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Background Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet as few as 10% access evidence-based treatment. One-day cognitive behavioral therapy (CBT)-based workshops for PPD have the potential to reach large numbers of sufferers and be integrated into stepped models of care. Methods This randomized controlled trial of 461 mothers and birthing parents in Ontario, Canada with Edinburgh Postnatal Depression Scale (EPDS) scores ⩾10, age ⩾18 years, and an infant Results Workshops led to meaningful reductions in EPDS scores (m = 15.77 to 11.22; b = −4.6, p < 0.01) and were associated with three times higher odds of a clinically significant decrease in PPD [odds ratio (OR) 3.00, 95% confidence interval (CI) 1.93–4.67]. Anxiety also decreased and participants had three times the odds of clinically significant improvement (OR 3.20, 95% CI 2.03–5.04). Participants reported improvements in mother–infant bonding, infant-focused rejection and anger, and effortful control in their toddlers. The workshop plus TAU achieved similar quality-adjusted life-years at lower costs than TAU alone. Conclusions One-day CBT-based workshops for PPD can lead to improvements in depression, anxiety, and the mother–infant relationship and are cost-saving. This intervention could represent a perinatal-specific option that can treat larger numbers of individuals and be integrated into stepped care approaches at reasonable cost.

Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools.The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context.A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results.Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system.School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended.What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.

This study modelled the factor structure and tested for measurement invariance between youth and parent reports on the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0; estimated agreement between informants; and, examined moderators of youth-parent discrepancies.Data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (The WHODAS 2.0 demonstrated measurement invariance [Youth and their parents interpret the construct of disability, as measured by the 12-item WHODAS 2.0, similarly. Thus, informant differences represent real differences that are not a consequence of error. Low parent-youth agreement reinforces the need for collecting multiple perspectives in the pediatric setting, especially for male youth.Implications for rehabilitationThe WHODAS 2.0 is one of the most widely used measures of disability and functioning.Measurement invariance of the WHODAS 2.0 suggests that youth and parents interpret the construct of disability similarly.Parent-youth agreement was low and youth typically report more disability compared to parent proxies.More consistent agreement with parents was found for female youth compared to male youth.

Scales currently validated to assess severity of chronic physical conditions in children are not well suited for limited-resource settings as they lack ease of use and interpretation. This study assessed the validity of the Global Assessment of Severity of Illness (GASI), a single-item scale designed for quick and simple assessment of illness severity in children with various chronic physical conditions. Study objectives were to examine validity, reliability, and responsiveness of the GASI. Clinicians assessed the severity of asthma, food allergy, epilepsy, diabetes, and juvenile arthritis in 55 children, and parents reported on children’s health-related quality of life. Area under the curve (AUC) computed by logistic regression and Kendall’s Tau-c (τc) assessed the strength of association between the GASI and other study measures. The kappa coefficient (κ), weighted kappa (κw), and McNemar’s test assessed stability in GASI ratings over time. The standardized response mean and Guyatt’s responsiveness index examined internal and external responsiveness of the GASI, respectively. The GASI correlated strongly with established severity scales (AUC = 0.83–0.96; τc = 0.57–0.78) and did not correlate with health-related quality of life (τc

Individuals with learning disabilities (LDs) are more likely to have a mental illness, yet few studies explore this association in emerging adulthood, a developmental period with an increased risk for mental illness. The purpose of the current study was to investigate psychological distress in emerging adults (15–29 years) with and without LDs. The 2012 Canadian Community Health Survey—Mental Health was used (n = 5630), and multiple and logistic regression models with survey weights were computed. Adjusting for demographic, psychosocial, and health covariates, there was no evidence for significant differences in psychological distress among emerging adults with vs. without LDs. However, age and sex were significant effect modifiers. Among emerging adults with LDs, both males (OR = 2.39 [1.01, 5.67]) and those aged 25–29 years (OR = 3.87 [1.05, 14.30]) had an increased odds of clinically relevant psychological distress in comparison to those without LDs. These findings suggest a need for improved awareness and support for prevention of psychological distress among emerging adults with LDs, especially for males and those in later emerging adulthood.

