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Abstract:We used concept-mapping methods to gain insights into promising HIV prevention intervention strategies from the collective experience of heterosexual Black men (HBM) in four cities of Ontario. We engaged 60 HBM in online group concept-mapping sessions. First, we held a brainstorming session where the HBM generated 226 statements anonymously on strategies to reduce HIV vulnerabilities. The statements were condensed to 123. Second, the HBM (n = 45) sorted the 123 statements into self-created categories. Tird, the HBM rated the strategy statements by importance (n = 45) and feasibility (n = 41). Finally, cluster analysis and multidimensional scaling were used to describe data patterns. The statements cluster tagged "family and individual level interventions" had the highest mean rating in importance (4.061) and feasibility (3.610). The policy interventions cluster solution was rated second highest in importance (IR = 4.058) and the sixth in feasibility (FR = 3.413). Other cluster solutions ratings were addressing racism (third highest in importance [IR = 4.030] and fourth highest in feasibility [FR = 3.514]); healthcare, research, and economic opportunities (fourth highest in importance [IR = 4.018] and third highest in feasibility [FR = 3.526]); sexual health awareness strategies (fifth highest in importance [IR = 3.993] and highest in feasibility [FR = 3.611]) and sex/HIV education (sixth highest in importance [IR = 3.975] and fifth highest in feasibility [FR = 3.442]); and individual and community empowerment (lowest in importance [IR = 3.846] and lowest in feasibility [FR = 3.375]). Intergenerational (family and individual), policy, and anti-racism interventions are the top three priority strategies for HIV prevention and care for HBM and communities in Ontario.

Psychiatry has increasingly adopted explanations for psychopathology that are based on neurobiological reductionism. With the recognition of health disparities and the realisation that someone's postcode can be a better predictor of health outcomes than their genetic code, there are increasing efforts to ensure cultural and social–structural competence in psychiatric practice. Although neuroscientific and social–cultural approaches in psychiatry remain largely separate, they can be brought together in a multilevel explanatory framework to advance psychiatric theory, research, and practice. In this Personal View, we outline how a cultural–ecosocial systems approach to integrating neuroscience in psychiatry can promote social–contextual and systemic thinking for more clinically useful formulations and person-centred care.

Family caregivers of people with neurodevelopmental disabilities (NDDs) experience high levels of stress, anxiety, and depression, yet few interventions target their wellbeing. Moreover, most evidence-based interventions fail to include caregivers in their design and delivery despite evidence that caregivers can play a vital role in enhancing the success of interventions to other caregivers. The present study explored the experiences of caregivers and clinicians who worked in partnership to co-deliver an Acceptance and Commitment Training (ACT) intervention to caregivers of people with NDDs in the community.

Providing mediator training using a telecommunication format increases access to training by reducing geographical and financial barriers, while maintaining or increasing efficiency. Limited research has implemented this format to train facilitators in acceptance and commitment training (ACT), an empirically supported intervention. The aim of this research was to examine the efficacy of behavioural skills training via telecommunication for training novice facilitators to provide ACT to caregivers of individuals with neurodevelopmental disabilities. This two-part study involved concurrent multiple-baseline designs, each across 4 participants. Quantitative data on fidelity and confidence were collected at baseline, post-training, and at 1-month follow-up. The results from this study provide preliminary support for the use of behavioural skills training via telecommunication to train ACT facilitators. Increasing the number of competently trained facilitators will help build capacity to increase access to ACT across geographical regions.

