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Objective: To estimate the intergenerational association in teenage pregnancy, and whether there is a coupling tendency between a mother and daughter in how their teen pregnancies end, such as a termination of pregnancy (TOP) versus a live birth.Design: Population-based cohort study.Setting: Ontario, Canada.Population: A total of 15 097 mothers and their 16 177 daughters.Methods: Generalised estimating equations generated adjusted odds ratios (aOR) of a daughter experiencing a teen pregnancy in relation to the number of teen pregnancies her mother had. Multinomial logistic regression estimated the odds that a teen pregnancy ended with TOP among both mother and daughter. All models were adjusted for maternal age and world region of origin, the daughter's socio-demographic characteristics and comorbidities, mother-daughter cohabitation, and neighbourhood-level teen pregnancy rate.Main Outcome Measures: Teen pregnancy in the daughter, between ages 15 and 19 years, and also the nature of the daughter's teen pregnancy, categorised as (1) no teen pregnancy, (2) at least one teen pregnancy, all exclusively ending with a live birth, and (3) at least one teen pregnancy, with at least one teen pregnancy ending with a TOP.Results: The proportion of daughters having a teen pregnancy among those whose mother had zero, one, two, or at least three teen pregnancies was 16.3, 24.9, 33.5 and 36.3%, respectively. The aOR of a daughter having a teen pregnancy was 1.42 (95% CI 1.25-1.61) if her mother had one, 1.97 (95% CI 1.71-2.26) if she had two, and 2.17 (95% CI 1.84-2.56) if her mother had three or more teen pregnancies, relative to none. If a mother had at least one teen pregnancy ending with TOP, then her daughter had an aOR of 2.12 (95% CI 1.76-2.56) for having a teen pregnancy also ending with TOP; whereas, if a mother had at least one teen pregnancy, all ending with a live birth, then her daughter had an aOR of 1.73 (95% CI 1.46-2.05) for that same outcome.Conclusion: There is a strong intergenerational occurrence of teenage pregnancy between a mother and daughter, including a coupling tendency in how the pregnancy ends.Tweetable Abstract: Strong intergenerational association for teenage pregnancy between mother and daughter. [ABSTRACT FROM AUTHOR]

Objective: To compare the risks for adverse maternal and offspring outcomes in women with and without intellectual and developmental disabilities.Design: Population-based cohort study.Setting: Ontario, Canada.Population: Singleton obstetrical deliveries to 18- to 49-year-old women with and without intellectual and developmental disabilities (n = 3932 in the exposed cohort, n = 382 774 in the unexposed cohort; 2002-2011 fiscal years).Methods: Women with intellectual and developmental disabilities were identified based on diagnoses in health administrative data or receipt of disability income support. The unexposed cohort comprised women without intellectual and developmental disabilities. Modified Poisson regression was used to compute adjusted relative risks (aRR) and 95% confidence intervals (CI) comparing the two cohorts.Main Outcome Measures: Primary maternal outcomes were: gestational diabetes, gestational hypertension, pre-eclampsia, eclampsia, and venous thromboembolism. Primary offspring outcomes were: preterm birth, small for gestational age, and large for gestational age.Results: The exposed cohort, compared with the unexposed cohort, had increased risks for pre-eclampsia (aRR 1.47, 95% CI 1.11-1.93) and venous thromboembolism (aRR 1.60, 95% CI 1.17-2.19). Their offspring had increased risks for preterm birth (aRR 1.63, 95% CI 1.47-1.80) and small for gestational age (aRR 1.35, 95% CI 1.25-1.45).Conclusions: These findings suggest that there is a need to address modifiable risk factors for adverse outcomes among women with intellectual and developmental disabilities prior to and during pregnancy. Moreover, there is a need to enhance monitoring for maternal and offspring complications in this population.Tweetable Abstract: Large cohort study: intellectual and developmental disabilities predispose women/babies to adverse outcomes. [ABSTRACT FROM AUTHOR]

BackgroundThe perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, peer support, and psychological therapy, all of which have been shown to be efficaciously delivered through digital means. Women experience significant barriers to care because of system- and individual-level factors, such as cost, accessibility, and availability of childcare. The use of mobile phones is widespread in this population, and the delivery of mental health services via mobile phones has been suggested as a means of reducing barriers. ObjectiveThis study aimed to understand the extent, range, and nature of mobile health (mHealth) tools for prevention, screening, and treatment of perinatal depression and anxiety in order to identify gaps and inform opportunities for future work. MethodsUsing a scoping review framework, 4 databases were searched for terms related to mobile phones, perinatal period, and either depression or anxiety. A total of 477 unique records were retrieved, 81 of which were reviewed by full text. Peer-reviewed publications were included if they described the population as women pregnant or up to 1 year postpartum and a tool explicitly delivered via a mobile phone for preventing, screening, or treating depression or anxiety. Studies published in 2007 or earlier, not in English, or as case reports were excluded. ResultsA total of 26 publications describing 22 unique studies were included (77% published after 2017). mHealth apps were slightly more common than texting-based interventions (12/22, 54% vs 10/22, 45%). Most tools were for either depression (12/22, 54%) or anxiety and depression (9/22, 41%); 1 tool was for anxiety only (1/22, 4%). Interventions starting in pregnancy and continuing into the postpartum period were rare (2/22, 9%). Tools were for prevention (10/22, 45%), screening (6/22, 27%), and treatment (6/22, 27%). Interventions delivered included psychoeducation (16/22, 73%), peer support (4/22, 18%), and psychological therapy (4/22, 18%). Cost was measured in 14% (3/22) studies. ConclusionsFuture work in this growing area should incorporate active psychological treatment, address continuity of care across the perinatal period, and consider clinical sustainability to realize the potential of mHealth.

