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Background Our aim was to examine the association between preterm delivery and incident maternal mental disorders using a population-based cohort of mothers in Canada. Methods Retrospective matched cohort study using Manitoba Centre for Health Policy (MCHP) administrative data in Manitoba. Mothers who delivered preterm babies (Results Mothers of preterm children ( N = 5,361) had similar incidence rates of any mental disorder (17.4% vs. 16.6%, IRR = 0.99, 95% CI, 0.91 to 1.07) compared to mothers of term children ( N = 24,932). Mothers of term children had a higher rate of any mental disorder in the first year while mothers of preterm children had higher rates from 2 to 5 years. Being the mother of a child born Interpretation Mothers of preterm and term children had similar rates of incident mental disorders within 5-years post-delivery. Extreme prematurity was a risk factor for any mental disorder. Targeted screening and support of this latter group may be beneficial.

Family history of substance use disorder (SUD) affects a child's risk of the disorder through both genetic and shared environmental factors. We aimed to estimate the association between parental or older sibling SUD history with the risk of adolescent SUD diagnosis.We conducted a population-based cohort study using administrative health-care databases in the Province of Manitoba, Canada, which has a universal and publicly funded health-care system. We included all children born from 1984 to 2000 who have linkages to both parents and were followed until age 18 years. We used generalized estimating equation models to produce unadjusted and adjusted relative risk (RR) estimates of adolescent SUD risk. The study cohort included 134 389 children and 31 307 full sibling pairs; 51.3% were male and 35.4% first-born.The exposure was SUD diagnosis in a mother or father in either hospitalization or outpatient physician visit records before the children's age of 13 years. The secondary exposure was an adolescent SUD diagnosis in an older full sibling. The outcome was SUD diagnosis during adolescence (13 and 18 years of age) identified in either hospitalization or physician visit records. Children demographics and characteristics associated with SUD diagnosis were included in the models.Of the 134 389 children, 9.5% had a mother with a history of SUD, 11.3% had a father and 1.3% had an older sibling with a history of SUD diagnosis; 2566 (1.9%) had an adolescent SUD diagnosis. An increased risk of adolescent SUD was observed with SUD history in mothers [adjusted RR (aRR) = 2.50; 95% confidence interval (CI) = 2.26, 2.79], fathers (aRR = 2.15; 95% CI = 1.95, 2.37), both parents (aRR = 3.74; 95% CI = 3.24, 4.31) and older sibling (aRR = 3.85; 95% CI = 2.53, 5.87).A family history of substance use disorder in parents or older siblings appears to be associated with increased SUD risk in adolescents.

BackgroundWinnipeg, Canada operates a 16-bed subacute unit, the Crisis Stabilization Unit (CSU), for voluntary patients in crisis not requiring hospital admission. The virtual CSU (vCSU) launched in March 2020 as an adjunct to the in-person CSU during the COVID-19 pandemic, providing the same resources virtually, allowing patients to remain at home.MethodsProgram data were collected for vCSU admissions between April 1, 2020 and April 7, 2021 (n = 266) to examine patient characteristics and discharge outcomes. Data were retrieved from the electronic patient record (EPR) for both in-person and vCSU admissions during the same period for comparison (n = 712). vCSU admissions (n = 191) were summarized by patient demographics, clinical factors/outcomes, and compared on the same measures to in-person CSU admissions (n = 521) using binary logistic regression.Results30.1% of patients admitted to the vCSU received initial mental health assessment virtually (phone/videoconference), therefore receiving all care at home. Clinical symptoms at assessment included depression/anxiety (39.0%), psychosis/mania (2.7%), suicidal behaviour/self-harm (27.4%), psychosocial event/stressor (19.8%). Average stay was 4.9 days. Compared to the in-person CSU, vCSU referrals were associated with the absence of psychosis [odds ratio (OR).40, 95% confidence interval (CI).18–0.89] and no prior 1-year contact with referral site (OR.43, 95% CI.28–0.64). Those living farther away from the referral site were more likely to receive a vCSU referral.ConclusionThe vCSU model is feasible for a diverse group of patients experiencing mental health crises. Future work is needed to better determine who the model is right for and examine longer term outcomes.