This study examined whether the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 demonstrated measurement invariance between young adolescents aged 10-16 years with a physical illness and older adolescents aged 15-19 years from the general population.Young adolescent data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (Measurement invariance of the WHODAS 2.0 was demonstrated: (Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents - a group that previously demonstrated measurement invariance with an adult sample. The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course. IMPLICATIONS FOR REHABILITATIONThe 12-item self-administered WHODAS 2.0 is one of the most widely used measures of disability and functioning.Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents and adults in Canada.Researchers and health professionals can be confident that differences in 12-item self-administered WHODAS 2.0 scores are real and meaningful.The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course.

Objective To evaluate the extent to which self-esteem mediates the impacts of epilepsy-specific and environmental factors on mental health outcomes in young people with epilepsy. Methods A prospective cohort of 480 young people with epilepsy and their families participated in five visits over 28 months. We collected data on clinical seizure burden, cognitive comorbidity, peer and parental support, self-esteem, and self-reported mental health symptoms. We used structural equation modeling to specify and test relationships among these constructs simultaneously. Direct, indirect, and total effects were estimated with confidence intervals constructed through bias-corrected bootstrapping. Results Self-esteem mediated the effects of clinical seizure burden ( β = 0.23, 95% confidence interval [0.05, 0.42]) and peer support ( β = -0.15, 95% CI [-0.28, -0.03]) on mental health. There were no mediating effects of parental support ( β = -0.07, 95% CI [-0.14, 0.00]) or cognitive comorbidity ( β = -0.01, 95% CI [-0.02, 0.01]) on mental health. Significance We found evidence that self-esteem mediates the impact that both clinical seizure burden and peer support have on mental health outcomes, indicating that assessment of and interventions targeting self-esteem may be appropriate for young people with epilepsy. Supporting self-esteem could mitigate negative influences on mental health, whether from resistant epilepsy or low peer support.

This study examined the mental health of siblings of children with physical illness (PI), with or without co-occurring mental illness.The sample included children aged 2 to 16 years with a chronic PI and their aged-matched healthy siblings (n = 169 dyads). Physical-mental comorbidity (PM) was present if children screened positive for ≥1 mental illness on the Mini International Neuropsychiatric Interview for Children and Adolescents. Parents completed the Strengths and Difficulties Questionnaire (SDQ) to measure child and sibling mental health.Within child-sibling dyads, siblings of children with PI had significantly worse mental health related to conduct problems (d = 0.31), peer problems (d = 0.18) and total difficulties (d = 0.20). Siblings of children with PM had significantly better mental health related to emotional problems (d = 0.42), hyperactivity/inattention (d = 0.23) and total difficulties (d = 0.32). Siblings of children with PI had similar mental health compared with child population norms used in the development of the SDQ. In contrast, siblings of children with PM had significantly worse mental health across all SDQ domains, with the exception of prosocial behaviour. After adjusting for parent psychopathology and family functioning, no statistically significant differences between siblings of children with PM versus siblings of children with PI were found.Differences in mental health exist between children with PI or PM versus their healthy siblings. However, differences between siblings of children with PI versus siblings of children with PM can be explained by parental and family factors (e.g. marital status, education and income). Findings reinforce family-centred care approaches to address the needs of children with PI or PM and their families.

