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Objectives: Exposure to child maltreatment is associated with physical, emotional, and social impairment, yet in Canada there is a paucity of community-based information about the extent of this problem and its determinants. We examined the prevalence of child physical and sexual abuse and the associations of child abuse with early contextual, family, and individual factors using a community-based sample in Ontario. Methods: The Ontario Child Health Study is a province-wide health survey of children aged 4 through 16 years. Conducted in 1983, a second wave was undertaken in 1987 and a third in 2000-2001. The third wave (N = 1,928) included questions about exposure to physical and sexual abuse in childhood. Results: Males reported significantly more child physical abuse (33.7%), but not severe physical abuse (21.5%), than females (28.2% and 18.3%, respectively). Females reported significantly more child sexual abuse (22.1%) than males (8.3%). Growing up in an urban area, young maternal age at the time of the first child's birth, and living in poverty, predicted child physical abuse (and the severe category), and sexual abuse. Childhood psychiatric disorder was associated with child physical abuse (and the severe category), while parental adversity was associated with child sexual abuse and severe physical abuse. Siblings of those who experienced either physical abuse or sexual abuse in childhood were at increased risk for the same abuse exposure; the risk was highest for physical abuse. Conclusions: These findings highlight important similarities and differences in risk factors for physical and sexual abuse in childhood. Such information is useful in considering approaches to prevention and early detection of child maltreatment. Clinicians who identify physical abuse or sexual abuse in children should be alert to the need to assess whether siblings have experienced similar exposures. This has important implications for assessment of other children in the home at the time of identification with the overall goal of reducing further occurrence of abuse. (Contains 4 tables and 1 figure.)

Objectives: To identify factors associated with repeat emergency department (ED) presentations for suicide-related behaviors (SRB)--hereafter referred to as repetition--among children/youth to aid secondary prevention initiatives. To compare rates of repetition in children/youth with substantiated maltreatment requiring removal from their parental home with their peers in the general population. Methods: A population-based (retrospective) cohort study was established for children/youth with a first ED SRB presentation at risk for repetition in the Province of Ontario, Canada between 1 January 2004 and 31 December 2008. Children/youth legally removed from their parental home because of substantiated maltreatment (n = 179) and their population-based peers (n = 6,305) were individually linked to administrative health care records over time to ascertain social, demographic, and clinical information and subsequent ED presentations for SRB during follow-up. These children/youth were described and their repetition-free probabilities over time compared. To identify factors associated with repetition we fit multivariable, recurrent event survival analysis models stratified by repetition and present unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Children/youth with substantiated maltreatment (as noted) were two times more likely to have repetition than their peers after adjustments for social, demographic, and clinical factors (conditional on prior ED SRB presentations). A number of these factors were independently associated with repetition. No one factor distinguished between having a first and second repetition nor was more strongly associated with repetition than another. Conclusions: The risk of repetition is higher in children with substantiated maltreatment (as noted) than their peers. No one factor stood out as predictive of repetition. Implications for secondary prevention initiatives include a non-selective approach, sensitive to family difficulties and the need to better contextualize repetition and harness data linkages. (Contains 2 figures and 2 tables.)

Objectives: To determine whether the rates of a first presentation to the emergency department (ED) for suicide-related behavior (SRB) are higher among children/youth permanently removed from their parental home because of substantiated maltreatment than their peers. To describe the health care settings accessed by these children/youth before a first SRB presentation to help design preventive interventions. Methods: A population-based (retrospective) cohort of 12-17-year-olds in Ontario, Canada was established. Children/youth removed from their parental home because of the above noted maltreatment (n = 4683) and their population-based peers (n = 1,034,546) were individually linked to administrative health care records over time to ascertain health service use and subsequent ED presentations for SRB during follow-up. Person-time incidence rates were calculated and Cox regression models used to estimate adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results: After controlling for demographic characteristics and prior health service use, maltreated children/youth were about five times more likely to have a first ED presentation for SRB compared to their peers, in both boys (HR: 5.13, 95% CI: 3.94, 6.68) and girls (HR: 5.36, 95% CI: 4.40, 6.54). Conclusions: Children/youth permanently removed from their parental home because of substantiated child maltreatment are at an increased risk of a first presentation to the ED for SRB. The prevention of child maltreatment and its recurrence and the promotion of resilience after maltreatment has occurred are important avenues to study toward preventing ED SRB presentations in children/youth. Provider and system level linkages between care sectors may prevent the need for such presentations by providing ongoing environmental support. (Contains 1 figure and 4 tables.)

Research Findings: Individual and contextual variables were examined in relation to children's ability to cope with socioemotional and academic challenges in a sample of typically developing (n = 51) and anxious (n = 72) children of elementary and middle school age. Anxious children had greater social difficulties than controls and showed different directions of cortisol response to a public speaking task, but there were no group differences in academic performance. Across the sample, greater salivary cortisol reactivity to the speech task was associated with both increased social difficulties and higher academic achievement. For a subset of younger (M = 6.9 years) but not older (M = 12.3 years) children, social functioning was also highly sensitive to contextual variables (e.g., family income level). Practice or Policy: Findings suggest that social functioning in elementary school is as sensitive to contextual variables as it is to physiological ones. Interventions promoting stress recovery, social interaction, and social competence may be beneficial during the elementary school years. (Contains 5 tables, 3 figures and 3 footnotes.)

