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This commentary on a case considers consequences of a so-called "zero-risk" paradigm now common in psychiatric inpatient decision making. Iatrogenic harms of this approach must be balanced against promoting patients' safety and well-being. This article suggests how to collaboratively assess risk and draw on recovery-oriented goals of care., (Copyright 2024 American Medical Association. All Rights Reserved.)

Nursing has articulated a shared commitment to equity in response to inequities in health and health care; however, understandings of how nurses enact equity are needed to uphold this professional mandate. This Foucauldian discourse analysis examined how nurses' equity-promoting practices are shaped by dominant discourses within the emergency department and illustrated that within this institutional context that constrained equity, nurses engaged in equity-promoting practices through subversion of discursive power. This study illustrates the need for embedding equity discourses within health care systems and ensuring meaningful supports for nurses in enacting equity-promoting practices within the emergency department setting., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This paper characterizes levels of mental distress among adults living in Canada amid the COVID-19 pandemic and examines the extent of virtual mental health resource use, including reasons for non-use, among adults with moderate to severe distress., Methods: Data are drawn from a cross-sectional monitoring survey (29 November to 7 December 2021) on the mental health of adults ( N   =  3030) in Canada during the pandemic. Levels of mental distress were assessed using the Kessler Psychological Distress Scale. Descriptive statistics were used to examine virtual mental health resource use among participants with moderate to severe distress, including self-reported reasons for non-use., Results: Levels of mental distress were classified as none to low (48.8% of participants), moderate (36.6%), and severe (14.6%). Virtual mental health resource use was endorsed by 14.2% of participants with moderate distress and 32% of those with severe distress. Participants with moderate to severe distress reported a range of reasons for not using virtual mental health resources, including not feeling as though they needed help (37.4%), not thinking the supports would be helpful (26.2%), and preferring in-person supports (23.4%), among other reasons., Conclusions: This study identified a high burden of mental distress among adults in Canada during the COVID-19 pandemic alongside an apparent mismatch between actual and perceived need for support, including through virtual mental health resources. Findings on virtual mental health resource use, and reasons for non-use, offer directions for mental health promotion and health communication related to mental health literacy and the awareness and appropriateness of virtual mental health resources., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CR reports receiving personal fees from the University of British Columbia during the conduct of this study. All other authors report no competing interests., (© The Author(s) 2023.)

Background: The COVID-19 pandemic has contributed to increases in negative emotions such as fear, worry, and loneliness, as well as changes in positive emotions, including calmness and hopefulness. Alongside these complex emotional changes has been an inequitable worsening of population mental health, with many people experiencing suicidal ideation and using substances to cope. This study examines how patterns of co-occurring positive and negative emotions relate to structural vulnerability and mental health amid the pandemic., Methods: Data are drawn from a cross-sectional monitoring survey (January 22-28, 2021) on the mental health of adults in Canada during the pandemic. Latent class analysis was used to group participants (N = 3009) by emotional response pattern types. Descriptive statistics, bivariate cross-tabulations, and multivariable logistic regression were used to characterize each class while quantifying associations with suicidal ideation and increased use of substances to cope., Results: A four-class model was identified as the best fit in this latent class analysis. This included the most at-risk Class 1 (15.6%; high negative emotions, low positive emotions), the mixed-risk Class 2 (7.1%; high negative emotions, high positive emotions), the norm/reference Class 3 (50.5%; moderate negative emotions, low positive emotions), and the most protected Class 4 (26.8% low negative emotions, high positive emotions). The most at-risk class disproportionately included people who were younger, with lower incomes, and with pre-existing mental health conditions. They were most likely to report not coping well (48.5%), deteriorated mental health (84.2%), suicidal ideation (21.5%), and increased use of substances to cope (27.2%). Compared to the norm/reference class, being in the most at-risk class was associated with suicidal ideation (OR = 2.84; 95% CI = 2.12, 3.80) and increased use of substances to cope (OR = 4.64; 95% CI = 3.19, 6.75)., Conclusions: This study identified that adults experiencing structural vulnerabilities were disproportionately represented in a latent class characterized by high negative emotions and low positive emotions amid the COVID-19 pandemic in Canada. Membership in this class was associated with higher risk for adverse mental health outcomes, including suicidal ideation and increased use of substances to cope. Tailored population-level responses are needed to promote positive coping and redress mental health inequities throughout the pandemic and beyond., (© 2022. The Author(s).)