Highlights the results of a report which suggests that nurses, doctors and other healthcare professionals in Great Britain need to be more careful about the risks to patient confidentiality. Confidential information which could be used to identify patients and their treatments; Publication of the report in the 'British Medical Journal.'

Background and Hypothesis: While maternal schizophrenia is linked to chronic childhood medical conditions, little is known about the risk of acute asthma exacerbations among children whose mothers have schizophrenia. This population-based study used health data for all of Ontario, Canada to evaluate whether having a mother with schizophrenia was associated with increased risk of asthma exacerbations., Study Design: The study cohort included 385,989 children diagnosed with asthma from age 2 years onward, followed from the time of their asthma diagnosis up to a maximum of age 19 years. Children whose biological mother was diagnosed with schizophrenia prior to the child's asthma diagnosis (n = 1407) were compared children whose mother was not (n = 384,582). Study outcomes were asthma-related hospitalization, and separately, asthma-related emergency department (ED) visit, each up to a maximum child age of 19 years. First exacerbations were evaluated using Cox proportional hazards models, and recurrent exacerbations by Andersen-Gill regression, adjusted for covariates., Study Results: First hospitalization for an asthma exacerbation occurred in 76 (6.9 per 1000 person-years) vs. 19,679 (5.4 per 1000 person-years) children with and without maternal schizophrenia (adjusted hazard ratio [aHR] 1.21, 95 % CI 0.97-1.51). For first asthma-related ED exacerbations, the rates were 25.1 vs. 20.7 per 100 person-years (aHR 1.06, 95 % CI 0.93-1.21). The adjusted rate ratio (aRR) for recurrent hospitalizations for asthma exacerbations was 1.27 (95 % CI 0.98-1.66), and 1.11 (95 % CI 0.94-1.31) for recurrent asthma-related ED exacerbations., Conclusions: This study did not observe meaningful differences in acute care utilization for asthma exacerbations among children whose biological mothers had schizophrenia., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships outside of the submitted work, which may be considered as potential competing interests: Simone Vigod and Gillian Hanley report royalties from UptoDate Inc for authorship of materials related to depression and pregnancy. Eyal Cohen reports a relationship with the Ontario Ministry of Health as an advisory board member on public drug policy for the Committee to Evaluate Drugs. Katherine Morrison reports an advisory board member relationship with Novo Nordisk Inc and Rhythm Pharmaceuticals. Alison Holloway reports an advisory board member relationship with Taylored Biotherapeutics. Natasha Saunders reports an honorarium from the BMJ Publishing Group Ltd and Archives of Diseases in Childhood. The other authors have no relevant conflicts of interest to they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Preventive health care for children comprises routine well-child visits and immunizations. Women with physical, sensory, or intellectual or developmental disabilities tend to experience more barriers to preventive health care; yet it is unknown whether such barriers are observed among their young children., Methods: This population-based study in Ontario, Canada included children born between 2012 and 2019 whose mothers had a physical (n = 74 084), sensory (n = 26 532), or intellectual or developmental (n = 1391) disability, multiple disabilities (n = 5774), or no disability (n = 723 442). Primary outcomes were receipt of the recommended number of well-child visits and routine immunizations in the first 2 years. Secondary outcomes included receipt of the enhanced 18-month developmental assessment and any developmental screen. Relative risks (aRR) were generated using modified Poisson regression and adjusted for maternal sociodemographics and mental health and child sex., Results: Compared with children of mothers without disabilities, those whose mothers had intellectual or developmental disabilities were less likely to receive the recommended number of well-child visits (56.3% vs 63.2%; aRR 0.92, 95% confidence interval [CI] 0.88-0.97), routine immunizations (43.8% vs 53.7%; aRR 0.88, 95% CI 0.83-0.94), enhanced 18-month developmental assessment (52.3% vs 60.8%; aRR 0.92, 95% CI 0.88-0.97), or any developmental screen (54.9% vs 62.5%; aRR 0.94, 95% CI 0.90-0.99). Other disability groups did not experience such disparities., Conclusions: There is a need to develop resources to improve access to preventive health care for young children of women with intellectual or developmental disabilities., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population., Aims: To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program., Methods: Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted., Results: Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming., Conclusions: Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.