This study measured physical activity (PA) and explored its correlates among children with multimorbidity (co-occurring chronic physical and mental illness; MM) versus those with chronic physical illness only (PI). This study used baseline data from the Multimorbidity in Children and Youth Across the Life Course (MY LIFE) study, an on-going cohort study following 263 children with a PI 2 to 16 years of age (mean age: 9.8 years, SD = 4.0; 47.7% female). PA was measured using accelerometry, and demographic and psychosocial variables were collected using questionnaires. Of the 55 children with MM and the 85 with PI with valid accelerometer data, 38.1% and 41.2%, respectively, met average daily PA guidelines. Correlates of moderate-to-physical PA (MVPA) among children with MM were age, ρ(53) = −0.45, p = .001, body mass index (BMI), ρ(48) = −0.28, p = .04, self-perceived behavioral conduct, ρ(24) = −0.45, p = .02, physical health-related quality of life, ρ(51) = 0.56, p < .001, and peer support, ρ(52) = 0.27, p = .04. Correlates of MVPA among children with PI were age, ρ(83) = −0.40, p < .001, sex, ρ(83) = −0.26, p = .01, self-perceived social competence, ρ(31) = 0.42, p = .02, self-perceived athletic competence, ρ(31) = 0.48, p = .005, physical health-related quality of life, ρ(83) = 0.34, p = .001, participation in community sport, ρ(31) = 0.41, p = .02, and family functioning, ρ(83) = 0.26, p = .02. These results demonstrate that children with PI and MM are insufficiently active and their PA is correlated with demographic and psychosocial factors.

Decades of evidence show that mothers provide emotional scaffolding to regulate their infants during moments of distress and that postpartum depression (PPD) can significantly disrupt this process. However, the mechanisms underlying mother-to-infant transmission of regulatory support in real-time are unclear. Examining these mechanisms is critical to understanding how mothers actively shape infant self-regulatory capacity, as well as how psychiatric risk may be transmitted from mother to child. In 32 healthy mother-infant dyads and 26 dyads affected by PPD (M

Background: Existing research suggests positive correlations between screen time sedentary behaviors (STSB) and substance use, including cannabis use, among youth. However, little research has examined what factors mediate these relationships.Methods: This study examined mediating pathways among STSB, internalizing symptoms (IS), and cannabis use in a linked longitudinal sample of 28 269 Canadian youth who participated in the COMPASS study over a two-year period (2017/18 to 2018/19). Structural equation modeling examined two main hypotheses cross-sectionally and over time: 1) if IS mediated associations between STSB and cannabis use frequency, and 2) if STSB mediated associations between IS and cannabis use frequency. Results: Results demonstrated significant partial mediation effects for both hypotheses. For example, indirect effects indicated that IS mediated the association between STSB and cannabis use both cross sectionally (95% CI: 0.021, 0.029) and longitudinally (95% CI: 0.006, 0.010). STSB also mediated associations between IS and cannabis use cross sectionally (95% CI: 0.015, 0.023) and longitudinally (95% CI: 0.010, 0.014). This study demonstrated that the associations between STSB, internalizing symptoms and cannabis use are complex, involving mediation in both directions.Discussion: These findings can be used to inform public health initiatives that aim to take a comprehensive approach to addressing negative health behaviors and outcomes, as it is clear that the multi-directional relationships between STSB and mental health may in-turn impact other health behaviors. Future research should continue to examine mediating factors between STSB and substance use among youth, including exploration of associations with other substances.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1922455 .

