Search

Many teens report experiencing anxiety in school, which can negatively impact their well-being. Considering that adolescents tend to adopt the same behaviors as their classmates with whom they spend, on average, 923 h every year, the current exploratory study (1) assessed whether an association exists between a student’s state anxiety score and his/her classmates’ average trait anxiety scores and (2) examined whether this association differed between boys and girls, as well as between elementary school and high school students. During two consecutive school years, 1044 Canadian students (59% girls) from six elementary schools (aged 10–12) and seven high schools (aged 15–17) completed the State-Trait Anxiety Inventory for Children. Multilevel analyses revealed a same-sex peer effect of classmates’ anxiety in girls only (β = 0.40, p < 0.001). This effect was similar for elementary and high school girls (β = 0.07, p = 0.27). Interestingly, no association was found for boys, same-sex peers (β = 0.11, p = 0.25), or opposite-sex peers (β = −0.01, p = 1.00). Our results suggest that factors related to sex may reinforce anxiety in school settings. Future studies should confirm these results and explore the mechanisms involved in this sex-specific difference.

OBJECTIVE Depression and anxiety symptoms are commonly observed among clinical populations, especially among women and maltreated individuals. Few investigations have, however, assessed the existence of distinct symptoms trajectories among clinical populations and how these relate to childhood maltreatment, sex differences, and stress physiology indexed by hair cortisol concentrations (HCC). The current study (1) identified distinct depression and anxious trajectories in a sample of psychiatric inpatients followed-up prospectively from their admission to a psychiatric emergency service (PES), and (2) examined whether HCC, childhood maltreatment and sex independently and jointly predict these trajectories. METHODS Adult inpatients (N = 402, 55% women) were recruited upon admission to PES (T1) during which HCC (reflecting cortisol secretion for the last 3 months), childhood maltreatment, and depression and anxiety symptoms were assessed. Symptoms were re-evaluated when patients were discharged from the hospital (T2), admitted to outpatient clinics (T3), and 12 months later or at the end of outpatient treatment (T4). RESULTS Three trajectories were identified for depression and anxiety symptoms. Among men, higher HCC predicted higher odds of evincing chronic depressive symptoms compared to a Low Stable trajectory (OR 3.46, 95% confidence interval [CI] 1.43-8.40). Greater childhood maltreatment among men predicted higher chances of exhibiting chronic anxious symptoms than the Low Stable (OR 1.47, 95% CI 1.07-2.02) and the High Decreasing trajectories (OR .70, 95% CI .51-.95). Opposite findings were noted for women. CONCLUSIONS Childhood maltreatment and HCC should be further investigated as predictors of anxious and depressive trajectories, during which sex-specific associations ought to be considered.

Cannabis use disorder (CUD) is a complex issue, even more so when it is comorbid with a severe mental disorder (SMD). Available interventions are at best slightly effective, and their effects are not maintained over time. Therefore, the integration of virtual reality (VR) may increase efficacy; however, it has not yet been investigated in the treatment of CUD. A novel approach, avatar intervention for CUD, uses existing therapeutic techniques from other recommended therapies (e.g., cognitive behavioral methods, motivational interviewing) and allows participants to practice them in real-time. During immersive sessions, participants are invited to interact with an avatar representing a significant person related to their drug use. This pilot clinical trial aimed to evaluate the short-term efficacity of avatar intervention for CUD on 19 participants with a dual diagnosis of SMD and CUD. Results showed a significant moderate reduction in the quantity of cannabis use (Cohen’s d = 0.611, p = 0.004), which was confirmed via urinary quantification of cannabis use. Overall, this unique intervention shows promising results. Longer-term results, as well as comparison with classical interventions in a larger sample, are warranted through a future single-blind randomized controlled trial.

Child protection workers (CPWs) are exposed to physical and psychological violence initiated by clients. The consequences associated with exposure to this type of trauma and others are compounded by the anxiety generated by the feelings of being accountable and the constant scrutiny and monitoring CPWs are under. Previous research suggests that acting according to one's professional values can help protect against the effects of trauma exposure and the anxiety associated with being held accountable when situations devolve into crises.Using path analysis, this study sought to investigate how this complex intersection between client aggression, felt accountability, and professional identity among 310 CPWs is related to their professional quality of life (ProQol).Results show that adherence to professional identity was strongly and positively associated with ProQoL scores (β = -0.42, p .001). Felt accountability and exposure to psychological violence (but no other forms of violence) were consistently and negatively related to ProQoL scores (β = -0.42, p .001/β = -0.20, p .001). The impact of felt accountability on ProQoL scores can be partially explained by lowered adherence to professional identity. This suggests that the current way CPWs are held accountable and evaluated comes at odds with their professional values.The article ends with a discussion on how organizational changes surrounding accountability can be anxiety-inducing for some CPWs who increasingly feel overwhelmed by the complexity of their cases. Organizations must therefore reflect on how they can better embody the values of their clinicians.

