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Koet LBM, Velek P, Bindels PJE, Bohnen AM, de Schepper EIT, Gerger H. Children and young people's consultation rates for psychosocial problems between 2016 and 2021 in the Netherlands. Eur J Gen Pract 2024; 30:2357780. [PMID: 38832626 DOI: 10.1080/13814788.2024.2357780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Worldwide, there are concerns about declining mental health of children and young people (CYP). OBJECTIVES To examine trends in GP consultation rates for psychosocial problems and the impact of the COVID-19 pandemic. METHODS We performed a population-based cohort study using electronic GP records of CYP (0-24 years) living in the Rotterdam metropolitan area between 2016 and 2021. We calculated monthly consultation rates for psychosocial problems, stratified by age group and sex. We used negative binomial models to model the pre-COVID-19 trend, and estimate expected rates post-COVID-19 onset. We modelled the effect of COVID-19 infection rate and school closure on consultation rates per sex and age group. RESULTS The cohort increased from 64801 to 92093 CYP between January 2016 and December 2021. Median age was 12.5 years and 49.3% was female. Monthly consultation rates increased from 2,443 to 4,542 consultations per 100,000 patient months over the six years. This trend (RR 1.009, 95%CI 1.008-1.011) started well before the COVID-19 pandemic. Consultation rates of adolescent girls and young women increased most strongly. Between March and May 2020, there was a temporary reduction in consultation rates, whereupon these returned to expected levels. COVID-19 infection rate and school closures showed small but significant associations with consultation rates for psychosocial problems but this did not affect the overall trend. Although consultation rates for psychosocial problems increased, this increment was stable over the entire study period. CONCLUSION The COVID-19 pandemic did not significantly increase consultation rates for psychosocial problems in CYP. The consultation rates increased, especially in adolescent girls and young women.
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Affiliation(s)
- Lukas B M Koet
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Premysl Velek
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Arthur M Bohnen
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Heike Gerger
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Clinical Psychology, Open University, Heerlen, The Netherlands
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2
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Yang Y(S, Law M, Vaghri Z. New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey. PLoS One 2024; 19:e0301008. [PMID: 38848408 PMCID: PMC11161078 DOI: 10.1371/journal.pone.0301008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/09/2024] [Indexed: 06/09/2024] Open
Abstract
In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.
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Affiliation(s)
- Yuzhi (Stanford) Yang
- Department of Psychology, Faculty of Science, Applied Science, and Engineering, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira Law
- Department of Psychology, Faculty of Science, St. Mary’s University, Halifax, Nova Scotia, Canada
| | - Ziba Vaghri
- Global Child Program, Integrated Health Initiative, Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
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3
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Fitzpatrick T, Buchan SA, Mahant S, Fu L, Kwong JC, Stukel TA, Guttmann A. Pediatric Respiratory Syncytial Virus Hospitalizations, 2017-2023. JAMA Netw Open 2024; 7:e2416077. [PMID: 38861259 DOI: 10.1001/jamanetworkopen.2024.16077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Importance Respiratory syncytial virus (RSV) transmission was disrupted worldwide following the COVID-19 pandemic, and further study is required to better understand these changes. Objective To compare observed and expected RSV hospital and intensive care unit (ICU) admission rates and characteristics of admitted children during the 2021-2022 and 2022-2023 seasons. Design, Setting, and Participants A population-based cohort study of all children aged younger than 5 years in Ontario, Canada, July 1, 2017, through March 31, 2023, was conducted. Exposures Individual and neighborhood-level sociodemographic and clinical characteristics were identified from administrative data, including age, palivizumab eligibility, complex medical conditions, rurality, and living in a marginalized neighborhood. Main Outcomes and Measures The main outcome was RSV-associated hospitalization. Secondary outcomes included ICU admissions, mechanical ventilation, extracorporeal membrane oxygenation, and in-hospital death. Poisson generalized estimating equations were used to model weekly age- and sex-specific hospitalization rates and estimate expected rates in the postpandemic era; adjusted rate ratios (RRs) and 95% CIs are reported. Results This cohort study included approximately 700 000 children per study year. Compared with prepandemic years (2017-2018, 2018-2019, and 2019-2020), the 2021-2022 RSV season peaked slightly earlier, but overall admission rates were comparable (289.1 vs 281.4-334.6 per 100 000, or approximately 2000 admissions). The 2022-2023 season peaked a month earlier and resulted in more than twice as many hospitalizations (770.0 per 100 000; n = 4977 admissions). The proportion of children admitted to an ICU in 2022-2023 (13.9%) was slightly higher than prepandemic (9.6%-11.4%); however, the population-based rate was triple the prepandemic levels (106.9 vs 27.6-36.6 per 100 000 children in Ontario). With the exception of palivizumab-eligible children, all sociodemographic and health status characteristics were associated with lower-than-expected RSV hospitalization rates in 2021-2022. In contrast, older age of patients was associated with higher-than-expected rates in 2022-2023 (ie, 24-59 months: RR, 1.90; 95% CI, 1.35-2.66). Conclusions and Relevance There were notable differences in RSV epidemiologic characteristics in Ontario following the COVID-19 pandemic. It is not yet clear whether and how long atypical RSV epidemics may persist. Clinicians and program planners should consider the potential for ongoing impacts to health care capacity and RSV immunization programs.
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Affiliation(s)
- Tiffany Fitzpatrick
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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4
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Koet LBM, Gerger H, Jansen W, Bindels PJE, de Schepper EIT. Evaluation of practice nurses' management of paediatric psychosocial problems in general practice. J Public Health (Oxf) 2024; 46:e261-e268. [PMID: 38299893 PMCID: PMC11141612 DOI: 10.1093/pubmed/fdae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Child mental health services are under major pressure worldwide. In the Netherlands, Youth Mental Health Practice Nurses (YMHPNs) have been introduced in general practice to improve access to care. In this study, we evaluated care delivered by YMHPNs. METHODS We used medical records of a population-based cohort (21 717 children, 0-17 years). Characteristics of children consulting a YMHPN, type of problem, care delivered by YMHPNs and referrals were assessed using quantitative content analysis. RESULTS Records of 375 children (mean age 12.9 years, 59.2% girl) were analysed. These children were often in their adolescence (57.3% was between 13 and 17 years), and more often female than male (59.2% vs 40.8%). YMHPNs had a median of four consultations (IQR 2-7) with the child. YMHPNs managed a variety of psychosocial problems. YMHPNs managed 22.4% of children without need of referral, 52.0% were eventually referred for additional care. 13.3% of children dropped out during the treatment trajectory. In the remaining 12.3% of children, the treatment trajectory was stopped because the child was already attending specialized services, the treatment trajectory was still ongoing or the medical record was inconclusive. CONCLUSIONS YMHPNs successfully managed one in four children with psychosocial problems without need for referral. Nevertheless, most children were eventually referred for additional care.
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Affiliation(s)
- Lukas B M Koet
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
| | - Heike Gerger
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
- Department of Clinical Psychology, Open University, 6419 AT Heerlen, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
- Department of Youth, City of Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
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Freeman SJ, Nisenbaum R, Jegathesan T, Sgro MD. Healthcare visits for new neurodevelopmental problems before and during the COVID-19 pandemic. Pediatr Res 2024:10.1038/s41390-024-03279-0. [PMID: 38796534 DOI: 10.1038/s41390-024-03279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/11/2024] [Accepted: 05/06/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare delivery. We hypothesized that children with neurodevelopmental problems would have reduced healthcare utilization during the pandemic compared to before the pandemic. METHODS We conducted a population-based study of healthcare visits for new neurodevelopmental problems among children ages 0-6 years in Ontario, Canada. Our outcome measure was rate per 1000 children-months for healthcare visits for new neurodevelopmental problems. We compared changes in monthly rates before and during the pandemic using interrupted time series analysis (ITSA). RESULTS The rate of new neurodevelopmental problems before the pandemic was 6.31 per 1000 children-months and during the pandemic was 6.58 per 1000 children-months. However, using ITSA, there were no differences in monthly rates of healthcare visits for new neurodevelopmental problems before and during the pandemic. The observed rate during the first 30 days of the pandemic dropped to 3.40 per 1000 children-months. CONCLUSION We found no significant difference in rates of healthcare visits for new neurodevelopmental problems before and during the pandemic. There was a decrease in the number of visits during the first 30 days of the pandemic compared to all months prior. IMPACT This study found no significant difference in rates of healthcare visits for new neurodevelopmental problems before and during the pandemic. There was a decrease in the number of visits during the first 30 days of the pandemic compared to all months prior. This study adds information on healthcare access for children during the COVID-19 pandemic. The rapid deployment of virtual healthcare delivery in Ontario, Canada may explain the fast recovery of healthcare utilization for children with neurodevelopmental problems.
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Affiliation(s)
- Sloane J Freeman
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Thivia Jegathesan
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael D Sgro
- Women and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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Eirich R, Pador P, Watt J, Racine N, Lyons-Ruth K, Madigan S. Evaluating the use of the AMBIANCE-Brief measure in clinical settings: Assessing acceptability, feasibility, and utility of the AMBIANCE-Brief. Infant Ment Health J 2024. [PMID: 38780376 DOI: 10.1002/imhj.22115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024]
Abstract
Community agencies and practitioners around the globe seek opportunities to learn various assessment tools and interventions rooted in attachment theory. However, information regarding the feasibility of implementation and sustainability of these tools once participants have been trained to use them, is limited. This study investigated the perceived acceptability, feasibility, utility, relevance, fidelity, and sustainability of the Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) among practitioners who had taken a training. Practitioners (N = 59) who attended a virtual AMBIANCE-Brief training originating from Canada between June 2020 and November 2021 completed an online follow-up survey. Practitioners reported that they primarily used the AMBIANCE-Brief for case conceptualization (68%). Additionally, 95% agreed that the AMBIANCE-Brief was relevant to their clinical practice, 98% agreed it was useful for their clinical work, 76% agreed that it was feasible to implement into their clinical work, and 59% found it easy to incorporate into their treatment planning with clients. Findings suggest that the AMBIANCE-Brief may be acceptable, feasible, and useful for practitioners. Avenues for continuing to evaluate the AMBIANCE-Brief include cross-cultural validity, coder drift, and booster sessions. Additional work clarifying how practitioners integrate the measure into practice would be valuable.
