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Nous avons utilisé les données des cycles de 2020 et de 2021 de l’Enquête sur la COVID-19 et la santé mentale pour étudier les idées suicidaires chez les adultes de 18 à 34 ans au Canada. La prévalence des idées suicidaires chez les adultes de 18 à 34 ans était de 4,2 % à l’automne 2020 et de 8,0 % au printemps 2021. C’est le sous-groupe des adultes de 18 à 24 ans qui a connu la prévalence la plus élevée, avec 10,7 % au printemps 2021. La prévalence variait en fonction des caractéristiques sociodémographiques et tendait à être plus élevée chez les personnes vivant dans un milieu défavorisé sur le plan matériel. Les idées suicidaires se sont révélées fortement associées aux facteurs de stress liés à la pandémie subis par les répondants.

Introduction D’après de récentes données probantes, il y aurait eu une augmentation des idées suicidaires au cours de la pandémie de COVID-19. Notre recherche visait à estimer la probabilité de la présence d’idées suicidaires chez les adultes du Canada ayant subi des répercussions de la pandémie et à caractériser l’évolution de cette probabilité tout au long de la pandémie. Méthodologie Nous avons analysé les données regroupées issues des deux cycles de l’Enquête sur la COVID-19 et la santé mentale, à laquelle ont participé 18 936 adultes de 18 ans et plus, qui ont répondu aux questions du 11 septembre au 4 décembre 2020 puis du 1er février au 7 mai 2021. Nous avons estimé la prévalence des idées suicidaires depuis le début de la pandémie puis nous avons évalué, par régression logistique, la probabilité d’idées suicidaires chez les adultes ayant subi des répercussions de la pandémie, en fonction de facteurs de risque sociaux, de l’état mental général, d’indicateurs de bonne santé mentale et des stratégies d’adaptation. Résultats Les adultes ayant eu des expériences négatives liées à la pandémie présentaient un risque significativement plus élevé d’avoir des idées suicidaires, avec une relation dose-réponse manifeste. Les personnes ayant augmenté leur consommation d’alcool ou de cannabis, se disant inquiètes de la violence à la maison ou présentant des symptômes modérés à graves de dépression, d’anxiété ou de trouble stress post-traumatique avaient également un risque significativement plus élevé d’idées suicidaires. Le risque était significativement plus faible chez les personnes se percevant comme ayant une bonne santé mentale ou ayant fait état d’un fort sentiment d’appartenance à leur communauté ou d’une grande satisfaction à l’égard de la vie, qui faisaient de l’exercice pour se maintenir en bonne santé mentale ou physique ou qui s’adonnaient régulièrement à un passe-temps. Conclusion La pandémie de COVID-19 a une influence sur les idées suicidaires au Canada. Les données probantes de notre étude pourront servir à mettre au point des interventions sanitaires ciblées en vue de la prévention du suicide.

Introduction Recent evidence has suggested that there has been an increase in suicidal ideation during the COVID-19 pandemic. Our objectives were to estimate the likelihood of suicidal ideation among adults in Canada who experienced pandemic-related impacts and to determine if this likelihood changed during the pandemic. Methods We analyzed pooled data for 18 936 adults 18 years or older from two cycles of the Survey on COVID-19 and Mental Health collected from 11 September to 4 December 2020 and from 1 February to 7 May 2021. We estimated the prevalence of suicidal ideation since the pandemic began and conducted logistic regression to evaluate the likelihood of suicidal ideation by adults who experienced pandemic-related impacts, and by factors related to social risk, mental health status, positive mental health indicators and coping strategies. Results Adults who had adverse pandemic-related experiences were significantly more likely to experience suicidal ideation; a dose–response relationship was evident. People who increased their alcohol or cannabis use, expressed concerns about violence in their home or who had moderate to severe symptoms of depression, anxiety or posttraumatic stress disorder also had significantly higher risk of suicidal ideation. The risk was significantly lower among people who reported high self-rated mental health, community belonging or life satisfaction, who exercised for their mental and/or physical health or who pursued hobbies. Conclusion The COVID-19 pandemic has influenced suicidal ideation in Canada. Our study provides evidence for targeted public health interventions related to suicide prevention.