Objective:Assessing global functioning in psychiatric emergency settings is important for clinicians to estimate severity of mental disorders, devise a treatment plan, and assess the evolution of their patients’ progression over time. The World Health Organization Disability Assessment Schedule-2.0 (WHODAS-2) measures psychological, social, and professional functioning and is recommended as a standardized instrument of choice for use in psychiatric settings. Yet, studies investigating disability profiles of mental disorders using the WHODAS-2 are scarce, and psychometric properties have not been evaluated in a psychiatric emergency context. We describe and compare WHODAS-2 (12-item version) scores across mental disorders (anxiety, mood, psychotic, personality, and substance abuse) in adults admitted to psychiatric emergency.Methods:Data from the Signature Bank were used. Participants admitted to psychiatric emergency completed the WHODAS-2 at admission ( n = 1,125). Mental disorders were evaluated by psychiatrists, and WHODAS-2 scores were compared across groups. Psychometric properties were evaluated using confirmatory factor analysis (CFA).Results:Higher mean WHODAS-2 scores were reported by those with anxiety, mood, and personality disorders ( P < 0.001) compared to other psychopathologies. The measure showed good internal consistency (global score α = 0.88; domain subscores α = 0.59 to 0.85) and acceptable goodness of fit indices in CFA confirming the original structure of WHODAS-2.Conclusions:Findings from this large-scale study could assist clinicians in interpreting WHODAS-2 scores in psychiatric populations and provide a more detailed portrait of disability profiles associated with different clinical diagnoses.

PURPOSE To compare the sealability of femtosecond laser (FSL)-assisted corneal incisions (CIs) with that of triplanar manual (M)-CIs and to determine FSL wound parameters minimizing leakage. SETTING Private practice. DESIGN Phase IV, single-surgeon, retrospective cohort study. METHODS One eye per patient was included. Two groups defined by the main wound (FSL-CI or M-CI) were compared for leakage, inferred by placement of a suture at the end of surgery. Leakage in FSL-CIs was analyzed as a function of customizable wound parameters: anterior plane depth (APD), posterior plane depth (PPD), anterior side-cut angle (ASCA), and posterior side-cut angle (PSCA). The risk of leakage of FSL-CIs with optimal and nonoptimal parameters was further compared with that of M-CIs. RESULTS A total of 1100 eyes (757 [68.8%] FSL-CI; 343 [31.2%] M-CI) were included. Wound leakage occurred in 133 FSL-CI (17.6%) and 30 M-CI eyes (8.7%) (P < .001). FSL wound parameters associated with the lowest risk of leakage were 60% APD, 70% PPD, 120 degrees ASCA, and 70 degrees PSCA. FSL-CIs constructed with at least 3 optimal parameters (60% APD, 70% PPD, and 120 degrees ASCA) had a similar risk of leakage to M-CIs (odds ratio [OR], 1.1; 95% CI, 0.5-2.3). FSL-CIs with suboptimal parameters had twice the risk of leakage of M-CIs (OR, 2.0; 95% CI, 1.1-3.8). CONCLUSIONS Overall, FSL-CIs leaked more than M-CIs. However, FSL-CIs with optimized wound profiles had an equivalent risk of leakage to M-CIs. Wound parameter customization is an asset of FSL technology that allows optimization of FSL-CI sealability.

Stress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.

Recidivism among released inmates is associated with a substantial societal burden given the financial and medical consequences of victimization. Among incarcerated North Americans, approximately 7% are housed in solitary confinement (SC). Studies show SC can lead to psychological deterioration and dispute it can effectively reduce institutional misconduct or recidivism. This meta-analysis aims to clarify the impact of SC on postrelease recidivism, which we hypothesized would increase following SC. A meta-analysis was conducted using PubMed, PsycINFO, Web of Science, and Google Scholar databases from inception until December 2019. Studies on adult inmates in correctional settings were included if they met an operational definition of SC, measured recidivism, and included a comparison group in general inmate population. Random-effect models were used to assess the impact of SC on multiple types of recidivism. Of the 2,713 identified records, 12 met inclusion criteria ( n = 194,078). A moderate association was found between SC and any recidivism (odds ratio [ OR] = 1.67, 95% confidence interval [1.41, 1.97]), which persisted in controlled studies ( OR = 1.41). This association was replicated across types of recidivism comprising violence ( OR = 1.41), rearrests ( OR = 1.37), and reincarceration ( OR = 1.67). Moreover, a more recent exposure to SC increased recidivism risk ( OR = 2.02), and a dose–response relationship was found between days in SC and recidivism. The overall database presented high heterogeneity but no publication bias. Findings show a small to moderate association between SC and future crime/violence. Considering the societal costs associated with antisocial behaviors following SC, mental health and psychosocial programming facilitating inmates’ successful reentry into society should be implemented and rigorously evaluated in strong research design.

The aim of this meta-analysis was to examine the association between any mental health problem and the risk of being placed into solitary confinement in correctional settings. PubMed, PsycINFO, Web of Science and Google Scholar were searched from each database's inception date to November 2019. All publications assessing both mental health problems and placement into solitary confinement in a sample of adult inmates in correctional settings were included. The meta-analysis was performed using random-effects models. Heterogeneity among study point estimates was assessed with Q statistics and quantified with I2 index. Publication bias was assessed with funnel plots. Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed throughout. After screening 2777 potential studies, 11 studies were included amounting to a total of 163 414 inmates. Included studies comprised of a mix of mental disorders rather than a specific diagnosis per se. The odds ratio (OR) from the pooled studies was 1.62 (confidence interval (CI) = 1.21-2.15). The observed relationship remained unchanged regardless of the removal of outliers (OR = 1.63, CI = 1.47-1.80) and regardless of the adjustment of confounders (OR = 1.58, CI = 1.32-1.88). The present study shows a moderate association between any mental health problem and placement into solitary confinement within a considerable sample of inmates. As more individuals suffering from mental illness enter the correctional system, it is essential that correction officials create new safe interventions to manage these inmates and offer them proper mental health care to limit the use of solitary confinement, which may have deleterious effects.

Objectives: Individuals with psychotic symptoms presenting to emergency psychiatry often have comorbid symptoms, such as substance misuse, depression, and anxiety. Many will also have symptoms link...