Objective: Although there is evidence of effective stigma reduction by various psychological and educational interventions, the mechanisms of change remain unclear. In this article, we examine hypothesized processes that might have mediated reductions in stigma observed among Asian men who had received in mental health promotion interventions in Greater Toronto Area, Canada.Method: Our sample consisted of 495 Asian men, who received either acceptance and commitment therapy (ACT; n= 133), contact-based empowerment education (CEE; n= 149), combination of ACT and CEE (n= 152), or psychoeducation (n= 61). Group differences on intervention outcomes, including stigmatizing attitudes (Community Attitudes toward the Mentally Ill), internalized stigma (Internalized Stigma of Mental Illness), valued living (Valued Living Questionnaire), and attitudes to engage in social change (Social Justice Scale) were hypothesized to be due to the impact of the different interventions and mediated by changes in specific underlying psychological processes. These process-related changes were modelled using measures of mindfulness (Freiburg Mindfulness Inventory), psychological flexibility (Acceptance and Action Questionnaire version II), and empowerment (Empowerment Scale [ES]). Their pre- and post changes were analyzed with repeated measures analysis of variance, and mediational analyses were performed.Results: Findings from mediational analyses suggest that empowerment (ES) mediated a significant portion of the effects observed in reduction in stigmatizing attitudes and internalized stigma across intervention groups (t= 3.67 to 3.78 for CEE groups, and t= 4.32 to 4.56 for ACT groups). For the ACT groups, reduction in internalized stigma might also have been partly mediated by psychological flexibility, an intervention-specific psychological process.Conclusions: Results from the current study suggest that different stigma reduction interventions may be mediated by increased empowerment as a common mechanism of change, while intervention-specific mechanism of change, improved psychological flexibility through ACT, may also contribute to improvement in internalized stigma.

Right ventricular (RV) structure and function influence the morbidity and mortality from coronary artery disease (CAD), dilated cardiomyopathy (DCM), pulmonary hypertension and heart failure. Little is known about the genetic basis of RV measurements. Here we perform genome-wide association analyses of four clinically relevant RV phenotypes (RV end-diastolic volume, RV end-systolic volume, RV stroke volume, RV ejection fraction) from cardiovascular magnetic resonance images, using a state-of-the-art deep learning algorithm in 29,506 UK Biobank participants. We identify 25 unique loci associated with at least one RV phenotype at P< 2.27 ×10−8, 17 of which are validated in a combined meta-analysis (n= 41,830). Several candidate genes overlap with Mendelian cardiomyopathy genes and are involved in cardiac muscle contraction and cellular adhesion. The RV polygenic risk scores (PRSs) are associated with DCM and CAD. The findings substantially advance our understanding of the genetic underpinning of RV measurements.

Background: Coronavirus disease 2019 (COVID-19) disproportionately affects older people. Observational studies suggest indolent cardiovascular involvement after recovery from acute COVID-19. However, these findings may reflect pre-existing cardiac phenotypes. Aims: We tested the association of baseline cardiovascular magnetic resonance (CMR) phenotypes with incident COVID-19. Methods: We studied UK Biobank participants with CMR imaging and COVID-19 testing. We considered left and right ventricular (LV, RV) volumes, ejection fractions, and stroke volumes, LV mass, LV strain, native T1, aortic distensibility, and arterial stiffness index. COVID-19 test results were obtained from Public Health England. Co-morbidities were ascertained from self-report and hospital episode statistics (HES). Critical care admission and death were from HES and death register records. We investigated the association of each cardiovascular measure with COVID-19 test result in multivariable logistic regression models adjusting for age, sex, ethnicity, deprivation, body mass index, smoking, diabetes, hypertension, high cholesterol, and prior myocardial infarction. Results: We studied 310 participants (n= 70 positive). Median age was 63.8 [57.5, 72.1] years; 51.0% (n= 158) were male. 78.7% (n= 244) were tested in hospital, 3.5% (n= 11) required critical care admission, and 6.1% (n= 19) died. In fully adjusted models, smaller LV/RV end-diastolic volumes, smaller LV stroke volume, and poorer global longitudinal strain were associated with significantly higher odds of COVID-19 positivity. Discussion: We demonstrate association of pre-existing adverse CMR phenotypes with greater odds of COVID-19 positivity independent of classical cardiovascular risk factors. Conclusions: Observational reports of cardiovascular involvement after COVID-19 may, at least partly, reflect pre-existing cardiac status rather than COVID-19 induced alterations.