Purpose The incidence of self-harm is an important indicator in suicide surveillance and a target outcome for suicide prevention. Self-harm rates vary by geographic location and rurality appears to be a risk factor. The objectives of this study were to estimate rates of self-harm hospitalization in Canada over a 5-year period by sex and age group, and examine relationships between self-harm and rurality. Methods Hospitalizations related to self-harm were identified in a national dataset (the Discharge Abstract Database) for all patients aged 10 years or older who were discharged from hospital between 2015 and 2019. Self-harm hospitalization rates were calculated and stratified by year, sex, age group, and level of rurality, as measured using the Index of Remoteness. A Poisson regression was fit to estimate rate ratios for the levels of rurality. Results Rates of self-harm hospitalization were higher for females than males across all levels of rurality and increased with each level for both sexes, except for among young males. The widest rural-to-urban disparities were observed for the 10–19 and 20–34-year old age groups. Females aged 10–19 in very remote areas had the highest self-harm hospitalization rate. Conclusion The rate of self-harm hospitalization in Canada varied by sex, age group, and level of rurality. Clinical and community-based interventions for self-harm, such as safety planning and increased access to mental health services, should be tailored to the differential risks across geographic contexts.

Data from the first round of the nationally representative Survey on COVID-19 and Mental Health (SCMH) revealed that the prevalence of recent suicidal ideation in the fall of 2020 in Canada did not differ significantly from that in the pre-pandemic period in 2019. The objective of the present study was to reassess the prevalence of recent suicidal ideation in the spring of 2021.The prevalence of suicidal ideation among adults in Canada was examined using the 2021 SCMH (conducted between February 1 and May 7, 2021), and it was compared with the prevalence in the 2019 Canadian Community Health Survey. Unadjusted logistic regression analysis was used to assess the differential likelihood of reporting suicidal ideation in population subgroups.Among adults in Canada, the prevalence of suicidal ideation since the pandemic began was 4.2%, which was significantly higher than the pre-pandemic prevalence of 2.7% in 2019. A statistically significant increase in prevalence was observed among females and males, age groups younger than 65, and several other sociodemographic groups, as well as in British Columbia, the Prairie provinces and Ontario. People who were younger than 65 years, were born in Canada, had lower educational attainment, or were never married were significantly more likely to report suicidal ideation than others during the pandemic.As the second year of the pandemic began, the prevalence of recent suicidal ideation in Canada was higher than it had been before the pandemic in 2019. Continuous monitoring of suicide-related outcomes and risks is necessary so that population-level changes can be detected and inform public health action.

The suitability of geospatial services for auditing neighbourhood features relevant to pediatric obesity remains largely unexplored. Our objectives were to (i) establish the measurement properties of a desk-based audit instrument that uses Google Street ViewOn-site audits of 55 street- and neighbourhood-level features were completed in 2008 in 512 neighbourhoods from the QUALITY cohort study. In 2015, both repeat on-site and desk-based audits were completed in a random sample of 30 of these neighbourhoods.Agreement between both methods was excellent for almost all street segment items (range 91.9-99.7%), except for road type (81.0%), ads/commercial billboards (81.7%), road-sidewalk buffer zone (76.1%), and road-bicycle path buffer zone (53.3%). It was fair to poor for perceived quality, safety and aesthetics items (range 59.9-87.6%), as well as for general impression items (range 40.0-86.7%). The desk-based method over-detected commercial billboards and road-sidewalk buffer zone, and generally rated neighbourhoods as less safe, requiring more effort to get around, and having less aesthetic appeal. Change detected over the 8-year period was generally similar for both methods, except that the desk-based method appeared to amplify the increase in the number of segments with signs of social disorder.The QUALITY-NHOOD tool is deemed adequate for evaluating and monitoring changes in pedestrian- and traffic-related features applicable to pediatric populations. Applications for monitoring the obesogenic nature of neighbourhoods appear warranted.