Purpose This study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors. Methods We conducted a cross-sectional survey of AYAs aged 18–49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia. Results The analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11–4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18–3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18–4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08–3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03–3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08–8.29) or unemployed (AOR 3.97, 95% CI 1.46–10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43–13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05–4.70) and being single (AOR 2.52, 95% CI 1.08–5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively. Conclusions The COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness. Implications for Cancer Survivors. Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01158-9.

Background Adolescents and young adults (AYAs) diagnosed with cancer are at an increased risk of experiencing social isolation and loneliness secondary to their cancer and its treatment. The physical distancing measures implemented during the COVID-19 pandemic may have further increased loneliness among this group. This study examined the prevalence of loneliness and factors associated with loneliness among AYAs with cancer during this pandemic. Methods We conducted a self-administered, online, cross-sectional survey of Canadian AYAs diagnosed with cancer between 15 and 39 between January and February 2021. Loneliness was measured using the 3-item UCLA Loneliness Scale. Factors associated with higher levels of loneliness were identified using multiple logistic regression. Results The analysis included 805 AYAs. The prevalence of loneliness was 52.2% [N = 419, 95% CI (confidence interval) 48.7 to 55.6%]. Individuals who were 18–25 years old [AOR (adjusted odds ratio)1.60, CI 1.03–2.47, p = 0.035], currently undergoing cancer therapy (AOR 1.46, 95% CI 1.03–2.07, p = 0.035), who self-disclosed the presence of a pre-pandemic mental health condition (AOR 2.09, 95% CI = 1.22–3.58, p = 0.007), or were not in a relationship (AOR 2.22, 95% CI 1.57–3.14, p

OBJECTIVE To determine whether childhood maltreatment is associated with immune-mediated inflammatory disorders (IMID; multiple sclerosis [MS], inflammatory bowel disease [IBD] and rheumatoid arthritis [RA]). We further aimed to determine the relationship between maltreatment and psychiatric comorbidity in IMID and whether these relationships differed across IMID. METHODS 681 participants (MS: 232, IBD: 216, RA: 130, healthy controls: 103) completed a structured psychiatric interview to identify psychiatric disorders, and the Childhood Trauma Questionnaire to evaluate five types of maltreatment: emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. We evaluated associations between maltreatment, IMID and psychiatric comorbidity using multivariable logistic regression models. RESULTS The prevalence of having ≥1 maltreatment was similar across IMID, but higher than in controls (MS: 63.8%, IBD: 61.6%, RA: 62.3%, healthy controls: 45.6%). Emotional abuse was associated with having an IMID (adjusted odds ratio [aOR] 2.37; 1.15-4.89). In the sex-specific analysis, this association was only present in women. History of childhood maltreatment was associated with a lifetime diagnosis of a psychiatric disorder in the IMID cohort (OR 2.24; 1.58-3.16), but this association did not differ across diseases. In those with IMID, total types of maltreatments (aOR 1.36; 1.17-1.59) and emotional abuse (aOR 2.64; 1.66-4.21) were associated with psychiatric comorbidity. CONCLUSIONS Childhood maltreatment is more common in IMID than in a healthy population, and is associated with psychiatric comorbidity. Given the high burden of psychiatric disorders in the IMID population, clinicians should be aware of the contribution of maltreatment and the potential need for trauma-informed care strategies.

We examine whether, among children diagnosed with ADHD, are those whose mothers have a history of psychotropic medication use more likely to treat their ADHD with medication? Children born in Manitoba, Canada from 2000 to 2010 diagnosed with ADHD between their 4th and 8th birthday. Maternal psychotropic medication use was assessed from one year before the child's birth to the child's fourth birthday. Logistic regression models examine the relationship between maternal history of psychotropic medication use and the use of medication to treat ADHD in children. Among the 2384 children diagnosed with ADHD, the rate of ADHD medication use was higher for those whose mother had a history of psychotropic medication use (76.6%) than for those whose mothers did not (72.5%) (OR 1.24, 95% CI 1.03, 1.49). Children whose mothers have a history of psychotropic medication use are more likely to have their ADHD treated with medication.

