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There is robust evidence that child maltreatment is a significant risk factor and linked to negative psychological outcomes. However, few studies have examined the impact of child maltreatment on mental health and substance use trajectories across adolescence.Data were drawn from a larger longitudinal project, in which participants were recruited starting in grade 7-8 and followed on two more occasions biennially. The final baseline sample was comprised of 765 youth (MYouth who experienced maltreatment were more likely to display more severe internalizing, externalizing, and substance use problem trajectories than youth without such histories. While not significant as moderators, perceived family support and school connectedness were significantly associated with each of the trajectories, with lower levels of perceived family support and school connectedness linked to more severe problem trajectories.Results highlight the ongoing and significant harmful impact of maltreatment among youth. Results also support further prevention and intervention efforts for child maltreatment, particularly at the family and school level.

Youth view gender as a spectrum of experiences, not the cis-binary framework of girls/women versus boys/men. However, research has historically focused on cisgender people, without considering the rich experiences of transgender and non-binary people. Method. To address gaps in the inclusion of transgender and gender non-binary youth in research, a group of transgender and non-binary youth came together through a research-based youth engagement initiative to discuss what they wanted researchers to know about gender. Results. Youth propose ten guidelines and principles that they ask researchers to acknowledge, respect, and apply. These guidelines and principles focus on acknowledging and accepting diverse experiences situated on a gender spectrum, committing to learning more about gender, incorporating gender appropriately in their research initiatives, and engaging with transgender and non-binary youth in the research they conduct. Funders, research ethics boards, and publishers are also responsible for attending to gender. Conclusions. Researchers are called on to consider these guidelines and principles and to engage in dialogue around them in order to better capture the experiences of transgender and non-binary youth in the new evidence base as it emerges.

Background There is growing recognition that engaging people with lived experience (PWLE) in mental health and substance use research improves the quality of the research in terms of relevance to the population and the feasibility of the work. Engagement also provides positive opportunities for research teams and the PWLE engaged. However, there are many gaps in the research on PWLE engagement. This scoping review synthesizes the gaps in the implementation of PWLE engagement and in the research on engagement as presented by research teams engaging PWLE in their work. Method A systematic electronic database search was conducted in 2022 for published articles on PWLE engagement in mental health and substance use research. Potential articles were screened for relevance. The search led to 49 final articles included in the review. The 49 articles were then coded using codebook thematic analysis to answer two research questions: (1) What are the research evidence gaps regarding the engagement of PWLE in mental health and substance use research?; and (2) What are the gaps in implementing PWLE engagement in mental health and substance use research? PWLE were engaged in the conduct of this review. Results Results showed that research evidence gaps include further work on conceptualizing engagement; developing resources, tools, and practice recommendations to support research teams; increasing diversity in evaluations of engagement; and evaluating engagement, including its impact on the research, on PWLE, and on researchers. Implementation gaps included several broader institutional gaps and gaps in the day-to-day practice of engagement. Conclusions Despite progress in PWLE engagement in mental health and substance use research in recent years, research evidence and implementation gaps remain. Research teams are encouraged to consider these gaps and conduct research and implementation activities to address them in a rigorous manner.

Background Youth and young adults have been significantly impacted by the opioid overdose and health crisis in North America. There is evidence of increasing morbidity and mortality due to opioids among those aged 15–29. Our review of key international reports indicates there are few youth-focused interventions and treatments for opioid use. Our scoping review sought to identify, characterize, and qualitatively evaluate the youth-specific clinical and pre-clinical interventions for opioid use among youth. Method We searched MedLine and PsycInfo for articles that were published between 2013 and 2021. Previous reports published in 2015 and 2016 did not identify opioid-specific interventions for youth and we thus focused on the time period following the periods covered by these prior reports. We input three groups of relevant keywords in the aforementioned search engines. Specifically, articles were included if they targeted a youth population (ages 15–25), studied an intervention, and measured impacts on opioid use. Results We identified 21 studies that examined the impacts of heterogeneous interventions on youth opioid consumption. The studies were classified inductively as psycho-social-educational, pharmacological, or combined pharmacological-psycho-social-educational. Most studies focused on treatment of opioid use disorder among youth, with few studies focused on early or experimental stages of opioid use. A larger proportion of studies focused heavily on male participants (i.e., male gender and/or sex). Very few studies involved and/or included youth in treatment/program development, with one study premised on previous research about sexual minority youth. Conclusions Research on treatments and interventions for youth using or at-risk of opioids appears to be sparse. More youth involvement in research and program development is vital. The intersectional and multi-factorial nature of youth opioid use and the youth opioid crisis necessitates the development and evaluation of novel treatments that address youth-specific contexts and needs (i.e., those that address socio-economic, neurobiological, psychological, and environmental factors that promote opioid use among youth).

Background Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction. Objective This study aims to understand how stigma influences service seeking among youth with mental health challenges. Methods Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis. Results Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling ‘sick enough’ and ‘not sick enough’ to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma’s effects on seeking and obtaining services. Conclusion A constant negotiation between being ‘sick enough’ or ‘not sick enough’ is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma’s impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.

Objective Integrated youth services (IYS) are an emerging model of care offering a broad range of mental health and social services for youth in one location. This study aimed to determine the IYS service characteristics most important to youth, as well as to determine whether different classes of youth have different service preferences, and if so, what defines these classes. Methods Ontario youth aged 14–29 years with mental health challenges were recruited to participate in a discrete choice experiment (DCE) survey. The DCE contained 12 attributes, each represented by 4 levels representing core characteristics of IYS models. To supplement the DCE questions, demographic information was collected and a mental health screener was administered. Preferences were examined, latent class analyses were conducted, and latent classes were compared. Results As a whole, participants endorsed the IYS model of service delivery. Among 274 youth, there were three latent classes: 1) the Focused Service (37.6%) latent class prioritized efficient delivery of mental health services. 2) The Holistic Services (30.3%) latent class prioritized a diverse array of mental health and social services delivered in a timely fashion. 3) The Responsive Services (32.1%) latent class prioritized services that matched the individual needs of the youth being served. Differences between classes were observed based on sociodemographic and clinical variables. Conclusions IYS is an acceptable model of care, in that it prioritizes components that reflect youth preferences. The differences in preference profiles of different groups of youth point to the need for flexible models of service delivery. Service design initiatives should take these preferences into account, designing services that meet the needs and preferences of a broad range of youth. Working locally to co-design services with the youth in the target population who wish to be engaged will help meet the needs of youth.

