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IntroductionMental health problems are common globally, and typically have their onset in adolescence and early adulthood—making youth (aged 11–25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings.ApproachAs a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses.Anticipated resultsAcross urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care.DiscussionComplex interventions such as AOM aim to shift care “upstream”: away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.

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Additional file 2. TIDieR checklist

BACKGROUND Background: The World Health Organization (WHO) declared a global coronavirus disease (COVID-19) pandemic on March 11, 2020. Subsequently, an intensive public health campaign recommending regular hand washing, physical distancing, and facemask use evolved as a global strategy to limit viral transmission. OBJECTIVE Objective: This study investigates the prevalence of Obsessive-Compulsive Disorder (OCD) symptoms at an early stage of the COVID-19 pandemic in Canada. METHODS Methods: This a population-based, cross-sectional online survey of Canadians aged 18 years and older. We used the contamination and cleanliness subscale of the Brief Obsessive-Compulsive Scale (BOCS), Perceived Stress Scale (PSS), likely Generalized Anxiety Disorder (GAD) with the Generalized Anxiety Disorder 7-item (GAD-7) scale, and likely Major Depressive Disorder (MDD) with the Patient Health Questionnaire-9 (PHQ-9) scale to investigate prevalence of OCD symptoms and their correlation to perceived stress, anxiety, and depression during the COVID-19 pandemic. RESULTS Results: 32,805 individuals who subscribed for supportive text messages with Text4Hope were invited to complete an online survey; 6,041 responded with a mean age of 42 years (age range 11-88 years) and a response rate of 18.4%. Overall, 60.3% of respondents, reported onset of obsessions related to contamination with dirt, germs, or viruses and while 53.8% had compulsions to wash hands during the COVID-19 pandemic. Respondents who were worried about dirt, germs, and viruses only since the start of the COVID-19 pandemic were significantly more likely to have moderate/high stress (z=6.4, p CONCLUSIONS Conclusion: Prevalence of OCD symptoms increased during the early phase of the COVID-19 pandemic, at a rate significantly higher than pre-pandemic rates reported for the sample population. Presenting with OCD symptoms during the pandemic significantly increases the likelihood for respondents to present with elevated stress levels, likely GAD and likely MDD. CLINICALTRIAL