Background Smoking is influenced by genetic factors including variation in CYP2A6 and CYP2B6 , which encode nicotine-metabolizing enzymes. In early adolescence, CYP2A6 slow nicotine metabolism was associated with higher dependence acquisition, but reduced cigarette consumption. Here we extend this work by examining associations of CYP2A6 and CYP2B6 with tobacco dependence acquisition in a larger sample of smokers followed throughout adolescence. Methods White participants from the Nicotine Dependence in Teens cohort that had ever inhaled ( n = 421) were followed frequently from age 12–18 years. Cox's proportional hazards models compared the risk of ICD-10 tobacco dependence acquisition (score 3+) for CYP2A6 and CYP2B6 metabolism groups. Early smoking experiences, as well as amount smoked at end of follow-up, was also computed. At age 24 ( N = 162), we assessed concordance between self-reported cigarette consumption and salivary cotinine. Results In those who initiated inhalation during follow-up, CYP2A6 slow (vs. normal) metabolizers were at greater risk of dependence (hazards ratio (HR) = 2.3; 95% CI = 1.1, 4.8); CYP2B6 slow (vs. normal) metabolizers had non-significantly greater risk (HR = 1.5; 95% CI = 0.8, 2.6). Variation in CYP2A6 or CYP2B6 was not significantly associated with early smoking symptoms or cigarette consumption at end of follow-up. At age 24, neither gene was significantly associated with dependence status. Self-reported consumption was associated with salivary cotinine, a biomarker of tobacco exposure, acquired at age 24 ( B = 0.37; P Conclusions Our findings extend previous work indicating that slow nicotine metabolism mediated by CYP2A6 , and perhaps CYP2B6 , increases risk for tobacco dependence throughout adolescence.

Objectives To determine if body image emotions (body-related shame and guilt, weight-related stress), perceptions (self-perceived overweight), or cognitions (trying to change weight) differ between adolescents characterized by smoking and physical activity (PA) behavior. Methods Data for this cross-sectional analysis were collected in 2010–11 and were available for 1017 participants (mean (SD) age = 16.8 (0.5) years). Participants were categorized according to smoking and PA status into four groups: inactive smokers, inactive non-smokers, active smokers and active non-smokers. Associations between body image emotions, perceptions and cognitions, and group membership were estimated in multinomial logistic regression. Results Participants who reported body-related shame were less likely (OR (95% CI) = 0.52 (0.29–0.94)) to be in the active smoker group than the inactive smoker group; those who reported body-related guilt and those trying to gain weight were more likely (2.14 (1.32–3.48) and 2.49 (1.22–5.08), respectively) to be in the active smoker group than the inactive smoker group; those who were stressed about weight and those perceiving themselves as overweight were less likely to be in the active non-smoker group than the inactive smoker group (0.79 (0.64–0.97) and 0.41 (0.19–0.89), respectively). Conclusion Body image emotions and cognitions differentiated the active smoker group from the other three groups., Highlights • We examined body image in physically active adolescent smokers. • Body-related shame and guilt were related to being a physically active smoker. • Trying to gain weight was also associated with being a physically active smoker. • Body image emotions and cognitions differentiate physically active smokers.

The first case series on nicotine addiction provided insight into how nicotine addiction develops. Physical dependence involves characteristic symptoms that develop in a characteristic pattern: wanting, craving, then needing. Once physical dependence develops, the duration of relief from withdrawal that is provided by smoking a cigarette shortens progressively, driving a relentless escalation in smoking frequency. Combined, these processes explain a great deal about the trajectory of nicotine addiction over a lifetime. No available measure of nicotine dependence adequately captures this biological aspect of nicotine addiction. Our review discusses a new approach to diagnosing nicotine addiction and new and old measures of nicotine addiction for adolescents. We outline a research strategy designed to sort out which of many potential contributors to nicotine addiction are integral to the process and which are epiphenomena.