Given the important implications of youth substance use, it is essential to document and describe changes in substance use during the coronavirus disease 2019 pandemic.This multimethod survey study examines the impacts of the coronavirus disease 2019 pandemic on youth substance use among 149 Canadian youth who were using substances at a mid-pandemic period. Participants were 21.9 years of age on average (SD=2.2), including 99 girls/young women, 42 boys/young men, and 8 transgender or nonbinary individuals. The majority were Caucasian and born in Canada. Qualitative and quantitative findings are reported, with thematic analysis combined with descriptive and inferential statistical analyses.Qualitatively, many youth reported increases or shifts in their substance use over the course of the pandemic. Youth reported using substances with limited numbers of peers, with family, or alone. Many reported using substances out of boredom and to cope. While legal substances remained highly accessible, illegal substances were reported to be more difficult to acquire and less trustworthy. Spending had increased. Quantitative findings suggested alcohol use has decreased, but other substance use has remained stable in the sample as a whole, although for each substance, some youth reported increases.Despite minimal quantitative change, qualitative findings show that some youth increased their use of some substances during the pandemic, decreased others, changed their motivation to use, and decreased in safety behaviors. Youth-serving organizations should be aware of individual differences, the changing context of substance use, and the potential long-term impacts.Compte tenu des implications importantes de la consommation de substances chez les jeunes, il est essentiel d’identifier, documenter et décrire l’évolution de la consommation de substances pendant la pandémie de COVID-19 afin d’élaborer des stratégies de prévention et des traitements efficaces.Cette étude d’enquête multiméthodes examine les impacts de la pandémie de COVID-19 sur la consommation de substances chez 149 jeunes canadiens qui consommaient des substances au milieu de la période de la pandémie. Les participants avaient 21,9 ans en moyenne (ET=2,2), dont 99 filles/jeunes femmes, 42 garçons/jeunes hommes et 8 personnes transgenres ou non binaires. La majorité des participants étaient caucasien et née au Canada. Les résultats qualitatifs et quantitatifs sont rapportés avec une analyse thématique combinée à des analyses statistiques descriptives et analogiques.Sur le plan qualitatif, de nombreux jeunes qui consommaient des substances pendant la pandémie ont signalé des augmentations ou des changements dans leur consommation de substances au cours de la pandémie. Les jeunes ont déclaré consommer des substances avec un nombre limité de pairs, en famille ou seul. De nombreux jeunes ont déclaré consommer des substances par ennui et pour faire face à la situation. Alors que les substances légales sont restées très accessibles, les substances illicites sont devenues plus difficiles à acquérir et moins dignes de confiance ce qui a entraîné une augmentation des dépenses. Les résultats quantitatifs suggèrent que la consommation d’alcool a diminué pour ces jeunes, mais la consommation d’autres substances est restée stable dans l’ensemble de l'échantillon, bien que pour chaque substance, certains jeunes ont signalé des augmentations.Malgré un changement quantitatif minime, les résultats qualitatifs montrent que chez les jeunes qui consommaient des substances au milieu de la période de la pandémie, certains jeunes ont connu une augmentation de la consommation de certaines substances pendant la pandémie, une diminution de leur consommation d’autres substances, des changements dans leur motivation à consommer des substances et une diminution des comportements sécuritaires. Les organisations au service des jeunes doivent être conscientes des différences individuelles, du contexte changeant de la consommation de substances et des impacts potentiels à long terme. Les prestataires de services devraient travailler avec les jeunes de manière centrée sur la personne pour identifier des solutions dans le contexte des expériences vécues en lien avec la COVID-19.

The objective of this paper was to examine the school-related experiences of youth during the COVID-19 pandemic. Participants represented both clinical and community youth aged 14 to 28 who were sampled as part of a larger study. Feedback from youth attending school during the pandemic was qualitatively examined and youth who planned to attend school prior to the pandemic and did ( n = 246) and youth who planned to attend but did not ( n = 28) were compared quantitatively. Youth appreciated the flexibility of online learning and some also reported experiencing a lack of support from their school and the need for instructor training on how to deliver virtual classes effectively. Future studies should examine what factors influence student engagement with virtual learning, what strategies could improve supports for student in their long-term career development, and the longitudinal experiences of youth who may have chosen not to go back to school due to the pandemic. This survey was conducted in Ontario, Canada. A more diverse sample collected outside of Ontario would improve generalizability. Qualitative data were based on survey responses and not interviews. Thus we were unable to discern the reasons youth decided to attend school, or not, during the COVID-19 pandemic.

BackgroundAmong patients diagnosed with COVID-19, a substantial proportion are experiencing ongoing symptoms for months after infection, known as ‘long COVID’. Long COVID is associated with a wide range of physical and neuropsychological symptoms, including impacts on mental health, cognition, and psychological wellbeing. However, intervention research is only beginning to emerge. This systematic review synthesizes currently registered trials examining interventions for mental health, cognition, and psychological wellbeing in patients with long COVID.MethodsStandard systematic review guidelines were followed. Trials registered in two large trial registries in 2020 to May 2022 were reviewed. Included studies were narratively synthesized by type of intervention and a risk-of-bias assessment was conducted.ResultsForty-two registered trials were included, with a total target sample size of 5814 participants. These include 11 psychological interventions, five pharmacological and other medical interventions, and five evaluating herbal, nutritional, or natural supplement interventions. An additional nine trials are examining cognitive and neurorehabilitation interventions and 12 are examining physiotherapy or physical rehabilitation. Most trials are randomized, but many are feasibility trials; trials are evaluating a wide spectrum of outcomes.ConclusionsWhile there is a newly emerging body of research testing interventions for mental health, cognition, and psychological wellbeing in long COVID, the breadth and scope of the research remains limited. It is urgently incumbent on researchers to expand upon the intervention research currently under way, in order to generate high-quality evidence on a wide range of candidate interventions for diverse long COVID patient populations.

Background Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges. Objective This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges. Method A total of 168 youth aged 14–24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic’s onset, then every two months between April 2020–2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics. Results There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories. Conclusions While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.

BACKGROUND The Family Connections™ (FC) program is a 12-week support and skill-training program for caregivers of youth with mental health challenges. The intervention was originally developed with a focus on borderline personality disorder (BPD). It is important to understand the experiences of caregivers in such interventions, as well as its applicability beyond BPD, for the purposes of evaluation and ongoing program improvement. OBJECTIVE To explore and analyse the experiences of caregivers of youth with diverse mental health challenges and who participated in FC. DESIGN Semi-structured interviews with thirteen FC-participating caregivers of youth with mental health challenges. RESULTS Thematic analysis uncovered three major themes regarding caregivers' experience with FC: (a) FC increased the caregivers' ability to manage their youth's mental health challenges; (b) participating in FC impacted their intra- and interpersonal spheres; and (c) improvements to the program were proposed. Following participation in FC, caregivers felt they learned a new approach to understanding themselves, their youth and mental health, and were better able to manage their youth's mental health challenges. DISCUSSION AND CONCLUSION FC is a promising intervention for caregivers of youth with mental health challenges, beyond the traditional BPD focus. The intervention has the potential to provide broad-based benefits for caregivers and should be considered for implementation and scale-up across youth- and caregiver-serving organizations. Potential areas of intervention flexibility and improvement are discussed. PATIENT/PUBLIC CONTRIBUTION Caregivers were involved in the program development and facilitation of FC. A person with lived experience was involved with the analysis.

Aim To examine mental health in conjunction with physical health during the COVID‐19 pandemic among youth with physical health conditions compared to those without. Methods A cross‐sectional survey of 622 youth aged 14 to 28 was conducted. Analyses were conducted to understand the changes in mental and physical health among youth in four groups: (a) participants with a friend or family member diagnosed with COVID‐19, (b) participants with symptoms associated with COVID‐19, (c) participants with atopic conditions (asthma and allergies), and (d) participants with other preexisting physical health conditions. Results Many participants with physical health concerns met screening criteria for an internalizing disorder, which was significantly higher than the rate found among participants without physical health conditions. Significantly greater declines in self‐reported mental health were observed during the COVID‐19 period compared to 3 months earlier among youth reporting physical health concerns compared to those without physical health concerns. Substance use does not appear to have been affected. Conclusions Mental health concerns are highly prevalent among youth with physical health concerns, and also appear to be exacerbated by the COVID‐19 pandemic. Physical health concerns appear to constitute risk factors for heightened mental health responses to the pandemic situation. System planners striving to adapt mental health services to meet social/physical distancing recommendations are urged to consider youth with physical health conditions and ensure that adequate integrated mental health and physical health supports are available to them.

