of 45,890 individuals, we found that prior MHA service use was moderately associated with recidivism (hazard ratio (HR): 1.20-1.50, all P < 0.001), with secondary analyses finding larger associations for addiction service use (HR range: 1.34-1.54, all P < 0.001) than for mental health service use (HR range: 1.09-1.18, all P < 0.001). We found high levels of post-release MHA hospitalization and low levels of outpatient MHA care relative to need even among individuals with prior MHA hospitalization.
Discussion: Despite a high risk of recidivism and acute MHA utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.
背景:关于心理健康和成瘾(MHA)病史与累犯之间的联系,证据不一。很少有研究对刑满释放后的心理健康和戒毒护理进行调查。我们的目标是研究之前(入狱前)使用心理健康和成瘾服务与释放后再犯罪和服务使用之间的联系:我们开展了一项基于人口的队列研究,将 2010 年省级教养机构的在押人员与卫生行政数据库联系起来。按照住院、急诊就诊和门诊就诊的顺序,对之前使用的MHA服务进行了分级。我们对刑满释放人员进行了长达 5 年的跟踪调查,以了解他们是否首次出现累犯、MHA 住院、急诊就诊和门诊就诊情况。我们使用 Cox 比例危险模型来检验之前使用 MHA 服务与每种结果之间的关联,并对之前的管教参与和人口特征进行调整:结果:在由 45,890 人组成的样本中,我们发现之前使用 MHA 服务与累犯之间存在中度关联(危险比 (HR):1.20-1.50,均为 P P P 讨论):尽管再犯的风险很高,并且在释放后也会急性使用 MHA 服务,但我们发现获得 MHA 门诊护理的机会很少,这突出表明有必要加大力度,促进有心理健康需求的人在惩教机构中获得护理和护理整合。
{"title":"The Association Between Prior Mental Health Service Utilization and Risk of Recidivism among Incarcerated Ontario Residents.","authors":"Michael Lebenbaum, Fiona Kouyoumdjian, Anjie Huang, Paul Kurdyak","doi":"10.1177/07067437221140385","DOIUrl":"10.1177/07067437221140385","url":null,"abstract":"<p><strong>Background: </strong>There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use.</p><p><strong>Methods: </strong>We conducted a population-based cohort study linking individuals held in provincial correctional institutions in 2010 to health administrative databases. Prior MHA service use was assigned hierarchically in order of hospitalization, emergency department visit and outpatient visit. We followed up individuals post-release for up to 5 years for the first occurrence of recidivism and MHA hospitalization, emergency department visit and outpatient visit. We use Cox-proportional hazards models to examine the association between prior MHA service use and each outcome adjusting for prior correctional involvement and demographic characteristics.</p><p><strong>Results: </strong>Among a sample consisting of 45,890 individuals, we found that prior MHA service use was moderately associated with recidivism (hazard ratio (HR): 1.20-1.50, all <i>P</i> < 0.001), with secondary analyses finding larger associations for addiction service use (HR range: 1.34-1.54, all <i>P</i> < 0.001) than for mental health service use (HR range: 1.09-1.18, all <i>P</i> < 0.001). We found high levels of post-release MHA hospitalization and low levels of outpatient MHA care relative to need even among individuals with prior MHA hospitalization.</p><p><strong>Discussion: </strong>Despite a high risk of recidivism and acute MHA utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10345851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-03-23DOI: 10.1177/07067437231164571
Ka Sing Paris Lai, Robyn Waxman, Daniel M Blumberger, Peter Giacobbe, Gary Hasey, Lisa McMurray, Roumen Milev, Lena Palaniyappan, Rajamannar Ramasubbu, Yuri E Rybak, Tegan Sacevich, Fidel Vila-Rodriguez, Amer M Burhan
Background: Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery.
Objective: The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes.
Methods: A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process.
Results: Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement.
Conclusions: This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry.
{"title":"Competencies for Repetitive Transcranial Magnetic Stimulation in Postgraduate Medical Education: Expert Consensus Using a Modified Delphi Process.","authors":"Ka Sing Paris Lai, Robyn Waxman, Daniel M Blumberger, Peter Giacobbe, Gary Hasey, Lisa McMurray, Roumen Milev, Lena Palaniyappan, Rajamannar Ramasubbu, Yuri E Rybak, Tegan Sacevich, Fidel Vila-Rodriguez, Amer M Burhan","doi":"10.1177/07067437231164571","DOIUrl":"10.1177/07067437231164571","url":null,"abstract":"<p><strong>Background: </strong>Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery.</p><p><strong>Objective: </strong>The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes.</p><p><strong>Methods: </strong>A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process.</p><p><strong>Results: </strong>Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement.</p><p><strong>Conclusions: </strong>This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9161343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-04-03DOI: 10.1177/07067437231167386
Bryan Tanner, Paul Kurdyak, Claire de Oliveira
Objective: The impacts of the COVID-19 pandemic on psychiatric hospitalizations in Ontario are unknown. The purpose of this study was to identify changes to volumes and characteristics of psychiatric hospitalizations in Ontario during the COVID-19 pandemic.
Methods: A time series analysis was done using psychiatric hospitalizations with admissions dates from July 2017 to September 2021 identified from provincial health administrative data. Variables included monthly volumes of hospitalizations as well as proportions of stays <3 days and involuntary admissions, overall and by diagnosis (mood, psychotic, addiction, and other disorders). Changes to trends during the pandemic were tested using linear regression.