Background Suicide is the third leading cause of death worldwide among youth aged 10- to 19, and mental disorders are often associated in the etiology of suicidal behavior. Mental disorders are often under-diagnosed and under-treated in young people, a situation likely to increase the severity of the disorder and suicide risk. Presence of school difficulties may, in some cases, be a consequence of mental disorder, and theses difficulties are observable. Therefore, early detection and early intervention of school difficulties may alleviate the development of mental disorders and suicide vulnerability. The aim of this study is to understand the link between school difficulties and suicide risk. Methods We used the data bank gathered by the McGill Group on Suicide Studies over the past two decades through interviews with the relatives of individuals who died by suicide and with individuals from the community as a control group. We included data on common sociodemographic characteristics, life events and mental health characteristics identified before age 18, among individuals who died before the age of 35 or were interviewed before the age of 35. We identified 200 individuals who died by suicide and 97 living controls. We compared groups according to gender and characteristics. Results Within the total sample, 74% were male, 13% had met with academic failure, 18% had engaged in inappropriate behavior at school, and 18% presented combined school difficulties. Combined school difficulties (academic failure and inappropriate behavior) for both sexes and academic failure alone for males were associated with higher suicide risk before the age of 35. School difficulties generally began in early childhood and were linked to mental disorders/difficulties and substance abuse before age 18. Conclusions This study underlines the importance for parents, teachers, and educators to identify children with school difficulties—academic failure and behavioral difficulties at school—as early as possible in order to be able to propose adapted interventions. Early identification and proper diagnosis may prevent chronicity of some disorders, accumulation of adverse events, and even suicide.

Many teens report experiencing anxiety in school, which can negatively impact their well-being. Considering that adolescents tend to adopt the same behaviors as their classmates with whom they spend, on average, 923 h every year, the current exploratory study (1) assessed whether an association exists between a student’s state anxiety score and his/her classmates’ average trait anxiety scores and (2) examined whether this association differed between boys and girls, as well as between elementary school and high school students. During two consecutive school years, 1044 Canadian students (59% girls) from six elementary schools (aged 10–12) and seven high schools (aged 15–17) completed the State-Trait Anxiety Inventory for Children. Multilevel analyses revealed a same-sex peer effect of classmates’ anxiety in girls only (β = 0.40, p < 0.001). This effect was similar for elementary and high school girls (β = 0.07, p = 0.27). Interestingly, no association was found for boys, same-sex peers (β = 0.11, p = 0.25), or opposite-sex peers (β = −0.01, p = 1.00). Our results suggest that factors related to sex may reinforce anxiety in school settings. Future studies should confirm these results and explore the mechanisms involved in this sex-specific difference.

Background: Studies report a growing tendency for students to experience state anxiety in schools. However, the combination of individual susceptibilities likely to trigger students’ anxious states remains unclear. Aims: This study examined whether distinct profiles of students emerge regarding their susceptibility to anxiety sensitivity and/or test anxiety and evaluated whether students’ profile predicted anxious states. We also verified whether susceptibility profiles varied across gender, school level, and school type. Sample and Methods: In total, 1404 Canadian students in Grades 5 and 10 (589 boys) from 13 public and private schools completed self-reported measures of state/trait anxiety, anxiety sensitivity and test anxiety. Results: Latent profile analyses identified four susceptibility profiles: (1) Double-susceptibility – highest anxiety sensitivity and test anxiety scores; (2) Unique-susceptibility to test anxiety – high test anxiety score and low anxiety scores score; (3) Unique-susceptibility to anxiety sensitivity – high anxiety sensitivity score and low test anxiety score; (4) No-susceptibility – lowest anxiety sensitivity and test anxiety scores. The profiles comprised 12%, 9%, 6%, and 73% of the sample, respectively, and their membership varied across gender and school type, but not across school levels. A linear mixed-effect model showed that state anxiety varied significantly between profiles, where the Double-susceptibility profile predicted the highest state anxiety scores, followed by the two Unique-susceptibility profiles (indifferently), and the No-susceptibility profile. Conclusions: Beyond their theoretical contribution to the state-trait anxiety literature, these findings suggest that selective interventions designed more specifically for students with the Double-susceptibility profile may be worthwhile. Results also highlight the high proportion of students with the No-susceptibility profile and shed light on the reassuring portrait regarding students’ anxiety.