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Affiliation(s)
- Rachel Eirich
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Paolo Pador
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Julianna Watt
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Racine
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Karlen Lyons-Ruth
- Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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7
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Hoffmann JA, Carter CP, Olsen CS, Ashby D, Bouvay KL, Duffy SJ, Chamberlain JM, Chaudhary SS, Glomb NW, Grupp-Phelan J, Haasz M, O'Donnell EP, Saidinejad M, Shihabuddin BS, Tzimenatos L, Uspal NG, Zorc JJ, Cook LJ, Alpern ER. Pediatric mental health emergency department visits from 2017 to 2022: A multicenter study. Acad Emerg Med 2024. [PMID: 38563444 DOI: 10.1111/acem.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/20/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected children's mental health (MH) and changed patterns of MH emergency department (ED) utilization. Our objective was to assess how pediatric MH ED visits during the COVID-19 pandemic differed from expected prepandemic trends. METHODS We retrospectively studied MH ED visits by children 5 to <18 years old at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022. We described visit length by time period: prepandemic (January 2017-February 2020), early pandemic (March 2020-December 2020), midpandemic (2021), and late pandemic (2022). We estimated expected visit rates from prepandemic data using multivariable Poisson regression models. We calculated rate ratios (RRs) of observed to expected visits per 30 days during each pandemic time period, overall and by sociodemographic and clinical characteristics. RESULTS We identified 175,979 pediatric MH ED visits. Visit length exceeded 12 h for 7.3% prepandemic, 8.4% early pandemic, 15.0% midpandemic, and 19.2% late pandemic visits. During the early pandemic, observed visits per 30 days decreased relative to expected rates (RR 0.80, 95% confidence interval [CI] 0.78-0.84), were similar to expected rates during the midpandemic (RR 1.01, 95% CI 0.96-1.07), and then decreased below expected rates during the late pandemic (RR 0.92, 95% CI 0.86-0.98). During the late pandemic, visit rates were higher than expected for females (RR 1.10, 95% CI 1.02-1.20) and for bipolar disorders (RR 1.83, 95% CI 1.38-2.75), schizophrenia spectrum disorders (RR 1.55, 95% CI 1.10-2.59), and substance-related and addictive disorders (RR 1.50, 95% CI 1.18-2.05). CONCLUSIONS During the late pandemic, pediatric MH ED visits decreased below expected rates; however, visits by females and for specific conditions remained elevated, indicating a need for increased attention to these groups. Prolonged ED visit lengths may reflect inadequate availability of MH services.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Camille P Carter
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Cody S Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - David Ashby
- Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kamali L Bouvay
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Susan J Duffy
- Department of Emergency Medicine, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC, USA
| | - Sofia S Chaudhary
- Division of Emergency Medicine, Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nicolaus W Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Erin P O'Donnell
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohsen Saidinejad
- Department of Emergency Medicine, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Bashar S Shihabuddin
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leah Tzimenatos
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA
| | - Neil G Uspal
- Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Valtuille Z, Acquaviva E, Trebossen V, Ouldali N, Bourmaud A, Sclison S, Gomez A, Revet A, Peyre H, Delorme R, Kaguelidou F. Psychotropic Medication Prescribing for Children and Adolescents After the Onset of the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e247965. [PMID: 38652474 DOI: 10.1001/jamanetworkopen.2024.7965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Importance Numerous studies have provided evidence for the negative associations of the COVID-19 pandemic with mental health, but data on the use of psychotropic medication in children and adolescents after the onset of the COVID-19 pandemic are lacking. Objective To assess the rates and trends of psychotropic medication prescribing before and over the 2 years after the onset of the COVID-19 pandemic in children and adolescents in France. Design, Setting, and Participants This cross-sectional study used nationwide interrupted time-series analysis of outpatient drug dispensing data from the IQVIA X-ponent database. All 8 839 143 psychotropic medication prescriptions dispensed to children (6 to 11 years of age) and adolescents (12 to 17 years of age) between January 2016 and May 2022 in France were retrieved and analyzed. Exposure Onset of COVID-19 pandemic. Main outcomes and Measures Monthly rates of psychotropic medication prescriptions per 1000 children and adolescents were analyzed using a quasi-Poisson regression before and after the pandemic onset (March 2020), and percentage changes in rates and trends were assessed. After the pandemic onset, rate ratios (RRs) were calculated between estimated and expected monthly prescription rates. Analyses were stratified by psychotropic medication class (antipsychotic, anxiolytic, hypnotic and sedative, antidepressant, and psychostimulant) and age group (children, adolescents). Results In total, 8 839 143 psychotropic medication prescriptions were analyzed, 5 884 819 [66.6%] for adolescents and 2 954 324 [33.4%] for children. In January 2016, the estimated rate of monthly psychotropic medication prescriptions was 9.9 per 1000 children and adolescents, with the prepandemic rate increasing by 0.4% per month (95% CI, 0.3%-0.4%). In March 2020, the monthly prescription rate dropped by 11.5% (95% CI, -17.7% to -4.9%). During the 2 years following the pandemic onset, the trend changed significantly, and the prescription rate increased by 1.3% per month (95% CI, 1.2%-1.5%), reaching 16.1 per 1000 children and adolescents in May 2022. Monthly rates of psychotropic medication prescriptions exceeded the expected rates by 11% (RR, 1.11 [95% CI, 1.08-1.14]). Increases in prescribing trends were observed for all psychotropic medication classes after the pandemic onset but were substantial for anxiolytics, hypnotics and sedatives, and antidepressants. Prescription rates rose above those expected for all psychotropic medication classes except psychostimulants (RR, 1.12 [95% CI, 1.09-1.15] in adolescents and 1.06 [95% CI, 1.05-1.07] in children for antipsychotics; RR, 1.30 [95% CI, 1.25-1.35] in adolescents and 1.11 [95% CI, 1.09-1.12] in children for anxiolytics; RR, 2.50 [95% CI, 2.23-2.77] in adolescents and 1.40 [95% CI, 1.30-1.50] in children for hypnotics and sedatives; RR, 1.38 [95% CI, 1.29-1.47] in adolescents and 1.23 [95% CI, 1.20-1.25] in children for antidepressants; and RR, 0.97 [95% CI, 0.95-0.98] in adolescents and 1.02 [95% CI, 1.00-1.04] in children for psychostimulants). Changes were more pronounced among adolescents than children. Conclusions and Relevance These findings suggest that prescribing of psychotropic medications for children and adolescents in France significantly and persistently increased after the COVID-19 pandemic onset. Future research should identify underlying determinants to improve psychological trajectories in young people.
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Affiliation(s)
- Zaba Valtuille
- Center of Clinical Investigations, Inserm CIC1426, Robert Debré University Hospital, APHP.Nord, Paris, France
- Paris Cité University, EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris, France
| | - Eric Acquaviva
- Department of Child and Adolescent Psychiatry, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Vincent Trebossen
- Department of Child and Adolescent Psychiatry, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Naim Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Aurelie Bourmaud
- Clinical Epidemiology Unit, Inserm CIC1426, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
| | - Stéphane Sclison
- Consulting Services & Analytics Department, IQVIA, Courbevoie, France
| | - Alexandre Gomez
- Consulting Services & Analytics Department, IQVIA, Courbevoie, France
| | - Alexis Revet
- Department of Child and Adolescent Psychiatry, Toulouse University Hospital, Toulouse, France
- CERPOP, UMR 1295, Inserm, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Hugo Peyre
- Autism Reference Centre of Languedoc-Roussillon CRA-LR, Montpellier University Hospital, Montpellier, France
- Excellence Centre for Autism and Neurodevelopmental disorders- CeAND, MUSE University, Montpellier, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Richard Delorme
- Department of Child and Adolescent Psychiatry, Robert Debré University Hospital, APHP.Nord, Paris Cité University, Paris, France
- Human Genetics & Cognitive Functions, Institut Pasteur, Paris, France
| | - Florentia Kaguelidou
- Center of Clinical Investigations, Inserm CIC1426, Robert Debré University Hospital, APHP.Nord, Paris, France
- Paris Cité University, EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris, France
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Debenham J, Birrell L, Champion KE, Newton N. An on-line school-based substance use harm reduction programme: The Illicit Project randomized controlled trial results. Addiction 2024; 119:741-752. [PMID: 38105000 DOI: 10.1111/add.16403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
AIMS The aim of this study was to measure the effectiveness of an on-line, neuroscience-based harm reduction intervention (The Illicit Project) on substance use, harms and knowledge over a 12-month period. DESIGN We used a two-arm cluster-randomized controlled trial. SETTING The study was conducted at eight secondary schools across New South Wales, Australia. PARTICIPANTS A total of 950 (mean age = 15.9; standard deviation = 0.68) in grades 10-12 at participating schools in 2020 took part. INTERVENTION AND COMPARATOR The Illicit Project intervention group (schools = five, n = 681) received an on-line, universal substance use and harm reduction programme over three classes. The active control group (schools = three, n = 269) received school-based health education as usual. MEASUREMENTS Self-report questionnaires assessed primary [alcohol, nicotine, cannabis, 3,4-methylenedioxymethamphetamine (MDMA), cocaine and prescription drug misuse] and secondary outcomes (alcohol-related harms and drug literacy) at baseline and the 6- and 12-month follow-up assessment. FINDINGS Approximately 63% (n = 595) of the sample completed the 12-month follow-up assessment, including 58% of the intervention group (n = 396/679) and 66% of the active control group (n = 179/271). Participants in the intervention group had slower annual increases in binge drinking [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.89], nicotine use (OR = 0.80, 95% CI = 0.52-1.23), MDMA use (OR = 0.14, 95% CI = 0.02-1.00), cocaine use (OR = 0.06, 95% CI = 0.01-0.64) and prescription drug misuse (OR = 0.07, 95% CI = 0.01-0.54) compared with the active control group. There was limited evidence of an intervention effect on cannabis use and alcohol-related harm (P > 0.5). The secondary outcomes showed that the intervention group maintained higher levels of drug literacy knowledge (β = 3.71, 95% CI = 1.86-5.56) and harm reduction help-seeking skills (β = 1.55, 95% CI = 0.62-2.48) compared with the active control group. CONCLUSION The Illicit Project (an on-line, neuroscience-based substance use harm reduction intervention) was effective in slowing the uptake of risky substance use and improving drug literacy skills among late secondary school students in Australia, compared with school-based health education as usual.
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Affiliation(s)
- Jennifer Debenham
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Louise Birrell
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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10
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Oblath R, Dayal R, Loubeau JK, Lejeune J, Sikov J, Savage M, Posse C, Jain S, Zolli N, Baul TD, Ladino V, Ji C, Kabrt J, Sidky L, Rabin M, Kim DY, Kobayashi I, Murphy JM, Garg A, Spencer AE. Trajectories and correlates of mental health among urban, school-age children during the COVID-19 pandemic: a longitudinal study. Child Adolesc Psychiatry Ment Health 2024; 18:32. [PMID: 38486248 PMCID: PMC10941406 DOI: 10.1186/s13034-024-00712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/25/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic posed numerous obstacles to psychosocial wellbeing for children. We conducted a longitudinal study to evaluate child mental health and social risks during the pandemic. METHODS Participants were 172 caregivers of children aged 6-11 years old who attended well child visits within 6 months before pandemic onset at an urban safety net hospital in the US. Prepandemic data was extracted from the electronic medical record, and surveys were administered at three time points between August 2020 and July 2021. We measured mental health symptoms with the Pediatric Symptom Checklist-17, social risks (e.g., food and housing insecurity) with the THRIVE questionnaire, and school modality (in-person, hybrid, remote). RESULTS Compared to pre-pandemic, children had significantly higher PSC-17 total scores (overall mental health symptoms) and THRIVE total scores (total burden of social risks) at all three mid-pandemic waves. Using longitudinal mixed models accounting for time, social risks, and school modality, both social risks (B = 0.37, SE = 0.14, p < 0.01) and school modality were significantly associated with PSC-17 scores (B = - 1.95, SE = 0.63, p < 0.01). Children attending in-person school had fewer mental health symptoms than those attending remote or hybrid school. CONCLUSION Mental health symptoms and social risks remained significantly higher fifteen months after the onset of the COVID-19 pandemic compared to prepandemic. In-person attendance at school appeared protective against persistently elevated mental health symptoms.
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Affiliation(s)
- Rachel Oblath
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
- BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Rohan Dayal
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- School of Public Health, Boston University, Boston, MA, USA
| | | | - Julia Lejeune
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jennifer Sikov
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychology, College of Arts, Sciences, and Education, Florida International University, FL, Miami, USA
| | - Meera Savage
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Catalina Posse
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Sonal Jain
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nicole Zolli
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Tithi D Baul
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Valeria Ladino
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Chelsea Ji
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Jessica Kabrt
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Lillian Sidky
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Megan Rabin
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Do Yoon Kim
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Imme Kobayashi
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- New York University Grossman School of Medicine, NY, New York City, USA
| | - J Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Arvin Garg
- Department of Pediatrics, Child Health Equity Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- University of Massachusetts Memorial Children's Medical Center, Worcester, MA, USA
| | - Andrea E Spencer
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, IL, Chicago, USA.
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11
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Movahedi Nia Z, Prescod C, Westin M, Perkins P, Goitom M, Fevrier K, Bawa S, Kong J. Cross-sectional study to assess the impact of the COVID-19 pandemic on healthcare services and clinical admissions using statistical analysis and discovering hotspots in three regions of the Greater Toronto Area. BMJ Open 2024; 14:e082114. [PMID: 38485179 PMCID: PMC10941105 DOI: 10.1136/bmjopen-2023-082114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic disrupted healthcare services, leading to the cancellation of non-urgent tests, screenings and procedures, a shift towards remote consultations, stalled childhood immunisations and clinic closures which had detrimental effects across the healthcare system. This study investigates the impact of the COVID-19 pandemic on clinical admissions and healthcare quality in the Peel, York and Toronto regions within the Greater Toronto Area (GTA). DESIGN In a cross-sectional study, the negative impact of the pandemic on various healthcare sectors, including preventive and primary care (PPC), the emergency department (ED), alternative level of care (ALC) and imaging, procedures and surgeries is investigated. Study questions include assessing impairments caused by the COVID-19 pandemic and discovering hotspots and critical subregions that require special attention to recover. The measuring technique involves comparing the number of cases during the COVID-19 pandemic with before that, and determining the difference in percentage. Statistical analyses (Mann-Whitney U test, analysis of variance, Dunn's test) is used to evaluate sector-specific changes and inter-relationships. SETTING This work uses primary data which were collected by the Black Creek Community Health Centre. The study population was from three regions of GTA, namely, the city of Toronto, York and Peel. For all health sectors, the sample size was large enough to have a statistical power of 0.95 to capture 1% variation in the number of cases during the COVID-19 pandemic compared with before that. RESULTS All sectors experienced a significant decline in patient volume during the pandemic. ALC admissions surged in some areas, while IPS patients faced delays. Surgery waitlists increased by an average of 9.75%, and completed IPS procedures decreased in several subregions. CONCLUSIONS The COVID-19 pandemic had a universally negative impact on healthcare sectors across various subregions. Identification of the hardest-hit subregions in each sector can assist health officials in crafting recovery policies.