Administration mode of patient-reported outcome measures (PROMs) may influence responses. We assessed if Patient Health Questionnaire-9 (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale - Depression subscale (HADS-D) item responses and scores were associated with administration mode. We compared (1) self-administration versus interview-administration; within self-administration (2) research or medical setting versus private; and (3) pen-and-paper versus electronic; and within interview-administration (4) in-person versus phone. We analysed individual participant data meta-analysis datasets with item-level data for the PHQ-9 (N = 34,529), EPDS (N = 16,813), and HADS-D (N = 16,768). We used multiple indicator multiple cause models to assess differential item functioning (DIF) by administration mode. We found statistically significant DIF for most items on all measures due to large samples, but influence on total scores was negligible. In 10 comparisons conducted across the PHQ-9, EPDS, and HADS-D, Pearson's correlations and intraclass correlation coefficients between latent depression symptom scores from models that did or did not account for DIF were between 0.995 and 1.000. Total PHQ-9, EPDS, and HADS-D scores did not differ materially across administration modes. Researcher and clinicians who evaluate depression symptoms with these questionnaires can select administration methods based on patient preferences, feasibility, or cost., Competing Interests: Declaration of competing interest All authors have completed the ICJME uniform disclosure form. Dr. Vigod declares that she receives royalties from UpToDate, outside the submitted work. Dr. Beck CT declares that she receives royalties for her Postpartum Depression Screening Scale published by Western Psychological Services. Dr. Bernstein declares that he has consulted to Abbvie Canada, Amgen Canada, Bristol Myers Squibb Canada, Eli Lilly, Ferring Canada, JAMP Pharmaceuticals, Janssen Canada, Pendopharm Canada, Pfizer Canada, Sandoz Canada, Takeda Canada. He has also received unrestricted educational grants from Abbvie Canada, Bristol Myers Squibb Canada, Eli Lilly, Ferring Canada, Organon Canada, Janssen Canada, Pfizer Canada, and Takeda Canada; as well as been on speaker's bureau of Abbvie Canada, Janssen Canada, Takeda Canada and Pfizer Canada, all outside the submitted work. Dr. Chan J CN is a steering committee member and/or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr. Chan LF declares personal fees and non-financial support from Otsuka, Lundbeck, and Johnson and Johnson; and non-financial support from Ortho-McNeil-Janssen, and Menarini, outside the submitted work. Dr. Hegerl declares that within the last three years, he was an advisory board member for Janssen and received a research grant from Medice, all outside the submitted work. Dr. Howard declares that she has received personal fees from NICE Scientific Advice, outside the submitted work. Dr. Inagaki declares that he has received personal fees from Meiji, Mochida, Takeda, Novartis, Yoshitomi, Pfizer, Eisai, Otsuka, MSD, Sumitomo Dainippon, Janssen, and Eli Lilly, all outside of the submitted work. Dr. Marrie declares that she is a co-investigator on a study funded in part by Biogen Idec and Roche (no funds to her), outside the submitted work. Dr. Pugh declares that she received salary support from Pfizer-Astella and Millennium, outside the submitted work. Dr. Sultan declares funding from Sanofi-Aventis Corporation, during conduct of the primary study. Dr. Sundström-Poromaa declares that she has served on advisory boards and acted as invited speaker at scientific meetings for MSD, Novo Nordisk, Bayer Health Care, and Lundbeck A/S. Dr. Lynne Wagner declares that she receives personal fees from Celgene, outside the submitted work. Dr. Yonkers declares that she receives royalties from UpTodate, outside the submitted work. All other authors declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The shortage of adequately trained healthcare providers (HCPs) able to treat adults who have experienced childhood interpersonal trauma (CIT) is a pressing concern. This study explored HCPs' training needs for a trauma-focused psychoeducational group intervention and the potential barriers and facilitators to accessing such training. Three 1-hour focus group sessions were conducted with HCPs ( n  = 17) from two urban and one rural community healthcare organization serving diverse populations in Ontario, Canada, including under-housed people, women struggling with mental health and addiction, and LGBTQ+ populations. On average, participants had 2.4 years in their current role and 18.1 years of mental health field experience. Thematic analysis revealed key findings: a strong clinical need for trauma services, accessible training programs, and broadly applicable interventions relevant for diverse populations. Notably, participants emphasized the clinical advantages and increased accessibility of a virtual training programs focused on psychoeducational treatment interventions, particularly within community-based healthcare settings. This study highlights the potential of a virtual psychoeducational training programs for HCPs to address this critical gap in healthcare provision for individual with CIT. It also underscores the need to move beyond training program development and focus on implementation and sustainability of interventions in clinical practice.