Few studies have assessed patterns of substance use among Canadian adolescents. This cross-sectional study examined substance use classes among Canadian secondary school students and associations with anxiety and depression.This study used data from Year 6 (2017/18) of the COMPASS study. Students (n = 51 767) reported their substance use (alcohol, cannabis, cigarette and e-cigarette use) and anxiety and depression symptoms. We employed latent class analysis to identify substance use classes and multinomial logistic regression to examine how anxiety and depression were associated with class membership.Overall, 40% of students indicated having anxiety and/or depression (50% in females; 29% in males) and 60% of students reported substance use (60% in females; 61% in males). We identified three substance use classes: poly-use, dual use, and non-use. Females with both anxiety and depression had the highest odds of being in the poly-use class compared to the non-use class (odds ratio [OR] = 4.09; 95% confidence interval [CI]: 3.59-4.65) followed by females with depression only (OR = 2.65; 95% CI: 2.31-3.04) and males with both anxiety and depression (OR = 2.48; 95% CI: 2.19-2.80). Symptomatology was also associated with belonging to the dual use class except among males with anxiety only (OR = 1.13; 95% CI: 0.94-1.37).Canadian secondary school students are engaging in dual and poly-substance use, and anxiety and depression were associated with such use. Females had a higher prevalence of anxiety and depression and should be a priority population for mental health programming.Peu d’études ont évalué les habitudes de consommation de substances chez les adolescents canadiens. Cette étude transversale porte sur les catégories de consommation de substances chez les élèves du secondaire au Canada et leurs associations avec l’anxiété et la dépression.Cette étude repose sur des données de l’année 6 (2017-2018) de l’étude COMPASS. Les élèves (n = 51 767) ont fait état de leur consommation de substances (alcool, cannabis, cigarettes et cigarettes électroniques) et de leurs symptômes d’anxiété et de dépression. Nous avons utilisé une analyse par classes latentes pour créer les catégories de consommation de substances et une analyse de régression logistique multinomiale pour examiner la manière dont l’anxiété et la dépression étaient associées à l’appartenance à une catégorie.Dans l’ensemble, 40 % des élèves ont indiqué souffrir d’anxiété ou de dépression (50 % des filles et 29 % des garçons) et 60 % des élèves ont fait état d’une consommation de substances (60 % des filles et 61 % des garçons). Nous avons établi trois catégories de consommation de substances : la polyconsommation, la double consommation et la non-consommation. Les plus susceptibles d’appartenir à la catégorie de polyconsommation plutôt qu’à la catégorie de non-consommation étaient les filles souffrant à la fois d’anxiété et de dépression (rapport de cote [RC] = 4,09; intervalle de confiance [IC] à 95 % : 3,59 à 4,65]), suivies des filles souffrant de dépression uniquement (RC = 2,65; IC à 95 % : 2,31 à 3,04) et des garçons souffrant à la fois d’anxiété et de dépression (RC = 2,48; IC à 95 % : 2,19 à 2,80). La symptomatologie a également été associée à l’appartenance à la catégorie de double consommation, sauf pour les garçons souffrant d’anxiété uniquement (RC = 1,13; IC à 95 % : 0,94 à 1,37).Les élèves du secondaire au Canada s’adonnent à une double consommation et à une polyconsommation de substances, et on a pu associer l’anxiété et la dépression à ces types de consommation. Les filles affichent une prévalence plus élevée d’anxiété et de dépression et devraient, de ce fait, constituer une priorité en matière de programmation en santé mentale.40% of students indicated anxiety and/or depression and 60% of students reported substance use. Females had a higher prevalence of anxiety and/or depression (50% vs. 29%). Overall, anxiety and/or depression were associated with dual use and poly-substance use. Females with both anxiety and depression had the highest odds of being in the poly-substance use class.40 % des élèves ont fait état de symptômes d’anxiété ou de dépression et 60 % d’une consommation de substances. Les filles affichaient une prévalence plus élevée d’anxiété ou de dépression (50 % contre 29 %). De manière générale, l’anxiété et la dépression étaient associées à la double consommation et à la polyconsommation de substances. Les filles souffrant à la fois d’anxiété et de dépression étaient les plus susceptibles de relever de la catégorie de polyconsommation de substances.