Aim The issue of youth who are not engaged in education, employment or training has been a focus of policymakers for decades. Although interventions exist for these youth, they often measure success in ways that fail to capture what youth seek to gain. The project aims to address this gap by assessing youth-oriented outcomes for interventions targeting upcoming youth. Acknowledging the stigma attached to the deficit-based notion of not engaged in education, employment or training, hereafter we refer to 'upcoming youth', a term coined by youth partners on the project. This study asks what youth want to achieve by participating in an intervention for upcoming youth, with a view to guiding service and research design. Methods A mixed-methods discrete choice experiment will be conducted with youth engaged as partners. A qualitative (focus group) stage will be conducted to design discrete-choice experiment attributes and levels. The experiment will be piloted and administered online to approx. 500 youth (aged 14-29) across Canada to identify the outcomes that youth prioritize for interventions. Latent class analyses will then be conducted to explore clusters of outcomes that different groups of youth prioritize. Conclusions From a strengths-based recovery-oriented framework, hearing the voices of the target population is important in designing and evaluating services. This youth-oriented research project will identify the intervention outcomes that are the highest priority for upcoming youth. Findings will inform the development, implementation and testing of interventions targeting relevant outcomes for youth who are not engaged in education, employment or training.

Early cannabis use is associated with mental health and substance use (MHSU) challenges into adulthood. Given the vulnerability of youth who use cannabis, it is important to understand their clinical profiles and markers of risk. This cross-sectional descriptive study examines youth who began using cannabis during early adolescence compared to those who initiated at an older age.634 youth and emerging adults (age M = 19.5, SD = 2.3; 46.5% female) were assessed at intake in a Canadian youth mental health and concurrent disorder out-patient service. Measures of demographic characteristics and MHSU were compared for youth who initiated cannabis use under the age of 14 versus 14 years or over.Nearly 30% of youth initiated cannabis use before age 14. Those who initiated cannabis early were younger and had distinct psychosocial risk factors. They were more likely to use cannabis (p = .005), tobacco (p = .006), powder cocaine (p = .030), and/or benzodiazepines (p = .033) at a high frequency. If they used other substances, they were more likely to have begun using them younger (all p .001). Early initiators had more externalizing mental health symptoms (p = .024), crime/violence concerns (p .001), and past trauma (p = .001).Distinct, clinically meaningful differences emerged between youth who initiated cannabis use early versus later. Early cannabis use is associated with multiple, overlapping needs. Cannabis use and concurrent MHSU should be systematically assessed from an early age, and prevention/promotion efforts should take early onset into account.

Background While interventions have been developed and tested to help youth who have become disconnected from work and school, there is a paucity of research on young people’s intervention preferences. This study aims to understand young people’s preferred intervention outcomes and approaches for youth who are out of work and school. Methods Thirty youth participated in virtual focus groups. Transcripts were analyzed using thematic analysis. Results Youth want interventions and approaches that support them in (1) vocational readiness, (2) securing a job, and (3) mental health and well-being, while providing them with (4) high-contact, individualized, and integrated support. Conclusions Young people want interventions to be individualized and integrated, providing a high level of support for their educational and employment pursuits as well as their mental health and well-being. Incorporating youth's perspectives when designing interventions can increase intervention relevance and potentially service uptake, helping youth continue to pursue their educational and vocational goals.

Background Problem-solving training is a common ingredient of evidence-based therapies for youth depression and has shown effectiveness as a versatile stand-alone intervention in adults. This scoping review provided a first overview of the evidence supporting problem solving as a mechanism for treating depression in youth aged 14 to 24 years. Methods Five bibliographic databases (APA PsycINFO, CINAHL, Embase, MEDLINE, Web of Science) and the grey literature were systematically searched for controlled trials of stand-alone problem-solving therapy; secondary analyses of trial data exploring problem-solving-related concepts as predictors, moderators, or mediators of treatment response within broader therapies; and clinical practice guidelines for youth depression. Following the scoping review, an exploratory meta-analysis examined the overall effectiveness of stand-alone problem-solving therapy. Results Inclusion criteria were met by four randomized trials of problem-solving therapy (524 participants); four secondary analyses of problem-solving-related concepts as predictors, moderators, or mediators; and 23 practice guidelines. The only clinical trial rated as having a low risk of bias found problem-solving training helped youth solve personal problems but was not significantly more effective than the control at reducing emotional symptoms. An exploratory meta-analysis showed a small and non-significant effect on self-reported depression or emotional symptoms (Hedges’ g = − 0.34; 95% CI: − 0.92 to 0.23) with high heterogeneity. Removing one study at high risk of bias led to a decrease in effect size and heterogeneity (g = − 0.08; 95% CI: − 0.26 to 0.10). A GRADE appraisal suggested a low overall quality of the evidence. Tentative evidence from secondary analyses suggested problem-solving training might enhance outcomes in cognitive-behavioural therapy and family therapy, but dedicated dismantling studies are needed to corroborate these findings. Clinical practice guidelines did not recommend problem-solving training as a stand-alone treatment for youth depression, but five mentioned it as a treatment ingredient. Conclusions On its own, problem-solving training may be beneficial for helping youth solve personal challenges, but it may not measurably reduce depressive symptoms. Youth experiencing elevated depressive symptoms may require more comprehensive psychotherapeutic support alongside problem-solving training. High-quality studies are needed to examine the effectiveness of problem-solving training as a stand-alone approach and as a treatment ingredient.

BACKGROUND There are growing calls to engage service users in research about issues relevant to them. Youth and family members can make meaningful contributions to research projects, improving quality and relevance. However, more information is needed on the contributions that youth and family members can make to various study designs. OBJECTIVE This paper describes the contributions that youth and family members have made to a multi-site pragmatic randomized-controlled trial, YouthCan IMPACT, and the way project-based engagement learnings accelerated change at the institutional level and beyond. RESULTS Youth and family members were full members of the project team, including the project's core governance and working groups. They contributed to project leadership, as funding co-applicants and as equal members of the governance team. They were also engaged in study design. Youth defined the primary outcome measure and contributed to decisions on all secondary measures. The service pathway was co-designed with youth and family members; for example, they guided the inclusion of peer support and a family member intervention as core service components. Study implementation contributions included ensuring a youth- and family-friendly research process and training research staff on working with youth and family members. Knowledge translation activities have included youth and family members as co-presenters and manuscript co-authors. The learnings from this trial have been leveraged to expand youth and family engagement at the institution and beyond. CONCLUSIONS Youth and family members make substantial contributions to complex research projects, including randomized-controlled trials, thereby improving project design, study implementation, associated interventions, and knowledge translation.