Background: The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults., Methods: CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process., Results: The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted., Conclusions: The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Camelia Adams has nothing to disclose. Anees Bahji has nothing to disclose. Serge Beaulieu reports research grants, personal fees, and/or nonfinancial support from Abbvie, Boehringer-Ingelheim, Canadian Institutes for Health Research (CIHR), DiaMentis, Idorsia, Eisai, Janssen, and Otsuka-Lundbeck. Venkat Bhat reports research grants from the American Foundation for Suicide Prevention, AMS, Brain and Behaviour Research Foundation, CIHR, Department of Defense, Eisai, New Frontiers in Research Fund, Novartis, Ontario Ministry of Health, Roche, Royal College of Physicians and Surgeons of Canada, and the University of Toronto. Pierre Blier received research grants and/or personal fees from Abbvie, Allergan, CIHR, Janssen, Lundbeck, Merck, Ontario Brain Institute (OBI), Otsuka, Pfizer, University of Ottawa Medical Research Fund, and VilaNova. Daniel M. Blumberger reports research grants, nonfinancial support, and/or other support from Brain Canada, CIHR, Magventure, National Institutes of Health (NIH), and Welcony Inc. Elisa Brietzke reports research grants from Queen’s University Centre for Neuroscience and the PSI Foundation. Trisha Chakrabarty has nothing to disclose. Dr. André Do reports research grants and/or personal fees from AbbVie, CIHR, Janssen, and Otsuka. Benicio N. Frey has nothing to disclose. Dr. Peter Giacobbe reports research grants from CIHR and salary support from the Academic Scholars Fund, Department of Psychiatry, University of Toronto. David David Gratzer has nothing to disclose. Dr. Sophie Grigoriadis reports personal fees from the Canadian Pharmacists Association, Norton, and UptoDate. Jeffrey Habert reports research grants, personal fees and/or other support from Abbvie, Amgen, Astra-Zeneca, Bausch, Bayer, BMS, Boehringer-Ingelheim, Eisai, Eli-Lilly, Elvium, GSK, HLS, Idorsia, Janssen, Lundbeck, Novartis, Novo-Nordisk, Otsuka, Pfizer, and Valeo. M. Ishrat Husain reports research grants and/or other support from the Centre for Addiction and Mental Health (CAMH) Foundation, CIHR, COMPASS Pathfinder, MindSet Pharma, Psyched Therapeutics, University of Toronto, and Wake Network. Zahinoor Ismail reports personal fees from Lundbeck and Otsuka. Sidney H. Kennedy reports research grants, personal fees and/or other support from Abbott, Abbvie, Boehringer-Ingelheim, Brain Canada, Canada’s Strategy for Patient-Oriented Research (SPOR), CIHR, -, Janssen, Lundbeck, Merck, -, OBI, Otsuka, - Servier, and Sunovion. Raymond W. Lam reports research grants, personal fees and/or other support from AbbVie, Asia-Pacific Economic Cooperation (APEC), Bausch, BC Leading Edge Endowment Fund, Brain Canada, CANMAT, Carnot, CIHR, Grand Challenges Canada, Healthy Minds Canada, Janssen, Lundbeck, Michael Smith Health Research BC, MITACS, Neurotorium, OBI, Otsuka, Pfizer/Viatris, Unity Health, and VGH-UBCH Foundation. Alexander McGirr reports other support from Allergan Canada; he holds a patent 63/193,643 pending. Roger S. McIntyre reports research grants and/or personal fees from Abbvie, Alkermes, Atai Life Sciences, Axsome, Bausch, Biogen, Boehringer Ingelheim, Braxia Scientific Corp., CIHR, Eisai, Global Alliance for Chronic Diseases, Intra-Cellular, Janssen, Kris, Lundbeck, Milken Institute, Mitsubishi Tanabe, National Natural Science Foundation of China, Neumora Therapeutics, Neurocrine, NewBridge Pharmaceuticals, Novo Nordisk, Otsuka, Pfizer, Purdue, Sage, Sanofi, Sunovion, Takeda, and Viatris. Erin E. Michalak reports research grants from the Otsuka-Lundbeck Alliance. Roumen V. Milev reports research grants and/or personal fees from AbbVie, Allergan, Canadian Biomarker Integration Network in Depression (CAN-BIND), CIHR, Eisai, Janssen, KYE, Lallemand, Lundbeck, Neonmind, Nubiyota, OBI, Ontario Mental Health Foundation, Otsuka, and Sunovion. Daniel J. Müller reports research grants or personal fees from CAMH AFP Innovation Fund, CAMH Foundation, CIHR, Novagenic, Nubiyota, and OBI. Sagar V. Parikh is the Medical Director for the National Network of Depression Centers and reports research grants, honoraria and/or personal fees from Aifred, Boehringer Ingelheim, Janssen, Medscape, Mensante, Merck, Myriad/Assurex, Otsuka, and Sage; and private shares in Mensante. Lena S. Quilty has nothing to disclose. Arun V. Ravindran has nothing to