The COVID-19 pandemic is adversely impacting suicidality at a population level, with consequences resulting from a variety of pandemic-driven disruptions, including social activities and connectedness. This paper uses a single case study design to explore how members of the Reddit r /COVID19_support community create a sense of connectedness among those who have suicidal thoughts due to the pandemic. Data were gathered from posts to the r/COVID19_support subreddit forum from February 2020 through December 2020. The second step of Klonsky and May's (2015) Three-Step Theory (3ST) of suicide, connectedness as a key protective factor , was used as the theoretical framework. This study explored r/COVID19_support 's constructed environment, users' dialogical interactions, and the four primary tenets of connectedness as proposed by Klonsky and May - Purpose and Meaning, Relationships, Religiosity, and Employment. Findings demonstrate a deep sense of connectedness for online community members. Relationships and Purpose and Meaning featured as the most salient sources of connectedness within this subreddit, whereas Religiosity was rarely discussed, and Employment was often spoken of in negative terms (i.e., creating mental distress, rather than facilitating connectedness). Contributors' responses offered various opportunities for connectedness both on- and off-line. Safe online spaces, such as r/COVID19_support , can serve as a protective factor amid suicidality, facilitating connectedness, and thereby helping to curtail suicidal thoughts from advancing to suicidal actions. This subreddit and similar online spaces can benefit specific populations who may otherwise find it challenging to access services or who wish to remain anonymous., Competing Interests: None declared., (© 2022 The Author(s).)

The Everyday Discrimination Scale (EDS) is one of the most widely used measures of discrimination in health research, and has been useful for capturing the impact of discrimination on health. However, psychometric analysis of this measure has been predominantly among Black Americans, with limited examination of its effectiveness in capturing discrimination against other social groups. This paper explores the theoretical and historical foundations of the EDS, and draws on the analytic framework of Messick's theory of unified validity to examine the effectiveness of the EDS in capturing diverse experiences of discrimination. Encompassing both social consequences and value implications, Messick's unified validity contends that psychometric evaluation alone is insufficient to justify instrument use or ensure social resonance of findings. We argue that despite the robust psychometric properties and utility in addressing anti-Black race-related discrimination, the theoretical foundations and research use of the EDS have yet to respond to current discrimination theory, particularly intersectionality. This paper concludes with guidance for researchers in using the EDS in health research across diverse populations, including in data collection, analysis, and presentation of findings.

Outreach is as a strategy employed by those in health and social services, which generally involves establishing relationships and providing support to people situated in hard-to-reach and hidden populations. However, there is a lack of clarity across the literature on how outreach is conceptualized, the central elements of outreach as a program and practice, and how the 'success' of outreach is empirically measured. Such gaps limit understandings of how outreach can be most effectively implemented and evaluated. The purpose of this scoping review responds to these challenges by systematically examining how outreach has been conceptualized, operationalized, and evaluated in community settings with hard-to-reach and hidden populations. This scoping review approach was undertaken in accordance with the 6-step framework developed by Arksey and O'Malley and advanced by Levac and colleagues. The search was conducted across four databases (CINAHL, MEDLINE, PubMed, and PsycINFO) and included research, review, and non-empirical articles published in English between January 1, 2008 and April 20, 2020.16,238 records were screened by title and abstract, followed by a review of 654 full-text articles and critical appraisal of 67 articles. Forty-two articles were included in the review, including 28 research articles (90%), two review, and two non-empirical. Findings illustrate that there is considerable variation in how outreach is conceptualized, implemented, and evaluated across the literature. Further, outreach is often inadequately defined, and predominantly overlooks the underlying and systemic reasons for clients' "disengagement" from health and social care. Outreach providers and researchers are encouraged to draw on client-led aims, goals, and outcome measures to determine the enactment, evaluation, and measurement of outreach, and to explicitly position outreach as working alongside clients to remove structural barriers to care., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Adverse mental health impacts of the COVID-19 pandemic are well documented; however, there remains limited data detailing trends in mental health at different points in time and across population sub-groups most impacted. This paper draws on data from three rounds of a nationally representative cross-sectional monitoring survey to characterize the mental health impacts of COVID-19 on adults living in Canada ( N = 9,061). Methods: Descriptive statistics were used to examine the mental health impacts of the pandemic using a range of self-reported measures. Multivariate logistic regression models were then used to quantify the independent risks of experiencing adverse mental health outcomes for priority population sub-groups, adjusting for age, gender, and survey round. Results: Data illustrate significant disparities in the mental health consequences of the pandemic, with inequitable impacts for sub-groups who experience structural vulnerability related to pre-existing mental health conditions, disability, LGBTQ2+ identity, and Indigenous identity. Conclusion: There is immediate need for population-based approaches to support mental health in Canada and globally. Approaches should attend to the root causes of mental health inequities through promotion and prevention, in addition to treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jenkins, Slemon, Richardson, Pumarino, McAuliffe, Thomson, Goodyear, Daly, McGuinness and Gadermann.)