The Professional Quality of Life (ProQOL) scale is one of the most widely used measures of compassion satisfaction and fatigue despite there being little publicly available evidence to support its validity. This study, conducted among a sample of 310 child protection workers, assessed the construct validity of this measure using confirmatory factor analysis (CFA) and bifactor modeling. The CFA failed to confirm the adequacy of the three-factor structure proposed by Stamm (2010). In response, a bifactor model postulating a factor structure with a general factor in addition to independent factors (compassion satisfaction, job burnout, and secondary traumatic stress) was proposed, highlighting the unidimensionality of the ProQOL while allowing for each subscale to be used separately. Moreover, this bifactor model of the ProQOL was moderately correlated with the Posttraumatic Disorder Checklist, r = -.427, p.001, and strongly correlated with scales of well-being at work, r = .694, p.001, and psychological distress at work, r = -.666, p.001, thus supporting the ProQOL's convergent validity. No associations were found between the ProQOL and the Life Event Checklist, which supports the ProQOL's discriminant validity. Overall, the results indicated that compassion satisfaction and compassion fatigue represent higher and lower levels of the same construct rather than two different constructs. Researchers and clinicians could therefore compute a single score to rate professionals' individual levels of professional quality of life.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Validez de Constructo del instrumento de medición de Calidad de Vida Profesional (ProQoL) en una muestra de trabajadores de protección infantil ESCALA DE CALIDAD DE VIDA PROFESIONAL: VALIDEZ DE CONSTRUCTO La escala de Calidad de Vida Profesional (ProQoL en su sigla en inglés) es una de las medidas más ampliamente usadas de compasión satisfacción y fatiga por compasión, a pesar de que hay escasa evidencia disponible públicamente que soporte su validez. Este estudio, realizado en una muestra de 310 trabajadores de protección infantil, evaluó la validez de constructo de esta medición usando análisis confirmatorio de factores (CFA, por su sigla en inglés) y modelado bifactor. El CFA no confirmó la idoneidad de la estructura de tres factores propuesta por Stamm (2010). En respuesta, se propone un modelo bifactor que postula una estructura factorial con un factor general junto a factores independientes (compasión satisfacción, agotamiento laboral y estrés traumático secundario), destacando la unidimensionalidad de la ProQoL mientras permite el uso por separado de cada subescala. Más aún, este modelo bifactor de la ProQoL estuvo moderadamente correlacionado con la Lista de Chequeo de Trastorno Postraumático, r = -.427, p.001, y fuertemente correlacionado con escalas de bienestar en el trabajo, r = .694, p.001, y malestar psicológico en el trabajo, r = -.666, p.001, apoyando por tanto la validez convergente de la ProQoL. No se encontraron asociaciones entre la ProQoL y la Lista de Chequeo de Eventos Vitales, lo cual apoya la validez discriminante de la ProQoL. En suma, los resultados indicaron que la compasión satisfacción y la fatiga por compasión representan niveles más altos y más bajos del mismo constructo más que dos constructos diferentes. Los investigadores y los clínicos podrían por lo tanto calcular un único puntaje para calificar los niveles individuales de calidad de vida profesional de los profesionales.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 Construct Validity of the Professional Quality of Life (ProQoL) measurement instrument among a sample of child protection workers Traditional Chinese 標題: 兒童護理工作者中, 專業生活品質(ProQOL)量表作為測量工具的建構效度 撮要: 雖然目前仍欠缺公開的實證以證明專業生活品質(ProQOL)量表的效度, 其仍為最廣泛用以測量慈心滿足及慈心疲倦的量表。本研究樣本為310名兒童護理工作者, 運用驗證性因素分析(CFA)和雙因素模型, 評估此量表的建構效度。CFA未能證實Stamm(2010)提出的三因素結構的適當性。因此, 我們採用一個雙因素模型, 假設一個除了獨立因素 (慈心滿足、工作枯竭、次級創傷後壓力) 外, 亦有一個共通因素的因素結構, 凸顯ProQOL量表的單向度性, 同時讓各個子量表可分開使用。此外, 這個ProQOL的雙因素模型跟創傷後壓力症檢查表有中等的關連(r = -.427, p.001), 並跟工作幸福感(r = .694, p.001)和工作中的心理悲痛(r = -.666, p.001)量表分數有強勁關連, 繼而證實了量表的聚合效度。ProQOL與生命事件量表並無關連, 證實了ProQOL的區別效度。整體來說, 慈心滿足及慈心疲倦反映為同一構念高低水平的分別, 而非來自兩個不同構念。因此, 研究員和臨床治療師可以單一分數, 為專業人員的專業生活品質水平評分。 Simplified Chinese 标题: 儿童护理工作者中, 专业生活质量(ProQOL)量表作为测量工具的建构效度 撮要: 虽然目前仍欠缺公开的实证以证明专业生活质量(ProQOL)量表的效度, 其仍为最广泛用以测量慈心满足及慈心疲倦的量表。本研究样本为310名儿童护理工作者, 运用验证性因素分析(CFA)和双因素模型, 评估此量表的建构效度。CFA未能证实Stamm(2010)提出的三因素结构的适当性。因此, 我们采用一个双因素模型, 假设一个除了独立因素 (慈心满足、工作枯竭、次级创伤后压力) 外, 亦有一个共通因素的因素结构, 凸显ProQOL量表的单向度性, 同时让各个子量表可分开使用。此外, 这个ProQOL的双因素模型跟创伤后压力症检查表有中等的关连(r = -.427, p.001), 并跟工作幸福感(r = .694, p.001)和工作中的心理悲痛(r = -.666, p.001)量表分数有强劲关连, 继而证实了量表的聚合效度。ProQOL与生命事件量表并无关连, 证实了ProQOL的区别效度。整体来说, 慈心满足及慈心疲倦反映为同一构念高低水平的分别, 而非来自两个不同构念。因此, 研究员和临床治疗师可以单一分数, 为专业人员的专业生活质量水平评分。.

Although a majority of people will be exposed to a traumatic event over the course of their lifespan, only a minority will develop post-traumatic stress disorder. Better understanding the factors contributing to the development of this psychopathology is of high importance and could significantly reduce the societal and human costs associated with PTSD. Acute stress disorder symptoms, which refers to clinical manifestations experienced in the aftermath of a traumatic event, have been shown to be associated with subsequent PTSD symptoms. Yet, many people who develop PTSD do not meet criteria for acute stress disorder in the first place, highlighting the need to refine the predictors of PTSD. The secretion of the stress hormone cortisol is dysregulated in PTSD patients. Whether combining clinical and biological measures in the aftermath of trauma could help to better explain subsequent PTSD symptoms remains to be tested. The current prospective study recruited 51 adults who were exposed to a traumatic event in their work setting, i.e. a psychiatric hospital. Acute stress disorder symptoms and cortisol awakening responses were assessed one to five weeks following trauma exposure (Time 1). PTSD symptoms were measured two months following trauma exposure. Results revealed a significant interaction between acute stress disorder symptoms and cortisol awakening response in predicting later PTSD symptoms. The results suggest that higher cortisol awakening response is a protective factor in that it abolishes the relationship between acute stress disorder symptoms and subsequent PTSD symptoms. These results point to the importance of considering multi-level information in the aftermath of trauma, such as clinical and biological measures, in order to better identify individuals who are at higher risk of developing PTSD.