Introduction Peu d’études ont évalué les habitudes de consommation de substances chez les adolescents canadiens. Cette étude transversale porte sur les catégories de consommation de substances chez les élèves du secondaire au Canada et leurs associations avec l’anxiété et la dépression. Méthodologie Cette étude repose sur des données de l’année 6 (2017-2018) de l’étude COMPASS. Les élèves (n = 51 767) ont fait état de leur consommation de substances (alcool, cannabis, cigarettes et cigarettes électroniques) et de leurs symptômes d’anxiété et de dépression. Nous avons utilisé une analyse par classes latentes pour créer les catégories de consommation de substances et une analyse de régression logistique multinomiale pour examiner la manière dont l’anxiété et la dépression étaient associées à l’appartenance à une catégorie. Résultats Dans l’ensemble, 40 % des élèves ont indiqué souffrir d’anxiété ou de dépression (50 % des filles et 29 % des garçons) et 60 % des élèves ont fait état d’une consommation de substances (60 % des filles et 61 % des garçons). Nous avons établi trois catégories de consommation de substances : la polyconsommation, la double consommation et la non-consommation. Les plus susceptibles d’appartenir à la catégorie de polyconsommation plutôt qu’à la catégorie de non-consommation étaient les filles souffrant à la fois d’anxiété et de dépression (rapport de cote [RC] = 4,09; intervalle de confiance [IC] à 95 % : 3,59 à 4,65]), suivies des filles souffrant de dépression uniquement (RC = 2,65; IC à 95 % : 2,31 à 3,04) et des garçons souffrant à la fois d’anxiété et de dépression (RC = 2,48; IC à 95 % : 2,19 à 2,80). La symptomatologie a également été associée à l’appartenance à la catégorie de double consommation, sauf pour les garçons souffrant d’anxiété uniquement (RC = 1,13; IC à 95 % : 0,94 à 1,37). Conclusion Les élèves du secondaire au Canada s’adonnent à une double consommation et à une polyconsommation de substances, et on a pu associer l’anxiété et la dépression à ces types de consommation. Les filles affichent une prévalence plus élevée d’anxiété et de dépression et devraient, de ce fait, constituer une priorité en matière de programmation en santé mentale.

This exploratory study described the distribution of mental health service costs in youth with mental disorder and determined if costs differed for youth with comorbid internalizing and externalizing disorder compared to those with comorbid internalizing disorders. Data come from youth (8–17 years; n=75) receiving mental health services at a children’s hospital in Canada. Billing amounts specified in the Health Insurance Act of Ontario were used to estimate costs. Overall, past-year service use costs were $7436.63. Hospitalizations represented the largest cost. Youth with comorbid internalizing and externalizing disorders had higher total (β=0.81 [0.17, 1.45]), hospital (β=0.93 [0.03, 1.84]), and professional (β=0.87 [0.04, 1.69]) costs. These preliminary findings suggest that comorbidity type is associated with the costs of past-year mental health services used by youth. Research is needed to understand the reasons for elevated costs and whether the increased services used by youth with comorbid internalizing and externalizing disorders are effective.

Purpose This epidemiological study examined associations between morbidity status and mental health care use among young people. Methods Data come from individuals aged 15–29 years (n = 5,630) in the Canadian Community Health Survey-Mental Health (2012). Physical health problems were measured using a standard checklist. The Composite International Diagnostic Interview assessed 12-month mental health and substance use problems. Individuals were asked which types of mental health care they had received in the past year. Logistic, ordinal, and multinomial regression models were computed and the method of variance estimates recovery was used to compare estimates. Results Individuals with comorbid physical health problems had higher odds of mental health care use for those with mental (odds ratio [OR] = 12.54 [7.07, 22.25]) and substance use problems (OR = 2.97 [1.75, 5.05]). While these estimates were higher than for individuals without physical comorbidity, differences were not statistically significant. For mental health care needs not being met, associations were found for individuals with mental (OR = 2.56 [1.24, 5.26]) or substance use problems only (OR = 2.48 [1.06, 5.82]). Conclusions Odds of perceiving the need for and using mental health care were high in individuals with a physical comorbidity, but similar to those with mental health or substance use problems only. Young people with a physical comorbidity were less likely to report that their mental health needs are not being met compared to those with mental health or substance use problems only. Research is needed to understand barriers and facilitators faced by young people with mental health or substance use problems as they navigate the health system.