disclose. Nisha Ravindran has nothing to disclose. Johanne Renaud has nothing to disclose. Joshua D. Rosenblat reports research grants and/or personal fees from Academic Scholars Award, Allergan, American Psychiatric Association, American Society of Psychopharmacology, Boehringer Ingelheim, Braxia Health (Chief Medical and Scientific Officer of Braxia Scientific; Medical Director of the Canadian Rapid Treatment Centre of Excellence [Braxia Health]), Brain and Cognition Discovery Foundation, Canadian Cancer Society, Canadian Psychiatric Association, CIHR, COMPASS, iGan, Janssen, Joseph M. West Family Memorial Fund, Labatt Brain Health Network, Lundbeck, Physician Services Inc. (PSI) Foundation, Sunovion, Timeposters Fellowship, University Health Network Centre for Mental Health, and University of Toronto. Zainab Samaan has nothing to disclose. Gayatri Saraf has nothing to disclose. Kathryn Schade has nothing to disclose. Ayal Schaffer reports personal fees from AbbVie, Lundbeck, and Otsuka. Mark Sinyor has nothing to disclose. Claudio N. Soares reports research grants and/or personal fees from Bayer, Boehinger-Ingelheim, Clairvoyant Therapeutics, Diamond Therapeutics, Eisai, OBI, and Otsuka, Jennifer Swainson reports personal fees, nonfinancial support, and/or other support from AbbVie, Bausch, Eisai, Idorsia, Janssen, Lundbeck, Newly Institute, and Otsuka. Valerie H. Taylor has nothing to disclose. Smadar V. Tourjman reports personal fees from AbbVie, Elvium, Esai, Idorsia, Janssen, Lundbeck, Otsuka, Pfizer, Sunovion, and Takeda. Rudolf Uher has nothing to disclose. Michael van Ameringen reports research grants, personal fees, and/or other support from Abbvie, Bausch Health, Biohaven, Boehringer Ingelheim, CIHR, Elvium (Purdue), Jazz, Lundbeck, Michael G. DeGroote Centre for Medicinal Cannabis Research, Otsuka, Sunovion, Takeda, UptoDate, and Vistagen. Gustavo Vazquez reports personal fees for Abbvie, Allergan, Asofarma, Elea/Phoenix, Eurofarma, Gador, Janssen, Lundbeck/Otsuka, NeonMind Biosciences, Psicofarma, Raffo, Sunovion, and Tecnofarma. Simone Vigod reports royalties from UpToDate. Daphne Voineskos holds the Labatt Family Professorship in Depression Biology, a University Named Professorship at the University of Toronto; she reports research grants from CIHR, CAMH, Centre for Mental Health at University Health Network, Department of Psychiatry at the University of Toronto, and the National Institute of Mental Health. Lakshmi N. Yatham reports research grants and/or personal fees from Abbvie, Alkermes, Allergan, Dainippon Sumitomo, Gedeon Richter, GSK, Intracellular Therapies, Merck, Sanofi, and Sunovion.

Background: Individuals with disabilities may require specific medications in pregnancy. The prevalence and patterns of medication use, overall and for medications with known teratogenic risks, are largely unknown. Methods: This population-based cohort study in Ontario, Canada, 2004-2021, comprised all recognized pregnancies among individuals eligible for public drug plan coverage. Included were those with a physical ( n = 44,136), sensory ( n = 13,633), intellectual or developmental ( n = 2,446) disability, or multiple disabilities ( n = 5,064), compared with those without a disability ( n = 299,944). Prescription medication use in pregnancy, overall and by type, was described. Modified Poisson regression generated relative risks (aRR) for the use of medications with known teratogenic risks and use of ≥2 and ≥5 medications concurrently in pregnancy, comparing those with versus without a disability, adjusting for sociodemographic and clinical factors. Results: Medication use in pregnancy was more common in people with intellectual or developmental (82.1%), multiple (80.4%), physical (73.9%), and sensory (71.9%) disabilities, than in those with no known disability (67.4%). Compared with those without a disability (5.7%), teratogenic medication use in pregnancy was especially higher in people with multiple disabilities (14.2%; aRR 2.03, 95% confidence interval [CI]: 1.88-2.20). Furthermore, compared with people without a disability (3.2%), the use of ≥5 medications concurrently was more common in those with multiple disabilities (13.4%; aRR 2.21, 95% CI: 2.02-2.41) and an intellectual or developmental disability (9.3%; aRR 2.13, 95% CI: 1.86-2.45). Interpretation: Among people with disabilities, medication use in pregnancy is prevalent, especially for potentially teratogenic medications and polypharmacy, highlighting the need for preconception counseling/monitoring to reduce medication-related harm in pregnancy.