This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)’s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA’s Board of Directors on February 8, 2019. The original position paper1was first approved by the CPA Board on September 28, 2011.

Differences in cardiac and aortic structure and function are associated with cardiovascular diseases and a wide range of other types of disease. Here we analyzed cardiovascular magnetic resonance images from a population-based study, the UK Biobank, using an automated machine-learning-based analysis pipeline. We report a comprehensive range of structural and functional phenotypes for the heart and aorta across 26,893 participants, and explore how these phenotypes vary according to sex, age and major cardiovascular risk factors. We extended this analysis with a phenome-wide association study, in which we tested for correlations of a wide range of non-imaging phenotypes of the participants with imaging phenotypes. We further explored the associations of imaging phenotypes with early-life factors, mental health and cognitive function using both observational analysis and Mendelian randomization. Our study illustrates how population-based cardiac and aortic imaging phenotypes can be used to better define cardiovascular disease risks as well as heart–brain health interactions, highlighting new opportunities for studying disease mechanisms and developing image-based biomarkers.

Abstract:The Youth Engagement Project (YEP) is a community-based pilot study in Toronto, Canada that we developed to better understand perspectives about and experiences of sexual health education among socioeconomically marginalized, racialized, and LGBTQ youth. We investigated: 1) what sex-related messages these young people received as they grew up, 2) how those messages affected their perspectives and sexual behaviour, and 3) their recommendations for sexual health education that meets their needs. Engaging youth whose voices are often overlooked due to their low socioeconomic status and their racial, sexual, and religious identities, and using a place-based method, we recruited a total of 47 young people, aged 16–24, and divided them into six groups based on gender and residential neighbourhood. The data was collected through a demographic and sexual practice survey, followed by a series of two focus groups. We conducted thematic analysis, guided by a socio-ecological approach and paying particular attention to participants’ intrapersonal, interpersonal and environmental factors. Our results indicate that participants received inadequate and contradictory sexuality related information from multiple sources. These mixed messages contributed to confusion, misconceptions, distress, and sexual vulnerabilities. Youth expressed their need for more inclusive and relevant sexual health education starting from an early age, more support for parents and teachers to help them talk with children and youth about sexuality, and more youth-driven integrated health promotion programs to allow them to make informed choices. Their voices and perspectives are useful in informing inclusive and youth-centred sexual health education at home, in school and in the community.

Research into social determinants of mental and emotional health problems highlighted the need to understand the cultural factors. Mental health of immigrants is influenced by a variety of cultural, psychological, social, and economic factors. There is some evidence to suggest that South Asian people have higher rates of mental and emotional health problems than the rest of the Canadian population. Limited research also suggests that psycho-social factors are highly likely to be responsible for these high rates of mental health problems. These psychosocial factors may be impeding access and engagement with the services. These socially determined emotional and mental health problems are more likely to respond to psychosocial interventions than biological treatments. Evidence-based psychosocial interventions such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) might offer the way forward. CBT can be offered in a low-cost, low intensity format in a variety of settings, thus addressing the attached stigma. However, these interventions need to be culturally adapted, as these are underpinned by a Western value system. CBT has been culturally adapted and found to be effective in this group elsewhere. This opinion paper describes the need to enhance research on psychosocial determinants of the mental and emotional health problems, status, and the psychosocial determinants of health amongst South Asians in Canada to inform our understanding of the cultural specificity of psychosocial interventions.

Supplemental Digital Content is available in the text.