The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92–0.97, p

OBJECTIVE In this study, we aimed to determine the lifetime prevalence of substance use disorder (SUD) in a Canadian rheumatoid arthritis (RA) cohort and factors associated with SUD in RA. METHODS Participants with RA (N = 154) were recruited via rheumatology clinics as part of a larger cohort study of psychiatric comorbidity in immune-mediated inflammatory diseases. SUD is defined as the uncontrolled use of a substance despite the harmful consequences of its use. To identify lifetime SUD, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was administered to participants. Participants' sociodemographic and RA clinical characteristics were also assessed. We examined factors associated with lifetime SUD using unadjusted and adjusted logistic regression modeling. RESULTS Twenty-three (14.9%) of 154 participants with RA met the criteria for a lifetime diagnosis of SUD. The majority of the participants were women, were White, had postsecondary education, and were on a disease-modifying antirheumatic drug. Factors associated with increased odds of SUD were male sex (adjusted odds ratio [aOR]: 3.63, 95% confidence interval [CI]: 1.03-12.73), younger age (aOR: 0.94, 95% CI: 0.90-0.98), and ever smoking (aOR: 6.44, 95% CI: 1.53-27.07). CONCLUSION We found that approximately 1 in 7 individuals with RA had a lifetime diagnosis of SUD, highlighting the importance of identifying and treating SUD in those with RA. In particular, the following factors were associated with higher odds of SUD: male sex, younger age, and smoking behaviors.

OBJECTIVES The objective of this research was to determine the unique contributions of sudden death bereavement to the mental health of university students compared to non-sudden death bereaved university students. Methods: We surveyed 1047 bereaved university students (retention rate 92%) and compared the non-sudden death bereaved university student population to the sudden death bereaved university population on outcomes including mental health symptomatology, and complicated grief using logistic regressions. Results: Sixty two percent of the sample reported sudden death bereavement. There were no differences on measures of PTSD, generalized anxiety disorder, depression, suicidal ideation, and at-risk drinking behavior across types of bereavement. However, sudden death bereavement compared to general bereavement was associated with increased likelihood of complicated grief. Conclusions: Sudden death bereavement in university students is associated with elevated risk of complicated grief. These findings confirm previous research and provide more insight into the unique needs of university student coping with sudden loss.

Background: Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Methods: Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal fluency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modified Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Results: Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn’s disease; mean (SD) age was 53.36 (13.95) years, and a high proportion were females (n = 58). As the risk score (FRS) increased, participants demonstrated lower performance in information processing speed (β=-0.12; 95% CI: -0.24, -0.006) and verbal learning (β=-0.14; 95% CI: -0.28, -0.01) at the 50th percentile. After adjusting for IBD type, higher FRS remained associated with lower information processing speed (β=-0.13; 95% CI: -0.24, -0.03). Conclusion: Vascular comorbidity is associated with lower cognitive functioning in persons with IBD, particularly in the areas of information processing speed and verbal learning. These findings suggest that prevention, identification, and treatment of vascular comorbidity in IBD may play a critical role for improving functional outcomes in IBD.

BACKGROUND AND AIMS High-risk alcohol consumption is associated with compromised health. This study aimed to compare the incidence of alcohol-related cancers, diabetes, ischemic heart disease (IHD) and mortality between those with and without an indication of alcohol use disorder (AUD). DESIGN Retrospective, population-based, matched cohort study using data from the Manitoba Population Research Data Repository. Rates were modeled using generalized linear models with either negative binomial distribution or Poisson distribution and a log offset of person-years to account for each person's time to follow-up. SETTING Manitoba, Canada. PARTICIPANTS Individuals aged ≥ 12 years with a first indication of AUD (index date) between 1 April 1990 and 31 March 2015 were matched to five controls based on age, sex and geographical region at index. This study included 53 410 individuals with AUD and 264 857 matched controls. MEASUREMENTS Adjusted rate ratios (aRR) and 95% confidence intervals (CI) were determined for each outcome from 5 years prior to and 20 years after AUD detection. FINDINGS Alcohol-related cancers (aRR = 4.85, 95% CI = 3.88-6.07 and aRR = 1.85, 95% CI = 1.35-2.53 for men and women, respectively), diabetes (aRR = 1.74, 95% CI = 1.50-2.02 and aRR = 2.43, 95% CI = 2.20-2.68) and IHD (aRR = 3.59, 95% CI = 3.31-3.90 and aRR = 2.92, 95% CI = 2.50-3.41) peaked in the 1 year prior to index for those with AUD compared with matched controls. All-cause mortality (aRR = 3.31, 95% CI = 3.09-3.55 and aRR =3.61, 95% CI = 3.21-4.04) was highest in the year of index and remained higher among cases compared with controls throughout the 20-year follow-up. CONCLUSION People with alcohol use disorder appear to have higher rates of adverse health outcomes in the year before alcohol use disorder recognition, and death at the time of alcohol use disorder recognition, compared with matched controls.