ImportanceHealth-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time.ObjectiveTo assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy.Design, Setting, and ParticipantsProspective cohort study assessing HRQOL longitudinally over 2 years. Participants were children recruited from 8 epilepsy centers in Canada from 2014 to 2019 with suspected DRE aged 4 to 18 years who were evaluated for surgery. Data were analyzed from May 2014 to December 2021.ExposuresEpilepsy surgery or medical therapy.Main Outcomes and MeasuresHRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55. HRQOL and seizure frequency were assessed at baseline, 6-month, 1-year, and 2-year follow-ups. Clinical, parent, and family characteristics were assessed at baseline. A linear mixed model was used to evaluate HRQOL over time, adjusting for baseline clinical, parent, and family characteristics.ResultsThere were 111 surgical and 154 medical patients (mean [SD] age at baseline was 11.0 [4.1] years; 118 [45%] were female). At baseline, HRQOL was similar among surgical and medical patients. HRQOL of surgical patients was 3.0 (95% CI, −0.7 to 6.8) points higher at 6-month, 4.9 (95% CI, 0.7 to 9.1) points higher at 1-year, and 5.1 (95% CI, 0.7 to 9.5) points higher at 2-year follow-ups compared with medical patients. Surgical patients experienced greater improvements in social functioning relative to medical patients, but not for cognitive, emotional, and physical functioning. At 2-year follow-up, 72% of surgical patients were seizure-free, compared with 33% of medical patients. Seizure-free patients reported higher HRQOL than those who were not.Conclusions and RelevanceThis study provided evidence on the association between epilepsy surgery and children’s HRQOL, with improvement in HRQOL occurring within the first year and remaining stable 2 years after surgery. By demonstrating that surgery improved seizure freedom and HRQOL, which has downstream effects such as better educational attainment, reduced health care resource utilization, and health care cost, these findings suggest that the high costs of surgery are justified, and that improved access to epilepsy surgery is necessary.

There is increasing interest in and evidence for the negative impacts of cannabis use in cognitive performance and symptoms of attention-deficit/hyperactivity disorder (ADHD), with age of first cannabis use as a potential amplifier of these associations. However, the existing literature is inconsistent, which may be due to methodological limitations, including small sample sizes. To examine current cannabis use and age of first cannabis use in relation to neurocognitive task performance and ADHD symptoms in a large sample of binge-drinking young adults. Participants were young adults (N=730, M age=21.44, 52.6% female) assessed for current cannabis use, neurocognitive task performance, and ADHD symptoms. Three-group ANCOVAs compared individuals reporting frequent (daily/multiple times daily), occasional (weekly/monthly), or no cannabis use. Covarying alcohol use, tobacco use, age, sex, income, and education, daily cannabis users exhibited significantly more impulsive delay discounting and hyperactive-impulsive ADHD symptoms compared to both other groups. However, cannabis use was not associated with inattentive ADHD symptoms, verbal intelligence, working memory, probability discounting, short-term verbal memory, or behavioral inhibition. Age of initiation of cannabis use exhibited neither main effects nor interactions in relation to any domains of cognitive performance or ADHD symptomatology. The current findings provide support for a link between cannabis use in relation to immediate reward preference and symptoms of hyperactive-impulsive ADHD in young adults, but only among frequent users. No other neurocognitive domains exhibited associations with cannabis and age of first use was neither independently nor interactively associated with cognitive outcomes.

Background: It is important to gain a better understanding of mental health issues in adolescents and young adults (AYA) with cerebral palsy (CP). In this cross-sectional study, we explore if demographics, social and clinical questionnaire scores, and cortisol levels in hair samples from AYA with CP are associated with higher scores on anxiety and/or depression questionnaires. Methods: Data from a community-based sample of 63 AYA with CP (30 females; ages 16 to 30 (median age of 25)) were analyzed. Forty-one (65%) participants (20 females) provided a hair sample. Outcomes were assessed using bivariate linear regression analyses and hierarchical regression analyses. Results: Clinical depressive and anxiety symptoms were present in 33% and 31% of participants, respectively. Family functioning, B = 9.62 (95%CI: 5.49–13.74), fatigue, B = 0.15 (95%CI: 0.05–0.25), and pain, B = 1.53 (95%CI: 0.48–2.58) were statistically significant predictors of depressive symptoms. Fatigue, B = 0.24 (95%CI: 0.12–0.35) and pain, B = 1.63 (95%CI: 0.33–2.94) were statistically significant predictors of anxiety. Cortisol levels from hair samples were not found to be associated with depressive symptoms or anxiety. Conclusions: A high prevalence of mental health problems and co-occurring physical problems was found in AYA with CP. Integrating mental support into regular care for AYA with CP is recommended.