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Affiliation(s)
- Zahra Movahedi Nia
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
| | - Cheryl Prescod
- Black Creek Community Health Centre, Toronto, Ontario, Canada
| | - Michelle Westin
- Black Creek Community Health Centre, Toronto, Ontario, Canada
| | - Patricia Perkins
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- Faculty of Environment and Urban Change, York University, Toronto, Ontario, Canada
| | - Mary Goitom
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- School of Social Work, York University, Toronto, Ontario, Canada
| | - Kesha Fevrier
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- Department of Geography and Planning, Queen's University, Kingston, New York, Canada
| | - Sylvia Bawa
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
- Department of Sociology, York University, Toronto, Ontario, Canada
| | - Jude Kong
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Resilience Research Atlantic Alliance on Sustainability, Supporting Recovery and Renewal (REASURE2) Network, Toronto, Ontario, Canada
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12
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Vandermorris A, Toulany A, McKinnon B, Tam MW, Li Z, Guan J, Stukel T, Fu L, Wang X, Begun S, Harrison ME, Wigle J, Brown HK. Sexual and Reproductive Health Outcomes Among Adolescent Females During the COVID-19 Pandemic. Pediatrics 2024; 153:e2023063889. [PMID: 38303635 DOI: 10.1542/peds.2023-063889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease 2019 (COVID-19) posed a significant threat to adolescents' sexual and reproductive health. In this study, we examined population-level pregnancy and sexual health-related care utilization among adolescent females in Ontario, Canada during the pandemic and evaluated relationships between these outcomes and key sociodemographic characteristics. METHODS This was a population-based, repeated cross-sectional study of >630 000 female adolescents (12-19 years) during the prepandemic (January 1, 2018-February 29, 2020) and COVID-19 pandemic (March 1, 2020-December 31, 2022) periods. Primary outcome was pregnancy; secondary outcomes were contraceptive management visits, contraception prescription uptake, and sexually transmitted infection (STI) management visits. Poisson models with generalized estimating equations for clustered count data were used to model pre-COVID-19 trends and forecast expected rates during the COVID-19 period. Absolute rate differences between observed and expected outcome rates for each pandemic month were calculated overall and by urbanicity, neighborhood income, immigration status, and region. RESULTS During the pandemic, lower-than-expected population-level rates of adolescent pregnancy (rate ratio 0.87; 95% confidence interval [CI]:0.85-0.88), and encounters for contraceptive (rate ratio 0.82; 95% CI:0.77-0.88) and STI management (rate ratio 0.52; 95% CI:0.51-0.53) were observed. Encounter rates did not return to pre-pandemic rates by study period end, despite health system reopening. Pregnancy rates among adolescent subpopulations with the highest pre-pandemic pregnancy rates changed least during the pandemic. CONCLUSIONS Population-level rates of adolescent pregnancy and sexual health-related care utilization were lower than expected during the COVID-19 pandemic, and below-expected care utilization rates persist. Pregnancy rates among more structurally vulnerable adolescents demonstrated less decline, suggesting exacerbation of preexisting inequities.
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Affiliation(s)
| | - Alene Toulany
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Michelle W Tam
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontaria, Canada
| | - Zhiyin Li
- University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Thérèse Stukel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Longdi Fu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | | | | | - Hilary K Brown
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- University of Toronto Scarborough, Toronto, Ontario, Canada
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13
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Park JL, Clark CA, Bagshawe M, Kuntz J, Andrea-Perri, Avril-Deegan, Marriott B, Rahman A, Susan-Graham, McMorris CA. A comparison of psychiatric inpatient admissions in youth before and during the COVID-19 pandemic. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2024; 33:3-17. [PMID: 38449720 PMCID: PMC10914150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/10/2023] [Indexed: 03/08/2024]
Abstract
Background The current understanding of the effect of COVID-19 on child and youth admissions to psychiatric inpatient units over time is limited, with conflicting findings and many studies focusing on the initial wave of the pandemic. Objectives This study identified changes in psychiatric inpatient admissions, and reasons for admission, including suicidality and self-harm, before and during the COVID-19 pandemic. Method This time series study analyzed 3,723 admissions of youth (ages 0-18.88 years) admitted to four major psychiatry inpatient units in a large Canadian city between January 1st, 2016 and December 31st, 2021. Pre-pandemic (before March 11, 2020) and during-pandemic (after March 11, 2020) trends of admissions were explored using a Bayesian structural time series model (BSTS). Results The model revealed that overall admissions during the pandemic period exceeded what would have been predicted in the absence of a pandemic, a relative increase of 29%. Additionally, a rise in the total number of admissions due to self-harm and suicidality (29% increase), externalizing/behavioral issues (69% increase), and internalizing/emotional issues (28% increase) provided strong evidence of increased admissions compared to what might have been expected from pre-pandemic numbers. Conclusions There was strong evidence of increases in psychiatric inpatient admissions during the COVID-19 pandemic compared to expected trends based on pre-pandemic data. To ensure accessible and continuous mental health supports and services for youth and their families during future pandemics, these findings highlight the need for rapid expanse of inpatient mental health services, similar to what occurred in many intensive care units across Canada.
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Affiliation(s)
- Joanne L Park
- Department of Psychology, University of Calgary, Calgary, Alberta
- Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Chris A Clark
- Werklund School of Education, University of Calgary, Calgary, Alberta
| | - Mercedes Bagshawe
- Werklund School of Education, University of Calgary, Calgary, Alberta
- Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Jennifer Kuntz
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Andrea-Perri
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Avril-Deegan
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Brian Marriott
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Abdul Rahman
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Susan-Graham
- Department of Psychology, University of Calgary, Calgary, Alberta
- Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, Alberta
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14
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Madigan S, Vaillancourt T, Dimitropoulos G, Premji S, Kahlert SM, Zumwalt K, Korczak DJ, von Ranson KM, Pador P, Ganshorn H, Neville RD. A Systematic Review and Meta-Analysis: Child and Adolescent Healthcare Utilization for Eating Disorders During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00077-7. [PMID: 38431196 DOI: 10.1016/j.jaac.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To conduct a meta-analysis documenting healthcare service utilization rates for pediatric (age <19 years) eating disorders during compared to before the COVID-19 pandemic. METHOD PsycINFO, MEDLINE, Embase, and Web of Science Core Collection were searched for studies published up to May 19, 2023. Studies with pediatric visits to primary care, inpatient, outpatient, and emergency department for eating disorders before and during the pandemic were included. This preregistered review (PROSPERO CRD42023413392) was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analyzed with random-effects meta-analyses. RESULTS A total of 52 studies reporting >148,000 child and adolescent eating disorder-related visits to >300 health settings across 15 countries were included (mean age, 12.7 years; SD = 4.1 years; 87% girls). There was strong evidence of an increase in healthcare use for eating disorders during the pandemic (rate ratio [RR] = 1.54, 95% CI = 1.38-1.71). Moderator analysis revealed larger rate increases among girls (RR = 1.48, 95% CI = 1.28-1.71) compared to boys (RR = 1.24, 95% CI = 1.06-1.45) and for adolescents (age ≥12 to 19 years) (RR = 1.53, 95% CI = 1.29-1.81) compared to children (RR = 0.87, 95% CI = 0.53-1.43). Moderator analysis demonstrated strong evidence of increased use of emergency department (RR = 1.70, 95% CI = 1.48-1.97), inpatient (RR = 1.56, 95% CI = 1.33-1.84), and outpatient (RR = 1.62, 95% CI = 1.35-1.95) services, as well as strong evidence of increased rates of anorexia nervosa (RR = 1.48, 95% CI = 1.24-1.75). CONCLUSION Healthcare use for pediatric eating disorders increased substantially during the COVID-19 pandemic, particularly among girls and adolescents. It is important to continue to monitor whether changes in healthcare use associated with acute pediatric mental distress are sustained beyond the COVID-19 pandemic. STUDY PREREGISTRATION INFORMATION Risk factors for eating disorders for youth during the COVID-19 pandemic; https://www.crd.york.ac.uk/; CRD42023413392. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
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Affiliation(s)
- Sheri Madigan
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | | | - Gina Dimitropoulos
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | | | | | - Daphne J Korczak
- Hospital for Sick Children, Toronto, Canada; and the University of Toronto, Toronto, Canada
| | - Kristin M von Ranson
- University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
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15
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Madhanagopal N, Ahmad A, Hu YH, Olango G, Molla M. Mental Health Symptoms and Service Use in Depressed and Anxious Minors at the Onset of COVID-19 in a County Clinic Serving a Predominantly Hispanic Population. Cureus 2024; 16:e55160. [PMID: 38558688 PMCID: PMC10979717 DOI: 10.7759/cureus.55160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The study's primary aim was to compare the utilization rates of services by minors with depression/anxiety in a county mental health clinic before (from December 1, 2019, to March 15, 2020) and during the COVID-19 pandemic (from March 16 to June 30, 2020). The secondary aim was to study demographics and psychiatric symptomatology. METHODS Service utilization rates were estimated. Univariate and multivariate logistic regression was used to identify significant predictors of worsening psychiatric symptoms, anxiety, and change in the frequency of therapy between the pre-COVID-19 period and the COVID-19 period. RESULTS Service utilization rates increased during the pandemic period. During the pandemic, the presence of mood symptoms, suicidal ideation, and relationship conflicts predicted worsening psychiatric symptoms. In addition, the presence of preexisting sleep problems and physical health issues that continued during COVID-19 exhibited correlations with worsening psychiatric symptoms during COVID-19. COVID-related stressors and physical health issues were associated with anxiety; suicidal ideation predicted a change in the frequency of therapy. CONCLUSIONS Prospective studies to recognize risk factors for worsening mental health in minors with psychiatric illness during a crisis are warranted to identify and allocate services to the high-risk groups.
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Affiliation(s)
- Nandhini Madhanagopal
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
| | - Ammar Ahmad
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
| | - Yu-Hsi Hu
- Psychiatry, Child and Adolescent Psychiatry, Veterans Administration, Palo Alto, USA
| | - Garth Olango
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
| | - Mohammed Molla
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
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16
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Antoniou T, Pajer K, Gardner W, Penner M, Lunsky Y, McCormack D, Tadrous M, Mamdani M, Gozdyra P, Juurlink DN, Gomes T. Impact of COVID-19 pandemic on prescription stimulant use among children and youth: a population-based study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02346-x. [PMID: 38180538 DOI: 10.1007/s00787-023-02346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
COVID-19 associated public health measures and school closures exacerbated symptoms in some children and youth with attention-deficit hyperactivity disorder (ADHD). Less well understood is how the pandemic influenced patterns of prescription stimulant use. We conducted a population-based study of stimulant dispensing to children and youth ≤ 24 years old between January 1, 2013, and June 30, 2022. We used structural break analyses to identify the pandemic month(s) when changes in the dispensing of stimulants occurred. We used interrupted time series models to quantify changes in dispensing following the structural break and compare observed and expected stimulant use. Our main outcome was the change in the monthly rate of stimulant use per 100,000 children and youth. Following an initial immediate decline of 60.1 individuals per 100,000 (95% confidence interval [CI] - 99.0 to - 21.2), the monthly rate of stimulant dispensing increased by 11.8 individuals per 100,000 (95% CI 10.0-13.6), with the greatest increases in trend observed among females, individuals in the highest income neighbourhoods, and those aged 20 to 24. Observed rates were between 3.9% (95% CI 1.7-6.2%) and 36.9% (95% CI 34.3-39.5%) higher than predicted among females from June 2020 onward and between 7.1% (95% CI 4.2-10.0%) and 50.7% (95% CI 47.0-54.4%) higher than expected among individuals aged 20-24 from May 2020 onward. Additional research is needed to ascertain the appropriateness of stimulant use and to develop strategies supporting children and youth with ADHD during future periods of long-term stressors.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- ICES, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.
| | - Kathleen Pajer
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - William Gardner
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Melanie Penner
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Yona Lunsky
- ICES, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Mina Tadrous
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research & Training, Unity Health Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - David N Juurlink
- ICES, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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Zeitouny S, McGrail K, Tadrous M, Wong ST, Cheng L, Law M. Impact of the COVID-19 pandemic on prescription drug use and costs in British Columbia: a retrospective interrupted time series study. BMJ Open 2024; 14:e070031. [PMID: 38176877 PMCID: PMC10773331 DOI: 10.1136/bmjopen-2022-070031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES To assess the impact of the COVID-19 pandemic on prescription drug use and costs. DESIGN Interrupted time series analysis of comprehensive administrative health data linkages in British Columbia, Canada, from 1 January 2018 to 28 March 2021. SETTING Retrospective population-based analysis of all prescription drugs dispensed in community pharmacies and outpatient hospital pharmacies and irrespective of the drug insurance payer. PARTICIPANTS Between 4.30 and 4.37 million individuals (52% women) actively registered with the publicly funded medical services plan. INTERVENTION COVID-19 pandemic and associated mitigation measures. MAIN OUTCOME MEASURES Weekly dispensing rates and costs, both overall and stratified by therapeutic groups and pharmacological subgroups, before and after the declaration of the public health emergency related to the COVID-19 pandemic. Relative changes in post-COVID-19 outcomes were expressed as ratios of observed to expected rates. RESULTS After the onset of the pandemic and subsequent COVID-19 mitigation measures, overall medication dispensing rates dropped by 2.4% (p<0.01), followed by a sustained weekly increase to return to predicted levels by the end of January 2021. We observed abrupt level decreases in antibacterials (30.3%, p<0.01) and antivirals (22.4%, p<0.01) that remained below counterfactuals over the first year of the pandemic. In contrast, there was a week-to-week trend increase in nervous system drugs, yielding an overall increase of 7.3% (p<0.01). No trend changes in the dispensing of respiratory system agents, ACE inhibitors, antidiabetic drugs and antidepressants were detected. CONCLUSION The COVID-19 pandemic impact on prescription drug dispensing was heterogeneous across medication subgroups. As data become available, dispensing trends in nervous system agents, antibiotics and antivirals warrant further monitoring and investigation.