IntroductionFor some people, COVID-19 infection leads to negative health impacts that can last into the medium or long term. The long-term sequelae of COVID-19 infection, or ‘long COVID’, negatively affects not only physical health, but also mental health, cognition or psychological well-being. Complex, integrated interventions are recommended for long COVID, including psychological components; however, the effectiveness of such interventions has yet to be critically evaluated. This protocol describes a systematic review to be conducted of scientific literature reporting on clinical trials of interventions to promote mental health, cognition or psychological well-being among individuals with long COVID.Methods and analysisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed. A health sciences librarian will identify the relevant literature through comprehensive systematic searches of Medline, Embase, APA PsycINFO, Cumulative Index to Nursing and Allied Health Literature, medRxiv, PsyArXiv, China National Knowledge Internet and WANFANG Data databases, as well as The Cochrane Central Register of Controlled Trials, clinicaltrials.gov and the WHO International Clinical Trials Registry Platform. Studies will be selected through a title and abstract review, followed by a full-text review using inclusion and exclusion criteria. Data extracted will include intervention descriptions and efficacy metrics. Data will be narratively synthesised; if the data allow, a meta-analysis will be conducted. Risk of bias assessment will be conducted using the Cochrane Risk of Bias 2.0 tool.Ethics and disseminationEthical approval for systematic reviews is not required. As researchers and clinicians respond to the new clinical entity that long COVID represents, this review will synthesise a rapidly emerging evidence base describing and testing interventions to promote mental health, cognition or psychological well-being. Results will therefore be disseminated through an open-access peer-reviewed publication and conference presentations to inform research and clinical practice.Prospero registration numberCRD42022318678

Introduction There is paucity of research on treatment-related coercion in youth: most research focuses on adult populations and legally mandated treatment. This study aims to examine the service-seeking profiles of youth with substance misuse issues who report a legal mandate or perceived coercion to enter treatment. Methods Differences between youth who were legally mandated and not legally mandated, and differences between youth reporting high and low perceived coercion, were examined for demographic characteristics, mental health and substance use profiles, motivation, and readiness to change. Results Compared to participants reporting low perceived coercion, those experiencing high perceived coercion reported more substance use problems, greater mental health needs, and greater external and introjected motivation. Legally mandated youth reported fewer mental health issues, lower identified motivation, and greater readiness to change than those reporting no legal mandate. Discussion Many youth who present for substance use services report experiencing a sense of coercion, which suggests the potential importance of considering youth-centered strategies for involving youth in treatment planning and the development of treatment goals. Youth seeking treatment also have multiple intersecting needs which may benefit from a collaborative and integrative approach.

Background The design and implementation of community-based integrated youth service hubs (IYSHs) is burgeoning around the world. This collaborative model of care aims to address barriers in youth service access by designing services that meet the needs of youth and caregivers. However, heterogeneity across models requires a better understanding of the preferences for key service characteristics. Method A discrete choice experiment was conducted among 274 caregivers of youth aged 14–29 years with mental health challenges. The experiment consisted of 12 attributes with four levels each, representing different service components; additional measures were collected, including demographics and burden assessments. Utility values were calculated, representing the degree of preference for a given level of an attribute. Latent class analysis was conducted to understand subgroups with different service preferences, identifying three latent classes with differing IYSH service preferences. Results The largest class (n = 173, 63.1%), entitled ‘Comprehensive, Integrative Service Access’, strongly valued practical aspects of service design, such as rapid access and support for a wide range of needs. The ‘Service Process Features’ class (n = 67, 24.5%) expressed a relative prioritization of process features of service access, while the smaller ‘Caregiver Involvement’ (n = 34, 12.4%) class most highly prioritized caregiver involvement in their youths’ services. Similar demographic characteristics and caregiver burden were found across classes, although participants in the Caregiver Involvement latent class were supporting younger youth. Discussion and Conclusions Caregivers have diverse youth service preferences and relative priorities that should be taken into account when designing services. System designers and service providers are encouraged to take caregivers’ preferences and priorities into account, alongside youth priorities, whether designing service delivery models or an individual service plan for a youth. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00510-6.

Objective To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients’ and family caregivers’ meaningful engagement as partners in research projects. Methods A prospective cross‐sectional web‐based survey in Canada and the USA, and also paper‐based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. Results 119 participants: 99 from Canada, 74 female, 51 aged 17‐35 years and 50 aged 36‐65 years, 60 had post‐secondary education, and 74 were Caucasian/white. The original 37‐item PEIRS was shortened to 22 items (PEIRS‐22), mainly because of low inter‐item correlations. PEIRS‐22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS‐22 scores revealed the following: (1) acceptable floor and ceiling effects (

This study characterizes patterns of mental health, substance use and their co-occurrence, and identifies developmental trajectories associated with progression from single to concurrent mental health and substance use concerns in an Ontario school-based population. It is a longitudinal extension of the Ontario Student Drug Use and Mental Health Survey, as part of the RAFT collaborative project.In this study, an Ontario-wide survey was administered to students across three biennial waves starting in grades 7-8 (ages 12-14). We explored how developmental patterns of externalizing, internalizing and co-occurring symptoms were differentially associated with late-adolescent (ages 17-19) problematic substance use.On average, students exhibited early (ages 12-14) moderate risk of an internalizing and/or externalizing disorder and approached the low threshold for a diagnostic concern for substance use disorder at age 17-19. The pattern confirmed a potential pathway from early mental health concerns to later adolescent problematic substance use, with rates of co-occurrence increasing with age. Youth with early moderate-to high externalizing and co-occurring internalizing and externalizing symptomology had the highest levels of problematic substance use, with scores indicating high likelihood of a substance use disorder diagnosis.Given the overall pattern of progression, early identification and referral of at-risk youth, especially youth with co-occurring mental health concerns, is of critical importance. Findings support the importance of integrated and co-located mental health and substance use services for youth to more effectively serve a diverse population of youth with varying levels of need.La présente étude caractérise les modèles de santé mentale, l’utilisation de substances et leur cooccurrence, et identifie les trajectoires développementales associées à la progression des problèmes isolés à concurrents de santé mentale et d’utilisation de substances dans une population scolaire de l’Ontario. Il s’agit d’une extension longitudinale du Sondage sur la consommation de drogues et la santé des élèves de l’Ontario, dans le cadre d’un projet RAFT de collaboration.Dans la présente étude, un sondage a été administré à l’échelle de l’Ontario à des élèves de trois vagues biennales commençant en 7En moyenne, les élèves montraient un risque modéré précoce (de 12 à 14 ans) d’un trouble d’internalisation et/ou d’externalisation et s’approchaient du seuil bas d’un problème diagnostique d’utilisation de substances entre 17 et 19 ans. Le modèle confirmait une trajectoire potentielle allant de problèmes précoces de santé mentale à l’apparition ultérieure d’une utilisation de substances problématique, avec des taux de cooccurrence augmentant avec l’âge. Les jeunes ayant une externalisation modérée à élevée et une symptomatologie d’internalisation et d’externalisation co-occurrentes avaient les taux les plus élevés d’utilisation de substances problématique, leurs scores indiquant une probabilité élevée d’un diagnostic de trouble d’utilisation de substances.Étant donné le modèle de progression général, l’identification précoce et l’aiguillage d’un jeune à risque, surtout les jeunes présentant des problèmes de santé mentale co-occurrents, sont d’une importance vitale. Les résultats appuient l’importance des services intégrés et en colocation de santé mentale et d’utilisation de substances pour les jeunes afin de servir plus efficacement une population de jeunes diversifiée dont les besoins sont de niveaux variés.