Objective: Children of teen mothers exhibit adverse outcomes through adolescence. It is unclear whether these adverse outcomes extend to adulthood and apply to all of her children, or only those born when she was a teen. We examine the associations between young adult functioning and being born to a teen mother aged less than or equal to 20 years at the time of birth (current teen), and being born to a teen mother later in her life (greater than 21 years, prior teen). Method: The 1983 Ontario Child Health Study (OCHS) and 2001 follow-up are used, including 2,355 participants 4 to 16 years old in 1983 with 2001 data. Using multilevel modeling we assessed the association between being born to a current versus prior teen mother, relative to a nonteen mother, and 2001 outcomes, controlling for individual and family level characteristics assessed in childhood. Results: Being born to a teen mother (versus a nonteen mother) is associated with poorer educational achievement, life satisfaction, and personal income. Accounting for time of sample children's birth in teen mothers' lives, individuals born to current and prior teen mothers showed a -0.8-year educational deficit, relative to individuals born to nonteen mothers in fully adjusted models. Individuals born to current teen mothers reported lower life satisfaction and personal income (-$7,262). There were no significant group differences at follow-up in mental or physical health between individuals born to nonteen mothers and those born to current or prior teen mothers. Conclusions: Although being born to a teen mother exerts a pervasive adverse effect on educational attainment, the adverse effects on life satisfaction and personal income appear to be selective for individuals born to a current teen mother. Further research is required to understand these differential effects. (Contains 8 tables.)

We examined whether associations between symptoms of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), depression, and anxiety assessed in a sample of 2,026 youth aged 6 to 16 years and socioeconomic functioning measured 18 years later varied as a function of whether parents or teachers had rated symptomatology. After accounting for confounding variables (e.g., family socioeconomic status in childhood), psychological symptoms explained 2.78% of the variability in adult socioeconomic status. Much of that variance was unique to teachers or parents (0.90% and 1.41%, respectively). Moreover, several informant-specific associations emerged: teacher-rated depression and parent-rated ADHD and ODD were significant predictors of later socioeconomic functioning. Overall, these findings provide further evidence that differences between informants are meaningful and support the utility of maintaining the unique perspective of each rater in analytic and measurement strategies. (Contains 3 tables.)

Adverse developmental effects associated with traumatic life experiences such as child sexual abuse will not apply to all individuals exposed. This general population study, compared the health and life circumstances of 45 respondents who spontaneously identified the experience of sexual abuse before age 22 as changing their life for the "better" (n = 12) versus "worse" (n = 33); with respondents who reported exposure to child sexual abuse on a standard questionnaire; and respondents not reporting such exposure. Individuals exposed versus non-exposed to sexual abuse experienced more adversity in early life and exhibited lower functioning in adulthood. However, individuals associating sexual abuse with a life change for the "better" exhibited a constellation of features consistent with more stable, supportive home environments and better prospects early on and healthier functioning later-on as adults. Studies are needed to understand the complex pathways between early exposure to sexual abuse and these diverse outcomes. (Contains 2 tables.)

Background: This study examines the use of the Brief Child and Family Phone Interview (BCFPI) to screen for childhood psychiatric disorder based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) classifications of attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety (SAD), generalized anxiety (GAD) and major depression (MDD). Methods: Data for analysis come from a sample of 399 children and adolescents aged 5-17 years old referred to child mental health outpatient services in three Ontario cities. Mothers were administered the BCFPI on three occasions: baseline, 2 and 13 months; and the DISC-IV on two occasions: 1 and 12 months. Results: Based on kappa, test-retest reliability for disorders classified by the BCFPI exceeded 0.50 for all conditions except MDD (0.45). In receiver operating characteristic (ROC) analysis, area-under-the-curve (AUC) estimates for BCFPI scale score associations with DISC-IV classifications of disorder exceeded 0.80 for CD, ODD, ADHD and SAD; and were lower for GAD (0.76) and MDD (0.75). In stratified analyses, there were no statistically significant differences in AUC estimates for boys versus girls and 5 to 11 versus 12 to 17-year-olds. Conclusions: Classifications of childhood disorder derived from the BCFPI provided a reasonable approximation to disorders classified by the DISC-IV administered by lay interviewers.

Background: This study describes the development of the Brief Child and Family Phone Interview (BCFPI)--a computer-assisted telephone interview which adapts the revised Ontario Child Health Study's (OCHS-R) parent, teacher, and youth self-report scales for administration as intake screening and treatment outcome measures in children's mental health services. It focuses on the factor structure of the BCFPI's hypothesized parent-reported child mental health scales describing attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and major depression (MDD). Methods: Data for the analysis come from an OCHS-R measurement study that included two groups of children and adolescents selected from the same urban area: a general population sample (n = 1,712) and a clinic-referred sample (n = 1,512); and a third sample that was enlisted in a province-wide implementation study of clinic-referred 6- to 18-year-olds (n = 56,825). We used confirmatory factor analysis to assess the factor structure of the BCFPI scales in different populations and to test measurement equivalence across selected groups. Results: Despite the strong constraints imposed on the measurement models, estimates of model fit across the three samples were comparable in magnitude and approached the cut-offs suggested for the GFI and CFI (greater than 0.9) and RMSEA (less than 0.05). Measurement equivalence was demonstrated between the OCHS-R clinic and provincial implementation samples. Within the implementation sample, the factor structure of the BCFPI scales was equivalent for boys versus girls and for 6- to 12- versus 13- to 18-year-olds. A companion paper examines the test-retest reliability, sensitivity, specificity, and validity of these BCFPI scales when used for screening. Conclusion: This project supports the feasibility and acceptability of a computer-assisted telephone interview for assessing emotional-behavioral problems of children and adolescents referred to children's mental health services.