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Affiliation(s)
- Seraphine Zeitouny
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mina Tadrous
- University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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Burrell TD, Sheu YS, Kim S, Mohadikar K, Ortiz N, Jonas C, Horberg MA. COVID-19 and Adolescent Outpatient Mental Health Service Utilization. Acad Pediatr 2024; 24:68-77. [PMID: 37302698 PMCID: PMC10250250 DOI: 10.1016/j.acap.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/20/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The COVID-19 pandemic created challenges in accessing mental health (MH) services when adolescent well-being declined. Still, little is known about how the COVID-19 pandemic affected outpatient MH service utilization for adolescents. METHODS Retrospective data were collected from electronic medical records of adolescents aged 12-17 years at Kaiser Permanente Mid-Atlantic States, an integrated health care system from January 2019 to December 2021. MH diagnoses included anxiety, mood disorder/depression, anxiety and mood disorder/depression, attention-deficit/hyperactivity disorder, or psychosis. We used interrupted time series analysis to compare MH visits and psychopharmaceutical prescribing before and after the COVID-19 onset. Analyses were stratified by demographics and visit modality. RESULTS The study population of 8121 adolescents with MH visits resulted in a total of 61,971 (28.1%) of the 220,271 outpatient visits associated with an MH diagnosis. During 15,771 (7.2%) adolescent outpatient visits psychotropic medications were prescribed. The increasing rate of MH visits prior to COVID-19 was unaffected by COVID-19 onset; however, in-person visits declined by 230.5 visits per week (P < .001) from 274.5 visits per week coupled with a rise in virtual modalities. Rates of MH visits during the COVID-19 pandemic differed by sex, mental health diagnosis, and racial and ethnic identity. Psychopharmaceutical prescribing during MH visits declined beyond expected values by a mean of 32.8 visits per week (P < .001) at the start of the COVID-19 pandemic. CONCLUSIONS A sustained switch to virtual visits highlights a new paradigm in care modalities for adolescents. Psychopharmaceutical prescribing declined requiring further qualitative assessments to improve the quality of access for adolescent MH.
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Affiliation(s)
- Tierra D Burrell
- Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md.
| | - Yi-Shin Sheu
- Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md
| | - Seohyun Kim
- Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md
| | - Karishma Mohadikar
- Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md
| | - Nancy Ortiz
- Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md
| | - Cabell Jonas
- Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute (TD Burrell, YS Sheu, S Kim, K Mohadikar, C Jonas, and MA Horberg), Rockville, Md; Kaiser Permanente Mid-Atlantic Permanente Medical Group (TD Burrell, YS Sheu, S Kim, K Mohadikar, N Ortiz, C Jonas, and MA Horberg), Rockville, Md
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19
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Campbell LA, Clark SE, Chorney J, Emberly D, Carrey NJ, Bagnell A, Blenus J, Daneff M, Campbell JC. Understanding the uptake of virtual care for first and return outpatient appointments in child and adolescent mental health services: a mixed-methods study. BMJ Open 2023; 13:e074803. [PMID: 38110381 DOI: 10.1136/bmjopen-2023-074803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service. DESIGN A pragmatic mixed-methods approach using routinely collected administrative data between 1 April 2020 and 31 March 2022 and semi-structured interviews with clients, caregivers, clinicians and staff. Interview data were coded according to the Consolidated Framework for Implementation Research (CFIR) and examined for patterns of similarity or divergence across data sources, respondents or other relevant characteristics. SETTING Child and adolescent outpatient mental health service, Nova Scotia, Canada. PARTICIPANTS IWK Health clinicians and staff who had participated in virtual mental healthcare following its implementation in March 2020 and clients (aged 12-18 years) and caregivers of clients (aged 3-18 years) who had received treatment from an IWK outpatient clinic between 1 April 2020 and 31 March 2022 (n=1300). Participants (n=48) in semi-structured interviews included nine clients aged 13-18 years (mean 15.7 years), 10 caregivers of clients aged 5-17 years (mean 12.7 years), eight Community Mental Health and Addictions booking and registration or administrative staff and 21 clinicians. RESULTS During peak pandemic activity, upwards of 90% of visits (first or return) were conducted virtually. Between waves, return appointments were more likely to be virtual than first appointments. Interview participants (n=48) reported facilitators and barriers to virtual care within the CFIR domains of 'outer setting' (eg, external policies, client needs and resources), 'inner setting' (eg, communications within the service), 'individual characteristics' (eg, personal attributes, knowledge and beliefs about virtual care) and 'intervention characteristics' (eg, relative advantage of virtual or in-person care). CONCLUSIONS Shared decision-making regarding treatment modality (virtual vs in-person) requires consideration of client, caregiver, clinician, appointment, health system and public health factors across episodes of care to ensure accessible, safe and high-quality mental healthcare.
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Affiliation(s)
- Leslie Anne Campbell
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Debbie Emberly
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - N J Carrey
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexa Bagnell
- Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jaime Blenus
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Miriam Daneff
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
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20
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Antoniou T, Pajer K, Gardner W, Penner M, Lunsky Y, Tadrous M, Mamdani M, Gozdyra P, Juurlink DN, Gomes T. Impact of the COVID-19 pandemic on antidepressant and antipsychotic use among children and adolescents: a population-based study. Front Pediatr 2023; 11:1282845. [PMID: 38146536 PMCID: PMC10749316 DOI: 10.3389/fped.2023.1282845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 12/27/2023] Open
Abstract
Background The COVID-19 pandemic was associated with increases in the prevalence of depression, anxiety and behavioural problems among children and youth. Less well understood is the influence of the pandemic on antidepressant and antipsychotic use among children. This is important, as it is possible that antidepressants and antipsychotics were used as a "stop-gap" measure to treat mental health symptoms when in-person access to outpatient care and school-based supportive services was disrupted. Furthermore, antipsychotics and antidepressants have been associated with harm in children and youth. We examined trends in dispensing of these medications two years following the pandemic among children 18 years of age and under in Ontario, Canada. Methods We conducted a population-based time-series study of antidepressant and antipsychotic medication dispensing to children and adolescents ≤18 years old between September 1, 2014, and March 31, 2022. We measured monthly population-adjusted rates of antidepressant and antipsychotics obtained from the IQVIA Geographic Prescription Monitor (GPM) database. We used structural break analyses to identify the pandemic month(s) when changes in the dispensing of antidepressants and antipsychotics occurred. We used interrupted time series models to quantify changes in dispensing following the structural break and compare observed and expected use of these drugs. Results Overall, we found higher-than-expected dispensing of antidepressants and antipsychotics in children and youth. Specifically, we observed an immediate step decrease in antidepressant dispensing associated with a structural break in April 2020 (-55.8 units per 1,000 individuals; 95% confidence intervals [CI] CI: -117.4 to 5.8), followed by an increased monthly trend in the rate of antidepressant dispensing of 13.0 units per 1,000 individuals (95% CI: 10.2-15.9). Antidepressant dispensing was consistently greater than predicted from September 2020 onward. Antipsychotic dispensing increased immediately following a June 2020 structural break (26.4 units per 1,000 individuals; 95% CI: 15.8-36.9) and did not change appreciably thereafter. Antipsychotic dispensing was higher than predicted at all time points from June 2020 onward. Conclusion We found higher-than-expected dispensing of antidepressants and antipsychotics in children and youth. These increases were sustained through nearly two years of observation and are especially concerning in light of the potential for harm with the long-term use of antipsychotics in children. Further research is required to understand the clinical implications of these findings.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON, Canada
| | - Kathleen Pajer
- Mental Health Program, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - William Gardner
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Melanie Penner
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto ON, Canada
| | - Yona Lunsky
- ICES, Toronto, ON, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research & Training, Unity Health Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - David N. Juurlink
- ICES, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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21
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Itzhaky L, Levin Y, Har-Sinay M, Levy T, Benatov J, Zalsman G. COVID-19 and the impact on psychiatric and suicide-related emergency department visits of 5-18-year-Old youth in Israel. J Psychiatr Res 2023; 168:300-303. [PMID: 37939624 DOI: 10.1016/j.jpsychires.2023.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
COVID-19 has been found to take a toll on the mental health of children and adolescents worldwide. This study retrospectively evaluated the changes in the number of general and suicide-related visits to a pediatric psychiatric emergency department (ED) at Geha Mental Health Center in Israel and the distribution of sex and age of the 5-18-year-old youth who visited the ED. The study looked at visits from the pre-pandemic years to the first and second years of the pandemic. The findings showed a sharp decrease in visits at the beginning of the pandemic, followed by a significant increase in the first year and a nonsignificant decline in the second year. The proportion of girls' ED visits was higher in the pandemic years compared to the pre-pandemic years. Regarding suicide-related visits, after a sharp decline at the beginning of the pandemic, the number of visits increased at a rate similar to the pre-pandemic period. We conclude that the pattern of change was similar to that of other population-level exposures to continuous stress conditions. Further research on the vulnerability of girls in similar situations is needed.
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Affiliation(s)
- Liat Itzhaky
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | | | | | - Tomer Levy
- Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Tel Aviv University, Israel
| | - Joy Benatov
- Department of Special Education, Haifa University, Israel
| | - Gil Zalsman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Tel Aviv University, Israel
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22
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Toulany A, Kurdyak P, Stukel TA, Strauss R, Fu L, Guan J, Fiksenbaum L, Cohen E, Guttmann A, Vigod S, Chiu M, Moore Hepburn C, Moran K, Gardner W, Cappelli M, Sundar P, Saunders N. Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:904-915. [PMID: 36855797 PMCID: PMC9982398 DOI: 10.1177/07067437231156254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
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.
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Affiliation(s)
- Alene Toulany
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Paul Kurdyak
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Therese A. Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Simone Vigod
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital and Women's College Research Institute, Toronto, Canada
| | - Maria Chiu
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Mario Cappelli
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Purnima Sundar
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Natasha Saunders
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
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23
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Toulany A, Vigod S, Kurdyak P, Stukel TA, Strauss R, Fu L, Guttmann A, Guan J, Cohen E, Chiu M, Hepburn CM, Moran K, Gardner W, Cappelli M, Sundar P, Saunders N. New and continuing physician-based outpatient mental health care among children and adolescents during the COVID-19 pandemic in Ontario, Canada: a population-based study. Front Psychiatry 2023; 14:1063203. [PMID: 38025438 PMCID: PMC10657868 DOI: 10.3389/fpsyt.2023.1063203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Alene Toulany
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | - Simone Vigod
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Hospital, Women’s College Research Institute, Toronto, ON, Canada
| | - Paul Kurdyak
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Therese A. Stukel
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | | | - Eyal Cohen
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | - Maria Chiu
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
| | | | - William Gardner
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Mario Cappelli
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Purnima Sundar
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Natasha Saunders
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
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24
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Kurdyak P, Lebenbaum M, Patrikar A, Rivera L, Lu H, Scales DC, Guttmann A. SARS-CoV-2 vaccination prevalence by mental health diagnosis: a population-based cross-sectional study in Ontario, Canada. CMAJ Open 2023; 11:E1066-E1074. [PMID: 37989512 PMCID: PMC10681672 DOI: 10.9778/cmajo.20220210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, there has been concern about the impact of SARS-CoV-2 infection among individuals with mental illnesses. We analyzed the SARS-CoV-2 vaccination status of Ontarians with and without a history of mental illness. METHODS We conducted a population-based cross-sectional study of all community-dwelling Ontario residents aged 19 years and older as of Sept. 17, 2021. We used health administrative data to categorize Ontario residents with a mental disorder (anxiety, mood, substance use, psychotic or other disorder) within the previous 5 years. Vaccine receipt as of Sept. 17, 2021, was compared between individuals with and without a history of mental illness. RESULTS Our sample included 11 900 868 adult Ontario residents. The proportion of individuals not fully vaccinated (2 doses) was higher among those with substance use disorders (37.7%) or psychotic disorders (32.6%) than among those with no mental disorders (22.9%), whereas there were similar proportions among those with anxiety disorders (23.5%), mood disorders (21.5%) and other disorders (22.1%). After adjustment for age, sex, neighbourhood income and homelessness, individuals with psychotic disorders (adjusted prevalence ratio 1.19, 95% confidence interval [CI] 1.18-1.20) and substance use disorders (adjusted prevalence ratio 1.35, 95% CI 1.34-1.35) were more likely to be partially vaccinated or unvaccinated relative to individuals with no mental disorders. INTERPRETATION Our study found that psychotic disorders and substance use disorders were associated with an increased prevalence of being less than fully vaccinated. Efforts to ensure such individuals have access to vaccinations, while challenging, are critical to ensuring the ongoing risks of death and other adverse consequences of SARS-CoV-2 infection are mitigated in this high-risk population.