ObjectiveVigorous physical activity (PA) in highly trained athletes has been associated with heightened left ventricular (LV) trabeculation extent. It has therefore been hypothesised that LV trabeculation extent may participate in exercise-induced physiological cardiac remodelling. Our cross-sectional observational study aimed to ascertain whether there is a ‘dose–response’ relationship between PA and LV trabeculation extent and whether this could be identified at opposite PA extremes.MethodsIn a cohort of 1030 individuals from the community-based UK Biobank study (male/female ratio: 0.84, mean age: 61 years), PA was measured via total metabolic equivalent of task (MET) min/week and 7-day average acceleration, and trabeculation extent via maximal non-compaction/compaction ratio (NC/C) in long-axis images of cardiovascular magnetic resonance studies. The relationship between PA and NC/C was assessed by multivariate regression (adjusting for potential confounders) as well as between demographic, anthropometric and LV phenotypic parameters and NC/C.ResultsThere was no significant linear relationship between PA and NC/C (full adjustment, total MET-min/week: ß=−0.0008, 95% CI −0.039 to –0.037, p=0.97; 7-day average acceleration: ß=−0.047, 95% CI −0.110 to –0.115, p=0.13, per IQR increment in PA), or between extreme PA quintiles (full adjustment, total MET-min/week: ß=−0.026, 95% CI −0.146 to –0.094, p=0.67; 7-day average acceleration: ß=−0.129, 95% CI −0.299 to –0.040, p=0.49), across all adjustment levels. A negative relationship was identified between left ventricular ejection fraction and NC/C, significantly modified by PA (ß difference=−0.006, p=0.03).ConclusionsIn a community-based general population cohort, there was no relationship at, or between, extremes, between PA and NC/C, suggesting that at typical general population PA levels, trabeculation extent is not influenced by PA changes.

Supplemental Digital Content is available in the text.

Marginalized communities bear a disproportionate burden of syndemic challenges related to HIV, mental illness and addiction. Stigma is a major barrier to effective responses. CHAMP, an innovative community-based intervention that integrated psychological intervention and collective empowerment strategies to reduce stigma, was found to be effective for such a population.

A position paper developed by the Canadian Psychiatric Association’s Education Committee and approved by the CPA’s Board of Directors on August 15, 2016.

Objective: Our objectives were to examine the prevalence and incidence of postpartum depressive, anxiety, and comorbid symptoms over the first postpartum year; the persistence of these symptoms; and the prevalence stratified by immigration status.Method: We conducted a longitudinal cohort study in Ontario, Canada. Participants were 571 Chinese recent immigrant, nonrecent immigrant, and Canadian-born women with live births in 2011 to 2014. Participants were assessed at 4, 12, and 52 weeks postpartum for the presence of possible and high depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS] >9 and >12, respectively), anxiety symptomatology (State-Trait Anxiety Inventory [STAI] >40), and comorbid symptomatology (EPDS >9 and STAI >40). Prevalence and incidence with 95% confidence intervals were calculated.Results: Prevalence rates were highest at 4 weeks and decreased across time, with possible depressive symptomatology most prevalent at most time points. Incidence rates at 12 and 52 weeks were generally similar. Of those with possible symptomatology at 4 weeks, 42.0% or less continued to have symptomatology at 12 weeks and 17.4% or less at 52 weeks. There were no differences in prevalence of any type of symptomatology between immigrant and Canadian-born Chinese women at 4 weeks, but at 12 and 52 weeks, most types of symptomatology were more common among recent and nonrecent immigrants.Conclusion: Our findings suggest that Chinese immigrant women are a high-risk group for postpartum depressive and anxiety symptomatology. Future research should identify cultural and psychosocial factors associated with immigration that could be addressed in the system of care for postpartum immigrant women.