This study examined the heterotypic continuity of aggression hypothesis (physical to indirect) using independent teacher reports of aggression drawn from a nationally representative sample of 749 Canadian girls and boys. Confirmatory factor analysis using an accelerated longitudinal design confirmed a two-factor model of physical and indirect aggression that was stable across time, but not sex. Mean levels of indirect aggression were highest for girls whereas mean levels of physical aggression were highest for boys. Results of a series of path analyses indicated statistically significant cross-lagged effects that varied by sex. Physical aggression at Time 1 (T1; aged six to nine years) significantly predicted increased levels of indirect aggression at Time 2 (T2; girls only) and Time 3 (T3; boys and girls). Indirect aggression at T1 predicted decreased physical aggression at T2 (boys only) and at T3 (boys and girls). These results offer support for the heterotypic continuity of aggression and underscore the usefulness of teacher reports in studies of childhood aggression.

We examined receptive language and academic abilities in children with selective mutism (SM; n = 30; M age = 8.8 years), anxiety disorders (n = 46; M age = 9.3 years), and community controls (n = 27; M age = 7.8 years). Receptive language and academic abilities were assessed using standardized tests completed in the laboratory. We found a significant group by sex interaction for receptive vocabulary scores such that, within females, the SM and mixed anxiety groups had significantly lower receptive vocabulary scores than community controls. We also found that children with SM and children with anxiety disorders had significantly lower mathematics scores than community controls. Despite these differences in mathematics and receptive vocabulary performance, children with SM and children with anxiety disorders still performed at age-level norms, while more children in the community control group performed above age-level norms. Findings suggest that despite their speaking inhibition in the school setting, children with SM are still able to attain the receptive vocabulary and academic abilities that are expected at their age levels. (Contains 2 figures, 3 tables, and 3 notes.)

This study uses multilevel models to examine longitudinal associations between contextual influences (neighborhood and family) assessed in 1983 in a cohort of 2,355 children, 4-16 years of age, and educational attainment in 2001. Variation in educational attainment in 2001 attributable to between-neighborhood and between-family differences was 8.17% and 36.88%, respectively. The final model explained 33.64% of the variance in educational attainment, with unique variances of 14.53% for neighborhood and family-level variables combined versus 10.94% for child-level variables. Among the neighborhood and family-level variables, indicators of status (5.29%) versus parental capacity/family process (4.03%) made comparable predictions to attainment while children from economically disadvantaged families did not benefit educationally from living in more affluent areas.

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship. (Contains 2 tables.) [This research was supported by the Wyeth Canada Inc. Canadian Institutes of Health Research (CIHR) Clinical Research Chair in Women's Mental Health and the CIHR Institutes of Gender and Health; Aging; Human Development, Child and Youth Health; Neurosciences, Mental Health and Addiction; and Population and Public Health.]

Objective: There are few well-evaluated uncomplicated community-based interventions for childhood aggression. The authors assess the impact of a community-based anger management group on child aggressive behaviors, using a randomized, controlled trial (RCT). Method: Families with children 7 to 11 years old were recruited through advertisements and randomized (N = 123). Inclusion required parent concern about anger/aggressive behavior, RCT agreement, and a telephone behavior screen. Intervention participants were offered three parent psychoeducation/skill-building group sessions, 10 weekly child group sessions, and three in-home family practice sessions. Nine groups ran from August 2002 to August 2004. Interviewers naive to randomization collected data on all participants pre- and postgroup. Outcomes included child-rated anger and parent-rated child aggressive behavior, externalizing behavior and hostility, parent-child relationship, and parenting stress. Intent-to-treat analyses were done. Results: Pre/postoutcome comparisons indicated no significant differences between intervention versus control, with small effect sizes for most outcomes (0.27-0.29). Although not significant, the magnitude of improvement favored intervention families on all parent-rated measures. Conclusions: Overall, there was no differential impact of participating in a community-based anger management group versus control on child aggressive behaviors and other associated measures. The impact of regression to the mean, effect, and sample size estimates; child comorbidity; and programmatic and methodological issues are discussed. (Contains 1 figure and 3 tables.)

Objective: To obtain preliminary evidence of the feasibility and effectiveness of adjunctive family psychoeducation in adolescent major depressive disorder. Method: Participants were from outpatient clinics in Hamilton and London, Ontario. Over 24 months, 41 adolescents ages 13 through 18 years meeting major depressive disorder criteria were recruited (31 in Hamilton, 10 in London). Participants were randomized to usual treatment or usual treatment plus family psychoeducation. Outcome measures were readministered at 2 weeks, mid-treatment, posttreatment, and 3-month follow-up. Intent-to-treat analyses used [chi square] and t tests and growth curve analysis. Standardized effects based on growth curve estimates were calculated for continuous outcomes. Results: The London site was withdrawn because of poor participant retention. In Hamilton, no participant missed more than one assessment and there was good family psychoeducation adherence. Compared to controls, participants in the experimental group showed greater improvement in social functioning and adolescent-parent relationships (with medium standardized effect size greater than 0.5), and parents reported greater satisfaction with treatment. Conclusions: There were positive treatment effects on family and social functioning processes postulated to mediate the clinical course of major depressive disorder. The study provides support for further evaluation of family psychoeducation in this clinical population. (Contains 4 tables.)