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used self-report instrument to screen for postpartum depression (PPD). Assessing the relevance of the EPDS as a screening tool for minority ethnic populations is pertinent for ensuring culturally appropriate care. This scoping review aimed to explore what is known about the cultural adaptations of the EPDS in antepartum and postpartum mothers and fathers in East Asian, Southeast Asian and South Asian populations, and to what extent these adaptations are able to accurately screen for postpartum depression symptoms among these cultural groups. The scoping review was guided by the PRISMA-ScR checklist. The search strategy included databases of MEDLINE, PsycINFO, EMBASE, CINAHL and Grey literature. Included studies were primary articles published in English language peer-reviewed journals that investigated the validation or cultural adaptation of the EPDS in mothers who were pregnant and/or had recently given birth, or fathers who were new parents, and were limited to the following cultural groups, whether living locally or abroad in a foreign country: East Asian, Southeast Asian or South Asian populations. Thirty-six of 2469 studies met criteria for inclusion. Twenty-one of 36 studies utilizing a culturally validated EPDS demonstrated a cut-off score lower than the original recommended cut-off. Important themes identified included the Role of Culture, Somatization of PPD, Method of Interview, and contrasting performance compared to other scales used to assess depression and/or anxiety. Accessibility to translated and validated EPDS and mindfulness of ethnically relevant EPDS cut-off scores are critical when using this tool among minority ethnic populations., (© 2023 John Wiley & Sons Australia, Ltd.)

Objective: We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic., Methods: This population-based repeated cross-sectional study of children and adolescents (3-17 years; N  = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status., Results: Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata., Conclusion: During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning., Competing Interests: Declaration of Conflicts of InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: N. Saunders reported receiving personal fees from the Archives of Diseases in Childhood, grants from the Canadian Institutes for Health Research and the Ontario Ministry of Health, grants from the Centre for Addiction and Mental Health, and grants from The Hospital for Sick Children outside the submitted work. S. Vigod reported receiving royalties from UpToDate Inc. for authorship of materials related to depression and pregnancy unrelated to the submitted work. No other disclosures were reported.

Objective: To assess physician-based mental health care utilization during the COVID-19 pandemic among children and adolescents new to care and those already engaged with mental health services, and to evaluate differences by sociodemographic factors., Study Design: We performed a population-based repeated cross-sectional study using linked health and administrative databases in Ontario, Canada among all children and adolescents 3-17 years. We examined outpatient visit rates per 1,000 population for mental health concerns for those new to care (no physician-based mental healthcare for ≥1 year) and those with continuing care needs (any physician-based mental healthcare <1 year) following onset of the pandemic., Results: Among ~2.5 million children and adolescents (48.7% female, mean age 10.1 ± 4.3 years), expected monthly mental health outpatient visits were 1.5/1,000 for those new to mental health care and 5.4/1,000 for those already engaged in care. Following onset of the pandemic, visit rates for both groups were above expected [adjusted rate ratio (aRR) 1.22, 95% CI 1.17, 1.27; aRR 1.10, 95% CI 1.07, 1.12] for new and continuing care, respectively. The greatest increase above expected was among females (new: aRR 1.33, 95% CI 1.25, 1.42; continuing: aRR 1.22 95% CI 1.17, 1.26) and adolescents ages 13-17 years (new: aRR 1.31, 95% CI 1.27, 1.34; continuing: aRR 1.15 95% CI 1.13, 1.17). Mood and anxiety concerns were prominent among those new to care., Conclusion: In the 18 months following onset of the pandemic, outpatient mental health care utilization increased for those with new and continuing care needs, especially among females and adolescents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Toulany, Vigod, Kurdyak, Stukel, Strauss, Fu, Guttmann, Guan, Cohen, Chiu, Hepburn, Moran, Gardner, Cappelli, Sundar and Saunders.)