This paper examines the mental health and substance use impacts of the COVID-19 pandemic among sexual and gender minority (SGM) populations as compared to non-SGM populations, and identifies risk factors for mental health and substance use impacts among SGM groups. Data were drawn from two rounds of a repeated cross-sectional monitoring survey of 6027 Canadian adults, with Round 1 conducted May 14-19, 2020 and Round 2 conducted September 14-21, 2020. Bivariate cross-tabulations with chi-square tests were utilized to identify differences in mental health and substance use outcomes between SGM and non-SGM groups. Separate multivariable logistic regression models were used to identify risk factors for mental health and substance use outcomes for all SGM respondents. Compared to non-SGM respondents, a greater proportion of SGM participants reported mental health and substance use impacts of the COVID-19 pandemic, including deterioration in mental health, poor coping, suicidal thoughts, self-harm, alcohol and cannabis use, and use of substances to cope. Among SGM respondents, various risk factors, including having a pre-existing mental health condition, were identified as associated with mental health and substance use impacts. These widening inequities demonstrate the need for tailored public mental health actions during and beyond the pandemic., (Copyright © 2021. Published by Elsevier B.V.)

Objective: With significant levels of mental distress reported by populations, globally, the magnitude of suicidal ideation during and beyond the COVID-19 pandemic is a central concern. The goal of this study was to quantify the extent of pandemic-related suicidal ideation in the Canadian population during the first ten months of the pandemic and identify sociodemographic and pandemic-related stressors associated with increased risk of ideation., Method: Data were derived from three rounds of a mental health monitoring survey, nationally representative by age, gender, household income, and region, delivered online in May 2020, September 2020, and January 2021. Bivariate analyses were used to quantify the proportion of respondents in Canada reporting suicidal ideation by sociodemographic factors and pandemic-related stressors. Unadjusted and adjusted multivariable logistic regression was used to study the association between suicidal ideation and correlates within four pandemic-related stressor categories (financial, relationship, substance use, COVID-19 exposure)., Results: Of the 7002 respondents, 6.2% (n = 433) reported experiencing suicidal thoughts or feelings as a result of the pandemic within the two weeks prior to taking the survey. In terms of sociodemographic factors, suicidal ideation was more commonly reported among those who were not cisgender, <65 years-old, single, Indigenous, LGBT2Q+, and who experience a pre-existing mental health condition. After adjusting for sociodemographic factors, indicators across all four pandemic-related stressor categories were associated with two or more times the odds of suicidal ideation., Conclusion: Disparities in COVID-19 related suicidal ideation have persisted throughout the first year of the pandemic for specific sociodemographic sub-groups and those who have faced stressors related to finances, relationships, increased substance use, and COVID-19 virus exposure. To best address these disparities and to prevent a transition from suicidal ideation to action, appropriate planning, resources, and policies are needed to ensure health and well-being for everyone., Competing Interests: CR reports receiving personal fees from the University of British Columbia during the conduct of this study. All other authors declare that they have no conflict of interest., (© 2021 The Authors.)