Background: With the recent legalization of nonmedical cannabis in Canada, it is important to document previous associations between cannabis use and major depressive episode and suicidal ideation, as well as the extent to which these associations have changed over time.Methods: This study uses pooled data from the 2002 and 2012 Canadian Community Health Survey's Mental Health Component, which are repeated cross-sectional surveys of nationally representative samples of Canadians 15 to 60 years of age (n = 43,466). Binary logistic regression was performed, applying weighting and bootstrapping, to examine the association between at least monthly use of cannabis and past 12-month suicidal ideation and major depressive episode (MDE).Results: At least monthly nonmedical cannabis use was associated with an increased odds of MDE and suicidal ideation, and both associations strengthened in 2012 compared to 2002. Canadians using cannabis at least once a month in 2012 had 1.59 (95% confidence interval [CI], 1.11 to 2.27) times the odds of experiencing suicidal ideation and 1.55 (95% CI, 1.12 to 2.13) times the odds of experiencing MDE compared to those who used cannabis at least once a month in 2002. This temporal change remained after controlling for other substance use.Conclusions: Monthly cannabis use was consistently related to both suicidal ideation and MDE, and these associations were stronger in 2012 compared to 2002. The findings of this study provide a baseline for the association between cannabis use and suicide and depression in the Canadian population that should be reevaluated now that nonmedical cannabis has been legalized. [ABSTRACT FROM AUTHOR]

Objective: To describe the methodology of the 2014 Ontario Child Health Study (OCHS): a province-wide, cross-sectional, epidemiologic study of child health and mental disorder among 4- to 17-year-olds living in household dwellings.Method: Implemented by Statistics Canada, the 2014 OCHS was led by academic researchers at the Offord Centre for Child Studies (McMaster University). Eligible households included families with children aged 4 to 17 years, who were listed on the 2014 Canadian Child Tax Benefit File. The survey design included area and household stratification by income and 3-stage cluster sampling of areas and households to yield a probability sample of families.Results: The 2014 OCHS included 6,537 responding households (50.8%) with 10,802 children aged 4 to 17 years. Lower income families living in low-income neighbourhoods were less likely to participate. In addition to measures of childhood mental disorder assessed by the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and OCHS Emotional Behavioural Scales (OCHS-EBS), the survey contains measures of neighbourhoods, schools, families and children, and includes administrative data held by the Ministries of Education and Health and Long-Term Care.Conclusions: The complex survey design and differential non-response of the 2014 OCHS required the use of sampling weights and adjustment for design effects. The study is available throughout Canada in the Statistics Canada Research Data Centres (RDCs). We urge external investigators to access the study through the RDCs or to contact us directly to collaborate on future secondary analysis studies based on the OCHS. [ABSTRACT FROM AUTHOR]

The article summarizes four of the 2014 Ontario Child Health Study (OCHS) findings with particular policy salience. Topics covered include the impact of income disparities and exposure on neighbourhood adversities, the diffusion of responsibility and authority across sectors and groups, and development of central expert leadership mechanisms.

Objective: We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care.Method: This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated.Results: Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days.Conclusions: The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the link between suicidal ideation in adolescence (age 12-16) and symptoms of psychopathology in adulthood (age 22-26) in a birth cohort of extremely low birth weight (ELBW; <1000g) survivors and matched normal birth weight (NBW; >2500 g) control participants. This study utilized data from a longitudinally followed cohort of 129 ELBW survivors and 116 NBW individuals born in Ontario, Canada between the years 1977 and 1982. Participants self-reported suicidal ideation via questionnaire during adolescence (age 12-16). The depression, anxiety, inattention, and antisocial behavior subscales of the Young Adult Self Report (YASR) were used to assess symptoms of psychopathology during adulthood (age 22-26). Associations were examined in each birth weight group separately prior to and after adjustment for covariates. Before and after adjustment for covariates, suicidal ideation in NBW adolescents predicted symptoms of depression, anxiety, inattention, and antisociality in adulthood. Suicidal ideation among ELBW adolescents predicted inattentive and depressive symptoms, and antisocial behavior only before adjustment. Adolescents born at NBW who endorse suicidal ideation are at elevated risk for developing symptoms of anxiety, depression, inattention, and antisocial problems in adulthood even after adjustment. Among ELBW survivors, the risks were lower and appear to be due to confounding factors. [ABSTRACT FROM AUTHOR]

Extremely low birth weight (ELBW; <1000 g) survivors are at increased risk for experiencing both peer victimization and overprotective parenting. This study investigated if overprotective parenting moderated associations between peer victimization and psychopathology among ELBW adult survivors who have been followed since birth. Participants included 81 (31 male, 50 female) adults born with an extremely low birth weight from Ontario, Canada. The participants were predominately Caucasian. The experience of peer victimization and overprotective parenting prior to age 16 was self-reported at age 22–26 years. Peer victimization was reported using the Childhood Experiences of Violence Questionnaire and overprotective parenting was reported using the Parental Bonding Instrument. Current anxiety disorder and alcohol or substance use disorder was assessed using the MINI International Neuropsychiatric Interview at age 29–36 years. The experience of overprotective parenting moderated the association between peer victimization and risk for an anxiety disorder in adulthood (OR 2.35, 95% CI, 1.01–5.50). If the ELBW survivor reported having an overprotective parent, peer victimization was associated with increased risk for having an anxiety disorder in adulthood (OR 2.45, 95% CI, 1.13–5.30). In contrast, this association was not significant in the absence of an overprotective parent (OR 1.04, 95% CI, 0.73–1.49). Future research should further investigate if parental support and encouragement of children’s independence may be important for reducing the negative effects of peer victimization among ELBW survivors. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. We identified courses of depressive symptoms in an epidemiological sample of emerging adults. Methods. We used latent class growth modeling to identify trajectories of depressive symptoms measured by the 12-item Center for Epidemiological Studies Depression Scale (CES-D) during a 14-year follow-up of 2825 Canadian youths aged 10 to 25 years enrolled in the National Longitudinal Survey of Children and Youth between 1994 and 2009. Results. After adjustment for youth, parent, and family factors, the 3 distinct trajectories of depressive symptoms were minimal (55%; CES-D < 6), subclinical (39%; CES-D = 9-13), and clinical (6%; CES-D > 18). All trajectories exhibited a parallel course, with peak symptoms at 15 to 17 years of age. Subclinical and clinical symptoms were more common than minimal symptoms in female youths and in respondents with lower self-concept, lower socioeconomic status, poorer interpersonal relations, and chronic health conditions (P < .01). Conclusions. Among emerging adults, trajectories of depressive symptoms do not trend upward or downward, and variables associated with identified trajectories demonstrated dose--response effects that agreed with vulnerability--stress theories of depression. [ABSTRACT FROM AUTHOR]