We aimed to describe the negative and positive impacts of changes in cancer care delivery due to COVID-19 pandemic for adolescents and young adults (AYAs) in Canada, as well as the correlates of negative impact and their perspectives on optimization of cancer care. We conducted an online, self-administered survey of AYAs with cancer living in Canada between January and February 2021. Multiple logistic regression was used to identify factors associated with a negative impact on cancer care. Of the 805 participants, 173 (21.5%) experienced a negative impact on their cancer care including delays in diagnostic tests (11.9%), cancer treatment (11.4%), and appointments (11.1%). A prior diagnosis of mental or chronic physical health condition, an annual income of &lt, 20,000 CAD, ongoing cancer treatment, and province of residence were independently associated with a negative cancer care impact (p-value &lt, 0.05). The majority (n = 767, 95.2%) stated a positive impact of the changes to cancer care delivery, including the implementation of virtual healthcare visits (n = 601, 74.6%). Pandemic-related changes in cancer care delivery have unfavorably and favorably influenced AYAs with cancer. Interventions to support AYAs who are more vulnerable to the adverse effects of the pandemic, and the thoughtful integration of virtual care into cancer care delivery models is essential.

The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort by a team of clinicians, neuropsychologists, and neuroimaging experts to investigate the neural basis of cognitive changes and their association with comorbidities among persons with multiple sclerosis (MS). The objectives are to determine the relationships among psychiatric (e.g., depression or anxiety) and vascular (e.g., diabetes, hypertension, etc.) comorbidities, cognitive performance, and MRI measures of brain structure and function, including changes over time. Because neuroimaging forms the basis for several investigations of specific neural correlates that will be reported in future publications, the goal of the current manuscript is to briefly review the CCOMS study design and baseline characteristics for participants enrolled in the three study cohorts (MS, psychiatric control, and healthy control), and provide a detailed description of the MRI hardware, neuroimaging acquisition parameters, and image processing pipelines for the volumetric, microstructural, functional, and perfusion MRI data.

Background Individuals with immune-mediated inflammatory diseases, such as inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis, are at increased risk for influenza and related complications. We examined and compared the uptake of influenza vaccination among people with and without these diseases, as well as the influence of psychiatric comorbidity on vaccine uptake. Methods Using administrative data from Apr. 1, 1984, to Mar. 31, 2016, we conducted a retrospective matched cohort study in Manitoba, Canada. We matched persons 18 years of age or older who had a diagnosis of inflammatory bowel disease, multiple sclerosis or rheumatoid arthritis (the immune-mediated inflammatory disease cohorts) with persons who did not have these diagnoses (the control cohorts) on age, sex and region. We then identified cohort members with any mood or anxiety disorder (depression, anxiety disorders, bipolar disorder). We identified influenza vaccinations through billing codes. Using binomial regression, we modelled the difference in the proportion of the immune-mediated inflammatory disease and matched cohorts vaccinated annually, with adjustment for sociodemographic characteristics, comorbidity and immune therapy. We tested additive interaction effects between a person's cohort and presence of a mood or anxiety disorder. Results We identified 32 880 individuals with 1 or more immune-mediated inflammatory diseases (10 148 with inflammatory bowel disease, 6158 with multiple sclerosis and 16 975 with rheumatoid arthritis) and a total of 164 152 controls. In fiscal year 2015, 8668 (41.3%, 95% confidence interval [CI] 40.6% to 42.0%) of the 20 982 persons with an immune-mediated inflammatory disease received an influenza vaccination, a rate higher than among controls (35 238 of 104 634; 33.7%, 95% CI 33.4% to 34.0%). After adjustment, participants with an immune-mediated inflammatory disease but no mood or anxiety disorder had 6.44% (95% CI 5.79% to 7.10%) greater uptake of vaccination than participants without such a disease. Among participants without an immune-mediated inflammatory disease, having a mood or anxiety disorder was associated with 4.54% (95% CI 4.20% to 4.89%) greater uptake of vaccination. However, we observed a subadditive interaction between immune-mediated inflammatory disease and psychiatric status (-1.38%, 95% CI -2.26% to -0.50%). Interpretation Uptake of influenza vaccination was consistently low in populations with immune-mediated inflammatory disease, and although psychiatric morbidity is associated with greater vaccine uptake by Manitobans, it negatively interacts with these diseases to reduce uptake. Changes in care delivery are needed to mitigate this gap in care.