Lesbian, gay, bisexual, trans, other queer, and Two-Spirit (LGBTQ2+) people are particularly at risk for the psycho-social consequences of the COVID-19 pandemic, though population-tailored research within this context remains limited. This study examines the extent of, and associations between, increased alcohol and cannabis use and deteriorating mental health among LGBTQ2+ adults in Canada during the COVID-19 pandemic. Data are drawn from LGBTQ2+ respondents to a repeated, cross-sectional survey administered to adults living in Canada (May 2020-January 2021). Bivariate cross-tabulations and multivariable logistic regression models were utilized to examine associations between increased alcohol and cannabis use, and self-reported mental health, overall coping, and suicidal thoughts. Five-hundred and two LGBTQ2+ participants were included in this analysis. Of these, 24.5% reported increased alcohol use and 18.5% reported increased cannabis use due to the pandemic. In the adjusted analyses, increased alcohol use was associated with poor overall coping (OR = 2.28; 95% CI = 1.28-4.07) and worse self-reported mental health (OR = 1.98; 95% CI = 1.21-3.25), whereas increased cannabis use was associated with suicidal thoughts (OR = 2.30; 95% CI = 1.16-4.55). These findings underscore the need for population-tailored, integrated substance use and mental health supports to address interrelated increases in alcohol/cannabis use and worsening mental health among LGBTQ2+ adults, in the context of the COVID-19 pandemic and beyond.

Objective: Little is known about the association between mental health and diminished food worry during the COVID-19 pandemic. This paper examines worry about having enough food to meet household needs and its association with mental health during the early months of the pandemic in Canada., Methods: Data are drawn from the first round of a multi-round mental health monitoring survey. Online surveys were administered between May 14 and 29, 2020, to a nationally representative sample of Canadian adults (n = 3000). Logistic regression models were used to examine associations between food worry and mental health indicators (anxious/worried, depressed, worse mental health compared with pre-pandemic, and suicidal thoughts/feelings), after adjusting for socio-demographic characteristics and pre-existing mental health conditions. Fully adjusted models explored the impact of controlling for financial worry due to the pandemic in the previous 2 weeks., Results: Overall, 17.3% of the sample reported food worry due to the pandemic in the previous 2 weeks, with the highest prevalence found among those with a reported disability (29.3%), Indigenous identity (27.1%), or pre-existing mental health condition (25.3%). Compared with participants who did not report food worry, those who did had higher odds of reporting feeling anxious/worried (OR=1.36, 95% CI: 1.08-1.71) and suicidal thoughts/feelings (OR=1.87, 95% CI: 1.24-2.80) when controlling for socio-demographics, pre-existing mental health conditions, and financial worry., Conclusion: This paper provides insights about the associations between food worry and mental health in Canada during the COVID-19 pandemic and indicates the need for improved policies and social supports to mitigate food worry and associated mental health outcomes., (© 2021. The Canadian Public Health Association.)

Background: The COVID-19 pandemic is having considerable impacts on population-level mental health, with research illustrating an increased prevalence in suicidal thoughts due to pandemic stressors. While the drivers of suicidal thoughts amid the pandemic are poorly understood, qualitative research holds great potential for expanding upon projections from pre-pandemic work and nuancing emerging epidemiological data. Despite calls for qualitative inquiry, there is a paucity of qualitative research examining experiences of suicidality related to COVID-19. The use of publicly available data from social media offers timely and pertinent information into ongoing pandemic-related mental health, including individual experiences of suicidal thoughts. Objective: To examine how Reddit users within the r/COVID19&#95;support community describe their experiences of suicidal thoughts amid the COVID-19 pandemic. Methods: This study draws on online posts from within r/COVID19&#95;support that describe users' suicidal thoughts during and related to the COVID-19 pandemic. Data were collected from creation of this subreddit on February 12, 2020 until December 31, 2020. A qualitative thematic analysis was conducted to generate themes reflecting users' experiences of suicidal thoughts. Results: A total of 83 posts from 57 users were included in the analysis. Posts described a range of users' lived and living experiences of suicidal thoughts related to the pandemic, including deterioration in mental health and complex emotions associated with suicidal thinking. Reddit users situated their experiences of suicidal thoughts within various pandemic stressors: social isolation, employment and finances, virus exposure and COVID-19 illness, uncertain timeline of the pandemic, news and social media, pre-existing mental health conditions, and lack of access to mental health resources. Some users described individual coping strategies and supports used in attempt to manage suicidal thoughts, however these were recognized as insufficient for addressing the multilevel stressors of the pandemic. Conclusions: Multiple and intersecting stressors have contributed to individuals' experiences of suicidal thoughts amid the COVID-19 pandemic, requiring thoughtful and complex public health responses. While ongoing challenges exist with self-disclosure of mental health challenges on social media, Reddit and other online platforms may offer a space for users to share suicidal thoughts and discuss potential coping strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Slemon, McAuliffe, Goodyear, McGuinness, Shaffer and Jenkins.)