Background: Maximizing measurement accuracy is an important aim in child development assessment and research. Parents are essential informants in the diagnostic process, and past research suggests that certain parental characteristics may influence how they report information about their children. This has not been studied in autism spectrum disorders (ASD) to date. We aimed, therefore, to investigate the possible effect that maternal depression might have on a mother's reports of her child's ASD behaviors. Using structural equation modeling, we disaggregated shared from unique variation in the association between latent variable measures of maternal depression and ASD behaviors. Methods: Data were obtained from a study of preschoolers aged 2-4 newly diagnosed with ASD ( n = 214). Information from a parent questionnaire, a semi-structured parent interview, and a semi-structured observational assessment was used to develop a latent variable measure of child ASD behaviors. Mothers reported on their own depression symptoms. We first modeled the covariance between maternal depression and child ASD behavior. Then, to quantify unique variation, we added covariance terms between maternal depression and the residual variation associated with the individual measures of child ASD behaviors. Results: The model demonstrated excellent fit to the underlying data. Maternal self-report of depression symptoms exhibited a significant association with the unique variance of the questionnaire report but not with the latent variable measure of child ASD behavior. A gradient pattern of association was demonstrated between maternal depression and the unique variance of the ASD measures: most strongly for the maternal questionnaire report, more weakly for the maternal semi-structured interview, and to a trivial extent for the observational interview. Conclusions: Parental depression may influence reporting of ASD behaviors in preschoolers. Shared method effects may also contribute to bias. This finding highlights the importance of obtaining multimethod reports of child ASD symptoms. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Post-traumatic stress disorder (PTSD) has become a global health issue, with prevalence rates ranging from 1.3% to 37.4%. As there is little current data on PTSD in Canada, an epidemiological study was conducted examining PTSD and related comorbid conditions. Modified versions of the Composite International Diagnostic Interview (CIDI) PTSD module, the depression, alcohol and substance abuse sections of the Mini International Neuropsychiatric Interview (MINI), as well as portions of the Childhood Trauma Questionnaire (CTQ) were combined, and administered via telephone interview in English or French. Random digit dialing was used to obtain a nationally representative sample of 2991, aged 18 years and above from across Canada. The prevalence rate of lifetime PTSD in Canada was estimated to be 9.2%, with a rate of current (1-month) PTSD of 2.4%. Traumatic exposure to at least one event sufficient to cause PTSD was reported by 76.1% of respondents. The most common forms of trauma resulting in PTSD included unexpected death of a loved one, sexual assault, and seeing someone badly injured or killed. In respondents meeting criteria for PTSD, the symptoms were chronic in nature, and associated with significant impairment and high rates of comorbidity. PTSD is a common psychiatric disorder in Canada. The results are surprising, given the comparably low rates of violent crime, a small military and few natural disasters. Potential implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Farther research is needed to understand the mechanism for this complex relationship. [ABSTRACT FROM AUTHOR]

Child maltreatment is associated with a huge burden of suffering, yet there are serious gaps in knowledge about its epidemiology and approaches to intervention. This article describes the development of a proposed national research framework in child maltreatment, as requested by the Department of Justice, Canada, based on (1) a review of the literature, (2) consultation with experts, and (3) application of evaluation criteria for considering research priorities. The article identifies gaps in knowledge about child maltreatment in Canada and proposes a research agenda to make evidence-based policy decisions more likely. Although this work was driven by gaps in Canada's knowledge about child maltreatment, the international scope of the review and consultation process could make the findings useful to broader research and policy audiences. [ABSTRACT FROM AUTHOR]

The article presents a randomized clinical study examining the best method for intimate partner violence screening in health care settings. The trial was conducted at emergency departments, women's health clinics, and family practices in Ontario, Canada. Three screening methods were examined, including a written self-completed questionnaire, a face-to-face interview with medical personnel, or a self-completed questionnaire on the computer. The Partner Violence Screen, the Women Abuse Screening Tool and the Composite Abuse Scale were used. The study found that women prefer the self-completed methods over the face-to-face approach. INSET: Screening Instruments Used in the Study.

In the present study, we examine whether higher rates of mental health service use observed among single-parent mothers is due to greater need (psychopathology) or other factors (predisposing and enabling characteristics) using a socio-behavioural model of health care use. We use data from two large surveys in Canada (the 1994–95 National Population Health Survey and the 1990 Ontario Mental Health Supplement). The bivariate results from both surveys revealed that single-parent mothers were two to three times more likely than married mothers to have sought professional help for mental health reasons over a 12-month period. Multivariate analyses showed that differences in predisposing and enabling characteristics between single and married mothers accounted for very little of the relationship between family structure and service use. Rather, differences in the prevalence of psychiatric disorders accounted for the higher use of services among single mothers. Single mothers are more likely than married mothers to seek professional help for mental health concerns. The use of services appears equitable in that need (higher rates of psychopathology) is the major factor differentiating use between married and single mothers. Further work should examine differences in pathways into formal care between single and married mothers. [Copyright &y& Elsevier]