Objective: The current study used the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS) to (1) examine the incidence and prevalence of mental disorders and (2) estimate the comorbidity of mental disorders over the follow-up period. Method: The CAFVMHS (2018) is a longitudinal study with two time points of assessment. The sample is comprised of 2,941 Canadian Forces members and veterans who participated in the 2002 Canadian Community Health Survey: Canadian Forces Supplement. The World Health Organization Composite International Diagnostic Interview (WHO-CIDI) was utilized to diagnose Diagnostic and Statistical Manual-IV post-traumatic stress disorder (PTSD), major depressive episode (MDE), generalized anxiety disorder, social anxiety disorder (SAD), and alcohol abuse and dependence. Self-report health professional diagnoses were assessed for attention deficit hyperactivity disorder (ADHD), mania, obsessive compulsive disorder (OCD), and personality disorder. We established weighted prevalence of mental disorders and examined the association between mental disorders using logistic regression. Results: In 2018, lifetime prevalence of any WHO-CIDI-based or self-reported mental disorder was 58.1%. Lifetime prevalence of any mood or anxiety disorder or PTSD was 54.0% in 2018. MDE (39.9%), SAD (25.7%), and PTSD (21.4%) were the most common mental disorders. There was a substantial increase in new onset or recurrence/persistence of mental disorders between the two measurement points (16-year assessment gap); 2002–2018 period prevalences were 43.5% for mood and anxiety disorder and 16.8% for alcohol abuse or dependence. The prevalence of self-reported ADHD, OCD, any personality disorder, and mania were 3.3%, 3.0%, 0.8%, and 0.8%, respectively. Comorbidity between mental disorders increased over the follow-up. Conclusions: This study demonstrates a high burden of mental disorders among a large Canadian military and veteran cohort. These findings underscore the importance of prevention and intervention strategies to reduce the burden of mental disorders and alcohol use disorders in these populations.

Objective Psychiatric comorbidity is frequent in rheumatoid arthritis (RA) and complicates treatment. The present study was undertaken to describe the impact of psychiatric comorbidity on health care use (utilization) in RA. Methods We accessed administrative health data (1984–2016) and identified a prevalent cohort with diagnosed RA. Cases of RA (n = 12,984) were matched for age, sex, and region of residence with 5 controls (CNT) per case (n = 64,510). Within each cohort, we identified psychiatric morbidities (depression, anxiety, bipolar disorder, and schizophrenia [PSYC]), with active PSYC defined as ≥2 visits per year. For the years 2006–2016, annual rates of ambulatory care visits (mean ± SD per person) categorized by provider (family physician [FP], rheumatologist, psychiatrist, other specialist), hospitalization (% of cohort), days of hospitalization (mean ± SD), and dispensed drug types (mean ± SD per person) were compared among 4 groups (CNT, CNT plus PSYC, RA, and RA plus PSYC) using generalized linear models adjusted for age, sex, rural versus urban residence, income quintile, and total comorbidities. Estimated rates are reported with 95% confidence intervals (95% CIs). We tested within‐person and RA‐PSYC interaction effects. Results Subjects with RA were mainly female (72%) and urban residents (59%), with a mean ± SD age of 54 ± 16 years. Compared to RA without PSYC, RA with PSYC had more than additive (synergistic) visits (standardized mean difference [SMD] 10.92 [95% CI 10.25, 11.58]), hospitalizations (SMD 13% [95% CI 0.11, 0.14]), and hospital days (SMD 3.63 [95% CI 3.06, 4.19]) and were dispensed 6.85 more medication types (95% CI 6.43, 7.27). Cases of RA plus PSYC had increased visits to FPs (an additional SMD 8.92 [95% CI 8.35, 9.46] visits). PSYC increased utilization in within‐person models. Conclusion Managing psychiatric comorbidity effectively may reduce utilization in RA.