Objective: This paper aims to explore how self-care is currently defined and conceptualized in nursing education literature and identify gaps in current conceptualizations of self-care for nursing students., Background: Given the considerable stressors experienced by nursing students, self-care is an important concept for enhancing well-being. However, self-care has been poorly defined in the literature to date, contributing to challenges in integrating self-care into nursing education in support of student mental health and well-being., Design: A scoping review was undertaken in accordance with Arksey and O'Malley's (2005) framework and Levac et al.'s (2010) subsequent guidance., Methods: The search was conducted up to 1 September 2020 across three databases: Medline (OVID), PsycINFO and CINAHL. Search terms 'self-care', 'nursing students' and 'nursing education' were used. Criteria for inclusion of articles included peer-reviewed articles published in English that addressed self-care in the context of nursing education and/or nursing students and provided a definition of self-care. Two reviewers independently screened 1181 records by title and abstract, with a third reviewer resolving discrepancies. Subsequently, full-text review was completed for 119 articles., Results: Twenty-seven studies were included in the review, including 21 empirical articles and 6 non-empirical articles. Sixteen (59%) articles described an educational intervention, including self-care courses, assignments, or integration of self-care modalities as a classroom activity. Qualitative thematic analysis of article aims, and self-care definitions illustrated three central themes in the conceptualization of self-care: self-care as an aspect of holistic nursing; self-care as practices that ensure a healthy lifestyle; and self-care as activities undertaken in response to stress., Conclusions: There is considerable variability in how self-care for nursing students is conceptualized, contributing to inconsistencies in the integration of this concept into nursing education. Nurse educators are encouraged to support students in identifying their own self-care strategies and engage in reflection and action toward shifting systemic contributors to stress and burnout among nursing students., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Globally, a tainted drug supply is claiming the lives of tens of thousands of people who use drugs and current measures are not quelling this crisis. Within this context, mothers who have lost a child to substance use have emerged as vocal advocates for drug policy changes. This paper explores mothers' experiences in drug policy advocacy to uncover how they are using their stories to drive policy change., Methods: Critical qualitative and narrative methods informed individual interviews with 43 mothers who had lost a child to substance use from across three regions in Canada: British Columbia, Prairie Provinces, and Eastern Provinces. Multisite qualitative analysis (MSQA) provided a rigorous analytical method to identify how social context informed participants' advocacy efforts within and across geographies, together with a theoretical lens from Haraway to understand mothers' activism as situated knowledge., Results: Mothers' drug policy advocacy was shaped by social context and norms, which influenced the types of advocacy targets pursued, within the constraints of the social and political ethos of each geographic region. Yet across regions, narratives of shared aims and experiences also emerged. Specifically, the notion that people of all backgrounds are dying and that losing a child to substance use can "happen to anyone" - though people who experience structural vulnerabilities are disproportionately impacted. Additionally, mothers' stories were identified as a particularly powerful tool for conveying emotional knowledge and prompting action that complements other forms of knowledge or evidence., Conclusion: To date, efforts to address the drug poisoning epidemic have done little to curb casualties. Mothers whose child's death is related to substance use are one group who are bringing their experiences to advocacy efforts aimed at generating new solutions, including calls for decriminalization and legal regulation of drugs. This and other lived experience perspectives represent a critical voice in decision-making and hold the potential to inform more responsive and impactful drug policy., Competing Interests: Declarations of Interest The authors do not declare any conflicts of interest., (Copyright © 2020. Published by Elsevier B.V.)