Studies have shown consistent associations between youth e-cigarette use and subsequent smoking uptake. However, it remains unclear why, as limited evidence exists regarding the mechanisms underlying these associations. Our study investigated whether having one or more smoking friends mediated the association between e-cigarette use and cigarette smoking onset among a longitudinal sample of Canadian youth who were never smokers at baseline. A longitudinal sample of youth that participated in three waves of the COMPASS study (2015–2016 to 2017–2018) was identified (N = 5,535). The product of coefficients method was used to assess whether having one or more smoking friends mediated the association between: (1) past 30-day e-cigarette use and cigarette smoking onset and (2) past 30-day e-cigarette use and subsequent dual use of e-cigarettes and cigarettes. Having one or more smoking friends did not mediate the association between (1) past 30-day e-cigarette use and cigarette smoking onset (β = 0.38, 95% CI − 0.12, 0.89) or (2) past 30-day e-cigarette use and subsequent dual use (β = 0.46, 95% CI − 0.16, 1.07). Post hoc tests indicated that smoking friends significantly predicted past 30-day e-cigarette use and cigarette smoking at wave 3 (aOR 1.68 and 2.29, respectively). Having smoking friends did not explain the association between e-cigarette use and smoking uptake despite being a common risk factor for both e-cigarette use and cigarette smoking. Prevention efforts should consider how best to incorporate effective programming to address these social influences.

This study examined psychometric properties of the Center for Epidemiological Studies Depression Scale (CESD), State-Trait Anxiety Inventory (STAI-T), and Parental Stress Scale (PSS) in parents who...

The purpose of this study was to identify which domains of family functioning were associated with odds of internalizing versus externalizing mental health disorder, past-year health professional consultations, hospitalizations, and length of hospital stay in a sample of children with a mental health disorder. One hundred children aged 6–17 years who received mental health services (inpatient or outpatient) and their parents at a large clinical paediatric tertiary care centre in Ontario were recruited in this cross-sectional study. The final recruited and analyzed sample was children aged 8–17 years. Family functioning was measured using the McMaster Family Assessment Device (FAD), child mental health disorder using the Mini International Neuropsychiatric Interview, and mental health service use using items from the 2012 Canadian Community Health Survey (Mental Health). Higher scores on affective involvement and problem solving were associated with greater odds of major depressive disorder [OR = 2.12 (1.01, 4.43)] and social phobia [OR = 1.80 (1.09, 2.98)]. Reports of better communication were correlated with lower odds of generalized anxiety disorder [OR = 0.55 (0.35, 0.84)] and shorter length of stay in hospital [OR = 0.93 (0.89, 0.97)]. Higher scores on behaviour control were associated with lower odds of social phobia and oppositional defiant disorder [OR = 0.48 (0.27, 0.86) and OR = 0.52 (0.32, 0.84)], respectively. Future research should aim to gain an understanding of strategies that ameliorate family functioning to limit the impact and severity of childhood mental health conditions.

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention. Electronic supplementary material The online version of this article (10.1007/s10803-020-04545-w) contains supplementary material, which is available to authorized users.

The challenges of living with cancer can compound the normative stresses of navigating emerging adulthood and have long-term psychiatric consequences. However, there is a lack of information on the mental health services required by this potentially vulnerable group of young people. This study estimated the prevalence of mental disorder among emerging adults (EAs) with cancer and examined their perceived needs for mental health care. Data from 5,590 individuals (15–29 years) who participated in the Canadian Community Health Survey—Mental Health were used in the analyses. The prevalence of mood or substance use disorder among those with cancer ( n = 42) was 42.9% compared to 32.2% among controls. EAs with cancer had higher odds of reporting unmet perceived needs for mental health care, OR = 7.72, 95% CI [1.85, 28.57]. This suggests an opportunity to improve future health services aimed at addressing the mental health care needs for EAs with cancer and potentially, other long-term chronic conditions.