Although many studies have established that owning a home is associated with a variety of health benefits (lower mortality and morbidity rates), important gaps in our understanding of the relationship between housing tenure and health remain. In particular, previous research has tended to rely upon single, binary measures of housing tenure (home owners versus renters). These broad categories do not capture the heterogeneity that exists within housing tenure classifications. This paper uses an expanded measure to differentiate home owners with mortgages, from those who do not have mortgages and from those who live in rental accommodation. The results reveal a gradient in housing tenure and psychological distress; individuals in rental situations report the highest levels of distress, home owners without mortgages the lowest levels. Moreover, housing tenure modifies the impact of stress on distress in these data. The findings are interpreted in the context of changes to housing policy in Canada, and the economic climate during the period in which these data were collected. Future research directions are discussed. [ABSTRACT FROM AUTHOR]

Objective: To report on the prevalence of seasonal bipolar disorder (BD) and the impact of latitude in a community sample in the province of Ontario.Method: This study used the telephone-administered Depression and Seasonality Interview. Exact latitude was determined for each participant.Results: Overall, 14 of 62 (22.6%) subjects with BD had the seasonal subtype of BD. Latitude did not appear to influence the proportion of subjects with the seasonal subtype.Conclusions: We identified a seasonal pattern of illness in a proportion of subjects with BD. [ABSTRACT FROM AUTHOR]

Evaluates the effect of the Community Action Program for Children on children at developmental risk in Canada. Issues about federal policies and spending priorities for addressing child health needs; Concern on the prospects for normal development of children; Responsibility of the Joint Management Committees in the management of the initiative.

Background: This study sought to determine whether the prevalence of the seasonal subtype of major depression (SAD) in the community varied as a function of latitude.Methods: Random telephone numbers were generated across 8 degrees of latitude (41.5 degrees N to 49.5 degrees N) for the province of Ontario. Eight strata of 1 degree each were sampled equally throughout a 12-month period. Using a validated and structured diagnostic interview, we interviewed by telephone respondents over 20 years of age who had lived in the region for 3 years or more. We evaluated patterns of symptom change across seasons to establish a diagnosis of SAD according to DSM-IV criteria.Results: Of the 2078 households that were assessed for eligibility, 1605 (77%) completed the interview. The crude prevalence of lifetime SAD was 2.6% (95% CI, 1.9 to 3.5). There was no impact of latitude on prevalence of either major depression or the seasonal subtype across the 8 strata, although the global measure of the severity of seasonal change in mood was significantly negatively correlated with latitude.Conclusions: SAD is a common subtype of major depression in Ontario, but there is no evidence to support an increase in prevalence with increasing latitude. [ABSTRACT FROM AUTHOR]

Evaluates the influence of neighborhoods and socioeconomic disadvantage on behavioral problems of children in Canada. Predictors of behavioral problems; Assessment of behavioral problems of children from well-off families living in disadvantaged neighborhoods; Evaluation of children from poor families living in advantage neighborhoods.

Examines the relationship between childhood maltreatment history and adult psychopathology in clinical populations in Ontario. Correlation between physical abuse and psychiatric morbidity; Issues on the social and environmental causes; Concerns on the nature and duration of the abuse.

Presents several correspondence related to psychiatry in the September 2001 issue of 'The Canadian Journal of Psychiatry.' Aim of the Alone Mothers Together Program; Analysis of neuroleptic malignant syndrome; Presentation of several lycanthropy cases.

Objective: To examine estimates of lifetime prevalence of seasonal affective disorder (SAD) in Toronto, Ontario.Method: Random telephone numbers were generated for the city of Toronto, and 781 respondents completed a telephone interview. Trained nonphysician interviewers conducted all interviews, which involved structured questions for diagnosing major depression. Patterns of symptom change across seasons were evaluated to establish a diagnosis of SAD according to DSM-III-R criteria.Results: Correcting for sex and age, the prevalence of SAD defined by DSM-III-R criteria was 2.9% (95% CI, 1.7% to 4.0%), and the overall lifetime prevalence of major depression in the sample was 26.4% (95% CI, 23.3% to 29.4%). Some subjects were contacted for a follow-up interview conducted in person; the positive predictive value for the diagnosis of major depression for the telephone interview was 100%, and the negative predictive value was 93%.Conclusions: The seasonal subtype of depression represents 11% of all subjects with major depression, suggesting that SAD is a significant public health concern. The telephone interview demonstrated adequate reliability, indicating that it is appropriate for epidemiological surveys of this nature. [ABSTRACT FROM AUTHOR]

Offers the results of a Canadian study on the possible long-term psychiatric effects of slapping and spanking in childhood. How those who reported being spanked often or sometimes had a significantly higher rate of anxiety disorders and/or alcohol abuse; Background; Methods; Results; Interpretation.