We used concept-mapping methods to gain insights into promising HIV prevention intervention strategies from the collective experience of heterosexual Black men (HBM) in four cities of Ontario. We engaged 60 HBM in online group concept-mapping sessions. First, we held a brainstorming session where the HBM generated 226 statements anonymously on strategies to reduce HIV vulnerabilities. The statements were condensed to 123. Second, the HBM (n = 45) sorted the 123 statements into self-created categories. Third, the HBM rated the strategy statements by importance (n = 45) and feasibility (n = 41). Finally, cluster analysis and multidimensional scaling were used to describe data patterns. The statements cluster tagged “family and individual level interventions” had the highest mean rating in importance (4.061) and feasibility (3.610). The policy interventions cluster solution was rated second highest in importance (IR = 4.058) and the sixth in feasibility (FR = 3.413). Other cluster solutions ratings were addressing racism (third highest in importance [IR = 4.030] and fourth highest in feasibility [FR = 3.514]); healthcare, research, and economic opportunities (fourth highest in importance [IR = 4.018] and third highest in feasibility [FR = 3.526]); sexual health awareness strategies (fifth highest in importance [IR = 3.993] and highest in feasibility [FR = 3.611]) and sex/HIV education (sixth highest in importance [IR = 3.975] and fifth highest in feasibility [FR = 3.442]); and individual and community empowerment (lowest in importance [IR = 3.846] and lowest in feasibility [FR = 3.375]). Intergenerational (family and individual), policy, and anti-racism interventions are the top three priority strategies for HIV prevention and care for HBM and communities in Ontario.

Previous studies have demonstrated that abnormal physiological observations are often recorded on patients’ observation charts but not acted on, with ensuing negative consequences. To address this issue within our hospital, traditional charts with a graphic depiction of observations were replaced with new charts combining early warning scores (EWS) with numerically depicted observations. However, the replacement did not include a graphic display of observations in the form of trend graphs. The present study compared the speed and accuracy of data interpretation between the 2 charts.

Un énoncé deprincipes rédigé par la Section de psychiatrie transculturelle el le Comité permanent de l'éducation de l'Association despsychiatres du Canada, et approuvé par le conseil d'administration del'APC, le 28 septembre 2011.

In many industrial inspection systems, it is required to have a high-precision three-dimensional measurement of an object under test. A popular technique is phase-measuring profilometry. In this paper, we develop some phase-shifting algorithms (PSAs). We propose a novel smoothness constraint in a regularization framework; we call this the R-PSA method and show how to obtain the desired phase measure with an iterative procedure. Both the simulation and experimental results verify the efficacy of our algorithm compared with current multiframe PSAs for interferometric measurements.

Although there has been an increase in research on postpartum depression (PPD), an inadequate focus has been placed on immigrant women. This is a significant limitation given the rapidly changing demographics in North America.

Objectives: In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD.Methods: MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included.Results: Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors.Conclusions: This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.

As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country. The authors conducted a systematic review of cultural competence by searching databases including PubMed, Psyc-INFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate “integrative” approach with a mindful, balanced emphasis on both generic and specific cultural competencies. Learning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (Can-MEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program’s emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive. The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

To provide effective psychotherapy for culturally different patients, therapists need to attain cultural competence, which can be divided broadly into the 2 intersecting dimensions of generic and specific cultural competencies. Generic cultural competence includes the knowledge and skill set necessary to work effectively in any cross-cultural therapeutic encounter. For each phase of psychotherapy— preengagement, engagement, assessment and feedback, treatment, and termination—we discuss clinically relevant generic cultural issues under the following headings: therapist, patient, family or group, and technique. Specific cultural competence enables therapists to work effectively with a specific ethnocultural community and also affects each phase of psychotherapy. Acomprehensive assessment and treatment approach is required to consider the specific effects of culture on the patient. Cultural analysis (CA) elaborates the DSM-IV cultural formulation, tailoring it for psychotherapy; it is a clinical tool developed to help therapists systematically review and generate hypotheses regarding cultural influences on the patient's psychological world. CA examines issues under 3 domains: self, relations, and treatment. We present a case to illustrate the influence of culture on patient presentation, diagnosis, CA, and psychotherapeutic treatment. Successful therapy requires therapists to employ culturally appropriate treatment goals, process, and content. The case also demonstrates various techniques with reference to culture, including countercultural, cultural reinforcing, or culturally congruent strategies and the use of contradictory cultural beliefs. In summary, developing both generic and specific cultural competencies will enhance clinician effectiveness in psychotherapy, as well as in other cross-cultural therapeutic encounters.