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Affiliation(s)
- Paul Kurdyak
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont.
| | - Michael Lebenbaum
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Aditi Patrikar
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Laura Rivera
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Hong Lu
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Damon C Scales
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- ICES Central (Kurdyak, Lebenbaum, Patrikar, Lu, Scales, Guttmann); Centre for Addiction and Mental Health (Kurdyak); Institute of Health Policy Management and Evaluation (Kurdyak, Lebenbaum, Scales), and Departments of Psychiatry (Rivera) and Paediatrics (Guttmann), and Edwin S.H. Leong Centre for Healthy Children (Guttmann), University of Toronto, Toronto, Ont
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Moin JS, Vigod SN, Plumptre L, Troke N, Asaria M, Papanicolas I, Wodchis WP, Brail S, Anderson G. Sex differences among children, adolescents and young adults for mental health service use within inpatient and outpatient settings, before and during the COVID-19 pandemic: a population-based study in Ontario, Canada. BMJ Open 2023; 13:e073616. [PMID: 37914301 PMCID: PMC10626835 DOI: 10.1136/bmjopen-2023-073616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVES The pandemic and public health response to contain the virus had impacts on many aspects of young people's lives including disruptions to daily routines, opportunities for social, academic, recreational engagement and early employment. Consequently, children, adolescents and young adults may have experienced mental health challenges that required use of mental health services. This study compared rates of use for inpatient and outpatient mental health services during the pandemic to pre-pandemic rates. DESIGN Population-based repeated cross-sectional study. SETTING Publicly delivered mental healthcare in primary and secondary settings within the province of Ontario, Canada. PARTICIPANTS All children 6-12 years of age (n=2 043 977), adolescents 13-17 years (n=1 708 754) and young adults 18-24 years (n=2 286 544), living in Ontario and eligible for provincial health insurance between March 2016 and November 2021. PRIMARY OUTCOME MEASURES Outpatient mental health visits to family physicians and psychiatrists for: mood and anxiety disorders, alcohol and substance abuse disorders, other non-psychotic mental health disorders and social problems. Inpatient mental health visits to emergency departments and hospitalisations for: substance-related and addictive disorders, anxiety disorders, assault-related injuries, deliberate self-harm and eating disorders. All outcomes were analysed by cohort and sex. RESULTS During the pandemic, observed outpatient visit rates were higher among young adults by 19.01% (95% CI: 15.56% to 22.37%; 209 vs 175 per 1000) and adolescent women 24.17% (95% CI: 18.93% to 29.15%; 131 vs 105 per 1000) for mood and anxiety disorders and remained higher than expected. Female adolescents had higher than expected usage of inpatient care for deliberate self-harm, eating disorders and assault-related injuries. CONCLUSIONS Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolescents and young women, and highlights the need to better monitor and identify mental health outcomes associated with COVID-19 containment measures and to develop policies to address these concerns.
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Affiliation(s)
- John S Moin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | | | - Miqdad Asaria
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Irene Papanicolas
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Shauna Brail
- Institute for Management & Innovation, University of Toronto Mississauga, Toronto, Ontario, Canada
| | - Geoff Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Levine DA, Oh PS, Nash KA, Simmons W, Grinspan ZM, Abramson EL, Platt SL, Green C. Pediatric Mental Health Emergencies During 5 COVID-19 Waves in New York City. Pediatrics 2023; 152:e2022060553. [PMID: 37860839 DOI: 10.1542/peds.2022-060553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES To describe the proportion of pediatric mental health emergency department (MH-ED) visits across 5 COVID-19 waves in New York City (NYC) and to examine the relationship between MH-ED visits, COVID-19 prevalence, and societal restrictions. METHODS We conducted a time-series analysis of MH-ED visits among patients ages 5 to 17 years using the INSIGHT Clinical Research Network, a database from 5 medical centers in NYC from January 1, 2016, to June 12, 2022. We estimated seasonally adjusted changes in MH-ED visit rates during the COVID-19 pandemic, compared with predicted prepandemic levels, specific to each COVID-19 wave and stratified by mental health diagnoses and sociodemographic characteristics. We estimated associations between MH-ED visit rates, COVID-19 prevalence, and societal restrictions measured by the Stringency Index. RESULTS Of 686 500 ED visits in the cohort, 27 168 (4.0%) were MH-ED visits. The proportion of MH-ED visits was higher during each COVID-19 wave compared with predicted prepandemic trends. Increased MH-ED visits were seen for eating disorders across all waves; anxiety disorders in all except wave 3; depressive disorders and suicidality/self-harm in wave 2; and substance use disorders in waves 2, 4, and 5. MH-ED visits were increased from expected among female, adolescent, Asian race, high Child Opportunity Index patients. There was no association between MH-ED visits and NYC COVID-19 prevalence or NY State Stringency Index. CONCLUSIONS The proportion of pediatric MH-ED visits during the COVID-19 pandemic was higher during each wave compared with the predicted prepandemic period, with varied increases among diagnostic and sociodemographic subgroups. Enhanced pediatric mental health resources are essential to address these findings.
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Affiliation(s)
- Deborah A Levine
- Departments of Emergency Medicine and Weill Cornell Medicine, Cornell University and New York-Presbyterian Hospital, New York, New York
| | - P Stephen Oh
- Department of Surgery, Weill Cornell Medicine, Cornell University and New York-Presbyterian Hospital, New York, New York
| | - Katherine A Nash
- Department of Pediatrics, New York Presbyterian Morgan Stanley Childrens Hospital, Columbia University, New York City, New York
| | - Will Simmons
- Department of Population Health, Weill Cornell Medicine, Cornell University and New York-Presbyterian Hospital, New York, New York
| | - Zachary M Grinspan
- Department of Pediatrics, Weill Cornell Medicine, Cornell University and New York-Presbyterian Hospital, New York, New York
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medicine, Cornell University and New York-Presbyterian Hospital, New York, New York
| | - Shari L Platt
- Departments of Emergency Medicine and Weill Cornell Medicine, Cornell University and New York-Presbyterian Hospital, New York, New York
| | - Cori Green
- Department of Pediatrics, Weill Cornell Medicine, Cornell University and New York-Presbyterian Hospital, New York, New York
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Benny C, Senthilselvan A, Patte KA, Smith BT, Veugelers PJ, Leatherdale ST, Pabayo R. Income inequality and mental health in adolescents during COVID-19, results from COMPASS 2018-2021. PLoS One 2023; 18:e0293195. [PMID: 37874840 PMCID: PMC10597521 DOI: 10.1371/journal.pone.0293195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023] Open
Abstract
INTRODUCTION Understanding the inequitable impacts of the ongoing COVID-19 pandemic on youth mental health are leading priorities. Existing research has linked income inequality in schools to adolescent depression, however, it is unclear if the onset of the pandemic exacerbated the effects of income inequality on adolescent mental health. The current study aimed to quantify the association between income inequality and adolescent mental health during COVID-19. MATERIAL AND METHODS Longitudinal data were taken from three waves (2018/19 to 2020/21) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) school-based study. Latent Growth Curve modelling was used to assess the association between Census District (CD)-level income inequality and depressive symptoms before and after the onset of COVID-19. RESULTS The study sample included 29,722 students across 43 Census divisions in British Columbia, Alberta, Ontario, and Quebec. The average age of the sample at baseline was 14.9 years [standard deviation (SD) = 1.5] and ranged between 12 and 19 years of age. Most of the sample self-reported as white (76.3%) and female (54.4%). Students who completed the COMPASS survey after the onset of COVID reported 0.20-unit higher depressive scores (95% CI = 0.16, 0.24) compared to pre-COVID. The adjusted analyses indicated that the association between income inequality on anxiety scores was strengthened following the onset of COVID-19 (β = 0.02, 95% CI = 0.0004, 0.03), indicating that income inequality was associated with a greater increase in anxiety scores during COVID-19. DISCUSSION The adjusted results indicate that the association between income inequality and adolescent anxiety persisted and was heightened at the onset of COVID-19. Future studies should use quasi-experimental methods to strengthen this finding. The current study can inform policy and program discussions regarding the effects of the COVID-19 pandemic and pandemic recovery for young Canadians and relevant social policies for improving adolescent mental health.
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Affiliation(s)
- Claire Benny
- Edmonton Clinic Health Academy, University of Alberta School of Public Health, Edmonton, Alberta, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Ambikaipakan Senthilselvan
- Edmonton Clinic Health Academy, University of Alberta School of Public Health, Edmonton, Alberta, Canada
| | - Karen A. Patte
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Brendan T. Smith
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul J. Veugelers
- Edmonton Clinic Health Academy, University of Alberta School of Public Health, Edmonton, Alberta, Canada
| | - Scott T. Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Roman Pabayo
- Edmonton Clinic Health Academy, University of Alberta School of Public Health, Edmonton, Alberta, Canada
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Wu P, Wang S, Zhao X, Fang J, Tao F, Su P, Wan Y, Sun Y. Immediate and longer-term changes in mental health of children with parent-child separation experiences during the COVID-19 pandemic. Child Adolesc Psychiatry Ment Health 2023; 17:113. [PMID: 37794411 PMCID: PMC10552287 DOI: 10.1186/s13034-023-00659-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The psychological impact of the COVID-19 pandemic has been understudied among vulnerable populations. This study aimed to examine the immediate and longer-term changes in the mental health of children with parent-child separation experiences during the COVID-19 pandemic, and identify potential buffering opportunities for mental health. METHODS This longitudinal cohort study used data from 723 rural Chinese children who provided data before (Oct. 2019) the COVID-19 pandemic and during the following 2 years. Changes in the probability of depressive symptoms, anxiety symptoms, non-suicide self-injurious (NSSI), suicidal ideation, suicide plan, and suicide attempt were tested across four waves using generalized estimating models (GEE). RESULTS Compared with children who never experienced parent-child separation, children persistently separated from parents since birth experienced greater deterioration in all mental health in the 2-year follow-up (average change: depressive symptoms: β = 0.59, 95% CI [0.26, 0.93]; anxiety symptoms: β = 0.45, 95% CI [0.10, 0.81]; NSSI: β = 0.66, 95% CI [0.31, 1.01]; suicide ideation: β = 0.67, 95% CI [0.38, 0.96]; suicide plan: β = 0.77, 95% CI [0.38, 1.15]; suicide attempt: β = 1.12, 95% CI [0.63, 1.62]). However, children with childhood separation from their parents but reunited with them during the transition to adolescence showed similar even lower changes to counterparts who never experienced parent-child separation (all ps > 0.05). CONCLUSION These results indicating improvements in supportiveness of the caregiving environment during the transition to adolescence may provide the opportunity to buffer the adverse impact of COVID-19 on mental health. Translating such knowledge to inform intervention and prevention strategies for youths exposed to adversity is a critical goal for the field.
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Affiliation(s)
- Peipei Wu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China
| | - Shihong Wang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China
| | - Xudong Zhao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China
| | - Jiao Fang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Puyu Su
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China
| | - Ying Sun
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, 81th Meishan Road, Box 230032, Hefei, Anhui Province, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui Province, China.
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Toulany A, Saunders NR, Kurdyak P, Strauss R, Fu L, Joh-Carnella N, Chen S, Guttmann A, Stukel TA. Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada. CMAJ 2023; 195:E1291-E1299. [PMID: 37788846 PMCID: PMC10637328 DOI: 10.1503/cmaj.221318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic. METHODS We conducted a population-based, repeated cross-sectional study using linked health administrative data for Ontario residents aged 10-105 years during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic (Mar. 1, 2020, to Aug. 31, 2022) periods. We evaluated monthly rates of emergency department visits and hospital admissions for eating disorders, stratified by age. RESULTS Compared with expected rates derived from the prepandemic period, emergency department visits for eating disorders increased during the pandemic among adolescents aged 10-17 years (7.38 v. 3.33 per 100 000; incidence rate ratio [IRR] 2.21, 95% confidence interval [CI] 2.17-2.26), young adults aged 18-26 years (2.79 v. 2.46 per 100 000; IRR 1.13, 95% CI 1.10-1.16) and older adults aged 41-105 years (0.14 v. 0.11 per 100 000; IRR 1.15, 95% CI 1.07-1.24). Hospital admissions for eating disorders increased during the pandemic for adolescents (8.82 v. 5.74 per 100 000; IRR 1.54, 95% CI 1.54-1.54) but decreased for all adult age groups, especially older adults aged 41-105 years (0.21 v. 0.30 per 100 000; IRR 0.72, 95% CI 0.64-0.80). INTERPRETATION Emergency department visits for eating disorders increased among adolescents, young adults and older adults during the pandemic, but hospital admissions increased only for adolescents and decreased for all adult groups. Differential rates of acute care use for eating disorders by age have important implications for allocation of inpatient mental health resources.