Results: A total of 236,634 psychiatric hospitalizations were identified. Volumes decreased in the first few months of the pandemic before returning to prepandemic volumes by May 2020. However, monthly hospitalizations for psychotic disorders increased by ∼9% compared to the prepandemic period and remained elevated thereafter. Short stays and involuntary admissions increased by approximately 2% and 7%, respectively, before trending downwards.
Conclusion: Psychiatric hospitalizations quickly stabilized in response to the COVID-19 pandemic. However, evidence suggested a shift towards a more severe presentation during this period.
{"title":"Adult Psychiatric Hospitalizations in Ontario, Canada Before and During the COVID-19 Pandemic.","authors":"Bryan Tanner, Paul Kurdyak, Claire de Oliveira","doi":"10.1177/07067437231167386","DOIUrl":"10.1177/07067437231167386","url":null,"abstract":"<p><strong>Objective: </strong>The impacts of the COVID-19 pandemic on psychiatric hospitalizations in Ontario are unknown. The purpose of this study was to identify changes to volumes and characteristics of psychiatric hospitalizations in Ontario during the COVID-19 pandemic.</p><p><strong>Methods: </strong>A time series analysis was done using psychiatric hospitalizations with admissions dates from July 2017 to September 2021 identified from provincial health administrative data. Variables included monthly volumes of hospitalizations as well as proportions of stays <3 days and involuntary admissions, overall and by diagnosis (mood, psychotic, addiction, and other disorders). Changes to trends during the pandemic were tested using linear regression.</p><p><strong>Results: </strong>A total of 236,634 psychiatric hospitalizations were identified. Volumes decreased in the first few months of the pandemic before returning to prepandemic volumes by May 2020. However, monthly hospitalizations for psychotic disorders increased by ∼9% compared to the prepandemic period and remained elevated thereafter. Short stays and involuntary admissions increased by approximately 2% and 7%, respectively, before trending downwards.</p><p><strong>Conclusion: </strong>Psychiatric hospitalizations quickly stabilized in response to the COVID-19 pandemic. However, evidence suggested a shift towards a more severe presentation during this period.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9234294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-02-28DOI: 10.1177/07067437231156254
Alene Toulany, Paul Kurdyak, Therese A Stukel, Rachel Strauss, Longdi Fu, Jun Guan, Lisa Fiksenbaum, Eyal Cohen, Astrid Guttmann, Simone Vigod, Maria Chiu, Charlotte Moore Hepburn, Kimberly Moran, William Gardner, Mario Cappelli, Purnima Sundar, Natasha Saunders
Objective: We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic.
Methods: This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status.
Results: Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata.
Conclusion: During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
{"title":"Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study.","authors":"Alene Toulany, Paul Kurdyak, Therese A Stukel, Rachel Strauss, Longdi Fu, Jun Guan, Lisa Fiksenbaum, Eyal Cohen, Astrid Guttmann, Simone Vigod, Maria Chiu, Charlotte Moore Hepburn, Kimberly Moran, William Gardner, Mario Cappelli, Purnima Sundar, Natasha Saunders","doi":"10.1177/07067437231156254","DOIUrl":"10.1177/07067437231156254","url":null,"abstract":"<p><strong>Objective: </strong>We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This population-based repeated cross-sectional study of children and adolescents (3-17 years; <i>N</i> = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status.</p><p><strong>Results: </strong>Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata.</p><p><strong>Conclusion: </strong>During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10831268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01Epub Date: 2023-07-09DOI: 10.1177/07067437231182658
E Stip, S F Javaid, K Abdel Aziz, D Arnone
The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to 'correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients' selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.
肯·凯西(Ken Kesey)的《飞越疯人院》(One Flew Over The Cuckoo’s Nest)出版周年纪念为我们提供了一个反思神经外科在精神病学中的应用的机会。我们用叙述、历史和辩证的方法来叙述这个有争议的话题。一个平衡的消极和积极方面的表现,承认一些可疑的道德做法,同时描述合理的应用程序提供。其中包括神经外科医生、精神科医生,他们以不必要的热情接受了这些手术,也有反对者。用于治疗严重精神障碍的神经外科技术已经从用于“纠正”与各种严重精神障碍相关的不良行为的基本程序发展到作为治疗特定精神健康状况的最后手段使用的更精细和选择性的方法。在缺乏具体的病因模型来指导消融手术目标的情况下,最近开发了非消融刺激技术,以便在手术治疗未能获得相当大的生活质量改善时实现可逆性。这一主题通过两张雄辩的临床图像得到了具体的说明:一张是对加拿大人群进行的一系列脑计算机断层扫描,他们在几十年前接受了白质切除术,另一张是更现代的硬膜外刺激植入手术。随着精神外科技术的进步,监管框架也逐渐发展起来,以确保对患者选择的适当性保持警惕。然而,为了患者的利益,世界各地的协议协调是必要的,以确保获得和维持尽可能高的道德标准的一致性。如果今天的神经科学承诺,在其新的、更好的框架和可逆的应用中,为未满足的治疗需求提供答案,我们仍然必须关注与引入侵入性技术有关的漂移,这些技术以控制或改变行为为目的,会阻碍我们的个人自由。
{"title":"Happy Birthday \"One Flew Over the Cuckoo's Nest\": A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery.","authors":"E Stip, S F Javaid, K Abdel Aziz, D Arnone","doi":"10.1177/07067437231182658","DOIUrl":"10.1177/07067437231182658","url":null,"abstract":"<p><p>The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to 'correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients' selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.</p>","PeriodicalId":55283,"journal":{"name":"Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9761083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}