Introduction: Outreach is regularly identified as an effective strategy to engage underserved, hard-to-reach and hidden populations with essential life-sustaining health services. Despite the increasing expansion of outreach programmes, particularly in HIV prevention and health promotion with youth, sex workers, people living with mental health and substance use challenges, and those affected by homelessness, there has been limited synthesis of the evidence concerning the core components of outreach programming or indicators of its successful implementation. Without this understanding, current outreach programmes may be limited in achieving the desired aims. The aim of this scoping review is to explore how outreach has been operationalised and implemented in various community settings with people underserved in current healthcare contexts. Understanding the state of knowledge pertaining to outreach as programming and as practice involving the engagement of people considered hard-to-reach will enable the identification of promising trends and limitations in the field., Methods and Analysis: This scoping review follows the Arksey and O'Malley's framework. CINAHL, MEDLINE, PsycINFO and PubMed databases will be searched for peer-reviewed references focused on outreach with hard-to-reach and hidden groups from 1 January 2008 to 30 April 2020. Guided by explicit inclusion and exclusion criteria, three reviewers will independently assess references in two successive stages. Titles and abstracts will be reviewed followed by full-text assessment of papers meeting the review criteria. A descriptive overview, tabular and/or graphical summaries and a thematic analysis will be carried out on extracted data., Ethics and Dissemination: Ethics approval was not required as the only data source was peer-reviewed documents. Outreach knowledge users who are members of the project team will participate in all aspects of study design, implementation and result dissemination strategies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Since the onset of the COVID-19 pandemic, many jurisdictions, including Canada, have made use of public health measures such as COVID-19 quarantine to reduce the transmission of the virus. To examine associations between these periods of quarantine and mental health, including suicidal ideation and deliberate self-harm, we examined data from a national survey of 3000 Canadian adults distributed between May 14-29, 2020. Notably, participants provided the reason(s) for quarantine. When pooling all reasons for quarantine together, this experience was associated with higher odds of suicidal ideation and deliberate self-harm in the two weeks preceding the survey. These associations remained even after controlling for age, household income, having a pre-existing mental health condition, being unemployed due to the pandemic, and living alone. However, the associations with mental health differed across reasons for quarantine; those who were self-isolating specifically due to recent travel were not found to have higher odds of suicidal ideation or deliberate self-harm. Our research suggests the importance of accounting for the reason(s) for quarantine in the implementation of this critical public health measure to reduce the mental health impacts of this experience., (Copyright © 2020. Published by Elsevier B.V.)

Background: The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low., Objective: The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic., Methods: Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators., Results: Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping "not well" with COVID-19-related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group., Conclusions: Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use., (©Chris G Richardson, Allie Slemon, Anne Gadermann, Corey McAuliffe, Kimberly Thomson, Zachary Daly, Travis Salway, Leanne M Currie, Anita David, Emily Jenkins. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.12.2020.)

Aims and Objectives: The purpose of this study was to explore how undergraduate students perceive and make decisions regarding mental health nursing as a career following completion of an inpatient mental health practicum., Background: Among nursing students, mental health is consistently perceived as the least desirable nursing career path. However, evidence to explain why this is the case remains limited, with a lack of research exploring students' experiences of mental health settings and how these experiences influence their perceptions of a mental health nursing career. This knowledge gap limits strategies to support nurses' selection of mental health nursing as a career path, contributing to a global shortage of mental health nurses., Design: This study used a qualitative narrative inquiry design., Methods: In-depth interviews (N = 15) were conducted with undergraduate nursing students to explore their experiences of mental health practicums. Participants had all completed a 6-week practicum in inpatient mental health settings in urban hospitals. Reporting follows COREQ guidelines., Results: Nursing students' decisions to not choose a career in mental health nursing were influenced by negative practicum experiences, including the institutional environments of the inpatient mental health settings and witnessing of harmful nursing practices. These factors were identified as barriers to pursuing a career in mental health nursing. However, students expressed desire to continue to work with clients with mental health challenges and aimed to pursue nursing careers that preserve this opportunity in different healthcare settings., Conclusions: These findings expand upon existing literature that frequently positions nursing students as "uninterested" in mental health nursing and offers insights that can contribute to addressing global mental health nursing shortages., Relevance to Clinical Practice: This study highlights the need for mental health nurses, nursing leaders, and educators to recognise and respond to students' difficult experiences in the inpatient mental health setting during practicums., (© 2019 John Wiley & Sons Ltd.)