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Affiliation(s)
- Alene Toulany
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont.
| | - Natasha R Saunders
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Paul Kurdyak
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Rachel Strauss
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Longdi Fu
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Nicolette Joh-Carnella
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Simon Chen
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
| | - Therese A Stukel
- Department of Pediatrics (Toulany, Saunders, Guttmann), University of Toronto; ICES Central (Toulany, Saunders, Kurdyak, Strauss, Fu, Chen, Guttmann, Stukel); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.; Schulich School of Medicine and Dentistry (Joh-Carnella), Western University, London, Ont.; Institute of Health Policy, Management and Evaluation (Stukel), University of Toronto, Toronto, Ont
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Motamedi M, Lau AS, Byeon YV, Yu SH, Brookman-Frazee L. Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents. J Behav Health Serv Res 2023; 50:468-485. [PMID: 37430134 DOI: 10.1007/s11414-023-09844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.
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Affiliation(s)
- Mojdeh Motamedi
- University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Anna S Lau
- University of California Los Angeles, Los Angeles, USA
| | | | | | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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Burrell TD, Kim S, Mohadikar K, Jonas C, Ortiz N, Horberg MA. Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic. J Adolesc Health 2023; 73:693-700. [PMID: 37032208 PMCID: PMC10081921 DOI: 10.1016/j.jadohealth.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/19/2022] [Accepted: 01/21/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization. METHODS Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence. RESULTS Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic. DISCUSSION Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.
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Affiliation(s)
- Tierra D Burrell
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland; Department of Pediatrics, MAPMG, Rockville, Maryland.
| | - Seohyun Kim
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Karishma Mohadikar
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Cabell Jonas
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Nancy Ortiz
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
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Poonai N, Freedman SB, Newton AS, Sawyer S, Gaucher N, Ali S, Wright B, Miller MR, Mater A, Fitzpatrick E, Jabbour M, Zemek R, Eltorki M, Doan Q. Emergency department visits and hospital admissions for suicidal ideation, self-poisoning and self-harm among adolescents in Canada during the COVID-19 pandemic. CMAJ 2023; 195:E1221-E1230. [PMID: 37722746 PMCID: PMC10506508 DOI: 10.1503/cmaj.220507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had profound effects on the mental wellbeing of adolescents. We sought to evaluate pandemic-related changes in health care use for suicidal ideation, self-poisoning and self-harm. METHODS We obtained data from the Canadian Institute for Health Information on emergency department visits and hospital admissions from April 2015 to March 2022 among adolescents aged 10-18 years in Canada. We calculated the quarterly percentage of emergency department visits and hospital admissions for a composite outcome comprising suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits and hospital admissions. We used interrupted time-series methods to compare changes in levels and trends of these outcomes between the prepandemic (Apr. 1, 2015-Mar. 1, 2020) and pandemic (Apr. 1, 2020-Mar. 31, 2022) periods. RESULTS The average quarterly percentage of emergency department visits for suicidal ideation, self-poisoning and self-harm relative to all-cause emergency department visits was 2.30% during the prepandemic period and 3.52% during the pandemic period. The level (0.08%, 95% confidence interval [CI] -0.79% to 0.95%) or trend (0.07% per quarter, 95% CI -0.14% to 0.28%) of this percentage did not change significantly between periods. The average quarterly percentage of hospital admissions for the composite outcome relative to all-cause admissions was 7.18% during the prepandemic period and 8.96% during the pandemic period. This percentage showed no significant change in level (-0.70%, 95% CI -1.90% to 0.50%), but did show a significantly increasing trend (0.36% per quarter; 95% 0.07% to 0.65%) during the pandemic versus prepandemic periods, specifically among females aged 10-14 years (0.76% per quarter, 95% CI 0.22% to 1.30%) and females aged 15-18 years (0.56% per quarter, 95% CI 0.31% to 0.81%). INTERPRETATION The quarterly change in the percentage of hospital admissions for suicidal ideation, self-poisoning and self-harm increased among adolescent females in Canada during the first 2 years of the COVID-19 pandemic. This underscores the need to promote public health policies that mitigate the impact of the pandemic on adolescent mental health.
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Affiliation(s)
- Naveen Poonai
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Stephen B Freedman
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Amanda S Newton
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Scott Sawyer
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Nathalie Gaucher
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Samina Ali
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Bruce Wright
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Michael R Miller
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Ahmed Mater
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Eleanor Fitzpatrick
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Mona Jabbour
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Roger Zemek
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Mohamed Eltorki
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
| | - Quynh Doan
- Departments of Pediatrics, Internal Medicine, and Epidemiology and Biostatistics (Poonai, Miller), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller), London Health Sciences Centre, London, Ont.; Divisions of Pediatric Emergency Medicine and Gastroenterology (Freedman), Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Pediatrics (Newton), Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alta.; Department of Pediatrics (Sawyer), University of Manitoba, Winnipeg, Man.; Centre hospitalier universitaire Sainte-Justine (Gaucher), Université de Montréal, Montréal, Que.; Department of Pediatrics, and Women and Children's Health Research Institute (Ali, Wright), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta.; Children's Emergency Services (Mater), Department of Pediatrics, Jim Pattison Children's Hospital, Saskatoon, Sask.; IWK Health and Division of Pediatric Emergency Medicine (Fitzpatrick), Dalhousie University, Halifax, NS; Department of Pediatrics and Emergency Medicine (Jabbour, Zemek), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Jabbour, Zemek), Ottawa, Ont.; Department of Pediatrics (Eltorki), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Pediatrics (Doan), University of British Columbia, Vancouver, BC
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Mitchell RHB, Toulany A, Chung H, Cohen E, Fu L, Strauss R, Vigod SN, Stukel TA, Moran K, Guttmann A, Kurdyak P, Artani A, Kopec M, Saunders NR. Self-harm among youth during the first 28 months of the COVID-19 pandemic in Ontario, Canada: a population-based study. CMAJ 2023; 195:E1210-E1220. [PMID: 37722745 PMCID: PMC10506509 DOI: 10.1503/cmaj.230127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Youth have reported worsening mental health during the COVID-19 pandemic. We sought to evaluate rates of pediatric acute care visits for self-harm during the pandemic according to age, sex and mental health service use. METHODS We conducted a population-based, repeated cross-sectional study using linked health administrative data sets to measure monthly rates of emergency department visits and hospital admissions for self-harm among youth aged 10-17 years between Jan. 1, 2017, and June 30, 2022, in Ontario, Canada. We modelled expected rates of acute care visits for self-harm after the pandemic onset based on prepandemic rates. We reported relative differences between observed and expected monthly rates overall and by age group (10-13 yr and 14-17 yr), sex and mental health service use (new and continuing). RESULTS In this population of about 1.3 million children and adolescents, rates of acute care visits for self-harm during the pandemic were higher than expected for emergency department visits (0.27/1000 population v. 0.21/1000 population; adjusted rate ratio [RR] 1.29, 95% confidence interval [CI] 1.19-1.39) and hospital admissions (0.74/10 000 population v. 0.43/10 000 population, adjusted RR 1.72, 95% CI 1.46-2.03). This increase was primarily observed among females. Rates of emergency department visits and hospital admissions for self-harm were higher than expected for both those aged 10-13 years and those aged 14-17 years, as well as for both those new to the mental health system and those already engaged in care. INTERPRETATION Rates of acute care visits for self-harm among children and adolescents were higher than expected during the first 2 and a half years of the COVID-19 pandemic, particularly among females. These findings support the need for accessible and intensive prevention efforts and mental health supports in this population.
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Affiliation(s)
- Rachel H B Mitchell
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Alene Toulany
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Hannah Chung
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Eyal Cohen
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Longdi Fu
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Rachel Strauss
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Simone N Vigod
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Therese A Stukel
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Kimberly Moran
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Astrid Guttmann
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Paul Kurdyak
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Azmina Artani
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Monica Kopec
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Natasha R Saunders
- Sunnybrook Health Sciences Centre (Mitchell); Evaluative Clinical Sciences, Sunnybrook Research Institute (Mitchell); Department of Psychiatry (Mitchell, Vigod, Kurdyak), University of Toronto; The Hospital for Sick Children (Toulany, Cohen, Guttmann, Saunders); Department of Pediatrics (Toulany, Cohen, Guttmann, Saunders), University of Toronto; ICES Central (Toulany, Chung, Cohen, Fu, Strauss, Vigod, Stukel, Guttmann, Kurdyak, Artani, Saunders); Institute of Health Policy, Management and Evaluation (Toulany, Cohen, Vigod, Stukel, Guttmann, Kurdyak, Saunders), University of Toronto; Child Health Evaluative Sciences (Toulany, Cohen, Guttmann, Kopec, Saunders), SickKids Research Institute; Edwin S.H. Leong Centre for Healthy Children (Toulany, Cohen, Guttmann, Saunders), University of Toronto; Women's College Hospital (Vigod); Women's College Research Institute (Vigod); Women's College Hospital Institute for Health System Solutions and Virtual Care (Vigod); Ontario College of Family Physicians (Moran); Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.
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Wong BHC, Cross S, Zavaleta-Ramírez P, Bauda I, Hoffman P, Ibeziako P, Nussbaum L, Berger GE, Hassanian-Moghaddam H, Kapornai K, Mehdi T, Tolmac J, Barrett E, Romaniuk L, Davico C, Moghraby OS, Ostrauskaite G, Chakrabarti S, Carucci S, Sofi G, Hussain H, Lloyd ASK, McNicholas F, Meadowcroft B, Rao M, Csábi G, Gatica-Bahamonde G, Öğütlü H, Skouta E, Elvins R, Boege I, Dahanayake DMA, Anderluh M, Chandradasa M, Girela-Serrano BM, Uccella S, Stevanovic D, Lamberti M, Piercey A, Nagy P, Mehta VS, Rohanachandra Y, Li J, Tufan AE, Mirza H, Rozali F, Baig BJ, Noor IM, Fujita S, Gholami N, Hangül Z, Vasileva A, Salucci K, Bilaç Ö, Yektaş Ç, Cansız MA, Aksu GG, Babatunde S, Youssef F, Al-Huseini S, Kılıçaslan F, Kutuk MO, Pilecka I, Bakolis I, Ougrin D. Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study. J Am Acad Child Adolesc Psychiatry 2023; 62:998-1009. [PMID: 36806728 PMCID: PMC9933093 DOI: 10.1016/j.jaac.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. METHOD This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. RESULTS Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). CONCLUSION Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
- Ben Hoi-Ching Wong
- East London NHS Foundation Trust, London, United Kingdom; King's College London, United Kingdom.
| | | | - Patricia Zavaleta-Ramírez
- Children's Psychiatric Hospital Dr. Juan N. Navarro., Servicios de Atención Psiquiatrica, Mexico City, Mexico
| | - Ines Bauda
- Medical University of Vienna, Vienna Austria
| | - Pamela Hoffman
- Yale Child Study Center, Child Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Patricia Ibeziako
- Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Laura Nussbaum
- Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tauseef Mehdi
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Jovanka Tolmac
- Harrow Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Omer S Moghraby
- King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Sara Carucci
- "A. Cao" Pediatric Hospital, "ARNAS G. Brotzu" Hospital Trust, Cagliari, Italy, and the University of Cagliari, Italy
| | - Gyula Sofi
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Haseena Hussain
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, United Kingdom
| | - Alexandra S K Lloyd
- Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | | | - Ben Meadowcroft
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Manish Rao
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Hakan Öğütlü
- Cognitive Behavioral Psychotherapies Association, Ankara, Turkey
| | - Eirini Skouta
- South London and Maudsley NHS Foundation Trust, London, United Kingdom; Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Isabel Boege
- ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Ravensburg, Germany, and University of Graz, Graz, Austria
| | | | - Marija Anderluh
- Child Psychiatry Unit, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | | | - Sara Uccella
- DINOGMI, University of Genoa, Genoa, Italy, and IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dejan Stevanovic
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Marco Lamberti
- Child and Adolescent Psychiatry Unit, "Franz Tappeiner" Hospital, Merano, Italy
| | - Amy Piercey
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | - Varun S Mehta
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Jie Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University
| | | | | | - Farah Rozali
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Benjamin J Baig
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Isa M Noor
- Dr. Soeharto Heerdjan Teaching Mental Hospital, Jakarta, Indonesia
| | - Saori Fujita
- Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Narges Gholami
- Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Anna Vasileva
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russia
| | - Katie Salucci
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Öznur Bilaç
- Manisa Celal Bayar University, Manisa, Turkey
| | | | | | | | | | - Fatima Youssef
- Dubai Department of Medical Education, Dubai, United Arab Emirates
| | - Salim Al-Huseini
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | | | | | | | | | - Dennis Ougrin
- King's College London, United Kingdom; Queen Mary University of London
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Ham E, Hilton NZ, Crawford J, Kim S. Psychiatric inpatient services in Ontario, 2019-2021: a cross-sectional comparison of admissions, diagnoses and acuity during the COVID-19 prerestriction, restriction and postrestriction periods. CMAJ Open 2023; 11:E988-E994. [PMID: 37875314 PMCID: PMC10609896 DOI: 10.9778/cmajo.20220158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic was associated with increased mental health problems in the general population, yet psychiatric hospital admissions decreased. Early evidence suggested that psychiatric admissions normalized within weeks; we sought to examine the longer-lasting impacts on the psychiatric inpatient population beyond this initial period. METHODS We compared Ontario Mental Health Reporting System admission data for patients admitted to 8 psychiatric hospitals in Ontario, Canada, between 3 time periods - before restrictions were imposed (June 22, 2019, to Mar. 16, 2020), during restrictions (Mar. 17 to June 21, 2020) and after restrictions were lifted (June 22, 2020, to Mar. 16, 2021) for changes in involuntary status, diagnoses and clinical presentation using descriptive analysis. For clinical presentation, we extracted scores on 4 Resident Assessment Instrument-Mental Health symptom scales (Depressive Severity Index, Cognitive Performance Scale, Positive Symptoms Scale-Long Version and Social Withdrawal Scale), and 2 behaviour scales (Aggressive Behavior Scale and Violence Sum). RESULTS A cross-sectional sample of 9848 patients was included in the analysis. The mean number of daily admissions decreased 19% from 16.4 (standard deviation [SD] 8.0) before the restriction period to 13.3 (SD 6.1) during the restriction period, and was still 6% below prerestriction levels after restrictions were lifted 15.4 (SD 6.8), with standard error difference of 1.03 (95% confidence interval -0.22 to 2.29). From the pre- to the postrestriction periods, the proportion of involuntary patients increased by 6 percentage points, and the proportions of patients diagnosed with a psychotic disorder or personality disorder increased by 4 percentage points and 1 percentage point, respectively. INTERPRETATION Psychiatric admissions did not fully return to prerestriction levels in absolute rates and patient acuity after COVID-19 restrictions were lifted. Psychiatric services must prepare to appraise and respond to any increased acuity through interventions for patients, workforce planning and mental health support for staff.