Background Adolescent physical activity (PA) levels track into adulthood. However it is not known if type of PA participated in during adolescence is associated with PA levels later in life. We aimed to identify natural groupings of types of PA and to assess whether number of years participating in these different groupings during adolescence is related to PA level in early adulthood. Methods 673 adolescents in Montreal, Canada, age 12–13 years at baseline (54 % female), reported participation in 29 physical activities every 3 months over 5 years (1999–2005). They also reported their PA level at age 24 years (2011–12). PA groupings among the 29 physical activities were identified using factor analysis. The association between number of years participating in each grouping during adolescence and PA level at age 24 was estimated using linear regression within a general estimating equation framework. Results Three PA groupings were identified: “sports”, “fitness and dance”, and “running”. There was a positive linear relationship between number of years participating in sports and running in adolescence and PA level at age 24 years (β (95 % confidence interval) = 0.09 (0.04-0.15); 0.08 (0.01-0.15), respectively). There was no relationship between fitness and dance in adolescence and PA level at age 24. Conclusions The association between PA participation in adolescence and PA levels in young adulthood may be specific to certain PA types and to consistency of participation during adolescence. Results suggest that efforts to establish the habit of participation in sports and running in adolescence may promote higher PA levels in adulthood.

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999–2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999–2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007–08 and 2011–12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor ( www.nditstudy.ca ).

International audience; Background: This study examined (1) the factor structure of a depressive symptoms scale (DSS), (2) the sex and longitudinal invariance of the DSS, and (3) the predictive validity of the DSS scale during adolescence in terms of predicting depression and anxiety symptoms in early adulthood. Methods: Data were drawn from the Nicotine Dependence in Teens (NDIT) study, an ongoing prospective cohort study of 1,293 adolescents. Results: The analytical sample included 527 participants who provided complete data or had minimal missing data over follow-up. Confirmatory factor analysis revealed that an intercorrelated three-factor model with somatic, depressive, and anxiety factors provided the best fit. Further, this model was invariant across sex and time. Finally, DSS scores at Time 3 correlated significantly with depressive and anxiety symptoms measured at Time 4. Conclusions: Results suggest that the DSS is multidimensional and that it is a suitable instrument to examine sex differences in somatic, depressive, and anxiety symptoms, as well as changes in these symptoms over time in adolescents. In addition, it could be used to identify individuals at-risk of psychopathology during early adulthood.

BACKGROUND: Binge drinking occurs frequently among young adults, posing risks to health and safety. Little is known, however, about which drinkers continue to binge later into adulthood. We sought to identify predictors of sustained binge drinking behaviors in young adulthood. METHODS: Participants from the Nicotine Dependence in Teens (NDIT) cohort (n = 609, 53% female) completed self-report questionnaires in 20 survey cycles (SCs) during secondary school between 1999 and 2005, and in 2 postsecondary school SCs in 2007 to 2008 (SC 21; Mage = 20 years) and 2011 to 2012 (SC 22; Mage = 24 years). Participants reporting past-year binge drinking in both SCs 21 and 22 were categorized as sustainers (n = 517). Using multivariable logistic regression, we investigated 25 potential predictors of sustained binge drinking, binge-drinking frequency, and change in frequency over time among sustainers. RESULTS: Compared with stoppers, sustainers (85% of participants) were more likely to be younger, male, and to have no college/university education. Sustainers began drinking alcohol and binge drinking earlier, drank at least monthly during more secondary school grades, binged more frequently at age 20, and scored higher on impulsivity and novelty seeking in adolescence. Among sustainers, frequent binge drinkers were more likely to be male, to be nonstudents, to score higher on novelty seeking, and to have reported more depressive symptoms in adolescence. Sustainers who decelerated their binge frequency between SCs 21 and 22 were more likely to be female, to have achieved a higher level of education, and to report more depressive symptoms in SC 21. CONCLUSIONS: The determinants of sustained binge drinking are similar to predictors of binge drinking reported in the literature. Early identification of, and intervention with, youth who are impulsive, inclined toward novelty seeking, and who report higher levels of early sub clinical depressive symptoms might forestall their involvement in risky alcohol use. Language: en