Background: Nursing students experience numerous personal, academic, and practice-related stressors, impacting their mental health. Nursing programs often contribute to student stress and should incorporate strategies to support students' mental health. Self-care has the potential to enhance students' ability to manage current stressors and to build capacity for addressing future stress and burnout; however, the concept has been limitedly integrated into nursing education., Objectives: To examine students' responses to a self-care assignment integrated into core nursing coursework., Design: Cross-sectional study using an online survey., Settings: An accelerated two-year undergraduate nursing program in Western Canada., Participants: Undergraduate nursing students in first- and second-year of a two-year program., Methods: A 16-question survey, including closed- and open-ended response fields was developed by the research team. Survey questions were grounded in Bloom's Cognitive, Psychomotor, and Affective learning domains to comprehensively examine the impact of the assignment on students' learning and self-care capacity., Results: 89 participants completed the survey (49% response rate). Participants' increase in self-care practices pre- and post-assignment was statistically significant (p = 0.023). Results further demonstrate that students' knowledge of self-care and capacity to identify and manage stressors were enhanced. Participants reported that overall the assignment supported their well-being. However, some participants described that aspects of the assignment detracted from well-being, including challenges with grading and feelings of guilt when not practicing self-care., Conclusions: A self-care assignment is an effective strategy for nursing educators to foster students' capacity to cope with stressors., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The aims of multisite qualitative research, originally developed within the case study tradition, are to produce findings that are reflective of context, while also holding broader applicability across settings. Such knowledge is ideal for informing health and social interventions by overcoming the limitations of research developed through methodological approaches that either "strip" context, or that hold relevance for a site-specific group or population. Yet, despite the potential benefits of multisite qualitative research, there is a paucity of analytical guidance to support researchers in achieving these yields. In this article, we present an analytical approach for conducting multisite qualitative analysis (MSQA) across various methodologies to maximize the potential of qualitative research, enhance rigor, and support the development of interventions that are tailored to the populations that they are intended to serve.

Mental health challenges are a leading health issue, and while nurses should be well positioned to provide care to this client population, nurses are not adequately prepared for this role during their education. This qualitative narrative inquiry explored nursing students' (N = 15) experiences within their mental health practicums. Analyzed through Foucault's concept of micropower, participants' narratives illustrate that students observed nurses holding power over patients, and enacted resistance to this power in a complex interplay of empowerment and disempowerment. Study findings speak to the need for systemic shifts in mental health practice and ongoing educator support of students in mental health practicums.

The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices., (© 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.)

Background: Youth substance use programming and educational strategies are frequently informed by prevention approaches that emphasize abstinence goals, which often do not resonate with youth in their lack of acknowledgment of young people's social context and how young people perceive positive effects of substance use. Further, approaches to drug prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing substance use in the context of population variation and inequities. In response to the limitations of current approaches to prevention, programming informed by harm reduction principles that aims to minimize harms without requiring abstinence is emergent in school settings. However, youth perspectives informing harm reduction are limited in both research and program development., Methods: This paper draws on data from the Researching Adolescent Distress and Resilience (RADAR) study, which utilized an ethnographic approach to bring youth voice to the literature on mental health and substance use. Qualitative data collection included individual interviews (n = 86) with young people aged 13-18 across three communities-representing urban, suburban, and rural geographies-in British Columbia, Canada. A multi-site qualitative analysis of interview data was conducted to identify themes across and within each research site., Results: Across all three sites, young people's individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, with youth describing their use in relation to the nature of substance use in peer groups and in the broader community. To manage their own substance use and reduce related harms, youth employed a variety of ad hoc harm minimization strategies that were reflective of their respective contexts., Conclusions: The findings from this study suggest the importance of harm reduction approaches that are contextually relevant and responsive to the lived experiences of youth. Youth perspectives in the development of harm reduction programming are needed to ensure that approaches are relatable and meaningful to young people, and effective for promoting the minimization of substance-related harms.

An Associative Elaboration Scale and an Integration Scale were constructed for evaluating Thematic Apperception Test (TAT) protocols. Interrater reliabilities and the correlation between the two scales were determined for a selection of TAT cards. The Integration Scale was dropped from further analyses, because its interrater reliabilities were low and it correlated highly with the Associative Elaboration Scale. The relation between the Associative Elaboration Scale and age was then investigated for randomly selected patients aged 7, 9, 11, 13, and 15. There tended to be a rapid increase in Associative Elaboration scores up to age 11 and then little or no increase in scores. There was no significant relation between Associative Elaboration and IQ.