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Affiliation(s)
- Elke Ham
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont.
| | - N Zoe Hilton
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
| | - Jennifer Crawford
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
| | - Soyeon Kim
- Waypoint Research Institute (Ham, Hilton, Crawford, Kim), Waypoint Centre for Mental Health Care, Penetanguishene, Ont.; Department of Psychiatry (Hilton), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Faculty of Health Sciences (Crawford), Ontario Tech University, Oshawa, Ont.; Psychiatry and Behavioural Neurosciences (Kim), McMaster University, Hamilton, Ont
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Saunders NR, Stukel TA, Strauss R, Fu L, Guan J, Cohen E, Vigod S, Guttmann A, Kurdyak P, Toulany A. Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study. BMJ Open 2023; 13:e070172. [PMID: 37451721 PMCID: PMC10350908 DOI: 10.1136/bmjopen-2022-070172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
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.
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Affiliation(s)
- Natasha Ruth Saunders
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Insitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada
- Insitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Insitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- Insitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Insitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Insitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alene Toulany
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Insitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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John JR, Khan JR, Lin PI, Jonnagaddala J, Hu N, Belcher J, Liaw ST, Lingam R, Eapen V. A nationwide study of COVID-19 impact on mental health-related presentations among children and adolescents to primary care practices in Australia. Psychiatry Res 2023; 326:115332. [PMID: 37453310 DOI: 10.1016/j.psychres.2023.115332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
This study explored the impacts of COVID-19 on the mental health (MH)-related visits to general practices (GPs) among children and young people (CYP) up to 18 years of age in Australia. This study analysed national-level data captured by the NPS MedicineWise program on monthly CYP MH-related visits per 10,000 visits to GPs from January 2014 to September 2021. We considered the pre-COVID-19 period (January 2014-February 2020) and the COVID-19 period (March 2020-September 2021). We used a Bayesian structural time series (BSTS) model to estimate the impact of COVID-19 on MH-related GP visits per 10,000 visits. A total of 103,813 out of 7,690,874 visits to GP (i.e., about 135 per 10,000 visits) were related to MH during study period. The BSTS model showed a significant increase in the overall MH-related visits during COVID-19 period (33%, 95% Credible Interval (Crl) 8.5%-56%), particularly, visits related to depressive disorders (61%, 95% Crl 29%-91%). The greatest increase was observed among females (39%, 95% Crl 12%-64%) and those living in socioeconomically least disadvantaged areas (36%, 95% Crl 1.2-71%). Our findings highlight the need for resources to be directed towards at-risk CYP to improve MH outcomes and reduce health system burden.
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Affiliation(s)
- James Rufus John
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Jahidur Rahman Khan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ping-I Lin
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | | | - Nan Hu
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Valsamma Eapen
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Local Health District, Liverpool, NSW, Australia.
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Rotenberg M, Gozdyra P, Anderson KK, Kurdyak P. The role of geography and distance on physician follow-up after a first hospitalization with a diagnosis of a schizophrenia spectrum disorder: A retrospective population-based cohort study in Ontario, Canada. PLoS One 2023; 18:e0287334. [PMID: 37327247 PMCID: PMC10275454 DOI: 10.1371/journal.pone.0287334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Timely follow-up after hospitalization for a schizophrenia spectrum disorder (SSD) is an important quality indicator. We examined the proportion of individuals who received physician follow-up within 7 and 30 days post-discharge by health region and estimated the effect of distance between a person's residence and discharging hospital on follow-up. METHODS We created a retrospective population-based cohort of incident hospitalizations with a discharge diagnosis of a SSD between 01/01/2012 and 30/03/2019. The proportion of follow-up with a psychiatrist and family physician within 7 and 30 days were calculated for each region. The effect of distance between a person's residence and discharging hospital on follow-up was estimated using adjusted multilevel logistic regression models. RESULTS We identified 6,382 incident hospitalizations for a SSD. Only 14.2% and 49.2% of people received follow-up care with a psychiatrist within 7 and 30 days of discharge, respectively, and these proportions varied between regions. Although distance from hospital was not associated with follow-up within 7 days of discharge, increasing distance was associated with lower odds of follow-up with a psychiatrist within 30 days. CONCLUSION Post-discharge follow-up is poor across the province. Geospatial factors may impact post-discharge care and should be considered in further evaluation of quality of care.
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Affiliation(s)
- Martin Rotenberg
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Kelly K. Anderson
- ICES, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Adrados-Pérez M, Llorca-Bofí V, Laín MM, Porcar CA, Nicolau-Subires E, Ibarra-Pertusa L, Jiménez-Mayoral A, Buil-Reiné E, Budny F, Resa-Pérez B, Velásquez-Acebey VG, Arenas-Pijoan L, Irigoyen-Otiñano M, López-Castroman J. Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020-2022 longitudinal study. Child Adolesc Psychiatry Ment Health 2023; 17:66. [PMID: 37291582 PMCID: PMC10248990 DOI: 10.1186/s13034-023-00619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements. METHOD We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared. RESULTS Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts. CONCLUSIONS The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.
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Affiliation(s)
- Marina Adrados-Pérez
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | - Vicent Llorca-Bofí
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
- Department of Medicine, University of Barcelona School of Medicine, Barcelona, Spain
| | - María Mur Laín
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
- University of Lleida, Lérida, Spain
| | - Carla Albert Porcar
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | - Eugènia Nicolau-Subires
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | - Lucía Ibarra-Pertusa
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain
| | | | - Esther Buil-Reiné
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
| | - Filip Budny
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
| | - Belén Resa-Pérez
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain
| | | | | | - María Irigoyen-Otiñano
- Department of Psychiatry, Santa Maria University Hospital, Lleida, Spain.
- Institut de Recerca Biomèdica Lleida, Biological Foundations of Mental Disorders, Lérida, Spain.
- CIBERSAM, Madrid, Spain.
| | - Jorge López-Castroman
- University of Montpellier, IGF, CNRS-INSERM, Montpellier, France
- Department of Psychiatry, Nimes University Hospital, Nimes, France
- CIBERSAM, Madrid, Spain
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Hosseinzadeh F, Negarandeh R, Sadat-Hoseini AS, Pashaeypoor S. The effects of virtual logotherapy on health-promoting lifestyle among single-parent adolescent girls during the coronavirus disease 2019 pandemic: a randomized clinical trial. BMC Womens Health 2023; 23:277. [PMID: 37208740 DOI: 10.1186/s12905-023-02431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 05/12/2023] [Indexed: 05/21/2023] Open
Abstract
Single-parent adolescents are vulnerable individuals and it is necessary to improve their health, particularly during epidemics. This study aimed to investigate the effects of virtual logotherapy (VL) on health-promoting lifestyle (HPL) among single-parent adolescent girls during the COVID-19 pandemic. This single-blind randomized clinical trial was conducted on 88 single-parent adolescent girls recruited from the support organization for vulnerable individuals in Tehran, Iran. They were randomly allocated to a control and an intervention group through block randomization. Participants in the intervention group received VL in three-five person groups in 90 min biweekly sessions. The Adolescent Health Promotion Short-Form was used to assess HPL. Data were analyzed using the SPSS software (v. 26.0) and through the independent-sample t, Chi-square, Fisher's exact, and Mann-Whitney U tests. There was no significant difference between the intervention and the control groups respecting the pretest mean score of HPL (73.58±16.74 vs. 72.80±9.30; P=0.085). However, the posttest mean score of HPL in the intervention group (82 with an interquartile range of 78-90) was significantly more than the control group (71.50 with an interquartile range of 63.25-84.50) (P=0.001). Moreover, after adjusting the effects of the significant between-group differences respecting pretest mean scores, the pretest-posttest differences of the mean scores of HPL and all its dimensions in the intervention group were significantly more than the control group (P<0.05). VL is effective in significantly improving HPL among single-parent adolescent girls. Healthcare authorities are recommended to use VL for health promotion among single-parent adolescents.Trial registrationThis research was registered (17/05/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200517001.
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Affiliation(s)
- Fatemeh Hosseinzadeh
- Department of Community Health Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Sadat Sadat-Hoseini
- Department of Pediatrics and Intensive Care of Neonatal, School of Nursing and Midwifery, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
- Community-Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
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Rachamin Y, Jäger L, Schweighoffer R, Signorell A, Bähler C, Huber CA, Blozik E, Seifritz E, Grischott T, Senn O. The Impact of COVID-19 on Mental Healthcare Utilization in Switzerland Was Strongest Among Young Females-Retrospective Study in 2018-2020. Int J Public Health 2023; 68:1605839. [PMID: 37273771 PMCID: PMC10235482 DOI: 10.3389/ijph.2023.1605839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Objectives: To provide a thorough assessment of the impact of the COVID-19 pandemic on the utilization of inpatient and outpatient mental healthcare in Switzerland. Methods: Retrospective cohort study using nationwide hospital data (n > 8 million) and claims data from a large Swiss health insurer (n > 1 million) in 2018-2020. Incidence proportions of different types of psychiatric inpatient admissions, psychiatric consultations, and psychotropic medication claims were analyzed using interrupted time series models for the general population and for the vulnerable subgroup of young people. Results: Inpatient psychiatric admissions in the general population decreased by 16.2% (95% confidence interval: -19.2% to -13.2%) during the first and by 3.9% (-6.7% to -0.2%) during the second pandemic shutdown, whereas outpatient mental healthcare utilization was not substantially affected. We observed distinct patterns for young people, most strikingly, an increase in mental healthcare utilization among females aged <20 years. Conclusion: Mental healthcare provision for the majority of the population was largely maintained, but special attention should be paid to young people. Our findings highlight the importance of monitoring mental healthcare utilization among different populations.
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Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Campus Stiftung Lindenhof Bern (SLB), Bern, Switzerland
| | - Levy Jäger
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Reka Schweighoffer
- Institute for Clinical Research, Department of Medicine, University of Basel, Basel, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Caroline Bähler
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Carola A. Huber
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Eva Blozik
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- SWICA Health Services Research, Winterthur, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Thomas Grischott
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Koppen A, Thoonen IMJ, Hunault CC, van Velzen AG, de Lange DW, Rietjens SJ. Significant Increase in Deliberate Self-Poisonings Among Adolescents During the Second Year of the COVID-19 Pandemic. J Adolesc Health 2023:S1054-139X(23)00151-9. [PMID: 37140519 PMCID: PMC10154158 DOI: 10.1016/j.jadohealth.2023.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE The COVID-19 pandemic has been associated with a decline in mental health of adolescents. The aim of this study was to analyze the rate of deliberate self-poisonings (DSPs) among adolescents reported to the Dutch Poisons Information Center before and during the COVID-19 pandemic. METHODS A retrospective study from 2016 until 2021 was performed to characterize DSPs among adolescents, and to analyze trends in the number of DSPs. All DSPs among adolescents with the age of 13 up to and including 17 years were included. DSP characteristics included: age, gender, bodyweight, used substance, dose, and treatment advice. Trends in the number of DSPs were analyzed using time series decomposition and Seasonal Autoregressive Integrated Moving Average models. RESULTS Six thousand nine hundred fifteen DSPs in adolescents were recorded from January first 2016 until December 31st 2021. Females were involved in 84% of adolescent DSPs. A strong increase in the number of DSPs was observed in 2021 (45% increase compared to 2020), which deviated from the predicted trend based on previous years. This increase was most prominent in 13-, 14-, and 15-year-old female adolescents. Commonly involved drugs were paracetamol, ibuprofen, methylphenidate, fluoxetine, and quetiapine. The contribution of paracetamol rose from 33% in 2019 to 40% in 2021. DISCUSSION The strong increase in the number of DSPs during the second year of the COVID-19 pandemic suggests that long-term containment measures such as quarantines, lockdowns, and school closures may enhance self-harm behavior among adolescents, especially among younger females (13-15 years of age), with a preference for paracetamol as DSP substance.