Background: Nationally representative Canadian data on the prevalence of child abuse and its relation with mental disorders are lacking. We used contemporary, nationally representative data to examine the prevalence of 3 types of child abuse (physical abuse, sexual abuse and exposure to intimate partner violence) and their association with 14 mental conditions, including suicidal ideation and suicide attempts. Methods: We obtained data from the 2012 Canadian Community Health Survey: Mental Health, collected from the 10 provinces. Respondents aged 18 years and older were asked about child abuse and were selected for the study sample (n = 23 395). The survey had a multistage stratified cluster design (household response rate 79.8%). Results: The prevalence of any child abuse was 32% (individual types ranged from 8% to 26%). All types of child abuse were associated with all mental conditions, including suicidal ideation and suicide attempts, after adjustment for sociodemographic variables (adjusted odds ratios ranged from 1.4 to 7.9). We found a dose-response relation, with increasing number of abuse types experienced corresponding with greater odds of mental conditions. Associations between child abuse and attention deficit disorder, suicidal ideation and suicide attempts showed stronger effects for women than men. Interpretation: We found robust associations between child abuse and mental conditions. Health care providers, especially those assessing patients with mental health problems, need to be aware of the relation between specific types of child abuse and certain mental conditions. Success in preventing child abuse could lead to reductions in the prevalence of mental disorders, suicidal ideation and suicide attempts. [ABSTRACT FROM AUTHOR]

Objective: This manuscript serves to provide an overview of the methods of the Multimorbidity in Children and Youth across the Life-course (MY LIFE) study, profile sample characteristics of the cohort, and provide baseline estimates of multimorbidity to foster collaboration with clinical and research colleagues across Canada. Method: MY LIFE is comprised of 263 children (2-16 years) with a physical illness recruited from McMaster Children's Hospital, their primary caregiving parent, and their closest-aged sibling. Participants are followed with data collection at recruitment, 6, 12, and 24 months which includes structured interviews, self-reported measures, and biological samples and occur in a private research office or at participants' homes. Post-COVID-19, data collection transitioned to mail and telephone surveys. Results: At recruitment, children were 9.4 (4.2) years of age and 52.7% were male. The mean duration of their physical illness was 4.5 (4.1) years; 25% represent incident cases (duration <1 year). Most (69.7%) had healthy body weight and intelligence in the average range (73.5%). Overall, 38.2% of children screened positive for =1 mental illness according to parent report (24.8% screened positive based on child self-report). Compared to 2016 Census data, the MY LIFE cohort overrepresents families of higher socioeconomic status. Conclusions: Multimorbidity is common among children and these baseline data will serve to measure relative changes in the mental health of children with physical illness over time. MY LIFE will provide new information for understanding multimorbidity among children, though underrepresentation of lower socioeconomic families may have implications for the generalizability of findings. [ABSTRACT FROM AUTHOR]

This study examined associations between teacher-student relationship quality at school and teachers' responsiveness to students' emotional concerns in a classroom and (a) students' intention to seek help at school for mental health concerns and (b) mental health-related service use. Data for analyses came from the School Mental Health Survey, a cross-sectional survey of 31,120 grade 6–12 students, in 1968 classrooms, attending 248 schools in Ontario, Canada. Three-level (student, classroom, school) binary logistic regression was used to address the study objectives. Student ratings of the quality of teacher-student relationships and teachers' responsiveness were included as predictors, both at the individual student level and aggregated to represent a contextual level characteristic at the school and classroom level, respectively. At the student level, both teacher-student relationship quality and teacher responsiveness were positively associated with intentions to seek help at school among both elementary and secondary students (ORs ranged from 1.14–1.19 for relationships and 1.06–1.08 for responsiveness). Aggregated to the school level, teacher-student relationship quality was positively associated with mental health service use for secondary students (OR = 1.36, 95% CI [1.10, 1.69]). Positive and responsive teacher-student relationships were associated with help-seeking behaviors among students. Longitudinal studies are warranted to disentangle the temporality of these associations. [ABSTRACT FROM AUTHOR]

Objective: From 2007-2017, pediatric emergency department (ED) visits for mental health concerns increased by 66% in Canada, with repeat visits accounting for a significant proportion of all visits. Our objective was to examine patient and visit characteristics associated with repeat visits to a tertiary care pediatric ED for mental health concerns. Method: Data were obtained from the administrative records of McMaster Children's Hospital ED for mental health-related visits from February 2013-December 2017. Data on 9,018 ED visits made by 4,976 unique patients were included in this study. Logistic regression analysis was used to examine characteristics associated with repeat visit within six months of index presentation. Results: 22% (n=1,088) of individuals returned to the ED for a mental health concern within six months following their index visit. A repeat visit within six months was associated with female sex (OR=1.19, p=0.019), age of 14-17 years (OR=1.42, p=0.016), receiving a risk assessment by the emergency psychiatry team (OR=1.63, p<0.001) and having an inpatient psychiatric admission (OR=1.67, p<0.001) at the index visit. Receiving anxiety-related discharge diagnoses at an index visit reduced the odds of a repeat visit within 6 months (OR=0.76, p=0.035), while receiving depression-related discharge diagnoses increased the odds of a repeat visit, but only for females (OR=1.3, p=0.011 vs. OR=0.93, p=0.589 for males). Conclusions: We found that approximately one in five patients presenting to the ED for a mental health concern have a repeat visit within six months, consistent with previous studies. This study provides support for previously identified risk factors for repeat visits and offers information on interactions between patient sex and diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the effects of socioeconomic status on the prevalence of current smoking, number of cigarettes smoked per day and pack-years, and the extent to which prevalence and consumption co-vary across communities, health regions, and provinces in Canada between 2001 and 2010. Current smoking, cigarettes per day, and pack-years were considered as outcomes within individuals using a multilevel analytical framework. Markers of SES were education, income, and occupation. Residual covariance estimated at the different levels of geography was used to determine if areas high in current smoking were also high on levels of consumption. A strong inverse gradient was found between education and current smoking and level of consumption with large variation found in levels of consumption between individual smokers. The co-variation between current smoking and level of consumption was positive and statistically significant at the level of communities and health regions. Our findings suggest that novel policy efforts may be needed to encourage smoking prevention/cessation among certain population groups and in places with high levels of smoking prevalence and tobacco use intensity. [Copyright &y& Elsevier]