Objectives: Patients admitted to psychiatric emergency services (PES) are highly heterogenous. New tools based on a transdiagnosis approach could help attending psychiatrists in their evaluation process and treatment planning. The goals of this study were to: (1) identify profiles of symptoms based on self-reported, dimensional outcomes in psychiatric patients upon their admission to PES, (2) link these profiles to developmental variables, that is, history of childhood abuse (CA) and trajectories of externalizing behaviours (EB), and (3) test whether this link between developmental variables and profiles was moderated by sex. Methods: In total, 402 patients were randomly selected from the Signature Biobank, a database of measures collected from patients admitted to the emergency of a psychiatric hospital. A comparison group of 92 healthy participants was also recruited from the community. Symptoms of anxiety, depression, alcohol and drug abuse, impulsivity, and psychosis as well as CA and EB were assessed using self-reported questionnaires. Symptom profiles were identified using cluster analysis. Prediction of profile membership by sex, CA, and EB was tested using structural equation modelling. Results: Among patients, four profiles were identified: (1) low level of symptoms on all outcomes, (2) high psychotic symptoms, (3) high anxio-depressive symptoms, and (4) elevated substance abuse and high levels of symptoms on all scales. An indirect effect of CA was found through EB trajectories: patients who experienced the most severe form of CA were more likely to develop chronic EB from childhood to adulthood, which in turn predicted membership to the most severe psychopathology profile. This indirect effect was not moderated by sex. Conclusion: Our results suggest that a transdiagnostic approach allows to highlight distinct clinical portraits of patients admitted to PES. Importantly, developmental factors were predictive of specific profiles. Such transdiagnostic approach is a first step towards precision medicine, which could lead to develop targeted interventions.

Background Robust evidence shows that schizophrenia is associated with significant cognitive impairments, including deficits in visuospatial abilities. While other cognitive domains have sparked several functional neuroimaging studies in schizophrenia, only a few brain activation studies have examined the neural correlates of visuospatial abilities in schizophrenia. Purpose Here, we propose to perform a functional connectivity study on visuospatial processing in schizophrenia, and to determine the classification accuracy of the observed alterations. Methods Thirty-nine schizophrenia patients and 42 healthy controls were scanned using functional magnetic resonance imaging while performing a mental rotation task. Task-based functional connectivity was examined using a region-of-interest (ROI) to ROI approach, as implemented in the CONN Toolbox. ROIs were selected from a previous meta-analysis on mental rotation. Logistic regression with Lasso regularization was performed, using train-test cross-validation. Results Schizophrenia was associated with a complex pattern of dysconnectivity between the superior, middle and inferior frontal gyrus, the precentral gyrus, the superior parietal lobule (SPL) and the inferior lateral occipital cortex. The classification accuracy was 86.1%. Mental rotation performance was predicted by the dysconnectivity between the right and left superior frontal gyrus (SFG), as well as between the left SFG and left SPL. Conclusion The results of the current study highlight that visuospatial processing is useful for examining the widespread dysconnectivity between executive, motor and visual brain regions in schizophrenia. We also demonstrate that very good classification accuracy can be achieved using visuospatial-related functional connectivity data.

Supplemental Material, sj-pdf-1-cpa-10.1177_07067437211018793 for Psychosocial Profiles of Patients Admitted to Psychiatric Emergency Services: Results from the Signature Biobank Project: Profils Psychosociaux de Patients Admis Dans des Services d’Urgence Psychiatrique : Résultats du Projet Banque Signature by Steve Geoffrion, Kévin Nolet, Charles-Édouard Giguère, Tania Lecomte, Stéphane Potvin, Sonia Lupien and Marie-France Marin in The Canadian Journal of Psychiatry

Le chapitre présente les avantages de l'utilisation de la régularisation dans l'analyse de régression linéaire et logistique. Afin d'illustrer les techniques de régularisation, nous donnons un exemple de régression logistique régularisée avec validation croisée cherchant à prédire le décrochage scolaire chez des élèves du secondaire au Québec. Avec 25 variables prédictives et un échantillon simulé de 1000 cas, les résultats de la régression logistique ordinaire sont comparés avec ceux de la régression avec régularisation ridge, lasso et elastic-net.

Background: Previous work provided conversion equations for overall indices of positive and negative symptomatology between the two most widely used scales to assess symptom severity in schizophrenia, namely the Positive and Negative Syndrome Scale (PANSS) and the Scales for the Assessment of Positive/Negative Symptoms (SAPS/SANS). Our objective was to provide such conversion equations for subdomains of positive and negative symptomatology in order to better account for the diversity of symptom profiles in schizophrenia. Method: Symptoms severity was assessed using both the PANSS and SAPS/SANS in 205 patients with schizophrenia. Two exploratory factor analyses combining items from both scales were first performed separately in the positive and negative symptom domains. For each identified factor, linear regression analyses were then conducted to obtain conversion equations from the PANSS to the SAPS/SANS and vice versa. Linear regression model estimation was performed on 80% of the data, and reliability was then evaluated on the 20% remaining data using intra-class correlation coefficient between the original and predicted scores. This procedure was repeated 100 times with random samplings for each factor cross-scale conversion.Results: Three-factor solutions were favored both in the positive and negative symptom domains. Based on the nature of items that strongly loaded on the different factors, positive factors were termed ‘Hallucinations’, ‘Delusions’ and ‘Disorganization’, while negative factors were associated with ‘Expressivity’, ‘Amotivation’ and ‘Cognition’. Intra-class correlation coefficients between the original and predicted scores were good to excellent (0.68-0.87) for all regressions, but for the cognition factor which were deemed as low (0.25, 0.26).Conclusion: The symptom subdomains identified by the decomposition of the positive and negative domains were consistent with current descriptions of symptom dimensions in schizophrenia. With the exception of the cognition subdomain, symptom severity scores can be converted with good accuracy between scales, beyond the positive/negative symptom dichotomy. Conversion equations are implemented in an R Shiny app to facilitate their use by the clinical research community.