In DSM-5, non-suicidal self-injury (NSSI) and suicide attempts (SA) are classified as distinct disorders in the section of conditions for further study. However, some have questioned the validity of distinguishing NSSI from SA. The objective of this study was to longitudinally examine the correlates, discharge disposition, and rate of re-presentation to emergency services of adults who engaged in NSSI and compare them to (a) adults who engage in SA and (b) adults with no self-harm or suicidal ideation (SI).Data came from 4,772 presentations to adult psychiatric services in the emergency departments of tertiary care hospitals in Winnipeg, Canada between January 2009 and June 2012. Chart reviews were conducted for all presentations with NSSI (Among the adults who returned to emergency services, those who originally presented with SA re-presented significantly sooner than those who presented with NSSI. (χOverall, these findings indicate a trajectory of escalation of self-harm behavior for certain people who engage in NSSI, especially those who re-present to emergency services.HIGHLIGHTSA quarter of people with self-harm re-present to emergency services within four-and-a-half years.Those with suicide attempts re-presented significantly sooner than non-suicidal self-injury.There is a need for increased interventions in emergency services for those with self-harm.

Background Inflammatory bowel disease (IBD) is associated with an increase in psychiatric comorbidity (PC) compared with the general population. We aimed to determine the impact of PC on health care utilization in persons with IBD. Methods We applied a validated administrative definition of IBD to identify all Manitobans with IBD from April 1, 2006, to March 31, 2016, and a matched cohort without IBD. A validated definition for PC in IBD population was applied to both cohorts; active PC status meant ≥2 visits for psychiatric diagnoses within a given year. We examined the association of active PC with physician visits, inpatient hospital days, proportion with inpatient hospitalization, and use of prescription IBD medications in the following year. We tested for the presence of a 2-way interaction between cohort and PC status. Results Our study matched 8459 persons with IBD to 40,375 controls. On crude analysis, IBD subjects had ≥3.7 additional physician visits, had >1.5 extra hospital days, and used 2.1 more drug types annually than controls. Subjects with active PC had >10 more physician visits, had 3.1 more hospital days, and used >6.3 more drugs. There was a synergistic effect of IBD (vs no IBD) and PC (vs no PC) across psychiatric disorders of around 4%. This synergistic effect was greatest for anxiety (6% [2%, 9%]). After excluding psychiatry-related visits and psychiatry-related hospital stays, there remained an excess health care utilization in persons with IBD and PC. Conclusion Inflammatory bowel disease with PC increases health care utilization compared with matched controls and compared with persons with IBD without PC. Active PC further increases health care utilization.

Background The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of “benefits” and “challenges.” Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic.

Mental disorders and psychotropic medications are known to increase the risk of osteoporosis and fractures. However, current evidence is mostly limited to studies that used bone mineral density (BMD), which does not provide information about the texture of bone tissue and can underestimate fracture risk.We tested the association between bone texture, as measured with lumbar spine trabecular bone score (TBS), and both diagnosed mental disorders and psychotropic medication use in a large population-based BMD registry from Manitoba, Canada. General linear and logistic regression models were used to test the association of TBS with mental disorders (anxiety, depression, schizophrenia, and alcohol use disorder) and psychotropic medications use (selective serotonin reuptake inhibitors [SSRI], tricyclic antidepressants [TCA], other antidepressants, lithium, non‑lithium mood stabilizers, antipsychotics, and benzodiazepines), adjusted for comorbidities and confounding factors.The study population contained 45,716 women (mean age = 64.1, SD = 10.4), which included 21.1 % with diagnoses for mental disorders and 18.7 % using psychotropic medications. We observed significant negative covariate-adjusted effects on TBS from diagnosed alcohol use disorder (3.1 % reduction in TBS, p 0.001) and exposure to SSRI (0.6 % reduction, p 0.001), TCA (0.8 % reduction, p 0.001), other antidepressants (0.8 % reduction, p 0.001), and lithium (3 % reduction, p 0.001). Logistic regression revealed that TBS in the lowest (versus highest) tertile was associated with alcohol use disorder (adjusted odds ratio [OR] = 2.87, 95 % confidence interval [CI]: 1.95, 4.21), exposure to SSRI (OR = 1.21; 95 % CI: 1.08, 1.35), TCA (OR = 1.18, 95 % confidence interval [CI]: 1.04, 1.35), other antidepressants (OR = 1.26; 95 % CI: 1.09, 1.45), and lithium (OR = 1.97; 95 % CI: 1.09, 3.57).Our results suggest that alcohol use disorder, antidepressants, and lithium are associated with poorer bone texture in women. These findings add to the current literature on the link of bone pathology with mental disorders and psychotropic medications.