Background Despite rapid and tangible progress in vaccine coverage and in premature mortality rates registered in sub-Saharan Africa, inequities to access remain firmly entrenched, large pockets of low vaccination coverage persist, and coverage often varies considerably across regions, districts, and health facilities' areas of responsibility. This paper focuses on system-related factors that can explain disparities in immunization coverage among districts in Burkina Faso. Methods A multiple-case study was conducted of six districts representative of different immunization trends and overall performance. A participative process that involved local experts and key actors led to a focus on key factors that could possibly determine the efficiency and efficacy of district vaccination services: occurrence of disease outbreaks and immunization days, overall district management performance, resources available for vaccination services, and institutional elements. The methodology, geared toward reconstructing the evolution of vaccine services performance from 2000 to 2006, is based on data from documents and from individual and group interviews in each of the six health districts. The process of interpreting results brought together the field personnel and the research team. Results The districts that perform best are those that assemble a set of favourable conditions. However, the leadership of the district medical officer (DMO) appears to be the main conduit and the rallying point for these conditions. Typically, strong leadership that is recognized by the field teams ensures smooth operation of the vaccination services, promotes the emergence of new initiatives and offers some protection against risks related to outbreaks of epidemics or supplementary activities that can hinder routine functioning. The same is true for the ability of nurse managers and their teams to cope with new situations (epidemics, shortages of certain stocks). Conclusion The discourse on factors that determine the performance or breakdown of local health care systems in lower and middle income countries remains largely concentrated on technocratic and financial considerations, targeting institutional reforms, availability of resources, or accessibility of health services. The leadership role of those responsible for the district, and more broadly, of those we label "the human factor", in the performance of local health care systems is mentioned only marginally. This study shows that strong and committed leadership promotes an effective mobilization of teams and creates the conditions for good performance in districts, even when they have only limited access to supports provided by external partners. Abstract in French See the full article online for a translation of this abstract in French.

Objective:To identify early predictors of suicidal ideation in young adults, and to determine when specific time-varying determinants become important in predicting later suicidal ideation.Methods:Data were available for 877 participants in the Nicotine Dependence in Teens study, an ongoing prospective cohort of students aged 12 to 13 years at cohort inception in 1999. Time-invariant covariates included age, sex, mother's education, language, and self-esteem. Time-varying covariates included depression symptoms, family stress, other stress, alcohol use, cigarette use, and team sports. Independent predictors of past-year suicidal ideation at age 20 years were identified in 5 multivariable logistic regression analyses, one for each of grades 7, 8, 9, 10, and 11.Results:Eight per cent of participants (mean age 20.4 years [SD 0.7]; 46% male) reported suicidal ideation in the past year. In grade 7, none of the potential predictor variables were statistically significantly associated with suicidal ideation. In grade 8, participation in sports teams in and (or) outside of school protected against suicidal ideation (OR 0.6; 95% CI 0.4 to 0.8; P = 0.002). Depression symptoms in grades 9, 10, and 11 were independent predictors of suicidal ideation (OR 2.2; 95% CI 1.5 to 3.2, OR 1.6; 95% CI 1.0 to 2.5, and OR 1.9; 95% CI 1.1 to 3.4, respectively). No other variables were statistically significant in the multivariate models.Conclusion:Depression symptoms as early as in grade 9 predict suicidal ideation in early adulthood. It is possible that early detection and treatment of depression symptoms are warranted as part of suicide prevention programs.

Background Stressful life events are associated with mood disorders in adults in clinical settings. Less described in the literature is the association between common life stressors and a wide range of psychopathology in young adolescents. This study uses a large non-clinical sample of young adolescents to describe the associations among worry or stress about common life events/difficulties, mental health and substance use. Methods Data on lifetime stress or worry about common life events/difficulties (i.e., romantic breakups, family disruption, interpersonal difficulties, and personal stress (health, weight, school work)), symptoms of depression, conduct disorder symptoms, and substance use were collected from 1025 grade 7 students (mean age 12.9 years; 45% male). The association between each source of stress and each mental health and substance use indicator was modeled in separate logistic regression analyses. Results The proportion of adolescents reporting worry or stress ranged from 7% for new family to 53% for schoolwork. Romantic breakup stress was statistically significantly associated with all the mental health and substance use indicators except illicit drug use. Family disruption was statistically significantly associated with depression symptoms, marijuana use, and cigarette use. Interpersonal difficulties stress was statistically significantly associated with depression symptoms. All sources of personal stress were statistically significantly related to depression symptoms. In addition, health-related stress was inversely related to binge drinking. Conclusion Young adolescents may benefit from learning positive coping skills to manage worry or stress about common stressors and in particular, worry or stress related to romantic breakups. Appropriate management of mental health symptoms and substance use related to common stressful life events and difficulties may help reduce emerging psychopathology.