BACKGROUND In times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated. OBJECTIVE This paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting. METHODS PSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups—patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)—compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test. RESULTS This pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020. CONCLUSIONS Study results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study. CLINICALTRIAL ClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/22500

Studies investigating rates of acute stress disorder following exposure to a traumatic event report widely varying results, even when examining the same types of traumatic events. The first purpose of this systematic review and meta-analysis was to describe rates of acute stress disorder following five different types of traumatic events. The second goal was to assess the methodological and trauma-related factors influencing these rates. Between May 2017 and October 2019, studies were identified by searching through the PsychINFO, PubMed/Medline, OVID, CINAHL, Scopus, and PILOTS databases. Records were included if (1) participants were 16 years old and over, (2) the assessment was completed within 30 days of the event, (3) a standardized assessment instrument was utilized, (4) the type of traumatic event was specified, and (5) the acute stress disorder rate was reported. The list of traumatic events used for the search strategy was based on the Diagnostic and Statistical Manual of Mental Disorders and was complemented by those listed in the Life Events Checklist and the National Comorbidity Survey Replication. Seventy-three samples from 70 studies totaling 20,065 participants met inclusion criteria. Results revealed that rates of acute stress disorder ranged from 14.1% for war-related trauma to 36.0% for interpersonal trauma. Interpersonal trauma was significantly more likely to lead to acute stress disorder than other types of events, except for disaster-related trauma. Differing assessment instruments, types of exposure and geographical locations, and the intentional nature of certain events contributed to heterogeneity in rates within each type of traumatic event.

The aim of this meta-analysis was to investigate the extent to which cannabis use among youths is associated with the risk of perpetrating physical violence.Searches were conducted in PubMed, PsycINFO, Web of Science, and Google Scholar for articles published from the inception of each database to July 2019. All studies that examined both cannabis use and the perpetration of physical violence in a sample of youths and young adults30 years old were included. The meta-analysis was performed with a random-effects model. Risk of publication bias was assessed with Egger's test. Guidelines from the Meta-Analysis of Observational Studies in Epidemiology were followed.After screening 11,348 potential studies, 30 study arms were included, yielding a total of 296,815 adolescents and young adults. The odds ratio for the pooled studies was 2.11 (95% CI=1.64, 2.72). The pooled odds ratios were 2.15 (95% CI=1.58, 2.94) and 2.02 (95% CI=1.26, 3.23) for the cross-sectional and longitudinal studies, respectively. Preliminary evidence suggests that the risk of violence was higher for persistent heavy users (odds ratio=2.81, 95% CI=1.68, 4.74) compared with past-year users (odds ratio=2.05, 95% CI=1.5, 2.8) and lifetime users (odds ratio=1.94, 95% CI=1.29, 2.93). The odds ratio for unadjusted studies was 2.62 (95% CI=1.89, 3.62), and for studies using odds ratios adjusted for potential confounding factors, 2.01 (95% CI=1.57, 2.56).These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence.

Although recent studies have shown a moderately strong association between cannabis use and violence among people with severe mental disorders, the direction of this association has not been investigated prospectively in a population with schizophrenia. Therefore, this study aims to determine, using cross-lag models, whether a temporal relationship between cumulative cannabis use and violence exists in a population with schizophrenia. The authors reported findings covering an 18-month period from a randomized, double-blind clinical trial of antipsychotic medications for schizophrenia treatment. Among the 1460 patients enrolled in the trial, 965 were followed longitudinally. Although persistent cannabis use predicted subsequent violence, violence did not predict cannabis use. The relationship was therefore unidirectional and persisted when controlling for stimulants and alcohol use. Finally, a significant body of evidence suggests a link between persistent cannabis use and violence among people with mental illnesses. Studies to further investigate the mechanisms underlying this association should be conducted.

Our objective was to assess the generalizability, across sites and cognitive contexts, of schizophrenia classification based on functional brain connectivity. We tested different training-test scenarios combining fMRI data from 191 schizophrenia patients and 191 matched healthy controls obtained at 6 scanning sites and under different task conditions. Diagnosis classification accuracy generalized well to a novel site and cognitive context provided data from multiple sites were used for classifier training. By contrast, lower classification accuracy was achieved when data from a single distinct site was used for training. These findings indicate that it is beneficial to use multisite data to train fMRI-based classifiers intended for large-scale use in the clinical realm.

Previous work provided conversion equations for overall indices of positive and negative symptomatology between the Positive and Negative Syndrome Scale (PANSS) and the Scales for the Assessment of Positive/Negative Symptoms (SAPS/SANS). Our objective was to provide such conversion equations for subdomains of positive and negative symptomatology in order to better account for the diversity of symptom profiles in schizophrenia. Symptoms severity was assessed using both the PANSS and SAPS/SANS in 205 patients with schizophrenia. Two exploratory factor analyses combining items from both scales were first performed separately in the positive and negative symptom domains. Positive factors were termed ‘Hallucinations’, ‘Delusions’ and ‘Disorganization’, while negative factors were associated with ‘Expressivity’, ‘Amotivation’ and ‘Cognition’, consistent with current descriptions of symptom dimensions in schizophrenia. For each factor, linear regression analyses were conducted on 80% of the data to obtain conversion equations from the PANSS to the SAPS/SANS and vice versa. Reliability was then evaluated on the 20% remaining data, with good to excellent intra-class correlation coefficients between the original and predicted scores for all but the cognition factor. These findings show that symptom severity scores can be converted with good accuracy between clinical scales beyond the positive/negative symptom dichotomy.