Child fireplay may be regarded as developmentally appropriate, yet can negatively impact those who engage in it and those around them. This study discusses the mental health, fire-specific, and psychosocial risk factors of children who set fires. Fifty-seven caregivers reported on their children’s demographics, firesetting behaviors, mental health symptoms, and family history. Children were aged 2–6 years and the majority were male. Most children used lighters and matches on paper and small objects. The majority of the children were motivated by curiosity. Children who set more fires had more externalizing symptoms, and were more likely to have accomplices, to have been exposed to firesetting media, and to have been disciplined or punished for their firesetting behaviors. The study identifies important psychosocial risk factors among young children who set fires. Given the long-term implications of firesetting, understanding firesetting in children will set the foundation of intervention and prevention models.

Background Cannabis is a highly used substance among youth, but has the potential to negatively impact the developing brain. Recreational cannabis use was legalized in Canada in October 2018. This exploratory study examines cannabis use profiles of high-risk youth before and after the national legalization of recreational cannabis use. Method This cross-sectional cohort study examines the cannabis use profiles of two cohorts of youth, one recruited prior to legalization (N = 101) and one recruited after legalization (N = 168). Results This study found few changes in cannabis use patterns after legalization. The rate of high-frequency cannabis use, polysubstance use, social circles of use, and mental health and substance use challenges showed no change, and the study found no associations with age. Exceptions were that youth were more likely to report purchasing cannabis from a legal source after legalization. Concealment of cannabis use from legal authorities declined after legalization among youth over the age of majority (19+ years), but not among younger youth ( Conclusions Minimal changes have occurred in the cannabis use patterns of service-seeking youth in the short term following legalization. This holds true both for youth who have reached the age of majority and those who have not. Nevertheless, this population has overlapping substantial mental health and substance use challenges. Integrated services should address cannabis use and other concurrent challenges and be sensitive to the postlegalization social climate.

Background: Schema theory, developed for chronic, treatment-resistant patients, has been largely applied to personality disorders. However, many patients with other psychiatric disorders, including mood and anxiety disorders, also demonstrate elevated early maladaptive schemas mas (EMSs). Based on schema theory and clinical observations, individuals with greater case complexity would be expected to demonstrate higher EMS activation. Aim: This study examines EMSs as a function of case complexity in individuals with mood and anxiety disorders. Method: 69 patients consulting for mood or anxiety disorders completed the YSQ-S3 and a thorough intake assessment. The relationship between EMSs and case complexity is explored.Results: Although some EMSs are more strongly activated as a function of comorbidities and degree of functional impairment, the greatest difference is a function of multiaxial case complexity. Conclusion: Complex clinical presentations are associated with EMS activation. Case complexity should be considered when applying schema theory to mood and anxiety disorders. Schema therapy may be a useful treatment alternative particularly for the more complex plex cases.Keywords: early maladaptive schemas; cognitive schemas; mood disorders; anxiety disorders; comorbiditySchema theory is an integrative theory developed to explain treatment-resistant psychological problems with a characterological underpinning (Young, 1990; Young, Klosko, & Weishaar, 2003). Consistent with Beckian cognitive theory, schema theory proposes that early experiences shape individuals' beliefs about themselves, the world and others, and that their impacts go on to influence behavior in adulthood. However, schema theory adds a broader conception of the developmental origins of the biases seen among people with severe psychopathology. It also expands the notion of schemas.At the heart of schema theory are "early maladaptive schemas" (EMSs), considered stable character traits that develop in reaction to toxic childhood experiences. The EMSs extend beyond cognition to incorporate emotions, memories, and bodily sensations. Young et al. (2003) have identified 18 different EMSs to date, each with its own proposed origin and long-term impact. The 18 EMSs are described in Table 1. A broad range of studies have demonstrated that EMSs are highly activated in a wide range of clinical populations (e.g., Halvorsen et al., 2009; Hawke & Provencher, 2012b; Renner, Lobbestael, Peeters, Arntz, & Huibers, 2012). Multiple studies have also confirmed that EMSs mediate the relationship between parenting style and the symptoms of depression and anxiety in adulthood, supporting the developmental aspect of the theory (e.g., Harris & Curtin, 2002; McGinn, Cukor, & Sanderson, 2005; Wright, Crawford, & Del Castillo, 2009).Schema theory has been widely associated with personality disorders, whereas EMSs have been clearly demonstrated to be elevated in this category of disorders (e.g., Jovev & Jackson, 2004). However, the theory also extends to mood and anxiety disorders (Hawke & Provencher, 2011). In fact, Young et al. (2003) propose that EMSs underlie chronic symptoms of depression and anxiety. Lending support to this notion, various studies have found that heightened EMS activation is associated with the general symptoms of depression and anxiety, as well as fully diagnosable depressive and anxiety disorders (Hawke & Provencher, 2011). Yet, schema activation is not limited to purely psychiatric disorders. Higher EMS scores have also been found among respondents who have physical health problems with a psychological component, such as chronic pain and obesity (Anderson, Rieger, & Caterson,2006; Saariaho, Saariaho, Karila, & Joukamaa, 2009). Furthermore, one preliminary investigation suggested an association between EMSs and global functional level (Hawke & Provencher, 2010).Given that schema theory was developed specifically for patients who are resistant to traditional cognitive behavioral therapy and who have considerable characterological issues underlying their diagnosed disorder, it would appear likely that EMSs would apply more strongly to complex, comorbid cases. …

Introduction Opioid misuse among youth is a significant concern given its potential negative consequences; yet youth who use opioids continue to face challenges in seeking treatment. The goal of this study was to understand the demographics, mental health, and substance use and co-occurring concerns of service-seeking youth with opioid use to inform future services and research. Methods This study characterized 1769 youth between 14 and 24 years old seeking services at an urban treatment facility in Toronto, Ontario (ON) between 2008 and 2019. Youth who could adequately read English, had no immediate psychiatric service needs, provided research consent, and responded to a question about opioid use history were eligible. Participants provided information on demographics, substance use, mental health, and treatment motivation. Results Youth who use opioids were more likely to report challenges with social determinants of health, use more substances, initiate substance use earlier, and use some substances at a higher frequency than youth who do not use opioids. Youth with opioid use reported more co-occurring mental health and substance use concerns than youth with no opioid use. They also endorsed more trauma and a likely PTSD diagnosis. Not being in employment, education, or training and using a higher number of substances positively predicted youth opioid use. In terms of treatment motivation, youth who use opioids endorsed more internal forms of motivation than youth who do not use opioids. Conclusions Youth who use opioids have complex social and co-occurring mental health and substance use needs that may be addressed with integrated community-based services. Future research should focus on developing evidence-based opioid treatment programs in this context and other innovative platforms.