The prenatal environment can exert important effects on mental health. While much research has linked low birth weight to psychopathology, the intrauterine environment associated with high birth weight (macrosomia; > 4000 g) is also sub-optimal and may increase risk. Given the increasing prevalence of macrosomic births, understanding the mental health outcomes of infants born macrosomic can help refine theories of etiology, predict disorder, and target preventive interventions. Using data from the 2014 Ontario Child Health Study (OCHS), we examined the risk for psychiatric disorders in adolescents born macrosomic. Youth (N = 2151) aged 12–17 years completed the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Rates of common mental disorders assessed by the MINI-KID were compared between those born at normal birth weight (NBW; 2500–4000 g, n = 1817) and adolescents born macrosomic (> 4000 g, n = 334). These associations were then adjusted for participant age, sex, socioeconomic status (SES) of the family, parental mental health, and gestational diabetes mellitus. After adjustment for covariates, adolescents born macrosomic had higher odds of conduct disorder (CD; OR = 3.19, 95% CI: 1.37–7.43), oppositional defiant disorder (ODD; OR = 1.79, 95% CI: 1.11–2.91), and ADHD (OR = 1.77, 95% CI: 1.21–2.80). Moderation analyses revealed that males born macrosomic were more likely to have psychiatric problems than their female peers. Socioeconomic disadvantage also amplified the risk posed by macrosomia for ODD, ADHD, major depressive disorder, and generalized anxiety disorder. In this study, macrosomia was associated with an increased risk of clinically significant externalizing problems in adolescence, most notably among boys and those facing socioeconomic disadvantage.

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as “highly anxious”. Compared to children who exhibited “few to none” anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children’s overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children.

Objectives To examine the effectiveness of group cognitive behavioural therapy (CBT) for postpartum depression (PPD) delivered by public health nurses with little to no previous psychiatric training at improving depression, worry, social support and the mother-infant relationship. Methods Mothers (n = 141) living in Ontario, Canada with Edinburgh Postnatal Depression Scale Scores ≥10 and an infant Results Participants in the experimental group had statistically significantly greater reductions in PPD symptoms immediately post-treatment (T2) (B = -5.35, p Conclusions Public health nurses with little to no previous psychiatric training can be trained to deliver effective group CBT for PPD to improve depression, worry, and the mother-infant relationship. Task shifting PPD treatment with group CBT to public health nurses could improve treatment uptake and lead to better outcomes for mothers, families, and the healthcare system. (Trial Registration NCT03039530)

Study objectives were to examine measurement invariance of the KIDSCREEN-27 between children with mental disorder and their parents; compare health-related quality of life (HRQL) scores to identify potential domain discrepancies; and, identify mental disorders associated with informant discrepancies. Participants consisted of parents with children who were currently receiving mental health services and screened positive for mental disorder according to the Mini International Neuropsychiatric Interview (n = 92). Measurement invariance was investigated using multiple-group confirmatory factor analysis using maximum likelihood estimation with robust standard errors. Multiple regression was used to identify child mental disorders associated with informant discrepancies, adjusting for relevant child and parent characteristics. Partial invariance was obtained for all domains on the KIDSCREEN-27 with the exception of Physical Well-being for which full invariance was obtained. Parents reported lower KIDSCREEN-27 scores compared to children with significant differences for Psychological Well-being [d = 1.98 (1.62, 2.33)] and Social Support and Peers [d = 0.41 (0.11, 0.70)]. For children with oppositional defiant or conduct disorder who report low HRQL, parents underestimate Psychological Well-being scores (B = 1.29, p