Objectif. L’objectif de cette étude est d’évaluer la validité de construit de la version française de l’échelle Perception Of Prevalence of Aggression Scale (POPAS), un questionnaire auto-rapporté mesurant l’exposition à la violence au travail commise par la clientèle du milieu de la santé et des services sociaux. Méthode. Un échantillon de 310 intervenants en protection de la jeunesse est utilisé afin de confirmer la structure interne à quatre facteurs de l’instrument. À défaut de confirmer cette structure, un modèle d’équation structurelle exploratoire est utilisé. Les facteurs retenus sont soumis aux tests d’alpha de Cronbach qui permettent d’évaluer leur cohérence interne. Ils sont corrélés avec la version française du Posttraumatic Stress Disorder Checklist Scale (PCLS) et du nombre de jours d’absence du travail causé par la violence afin d’évaluer la validité convergente. Il sont également corrélées avec le Felt Accountability (FA) afin d’évaluer la validité divergente. Des analyses de comparaison en fonction du lieu de travail permettent d’explorer la validité de critère. Résultats. L’analyse factorielle confirmatoire ne confirme pas la structure à quatre facteurs du POPAS. L’équation structurelle exploratoire valide une structure à trois facteurs : « violence verbale », « violence physique » et « violence envers soi-même ». Les deux premiers possèdent une bonne cohérence interne. Les corrélations positives entre ces deux facteurs et le PCLS, ainsi qu’entre ces deux facteurs et le nombre de jours d’absence appuient la validité convergente du POPAS. Toutefois, l’absence de corrélation significative entre le dernier facteur et le PCLS, et entre ce facteur et le nombre de jour d’absence n’appuient pas cette convergence. L’absence de corrélation des facteurs avec le FA appuie la validité divergente du POPAS. Les différences observées selon les environnements de travail attestent aussi de la validité de critère. Discussion. La validité de construit de la version française canadienne du POPAS suggère que l’outil permet d’évaluer la fréquence subjective de différentes formes de violence au travail vécues par les intervenants en protection de la jeunesse. Il offre ainsi une alternative aux données officielles (c.-à-d. déclaration d’incidents à l’employeur) qui reflètent peu la réalité de ces travailleurs compte tenu de la sous-déclaration des incidents de violence dans ce milieu., Objective. The objective of this study is to evaluate the construct validity of the French Canadian version of the Perception Of Prevalence of Aggression Scale (POPAS), a self-report questionnaire measuring exposure to workplace violence committed by clients in the health and social services sector. Method. A sample of 310 youth protection workers is utilized to confirm the four-factor internal structure of the instrument. If this structure is not confirmed, an exploratory structural equation model is used. The selected factors undergo Cronbach alpha tests that assess their internal consistency. They are correlated with the French version of the Posttraumatic Stress Disorder Checklist Scale (PCLS) and the number of absentee days caused by violence in order to measure convergent validity. There are also correlated with the Felt Accountability (FA) scale to assess divergent validity. Comparison analyses according to work environments assess criterion validity. Results. The confirmatory factor analysis does not corroborate the four-factor structure of the POPAS. The exploratory structural equation model validates a three-factor structure: ‘‘verbal violence’’, ‘‘physical violence’’ and ‘‘violence against oneself’’. The first two possess good internal consistency. The positive correlations between these two factors and the PCLS, as well as between these two factors and the number of absentee days, support the convergent validity of POPAS. However, the absence of a significant correlation between the last factor and the PCLS, as well as between this factor and the number of absentee days, does not support convergence. The lack of correlation between the factors and the FA supports the divergent validity of the POPAS. The differences observed as they relate to work environments also attest to criterion validity. Discussion. The construct validity of the French Canadian version of the POPAS suggests that this instrument allows for an evaluation of the subjective frequency of different forms of workplace violence experienced by youth protection workers. It therefore represents an alternative to the use of official data (i.e. incident reports made to the employer), which poorly reflect the reality of these workers given the underreporting of violent incidents in this sector.

Background Substance use disorders (SUDs) are significant risk factors for psychiatric relapses and hospitalizations in psychiatric populations. Unfortunately, no instrument has been validated for the screening of SUDs in psychiatric emergency settings. The Drug Abuse Screening Test (DAST) is widely used in the addiction field, but is has not been validated in that particular context. The objective of the current study is to examine the psychometric properties of the DAST administered to psychiatric populations evaluated in an emergency setting. Methods The DAST was administered to 912 psychiatric patients in an emergency setting, of which 119 had a SUD (excluding those misusing alcohol only). The internal consistency, the construct validity, the test-retest reliability and the predictive validity (using SUD diagnoses) of the DAST were examined. The convergent validity was also examined, using a validated impulsivity scale. Results Regarding the internal consistency of the DAST, the Cronbach's alpha was 0.88. The confirmatory factor analysis showed that the DAST has one underlying factor. The test-retest reliability analysis produced a correlation coefficient of 0.86. ROC curve analyses produced an area under the curve of 0.799. Interestingly, a sex effect was observed. Finally, the convergent validity analysis showed that the DAST total score is specifically correlated with the sensation seeking dimension of impulsivity. Discussion The results of this validation study shows that the DAST preserves its excellent psychometric properties in psychiatric populations evaluated in an emergency setting. These results should encourage the use of the DAST in this unstable clinical situation.