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Affiliation(s)
- Arjen Koppen
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Ilze M J Thoonen
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Claudine C Hunault
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Agnes G van Velzen
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dylan W de Lange
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia J Rietjens
- Dutch Poisons Information Center (DPIC), University Medical Center Utrecht, Utrecht, the Netherlands
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Gorfinkel LR, Snell G, Long D, Del Casal M, Wu J, Schonert-Reichl K, Guhn M, Samji H. Access to mental health support, unmet need and preferences among adolescents during the first year of the COVID-19 pandemic. Health Promot Chronic Dis Prev Can 2023; 43:182-190. [PMID: 36651881 PMCID: PMC10111570 DOI: 10.24095/hpcdp.43.4.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had widespread effects on adolescent mental health. However, little is known about support-seeking, unmet need and preferences for mental health care among adolescents. METHODS The Youth Development Instrument (YDI) is a school-administered survey of adolescents (N = 1928, mean age = 17.1, SD = 0.3) across British Columbia, Canada. In this cohort, we assessed the characteristics of accessed mental health supports, prevalence of unmet need and preferences for in-person versus internet-based services. RESULTS Overall, 40% of adolescents obtained support for mental health, while 41% experienced unmet need. The most commonly accessed supports were family doctors or pediatricians (23.1%) and adults at school (20.6%). The most preferred mode of mental health care was in-person counselling (72.4%), followed by chat-based services (15.0%), phone call (8.1%) and video call (4.4%). The adjusted prevalence of accessing support was elevated among adolescents with anxiety (adjusted prevalence ratio [aPR] = 1.29, 95% CI: 1.10-1.51), those who used alcohol (1.14, 1.01-1.29), gender minorities (1.28, 1.03-1.58) and sexual minorities (1.28, 1.03-1.45). The adjusted prevalence of unmet need was elevated among adolescents with depression (1.90, 1.67-2.18), those with anxiety (1.78, 1.56-2.03), females (1.43, 1.31-1.58), gender minorities (1.45, 1.23-1.70) and sexual minorities (1.15, 1.07-1.23). CONCLUSION Adolescents of gender or sexual minority status and those with anxiety were more likely than others to have discussed mental health concerns and also to have reported unmet need. The most common sources of support were primary health care providers and adults at school, while the most and least preferred modes of support were in-person and video call services, respectively.
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Affiliation(s)
- Lauren R Gorfinkel
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gaelen Snell
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David Long
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mari Del Casal
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Judy Wu
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kimberly Schonert-Reichl
- Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Guhn
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Hasina Samji
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- The British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Hedden L, Spencer S, Mathews M, Marshall EG, Lukewich J, Asghari S, Brown JB, Gill PS, Freeman TR, McCracken RK, Ryan BL, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, McKay M, Schacter G. "There's nothing like a good crisis for innovation": a qualitative study of family physicians' experiences with virtual care during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:338. [PMID: 37016330 PMCID: PMC10072815 DOI: 10.1186/s12913-023-09256-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/07/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. METHODS We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. RESULTS We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. CONCLUSION Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rita K McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Kourgiantakis T, Markoulakis R, Lee E, Hussain A, Lau C, Ashcroft R, Goldstein AL, Kodeeswaran S, Williams CC, Levitt A. Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers. Int J Ment Health Syst 2023; 17:4. [PMID: 36918893 PMCID: PMC10011786 DOI: 10.1186/s13033-023-00572-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/31/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. METHODS This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. RESULTS The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do." CONCLUSION Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Carrie Lau
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Sun Y, Wu Y, Fan S, Dal Santo T, Li L, Jiang X, Li K, Wang Y, Tasleem A, Krishnan A, He C, Bonardi O, Boruff JT, Rice DB, Markham S, Levis B, Azar M, Thombs-Vite I, Neupane D, Agic B, Fahim C, Martin MS, Sockalingam S, Turecki G, Benedetti A, Thombs BD. Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ 2023; 380:e074224. [PMID: 36889797 PMCID: PMC9992728 DOI: 10.1136/bmj-2022-074224] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic. DESIGN Systematic review. DATA SOURCES Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies. RESULTS As of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval -0.00 to 0.22) or anxiety symptoms (0.05, -0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses. CONCLUSIONS High risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health). REVIEW REGISTRATION PROSPERO CRD42020179703.
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Affiliation(s)
- Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Suiqiong Fan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Tiffany Dal Santo
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Letong Li
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Xiaowen Jiang
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kexin Li
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Yutong Wang
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Amina Tasleem
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Olivia Bonardi
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Danielle B Rice
- Department of Psychology, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Markham
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ian Thombs-Vite
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christine Fahim
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Michael S Martin
- School of Epidemiology and Public Health, University of Ottawa; Ontario, Canada
- Correctional Service of Canada, Ottawa, Ontario, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
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Child and Adolescent Mental Health during the COVID-19 Pandemic: Challenges of Psychiatric Outpatient Clinics. Healthcare (Basel) 2023; 11:healthcare11050765. [PMID: 36900770 PMCID: PMC10000553 DOI: 10.3390/healthcare11050765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. METHODS a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic). RESULTS The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = -117.5, t (69) = -4.07, p = 0.0002, Cohen's d = -0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = -3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients. CONCLUSIONS The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients.
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Yan Y, Hou J, Li Q, Yu NX. Suicide before and during the COVID-19 Pandemic: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3346. [PMID: 36834037 PMCID: PMC9960664 DOI: 10.3390/ijerph20043346] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 06/01/2023]
Abstract
Synthesizing evidence to examine changes in suicide-related outcomes before and during the pandemic can inform suicide management during the COVID-19 crisis. We searched 13 databases as of December 2022 for studies reporting both the pre- and peri-pandemic prevalence of suicidal ideation, suicide attempts, or rate of death by suicide. A random-effects model was used to pool the ratio of peri- and pre-pandemic prevalence of suicidal ideation and attempt (Prevalence Ratio-PR) and rate of death by suicide (Rate Ratio; RR). We identified 51, 55, and 25 samples for suicidal ideation, attempt, and death by suicide. The prevalence of suicidal ideation increased significantly among non-clinical (PR = 1.142; 95% CI: 1.018-1.282; p = 0.024; k = 28) and clinical (PR = 1.134; 95% CI: 1.048-1.227; p = 0.002; k = 23) samples, and pooled estimates differed by population and study design. Suicide attempts were more prevalent during the pandemic among non-clinical (PR = 1.14; 95% CI: 1.053-1.233; p = 0.001; k = 30) and clinical (PR = 1.32; 95% CI: 1.17-1.489; p = 0.000; k = 25) participants. The pooled RR for death by suicide was 0.923 (95% CI: 0.84-1.01; p = 0.092; k = 25), indicating a nonsignificant downward trend. An upward trend of suicidal ideation and suicide attempts was observed during the COVID-19 pandemic, despite suicide rate remaining stable. Our findings suggest that timely prevention and intervention programs are highly needed for non-clinical adult population and clinical patients. Monitoring the real-time and long-run suicide risk as the pandemic evolves is warranted.
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Affiliation(s)
- Yifei Yan
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
| | - Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
| | - Qing Li
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
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Richard V, Dumont R, Lorthe E, Loizeau A, Baysson H, Zaballa ME, Pennacchio F, Barbe RP, Posfay-Barbe KM, Guessous I, Stringhini S. Impact of the COVID-19 pandemic on children and adolescents: determinants and association with quality of life and mental health-a cross-sectional study. Child Adolesc Psychiatry Ment Health 2023; 17:17. [PMID: 36726179 PMCID: PMC9891202 DOI: 10.1186/s13034-023-00563-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The medium-term impact of the COVID-19 pandemic on the wellbeing of children and adolescents remains unclear. More than 2 years into the pandemic, we aimed to quantify the frequency and determinants of having been severely impacted by the COVID-19 pandemic and estimate its impact on health-related quality of life (HRQoL) and mental health. METHODS Data was drawn from a population-based cohort of children and adolescents, recruited between December 2021 and June 2022, in Geneva, Switzerland. The Coronavirus impact scale was used to assess the multidimensional impact of the pandemic on children through parent's report. A score higher than one standard deviation above the mean was deemed a severe impact. Parents additionally reported about their offspring HRQoL and mental health with validated scales. Determinants of having been severely impacted were assessed with logistic models, as were the associations between having experienced a severe impact and poor HRQoL or mental health. RESULTS Out of 2101 participants aged 2-17, 12.7% had experienced a severe pandemic impact. Having a lasting health condition, a pandemic-related worsening of lifestyle habits or an unfavorable family environment were associated with having been severely impacted by the pandemic, while a previous anti-SARS-CoV-2 infection was not. Participants who had experienced a severe pandemic impact were more likely to present poor HRQoL (aOR = 3.1; 95% CI 2.3-4.4) and poor mental health (aOR = 3.9; 95% CI 2.5-6.2). CONCLUSION The COVID-19 pandemic may have persistent consequences on the wellbeing of children and adolescents, especially among those with health and family vulnerabilities.
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Affiliation(s)
- Viviane Richard
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Roxane Dumont
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Elsa Lorthe
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Andrea Loizeau
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Hélène Baysson
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - María-Eugenia Zaballa
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Francesco Pennacchio
- grid.150338.c0000 0001 0721 9812Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205 Geneva, Switzerland
| | - Rémy P. Barbe
- grid.150338.c0000 0001 0721 9812Division of Child and Adolescent Psychiatry, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Klara M. Posfay-Barbe
- grid.150338.c0000 0001 0721 9812Division of General Pediatrics, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- grid.8591.50000 0001 2322 4988Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Rue Jean-Violette 29, 1205, Geneva, Switzerland. .,Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland.
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Centeio EE, Barcelona JM, Mercier K, Hart A, Foley JT. Believe in You student empowerment program: A pilot study. Front Sports Act Living 2023; 4:1078002. [PMID: 36726393 PMCID: PMC9885005 DOI: 10.3389/fspor.2022.1078002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/22/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction The social and emotional health of youth is important, especially after students experience the COVID-19 pandemic. The purpose of this study was to understand the influence that the Believe In You Student Empowerment Program had on students social emotional learning (SEL) behaviors over a 10 week period during the COVID-19 pandemic. Materials and methods A part of this quantitative study, one school in each the intervention and the control group (delayed intervention; 2 schools total) participated in the study. Students enrolled in physical education within each school participated (n = 166; Intervention = 88). Students in each group took a survey at week 1 (baseline measure), week 5, and week 10. Students who were in the intervention group started the program after week 1, while the delayed intervention group began the program in week 5. Results A series of ANCOVA's examined the difference of social emotional learning knowledge and social emotional learning scales between the treatment and control groups. Self-awareness (F = 13.91, p < .01), self-management (F = 6.14, p < .01) & relationship skills (F = 5.50, p < .05) saw significant differences over time compared to the control group. The second series of analyses looked only at the intervention group and analyzed to determine significant differences in mean scores of SEL variables between weeks one and ten. Emotional regulation saw significant differences (t = 2.5, p < .01). The final set of analyses conducted were with the delayed intervention group and examined the difference in mean SEL scores over the three time periods. Again, emotional regulation saw significance with an interaction of time and gender (F = 4.162, p < .01). Discussion and Conclusion In a short period of time, Believe in You Student Empowerment Program has shown the potential to have a positive influence on students social emotional learning behaviors, even during the COVID-19 pandemic. More research should be conducted over a longer period of time, in-person, and with an experimental design to better understand the effects of the Varsity Brands Believe in You Student Empowerment Program and its implications with student social emotional learning behaviors.
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Affiliation(s)
- Erin E. Centeio
- College of Education, Department of Kinesiology and Rehabilitation Science, University of Hawai‘I at Mānoa, Honolulu, HI, United States,Correspondence: Erin E. Centeio
| | - Jeanne M. Barcelona
- College of Education, Division of Kinesiology, Health, and Sport Studies, Wayne State University, Detroit, MI, United States
| | - Kevin Mercier
- College of Education and Health Sciences, Department of Health and Sport Sciences, Adelphi University, Garden, NY, United States
| | - Aaron Hart
- Vice President of Curriculum & Program Engagement, Varsity Brands, Cortland, NY, United States
| | - John T. Foley
- Department of Physical Education, SUNY Cortland, Cortland, NY, United States
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