Objective This study examined cross-informant evidence for a general factor of psychopathology (“P”) and a narrower, clinically oriented dysregulation general factor based on the Dysregulation Profile (“DP”) in a large clinical sample of children and adolescents. We also compared the magnitude of P and DP general factor associations with self-harm and suicidal ideation as an indicator of criterion validity. Method Itemwise data from the Child Behavior Checklist (N = 2,934; 4−18 years of age) were analyzed using confirmatory bifactor modeling and replicated in a supplementary analysis using Youth Self Report data (N = 2,395). Results General P and DP bifactor models fit the data better than single-factor and correlated factor models. Cross-informant criterion analyses on a subset of youth (n = 1,552) suggested that whether modeled as latent P or DP, associations with a brief composite index of self-harm and suicidal ideation are essentially of the same magnitude. Conclusion Our findings provide novel, large-sample support for the existence of general factors of psychopathology and dysregulation in clinically referred children and adolescents using a standardized rating system of psychopathology symptoms. Moreover, our results provide preliminary evidence that general psychopathology and dysregulation factors are clinically meaningful constructs. In addition, our findings raise the possibility that the DP general factor may serve as an efficient proxy for the general psychopathology factor in future clinical applications. Further efforts are necessary to understand the core empirical meaning of the P factor and to determine how it can be applied to clinical assessment and intervention.

Context Engaging youth as partners in academic research projects offers many benefits for the youth and the research team. However, it is not always clear to researchers how to engage youth effectively to optimize the experience and maximize the impact. Objective This article provides practical recommendations to help researchers engage youth in meaningful ways in academic research, from initial planning to project completion. These general recommendations can be applied to all types of research methodologies, from community action‐based research to highly technical designs. Results Youth can and do provide valuable input into academic research projects when their contributions are authentically valued, their roles are clearly defined, communication is clear, and their needs are taken into account. Researchers should be aware of the risk of tokenizing the youth they engage and work proactively to take their feedback into account in a genuine way. Some adaptations to regular research procedures are recommended to improve the success of the youth engagement initiative. Conclusions By following these guidelines, academic researchers can make youth engagement a key tenet of their youth‐oriented research initiatives, increasing the feasibility, youth‐friendliness and ecological validity of their work and ultimately improve the value and impact of the results their research produces.

ObjectiveThis study analyses longitudinal data to understand how youth mental health and substance use are evolving over the course of the COVID-19 pandemic, which is critical to adjusting mental health response strategies.SettingParticipants were recruited from among existing participants in studies conducted in an urban academic hospital in Ontario, Canada.ParticipantsA total of 619 youth aged 14–28 years participated in the study (62.7% girls/young women; 61.4% Caucasian).MeasuresData on mood, substance use and COVID-19-related worries were collected over four time points, that is, every 2 months beginning in the early stages of the pandemic in April 2020. Latent class analyses were conducted on the longitudinal data to identify distinct groups of youth who have different trajectory profiles of pandemic impact on their mood, substance use and COVID-19-related worries.ResultsFor the majority of participants, mood concerns increased early in the pandemic, declined over Canada’s summer months and subsequently increased in autumn. Among the youth with the highest level of mood symptoms at the beginning of the pandemic, increases in mental health concerns were sustained. Substance use remained relatively stable over the course of the pandemic. COVID-19-related worries, however, followed a trajectory similar to that of mood symptoms. Girls/young women, youth living in urban or suburban areas, in larger households, and with poorer baseline mental and physical health are the most vulnerable to mental health concerns and worries during the pandemic.ConclusionsYouth mental health symptom levels and concerns are evolving over the course of the COVID-19 pandemic, in line with the evolution of the pandemic itself, and longitudinal monitoring is therefore required. It is also essential that we engage directly with youth to cocreate pandemic response strategies and mental health service adaptations to best meet the needs of young people.

Background The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines. Methods Several government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities. Results 413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13–17 (70%) and transition aged youth (18–25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities. Conclusions This study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.

Background The worldwide prevalence of depressive disorders among children and youth has been reported in ranges from just under 3% to over 10%. In Canada, 7% of youth report past year depression, which is higher than any other age demographic. Yet, many of these youth do not receive evidence based interventions, increasing their risk for serious lifetime consequences. To better understand low service use, it is crucial to map and evaluate current services. This study aimed to determine the scope and nature of services available to depressed children and youth, and compare services to best evidence treatment guidelines. Methods Several government and non-government resources were utilized to develop a new multi-sectoral database of depression services for children and youth across Ontario. An online survey was sent to program managers serving children/youth with depression, examining agency characteristics, populations served, services provided, patterns of service use, evaluation activities, and research priorities. Results 413 agencies with 869 program managers participated, representing mental health, addictions and other sectors. Age groups served included children up to 12 years of age (31%), adolescents aged 13-17 (70%) and transition aged youth (18-25 years) (81%). Over half of respondents worked in the mental health (43.4%) or mental health and addiction (24.4%) sectors. The most frequently provided services were assessment, psychotherapy, case management, and psychoeducation; the most common types of psychotherapy provided included cognitive behavioral therapy, social skills training, and solution-focused therapy. Psychotherapies are offered in widely varying formats, frequencies and durations. Discontinuation rates varied, with higher discontinuation among transition aged youth as compared to children. Respondents identified effective treatment, improving access, and reducing service gaps as top future research priorities. Conclusions This study provides important new data on service provision and uptake for depressed children and youth. Comparing these results with best-evidence practice guidelines raises significant concerns about the services most commonly offered and their delivery formats. In addition, high early discontinuation rates raise questions about the service experiences of children, youth and their families. Other factors which may contribute to ongoing treatment engagement challenges include access barriers, service or client characteristics, and unintentional treatment impacts.

In order to improve the youth mental health system, there is an international movement toward developing community-based service hubs that provide integrated, collaborative care to youth. However, the implementation of multisystem collaboration is complex and can be hampered by barriers. This paper presents a formative evaluation of the YouthCan IMPACT integrated youth services project based on the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers to successful implementation. Results highlight that previous positive working relationships along with collaborative investment of resources from partnering organizations are essential to implement an integrated youth service model. In addition, it is important that representative members of all key stakeholder groups, including staff, youth, and caregivers, be involved in the development and execution of the project to ensure effective implementation. Attention to the facilitators and barriers to implementation may help teams seeking to implement highly collaborative, integrated models of service delivery for youth in the community.

Background Community-based, integrated youth service hubs have the potential to address some of the longstanding issues with mental health services for youth, including problems with access and system fragmentation. Better understanding of these approaches, particularly efforts to create a single point of entry to comprehensive, evidence-based services through youth service hubs, is needed to help guide future implementation and evaluation. This scoping review identifies the key principles and characteristics of these models of care, as well as the state of the literature, particularly with regard to implementation and replicability. Method Electronic databases and grey literature sources were searched for material from 2001 to 2019, with diverse search terms capturing the concept of “integrated” or “one-stop shop” youth mental health services. Title/abstract and full text review were conducted, as well as additional focused searching. After screening 4891 texts at the title/abstract level and 496 at the full-text level, 110 documents were included for data extraction. Results Several integrated care hub models for youth mental health services and related frameworks were identified internationally, largely in high-income countries. Common principles included an emphasis on rapid access to care and early intervention, youth and family engagement, youth-friendly settings and services, evidence-informed approaches, and partnerships and collaboration. Program characteristics also revealed similarities (e.g., providing evidence-informed or evidence-based services in youth-friendly spaces), with some differences (e.g., care coordination methods, types of service providers), potentially attributable to lack of available information about key ingredients. Outcome research was limited, with few rigorous evaluations of youth outcomes. Moreover, sufficient information for replication, community evaluation of feasibility or actual implementation was rarely provided. Conclusion Internationally, integrated youth service hubs were found to share common key principles, while providing comprehensive services to youth with mental health difficulties. There is a great need for common language and measurement framework to facilitate replication, rigorous evaluation of outcomes, knowledge exchange, and dissemination of findings.