Objective: To understand practice patterns and identify care gaps within a large-scale depression screening program for patients with head and neck cancer (HNC)., Study Design: Retrospective cohort study., Methods: This was a population-based study of adults diagnosed with a HNC between January 2007 and October 2020. Each patient was observed from time of first symptom assessment until end of study date, or death. The exposure of interest was a positive depressive symptom screen on the Edmonton Symptom Assessment System (ESAS). Outcomes of interest included psychiatry/psychology assessment, social work referral, or palliative care assessment. Cause specific hazard models with a time-varying exposure were used to investigate the exposure-outcome relationships., Results: Of 14,054 patients with HNC, 9016 (64.2%) reported depressive symptoms on at least one ESAS assessment. Within 60 days of first reporting depressive symptoms, 223 (2.7%) received a psychiatry assessment, 646 (7.9%) a social work referral, and 1131 (13.9%) a palliative care assessment. Rates of psychiatry/psychology assessment (HR 3.15 [95% CI 2.67-3.72]), social work referral (HR 1.83 [95% CI 1.64-2.02]), and palliative care assessment (HR 2.34 [95% CI 2.19-2.50]) were higher for those screening positive for depression. Certain patient populations were less likely to receive an assessment including the elderly, rural residents, and those without a prior psychiatric history., Conclusion: A high proportion of head and neck patients report depressive symptoms, though this triggers a referral in a small number of cases. These data highlight areas for improvement in depression screening care pathways., Level of Evidence: 3 Laryngoscope, 133:2638-2646, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: To measure trends in the rates and costs of hospitalizations over a 15-year period among young adults with physical and/or psychiatric disorders., Methods: This population-based, repeated cross-sectional study identified all 18- to 26- year-olds hospitalized in Ontario, Canada from April 1, 2003 and March 31, 2018 (fiscal years 2003-2017). Using discharge diagnoses, we assigned hospitalizations to one of four categories: 1) psychiatric disorder only; 2) primary psychiatric disorder with comorbid physical illness; 3) primary physical with comorbid psychiatric disorder; and 4) physical illness only. We compared health service utilization and changes in rates of hospitalizations over time using restricted cubic spline regression. Secondary outcome measures included change in hospital costs for each hospitalization category over the study period., Results: Of 1,076,951 hospitalizations in young adults (73.7% female), 195,726 (18.2%) had a psychiatric disorder (either primary or comorbid). There were 129,676 hospitalizations (12.0%) with psychiatric disorders only, 36,287 (3.4%) with primary psychiatric and comorbid physical disorders, 29,763 (2.8%) with primary physical and comorbid psychiatric disorders, and 881,225 (81.8%) with physical disorders only. Rates of hospitalization for psychiatric disorders only increased 81% from 4.32 to 7.84/1,000 population, and those with physical health disorders with comorbid psychiatric disorders increased 172% from 0.47 to 1.28/1,000 population. Substance-related disorders were the most common comorbid psychiatric disorders among youth hospitalized for physical illness and increased 260% from 0.9 to 3.3/1,000 population., Discussion: Hospitalizations among young adults with primary and comorbid psychiatric disorders have increased significantly over the past 15 years. Health system resources should be adequately directed to meet the shifting and complex needs of hospitalized young adults., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Individuals with orofacial cleft (OFC) may be at a higher risk of developing psychiatric disorders (PD) than the general population. We determined the risk of psychiatric diagnoses in children with OFC in Canada., Methods: This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born between April 1, 1994, and March 31, 2017, in Ontario were matched to five non-OFC children based on sex, date of birth, and mother's age. We determined the rate of events and time-to-event for first diagnosis of PD in children aged ≥ 3 years (y), and for intellectual developmental delay (IDD) from birth. Risk factors for PD and IDD were assessed using 1-way ANOVA for means, Kruskal-Wallis for medians, and the χ 2 test for categorical variables., Outcomes: There were 3051 children with OFC (matched to 15,255 controls), of whom 2515 patients with OFC (12,575 controls) had a complete follow-up to the third birthday. Children with OFC were more likely to have PD than controls (54.90 vs. 43.28 per 1000 patient-years, P < .001), with a mean age to first diagnosis of 8.6 ± 4.2 y. The cleft palate group had the highest risk (HR 1.33, 95% CI 1.18-1.49). Children with OFC also had a higher risk of IDD than non-OFC children (27.78 vs. 3.46 per 1000 patient-years, p < .001)., Interpretation: Children born with OFC in Ontario had a higher risk of psychiatric diagnosis and IDD compared to controls. Further research is also required to better understand the predictors of variation in risk, including geographic location and the presence of congenital abnormalities, and identify potential areas for intervention., Evidence Rating Scale for Prognostic/risk Studies: Level II., Competing Interests: Declaration of Competing Interest No conflict of interest. Dr. Benchimol has acted as a consultant for McKesson Canada and the Dairy Farmers of Ontario and a legal consultant for Hoffman La-Roche Limited and Peabody & Arnold LLP for matters unrelated to this manuscript. Simone Vigod reports royalties from UpToDate Inc for authorship of chapters related to depression and pregnancy. The remaining authors have no conflicts of interest to disclose., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The authors used a population-representative sample and health administrative data to quantify suicide-related behavior leading to acute care or deaths across self-identified heterosexual, gay/lesbian, and bisexual individuals., Methods: Data from a population-based survey (N=123,995) were linked to health administrative data (2002-2019), and differences in time to suicide-related behavior events across sexual orientations were examined using Cox proportional hazards regression., Results: The crude incidence rates of suicide-related behavior events per 100,000 person-years were 224.7 for heterosexuals, 664.7 for gay/lesbian individuals, and 5,911.9 for bisexual individuals. In fully adjusted (gender-combined) models, bisexual individuals were 2.98 times (95% CI=2.08-4.27) more likely to have an event, and gay men and lesbians 2.10 times (95% CI=1.18-3.71) more likely, compared with heterosexual individuals., Conclusions: In a large population-based sample of Ontario residents, using clinically relevant outcomes, the study found gay/lesbian and bisexual individuals to be at elevated risk of suicide-related behavior events. Increased education among psychiatric professionals is needed to improve awareness of and sensitivity to the elevated risk of suicide-related behavior among sexual minority individuals, and further research on interventions is needed to reduce such behaviors., Competing Interests: Dr. Kennedy has served as a consultant or speaker for AbbVie, Boehringer Ingelheim, Janssen, Lundbeck, Merck, Neurotorium, Otsuka, Pfizer, Sunovion, and Servier; he has received research support from Abbott, Brain Canada, the Canadian Institutes of Health Research, Janssen, Lundbeck, Ontario Brain Institute, Otsuka, and Canada's Strategy for Patient-Oriented Research; and he has stock/stock options in Field Trip Health. The other authors report no financial relationships with commercial interests.