We estimated the incidence and prevalence of benzodiazepine and Z-drug (separately and jointly as BZD) use in the inflammatory bowel disease (IBD) population compared with matched controls without IBD and examined the association of mood/anxiety disorders (M/ADs) with the use of BZD from 1997 to 2017.Using administrative data from Manitoba, Canada, we identified 5,741 persons with incident IBD who were matched in a 1:5 ratio to controls on sex, birth year, and region. Validated case definitions were used to identify M/AD. Dispensations of BZD were identified. Multivariable generalized linear models were used to assess the association between IBD, M/AD, and BZD use.In 2016, the incident age/sex-standardized benzodiazepine use rates per 1,000 were 28.06 (95% confidence interval [CI] 26.41-29.81) in the IBD cohort and 16.83 (95% CI 16.28-17.39) in controls (adjusted rate ratio = 1.69 [95% CI 1.56-1.79]). Benzodiazepine incidence rates were higher for women with IBD than men, but the RR between cases and controls were similar for men and women. The incident age/sex-standardized Z-drug use rate per 1,000 was 21.07 (95% CI 19.69-22.41) in the IBD cohort. This was 1.87-fold higher than in controls (95% CI 1.73-2.01). In 2017, approximately 20% of persons with IBD used benzodiazepines and 20% used Z-drugs. There was a subadditive effect of both benzodiazepine and Z-drug uses between IBD and M/AD after adjusting for covariates.The use of BZD is more common in people with IBD than in population controls. Strategies to reduce the use of BZDs in persons with IBD and to offer alternative management strategies for M/ADs, sleep disorders, and other symptomatic concerns are needed.

This study compares a longitudinal population-based sample of spouses bereaved by suicide and those bereaved by other sudden deaths to determine if suicide-bereaved spouses (SBS) experience greater rates of physician-diagnosed mental disorders.First, married individuals whose spouse died by suicide, sudden natural death (SND) and unintentional injury (UI) were compared to non-bereaved matched cohorts to determine if there were differences in mental disorder rates between bereavement groups and non-bereaved matches. Second, SBS (n = 365), spouses bereaved by SND (n = 1000), and spouses bereaved by UI (n = 270), were compared using inverse probability treatment weighting and generalized estimating equations to calculate relative rates of mental disorders 5 years before/after death.All bereaved cohorts had higher rates of mental disorders compared to non-bereaved cohorts. SBS had the greatest rate of depression post-bereavement (50·96%), followed by UI (38·52%) and SND (33·70%) spouses. When comparing bereavement cohorts, a significant group-by-time interaction (P = 0·047) revealed the rate change for depression was significantly different between suicide and UI-bereaved spouses, with SBS having higher rates of depression before bereavement. SBS had increased rates of any mental disorder both pre (ARR = 1·35, 95% CI = 1·03-1·18, P·05) and post spousal death (ARR = 1·24, 95% CI = 1·03-1·45, P·05) when compared to UI spouses signifying pre-existing mental disorders. Post-bereavement, SBS had greater rates of depression only when compared to SND-bereaved spouses (ARR = 1·31, 95% CI = 1·10-1·55, P·01).SBS have the greatest rates of depression and any mental disorder before the death of their spouse, suggesting suicide bereavement may be unique. Sudden spousal bereavement is a vulnerable time for mental disorders.

Background: Little is known about the effects of changes in the presence or absence of psychiatric disorders on health care utilization in multiple sclerosis (MS). Objective: To evaluate the association between “active” mood and anxiety disorders (MAD) and health care utilization in MS. Methods: Using administrative data from Manitoba, Canada, we identified 4748 persons with MS and 24,154 persons without MS matched on sex, birth year, and region. Using multivariable general linear models, we evaluated the within-person and between-person effects of any “active” MAD on annual physician visits, hospital days, and number of drug classes dispensed in the following year. Results: Annually, the MS cohort had an additional two physician visits, two drug classes, and nearly two more hospital days versus the matched cohort. Individuals with any MAD had more physician visits, had hospital days, and used more drug classes than individuals without a MAD. Within individuals, having an “active” MAD was associated with more utilization for all outcomes than not having an “active” MAD, but the magnitude of this effect was much smaller for visits and drugs than the between-person effect. Conclusion: Within individuals with MS, changes in MAD activity are associated with changes in health services use.