Background Youth with concurrent substance use and mental health concerns have diverse psychosocial needs and may present to a multitude of clinical and social service sectors. By integrating service sectors at a system level, the diversity of needs of youth with concurrent disorders can be addressed in a more holistic way. The objective of the present study was to quantify the level of cross-sectoral integration in youth-focused services in Canada. Methods Social network analysis (SNA) was used to examine the relationships between eight sectors: addictions, child welfare, education, physical health, housing, mental health, youth justice, and other social services. A total of 597 participants representing twelve networks of youth-serving agencies across Canada provided information on their cross-sectoral contacts and referrals. Results Overall, results suggested a moderate level of integration between sectors. The mental health and the addictions sectors demonstrated only moderate integration, while the addictions sector was strongly connected with the youth justice sector. Conclusions Despite evidence of moderate integration, increased integration is called for to better meet the needs of youth with concurrent mental health and substance use concerns across youth-serving sectors. Ongoing efforts to enhance the integration between youth-serving sectors should be a primary focus in organizing networks serving youth with concurrent mental health and substance use needs.

KEY POINTS In Canada, some 20% of youth experience mental health and addiction disorders,[1][1] yet rapid access to developmentally sensitive, evidence-based care is limited. Youth and caregivers consider Ontario’s system of care for mental health and addiction disorders in youth to be fragmented

Cannabis use among youth is of significant concern given the potential negative health impacts on young people. This study describes the mental health characteristics, cannabis use, and substance use profiles of youth aged 14 to 24 years seen at the Youth Addiction and Concurrent Disorders Service at the Centre for Addiction and Mental Health, through an age and gender lens. Almost all participating youth indicated lifetime cannabis use. Substance use and mental health profiles among those indicating a history of cannabis use differed along sex and age. Male youth were more likely to use cannabis more frequently, while female youth were more likely to use greater variety of substances and display more co-occurring mental health problems. Adolescent problematic substance use tended to co-occur with externalizing problems whereas problematic young adult substance use tended to co-occur with internalizing problems. Implications for the integrated, coordinated care of substance use and mental health concerns, with attention to the unique needs of subgroups of youth, are discussed.

IntroductionTo better reach youth in need of mental health and addiction (MHA) services, there is increasing emphasis on making MHA services ‘youth friendly.’ However, it is unclear what youth friendliness means on a practical level. This scoping review explores (1) how youth friendliness in mental health services is defined in the literature, (2) what characteristics make MHA services youth friendly and (3) how youth friendliness is expected to impact service use by young people.MethodsA search will be conducted of eight electronic bibliographic databases over the last 15 years (2002–2017) to identify literature on youth friendliness consistent with the modern youth experience. Grey literature will also be searched. The search and literature selection process will include all study designs, as well as non-research literature. Two independent raters will determine eligibility based on a review of the titles and abstracts of the identified literature, followed by full text reviews when required. Data will be extracted from the identified literature and then synthesised using qualitative and quantitative approaches. As a final step, we will conduct stakeholder consultations with youth, family members and service provider groups to validate the findings and identify any characteristics of youth friendliness that they deem important that were not reported in the findings.Ethics and disseminationResults will be disseminated through a peer-reviewed publication, as well as international, national and local conference presentations. Agency reports will be developed to present the findings in a user-friendly format, including a youth-friendliness checklist for youth-serving organisations. Research ethics approval has been obtained for the consultation component of this study.

Introduction Efforts to move towards integrated care have been met with increased interest and enthusiasm in recent years given the potential to improve care and population health while containing costs. However, there is a need to better understand community-based integrated care approaches for youth with mental health and/or addiction concerns to guide future implementation efforts and develop a set of standards for key components. The objectives of this scoping review are to: (1) identify the populations, settings, service providers, interventions, infrastructure and care coordination methods that have been included in integrated care for youth with mental health and/or addiction needs and (2) identify constructs that have been measured and evaluated (eg, outcomes, engagement) in the context of youth integrated care. Methods and analysis Seven electronic databases and several grey literature sources will be searched for material from 2001 to 2016. Inclusion criteria will be broad with respect to type of work, as we will include all types of research studies as well as non-research studies that provide information relevant to characteristics and constructs measured in the context of integrated care for youth mental health. Titles and abstracts will be independently screened for eligibility by two raters using inclusion criteria. Full-text articles will then be accessed and independently screened for inclusion. A formal data extraction method will be employed, enabling synthesis of results in quantitative and qualitative formats. Ethics and dissemination Results will be widely disseminated to various stakeholders to inform implementation and research efforts. Findings will also launch a Delphi method study leading to the development of an assessment tool for youth mental health services integration. This review does not require ethics approval.

Background Youth who are not engaged in employment, education or training (NEET) face multiple health, economic and psychosocial challenges. Despite the popularity of the NEET metric internationally, there is a paucity of research describing Canadian NEET youth. Method The proportion of NEET youth aged 12 to 24 presenting for services across multiple service sectors in Canada was examined. Their sociodemographic characteristics and mental health concerns were compared with those of their non-NEET peers. Results Over a quarter of youth were NEET, and they presented for services across all sectors. NEET youth showed multiple psychosocial risk factors. They were also more likely to endorse substance use and crime/violence concerns than their non-NEET service-seeking counterparts. Gender-based differences were observed. Discussion Since many youth presenting for services across sectors are NEET, youth-serving agencies should be prepared to offer a wide range of services to address their diverse needs. Implications for systematic screening and integrated service provision are discussed.

Various efficacious psychosocial interventions for Bipolar Disorder (BD) share common elements, with psychoeducation being a main component. Recent treatment guidelines for BD recommend psychoeducation, especially when delivered in brief, cost-effective formats. Its format has several implications for the feasibility of its dissemination in the health care system. The Life Goals Program (LGP) is an evidence-based, cost-effective psychoeducational treatment for BD. Despite its demonstrated benefits for patients and the healthcare system, most patients do not have access to this type of treatment. The goal of this study is to examine the dissemination of the LGP and its effectiveness in three community mental health care centers in Quebec, Canada. A sample of 15 healthcare service providers received thorough training in the delivery of the LGP and delivered the treatment to 73 patients with BD. The treatment consisted of six 90-minute sessions described in the treatment manual with session six being repeated with a family member attending. Treatment integrity and clinical effectiveness were assessed with objective measures. The intervention was successfully implemented, with high rates of treatment fidelity and positive impacts on clinical outcomes. Patients demonstrated marked gains in knowledge about BD, increased acceptance of the illness, reductions in depressive symptoms and improvements in medication behaviors. Treatment effect sizes were moderate to large. Results show that the LGP can be successfully implemented in routine mental health settings given the brief format of the intervention, its proven cost effectiveness, and its less extensive training requirements.