Objectives. Reports on child health in Canada often refer to the disproportionate burden of poor health experienced by Aboriginal children and youth, yet little national data are available. This paper describes the health of First Nations and Inuit children and youth based on the First Nations and Inuit Regional Health Survey (FNIRHS). Study design. The FNIRHS combines data from 9 regional surveys conducted in 1996-1997 in Aboriginal reserve communities in all provinces. The target population consisted of all onreserve communities. All households or a random sample of households or adults (depending on province) were selected based on their population representation. Methods. One child was randomly selected from each participating household, except in Ontario and Nova Scotia, where children were randomly selected based upon their population representation. Alberta did not include the section on children's health in their regional survey. Results. Approximately 84% of adults, who were proxy respondents for their child, rated their children's health as very good or excellent. The most frequently reported conditions were ear problems (15%), followed by allergies (13%) and asthma (12%). Broken bones or fractures were the most frequently reported injuries (13%). Respondents reported that 17% of children had behavioural or emotional problems. Overall, 76% of children were reported to get along with the family "very well" or "quite well."Conclusions. While most respondents rated their child's health as very good or excellent, injuries, emotional and behavioural problems, respiratory conditions and ear problems were reported among many Aboriginal children. Issues such as substance abuse, exposure to violence and academic performance were not addressed in the 10 core survey questions. Clearly there is a need for more in-depth information about both the physical and emotional health of Aboriginal children and youth. [ABSTRACT FROM AUTHOR]

Objectives: To examine the link between stability and change in social assistance (SA) use and children's mental health trajectories to better understand whether social policies targeted at low-income families might be an effective population-based mechanism for preventing mental health problems among children at risk., Methods: The National Longitudinal Survey of Children and Youth (N = 8981) is used to classify children into 5 categories based on their family's pattern of SA use from age 4-5 to 10-11: always or never on SA, a single transition on or off SA, or fluctuations on and off SA. Latent growth modelling is used to compare trajectories of emotional and behavioural problems among children with different patterns of SA exposure to their counterparts never on SA over this same time period., Results: Child emotional and behavioural problems are exacerbated over time in accordance with patterns of SA use: chronic SA use (behavioural) and moving onto SA (emotional and behavioural). These differential rates of change result in mental health disparities at age 10-11 that were not present at age 4-5. Children exposed to SA when they were age 4-5 but subsequently moved off continue to demonstrate elevated levels of emotional and behavioural problems at age 10-11., Conclusions: Successful social policies and interventions will require understanding the specific mechanisms through which SA undermines child mental health and how programs can be modified to reduce its negative consequences.

Introduction: Multimorbidity, the co-occurrence of a chronic physical condition and mental disorder, affects a substantial number of children and youth and can lead to compromised quality of life, hardship for families, and an increased burden on the healthcare system. We are conducting a study to document the course of mental disorder in children and youth diagnosed with a chronic physical condition; identify predictors of child and youth multimorbidity; examine whether the effects of these predictors are moderated by relevant psychosocial and biological factors; explore potential inflammatory and stress biomarkers that mediate the onset of child and youth multimorbidity; and, assess whether multimorbidity in children and youth alters patterns of mental health service use., Methods and Analysis: Multimorbidity in Children and Youth Across the Life-course (MY LIFE) is a prospective study. Two hundred and fifty children and youth aged 2-16 years diagnosed with a chronic physical condition along with one parent will be recruited from the outpatient clinics at a paediatric tertiary care centre. Data will be collected using a multi-informant, multimethod design at four time-points (at recruitment, and at 6, 12 and 24 months postrecruitment). Parents will provide reports for all children/youth. In addition, youth ≥10 years will self-report. Mental disorder will be assessed using structured interviews. On completion of data collection, participant-reported data will be linked to provincial health records to identify mental health services use. Multilevel analyses (survival, proportional hazard, structural equation modelling) will be used to address MY LIFE objectives., Ethics and Dissemination: This study has been approved by the University of Waterloo Human Research Ethics Board and the Hamilton Integrated Research Ethics Board. Findings will be disseminated to key stakeholders using a number of outlets (peer-reviewed publications and conferences, lay informational pamphlets, social media)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: We investigated the prevalence of substance use disorders (SUDs) among emerging adults and quantified the extent to which emerging adults, compared with young adults, have increased odds for SUDs., Methods: Data were from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Respondents were 15 to 39 y of age ( n = 9228) and were categorized as: early emerging adults (15 to 22 y); late emerging adults (23 to 29 y); and, young adults (30 to 39 y). SUDs [alcohol or drug abuse/dependence (AAD or DAD)] were measured using the WHO Composite International Diagnostic Interview 3.0. The prevalence of SUDs was compared across age groups, and odds ratios (OR) and 95% confidence intervals (CI) were computed from logistic regression models adjusting for sociodemographic and health covariates. Analyses were weighted to maintain representativeness to the Canadian population., Results: The prevalence of AAD was 8.0%, 6.6%, and 2.7% for early emerging adults, late emerging adults, and young adults, respectively. For DAD, the prevalence was 6.4%, 3.6%, and 1.3%. After covariate adjustment, early and late emerging adults had greater odds of reporting AAD (OR = 3.2, 95% CI = 2.2 to 4.9 and OR = 2.4, 95% CI = 1.6 to 3.4, respectively) or DAD (OR = 4.2, 95% CI = 2.5 to 7.0 and OR = 2.5, 95% CI = 1.6 to 4.1, respectively) compared with young adults. Differences between early and late emerging adults were not significant., Conclusion: Emerging adults are at increased odds for SUDs. Lack of differences between early and late emerging adults provide evidence of the extension of emerging adulthood into the late 20s. Findings have implications for the provision of screening and treatment of SUDs during this developmental period.