The merging of evidence-based interventions with supported employment programs are being increasingly studied, with encouraging results. The current study is aimed at determining the impact of a brief cognitive behaviour therapy group intervention adapted for supported employment programs (called CBT-SE) on the work outcomes of: obtaining a competitive job, number of weeks worked, and number of hours worked per week. Participants were randomized to either receive the 8-session CBT-SE group on top of their supported employment program, or to only receive their support employment program. The results show that those who received CBT-SE were significantly more likely to obtain a job (75% vs 58%), and worked a significantly greater number of hours (24 vs 18 hours per week). No differences were found in terms of number of weeks worked. Those in the CBT-SE condition also experienced a significant decrease in their negative symptoms over time, compared to the control condition. Although replication is needed, these results suggest that a brief cognitive-behavioural intervention specifically tailored to work-related issues can be greatly beneficial.

International audience; Physical and sexual abuse in childhood is a worldwide phenomenon with potentially dramatic consequences of both a psychological and physical nature. Measures of primary prevention have been developed in some countries. In the USA, child protection services reports and research surveys indicate that child sexual abuse has been on the decline in recent decades. Results are less clear for physical and overall abuse. The aim of this study was to describe how childhood abuse has changed over the years in Canada through an analysis of the 2012 Canadian Community Health Survey: Mental Health Edition data. The sample comprised 22,775 respondents ages 20 and over who completed a child abuse questionnaire. Respondents born from 1983 to 1992 reported significantly less overall abuse, physical abuse, and sexual abuse than did older generations, with the exception of people born in 1942 or earlier. The decrease was observed among men and women and across all the regions of Canada.Conclusion: The results are encouraging in that they may have an impact on life expectancy, severity of various chronic disorders, and suicide in the population. They also support policies that have focused on improving the childhood environment in the 1990s. Results also underline the importance of using different kinds of data sources for evaluating child abuse. What is Known: • Physical and sexual abuse in childhood has been associated with lower life expectancy in connection with an array of chronic diseases, including mental disorders, and with suicide. • Measures of primary prevention have been developed in some countries, such as the USA and Canada. What is New: • Canadians born from 1983 to 1992 report significantly less overall abuse, physical abuse, and sexual abuse than older generations do. • These encouraging results support policies implemented in the 1990s focused on improving the childhood environment.

Objectives Gendered inequalities in workplace stress are linked to sex-specific health trajectories that are poorly understood. Measuring gendered inequalities is challenging but necessary to better explain individual differences in occupational health. The aim of this exploratory, retrospective study was to create a measure of occupational gender-roles and use structural equation models to investigate pathways linking layers of gendered factors to workplace stress, allostatic load, and mental health in a sample of psychiatric hospital workers (N = 192). Methods Individual-level gender-roles were measured with the Bem Sex-Role Inventory Short-Form. Occupational gender-roles were measured using a novel web-based survey approach. Sex-specific allostatic load indices were constructed using 23 biomarkers (e.g., neuroendocrine, immune, cardiovascular, and metabolic). Workplace stress was assessed using the Job Content Questionnaire and the Effort-Reward at Work Questionnaire. Depressive symptoms were assessed with the Beck Depression Inventory-II, burnout symptoms with the Maslach Burnout Inventory – General Survey, and trauma symptoms with the PTSD Civilian Checklist. Results Individual-level masculine gender-roles were positively associated with psychological demands (R2 = 0.103) and social support (R2 = 0.078). Masculine and feminine occupational gender-roles were positively associated with decisional latitude (R2 = 0.157) and effort-reward ratio (R2 = 0.058). Both individual masculine and feminine gender-roles had protective effects on depressive symptoms (R2 = 0.289) and burnout symptoms (R2 = 0.306) but only individual masculine gender-roles had protective effects on trauma symptoms (R2 = 0.198). We found no association between occupational gender-roles and mental health and allostatic load. Conclusion Beyond individual gender-roles, our study shows the utility of measuring occupational gender-roles to delineate associations between workplace stressors and mental health that should be applied in future studies of sex differences in occupational health.

Recent evidence suggests that patients with psychotic disorders have metabolic disturbances (e.g., insulin resistance, dyslipidemia) at the onset of the disease and before antipsychotic exposure. Such disturbances are strongly associated with adipose tissue dysregulation. Measuring adipokines, the molecular mediators of adipose function, could provide a picture of the state of metabolic regulation at the onset of psychosis. The present study explores adipokine changes in a population of first-episode psychosis (FEP) patients with minimal prior exposure to antipsychotics. The effects of social determinants of health (childhood trauma and minority status) associated with both metabolic and psychotic disorders were studied as potential determinants of this phenomenon. Data was collected through the Signature project, a biobank of clinical, socio-demographic, and biological markers. Adipokines (leptin, adiponectin, resistin and chemerin) were measured in serum of FEP patients with minimal exposure to antipsychotics (N = 48) and controls (N = 39). Data were analyzed with univariate (t-tests) and multivariate (linear regression) statistical methods. Patients, compared to controls, had significantly higher levels of adiponectin and resistin, and significantly lower levels of leptin and chemerin. These results persisted after controlling for sex, waist-to-height ratio, childhood trauma, and visible minority status. Adiponectin and chemerin retained their effects after further controlling for tobacco and depression. Resistin increased with childhood trauma scores; chemerin was higher in visible minority patients. Adipose tissue dysfunction is present in FEP patients, before exposure to antipsychotics. Social determinants of health contribute to adipose (and metabolic) dysregulation in FEP, but may not be the main determinants of this relationship.