Background: Stigma toward people with bipolar disorder (BD) is pervasive and can have many negative repercussions. Common approaches to stigma reduction include education and intergroup contact. From this perspective, the Collaborative RESearch Team to study psychosocial issues in Bipolar Disorder (CREST.BD) and Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to develop an intervention to combat stigma. The result is a personal narrative intervention that combines contact, education and drama to educate audiences and dispel the myths that drive stigma. Aim: This study reports on the impact of the CREST.BD-CANMAT stigma-reduction intervention in filmed format. Methods: A sample of 137 participants was recruited to view the film, including health-care service providers, university students in a health-care-related course, people with BD and their friends and family members and the general public. Participants were evaluated for stigmatizing attitudes and the desire for social distance before and after the intervention and 1 month later. Results: For health-care service providers, the intervention was associated with statistically significant improvements in several categories of stigmatizing attitudes, with maintenance 1 month later. The impact was more modest for the other subsamples. Students demonstrated progressive, significant improvements in the desire for (less) social distance. Some improvements were observed among members of the BD community and the general public, but these were limited and eroded over time. Conclusion: This study demonstrated that a filmed dramatic intervention based on the lived experience of BD has statistically significant, sustainable stigma-reduction impacts for health-care service providers and more limited impacts for other target groups. This intervention can be considered an effective tool for use in stigma-reduction campaigns specifically targeting members of the health-care sector. Results are discussed in the context of multi-component stigma-reduction campaigns and the potential needs of target groups.

Background Psychiatric stigma is pervasive injustice that complicates the course of illness and reduces quality of life for people with mental illnesses. This article reviews the research examining stigma towards bipolar disorder (BD) with a view to guiding the development of stigma reduction initiatives and ongoing research. Methods PsychInfo, Medline, and Embase databases were searched for peer-reviewed studies addressing stigma in BD. Results Stigma is a serious concern for individuals with BD and their families. Stigma occurs within affected individuals, families, social environments, work and school environments, and the healthcare industry. With stigma often come a loss of social support and occupational success, reduced functioning, higher symptom levels and lower quality of life. BD stigma is comparable to that of other severe mental illnesses, such as schizophrenia. Few interventions are available to specifically target stigma against BD. Limitations Most studies have used explicit, attitude-based measures of stigma without controlling for social desirability, which may not translate into real-world stigmatizing behaviors. Furthermore, many studies have not clearly delineated results in a manner consistent with the conceptual framework of stigmatization. Conclusions Stigma toward BD is ubiquitous and has insidious consequences for affected individuals and their families. Stigma reduction initiatives should target individuals living with BD, their families, workplaces, and the healthcare industry, taking into account the experiences and impacts of BD stigma to improve social support, course of illness, and quality of life.

Objective: To examine the impact of anxiety disorders comorbid to bipolar disorder (BD) in a large, nationally representative sample, to describe the sociodemographic and clinical profiles of Canadians living with BD and with or without comorbid anxiety disorders, to identify the characteristics uniquely associated with comorbid anxiety, and to examine treatment patterns.Method: We analyzed data from the Canadian Community Health Survey: Mental Health and Well-Being, conducted among 38 492 Canadians. People meeting the criteria for BD (η = 808) were compared based on the presence or absence of an assessed anxiety disorder (that is, social phobia, panic disorder, and agoraphobia).Results: People with BD and a comorbid anxiety disorder fare worse in terms of BD relapses, suicidality, and sleep disturbance, and are more likely to be taking psychiatric medication. They have more impairment in their work and social functioning and rate their health and life satisfaction lower. Despite the greater severity, they are not receiving additional psychological treatment, they feel they are not receiving the treatment they need, and they report more barriers to treatment.Conclusions: This study confirms the critical impact of comorbid anxiety on the course of BD in a large, nationally representative sample and reveals that the psychological treatment needs of this population are not being met. Clinical and research implications are discussed.Key Words: bipolar disorder, anxiety disorders, comorbidityReceived September 2012, revised, and accepted November 2012Troubles anxieux comorbides chez les Canadiens souffrant de trouble bipolaire : caracteristiques cliniques et utilisation des servicesObjectif : Examiner l'effet des troubles anxieux comorbides sur le trouble bipolaire (TB) dans un vaste echantillon representatif national, decrire les donnees sociodemographiques et les profils cliniques des Canadiens vivant avec le TB avec ou sans troubles anxieux comorbides, identifier les caracteristiques uniquement associees a l'anxiete comorbide, et examiner les modeles de traitement.Methode : Nous avons analyse les donnees du volet Sante et bien-etre de l'Enquete sur la sante dans les collectivites canadiennes, menee aupres de 38 492 Canadiens. Les personnes satisfaisant aux criteres du TB (η = 808) ont ete comparees en fonction de la presence ou de l'absence d'un trouble anxieux evalue (c'est-a-dire, phobie sociale, trouble panique, et agoraphobie).Resultats : Les personnes souffrant de TB et d'un trouble anxieux comorbide s'en tirent moins bien en ce qui concerne les rechutes de TB, la suicidalite, et la perturbation du sommeil, et elles sont plus susceptibles de prendre des medicaments psychiatriques. Elles ont plus d'incapacite au travail et dans leur fonctionnement social, et l'evaluation de leur sante et de leur satisfaction a vivre est plus faible. Malgre la gravite plus marquee, elles ne recoivent pas de traitement psychologique additionnel, elles croient qu'elles ne recoivent pas le traitement dont elles ont besoin, et elles denoncent plus d'obstacles au traitement.AbbreviationsAD antidepressantBD bipolar disorderCCHS 1.2 Canadian Community Health Survey: Mental Health and Well-BeingCIDI Composite International Diagnostic InterviewGAD generalized anxiety disorderMDD major depressive disorderMDE major depressive episodeOCD obsessive-compulsive disorderPTSD posttraumatic stress disorderWMH World Mental HealthConclusions : Cette etude confirme l'effet critique de l'anxiete comorbide sur le cours du TB dans un vaste echantillon nationalement representatif et revele que les besoins de traitement psychologique de cette population ne sont pas combles. Les implications cliniques et pour la recherche sont presentees.Bipolar disorder is a complex mood disorder characterized by episodes of depression and mania or hypomania. …

Le trouble bipolaire est une maladie chronique caractérisée par une récurrence des rechutes thymiques, et par des symptômes résiduels interférant avec le fonctionnement de l’individu. La pharmacothérapie demeure la pierre angulaire du traitement. Malheureusement, la médication a des effets limités sur certains aspects de la maladie, sans compter qu’une grande proportion de patients présente des problèmes d’observance à leur traitement pharmacologique. Cette recension des écrits aborde le rôle de la psychoéducation comme traitement complémentaire dans la prise en charge des patients bipolaires. Les différentes modalités de psychoéducation structurée, dont deux programmes psychoéducatifs manualisés appuyés par des données probantes, sont présentées. Dans une perspective de transfert des connaissances, des recommandations pour l’implantation de la psychoéducation dans le système de santé québécois sont proposées., Bipolar disorder is a chronic mental illness characterized by recurrent affective episodes, as well as marked residual symptoms that interfere with functioning. Pharmacotherapy remains the cornerstone of treatment. Unfortunately, medication has limited effects on some aspects of the disorder, while many patients have difficulty complying with pharmacological treatment. This literature review examines the role of psychoeducation as a complementary treatment for patients with bipolar disorder. Different formats of structured psychoeducation are presented, including two evidence-based, manualized treatments. With a view to dissemination, recommendations are proposed for the implantation of psychoeducation in Quebec’s healthcare system.