Objective: To examine physician factors associated with practice-level uptake of virtual mental healthcare for children and adolescents., Design, Setting and Participants: A population-based data linkage study of a cohort of all physicians (n=12 054) providing outpatient mental healthcare to children and adolescents (aged 3-17 years, n=303 185) in a single-payer provincial health system in Ontario, Canada from 1 July 2020 to 31 July 2021., Exposures: Physician characteristics including gender, age, specialty, location of training, practice region, practice size and overall and mental health practice size., Main Outcomes: Practice-level proportion of outpatient virtual care provided: (1) mostly in-person (<25% virtual care), (2) hybrid (25%-99% virtual care) or (3) exclusively virtual (100% virtual care). Multinomial logistic regression models tested the association between practice-level virtual care provided and physician characteristics., Results: Among physicians, 1589 (13.2%) provided mostly in-person mental healthcare with 8714 (67.8%) providing hybrid care, and 2291 (19.0%) providing exclusively virtual care. The provision of exclusive virtual care (vs mostly in-person) was associated with female sex (adjusted OR (aOR) 1.97, 95% CI 1.70 to 2.27 (ref: male)), foreign training (aOR 1.27, 95% CI 1.07 to 1.50 (ref: Canadian-trained)), family physicians (aOR 2.05, 95% CI 1.56 to 2.69 (ref: psychiatrist)) and reversely associated with large practice size (aOR 0.32, 95% CI 0.25 to 0.40 (ref smallest quintile)). Mostly in-person care was associated with older age physicians (71+ years) and practice outside the Toronto region., Conclusions and Relevance: In a single-payer universal healthcare system that remunerates physicians using the same fee structure for in-person and virtual outpatient care, there is heterogeneity in utilisation of virtual care that is associated with provider factors. This practice variation, with limited evidence on effectiveness and appropriate contexts for virtual care use, suggests there may be opportunity for further outcomes research and guidance on appropriate context for paediatric virtual mental healthcare delivery., Competing Interests: Competing interests: NRS reported receiving personal fees from the Archives of Diseases in Childhood, grants from the Canadian Institutes for Health Research and the Ontario Ministry of Health, grants from the Centre for Addiction and Mental Health and grants from The Hospital for Sick Children outside the submitted work. SV reported receiving royalties from UpToDate for authorship of materials related to depression and pregnancy outside the submitted work. No other disclosures were reported., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Latent class analysis (LCA) is an analytical approach for the identification of more homogeneous subgroups within an otherwise dissimilar patient population. In the current paper, Part II, we present a practical step-by-step guide for LCA of clinical data, including when LCA might be applied, selecting indicator variables, and choosing a final class solution. We also identify common pitfalls of LCA, and related solutions., Competing Interests: Declaration of competing interest The authors confirm that there are no known conflicts of interest associated with this work., (Copyright © 2023. Published by Elsevier Inc.)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). This article has been retracted at the request of the Editors-in-Chief, and with the full cooperation of the authors of the article. The article used notable portions of text from papers previously published by Pratik Sinha, Carolyn S. Calfee and Kevin L. Delucchi in Crit Care Med 49(2021) e63-e79 (https://doi.org/10.1097/CCM.0000000000004710) and by Bridget E. Weller, Natasha K. Bowen and Sarah J. Faubert in J Black Psychol 46(2020) 287-311 (https://doi.org/10.1177/0095798420930932). While these two papers were cited in the original article, a reader brought to the Editors' attention areas of verbatim text overlap without clear attribution through the use of quotation marks. One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any text must be appropriately cited and made visible/transparent to the reader. The scientific community takes a very strong view on this matter. We apologize to readers of the journal that this was not detected ahead of publication. The article has been republished with an updated version with clear attribution of all text where appropriate., (Copyright © 2023 Elsevier Inc. All rights reserved.)