BACKGROUND: Alcohol is the drug most commonly used by Canadians, with multiple impacts on health and health service use. We examined patterns of short- and long-term health service use among people with a diagnosis of alcohol use disorder. METHODS: In this retrospective matched cohort study, we used population-based administrative data from the province of Manitoba, Canada, to identify individuals aged 12 years or older with a first indication of alcohol use disorder (index date) in the period 1990 to 2015. We matched cases (those with diagnosis of alcohol use disorder) to controls (those without this diagnosis), at a 1:5 ratio, on the basis of age, sex, geographic region and income quintile at the index date. The outcome measures were inpatient hospital admission, outpatient physician visits, emergency department visits and use of prescription medications. We modelled crude rates using generalized estimating equations with either a negative binomial or a Poisson distribution RESULTS: We identified 53 410 people with alcohol use disorder and 264 857 matched controls. All outcomes occurred at a higher rate among people with the disorder than among controls. For example, during the year of diagnosis, the rate ratio for hospital admission was 4.0 (95% confidence interval [CI] 3.9–4.2) for women and 4.5 (95% CI 4.4–4.7) for men. All rates of health service use peaked close to the index date, but remained significantly higher among people with alcohol use disorder than among controls for 20 years. Among people with alcohol use disorder, the most commonly filled prescriptions were for psycholeptics, whereas among controls, the most commonly filled prescriptions were for sex hormones (women) and antihypertensives (men). INTERPRETATION: Compared with controls, people with alcohol use disorder used significantly more health services from the time of diagnosis and over the next 20 years. This finding highlights the need for better detection and early intervention to reduce the need for acute and emergency care, as well as the need for improved management of alcohol use disorder over the longer term.

Background: Longitudinal studies assessing depression and anxiety effects on cognition in multiple sclerosis (MS) are limited. Objective: We tested whether within-person fluctuations in symptoms of depression or anxiety over time affect cognition in persons with MS, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and a lifetime history of depression/anxiety disorders (DEP/ANX) but without an immune-mediated inflammatory diseases (IMID). Methods: We followed participants (MS: 255, IBD: 247, RA: 154, and DEP/ANX: 306) for 3 years. Annually, they completed the hospital anxiety and depression scale (HADS) and cognitive tests including the symbol digit modalities test (SDMT). We evaluated associations of elevated symptoms (scores ⩾ 11) of anxiety (HADS-A) and depression (HADS-D) with SDMT z-scores using multivariable linear models—estimating between-person and within-person effects. Results: Participants with MS performed worse on the SDMT than participants in the DEP/ANX cohort (β = −0.68; 95% CI: −0.88, −0.48). Participants with elevated HADS-A scores performed worse on the SDMT than those without elevated scores (β = −0.43; 95% CI: −0.65, −0.21), particularly those with RA. Time-varying within-person elevations in depressive symptoms were associated with worse SDMT performance (β = −0.12; 95% CI: −0.21, −0.021). Conclusions: Across persons, elevated symptoms of anxiety adversely affected information processing. Elevated symptoms of depression within-persons over time were associated with declines in information processing speed.

Abstract. Background: In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the distinction between nonsuicidal self-injury (NSSI) and suicide attempts (SA) is highlighted in the section of conditions for further study. Aims: The objective of this study was to examine the correlates of people who presented to emergency departments (ED) with NSSI compared with those who presented with SA and no self-harm or suicidal ideation (no SH or SI). Method: Data came from 4,772 presentations to ED of tertiary care hospitals in Manitoba, Canada, between January 2009 and June 2012. Chart reviews were conducted for presentations with NSSI ( n = 158), and a sample of SA ( n = 172) and no SH or SI ( n = 173). Results: NSSI was associated with borderline personality traits/disorders, previous history of SH, and aggression/impulsivity compared with no SH or SI. SA was associated with a lower likelihood of adjustment disorder ( OR = 0.58; 95 % CI [0.34, 0.99]) and previous history of NSSI ( OR = 0.30; 95 % CI [0.17, 0.53]) compared with NSSI. Limitations: A limitation of this study is its cross-sectional design. Conclusion: Given the distress associated with NSSI, the findings highlight the need for treatment plans that address all those who present to ED with SH regardless of intent.

The covid-19 pandemic created major challenges for mental health crisis care. Our crisis centre in Winnipeg, Manitoba rapidly virtualized the full spectrum of services offered with remarkable uptake, resulting in avoided hospitalizations and reduced transmission risk for covid-19. We must determine how to best adopt these approaches into post-pandemic crisis care.