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Mosandl CF, Baltes-Flückiger L, Kronschnabel J, Meyer M, Guessoum A, Herrmann O, Vogel M, Walter M, Pichler EM. Cannabis use and its association with psychopathological symptoms in a Swiss adult population: a cross-sectional analysis. Front Public Health 2024; 12:1356988. [PMID: 38841675 PMCID: PMC11151851 DOI: 10.3389/fpubh.2024.1356988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Background As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research to guide policymakers and healthcare providers in harm reduction and treatment strategies. Nonetheless, the relationship between psychopathological symptoms and cannabis use remains inadequately understood. Methods A sample of regular cannabis consumers completed self-reported assessments for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), Attention-Deficit/Hyperactivity Disorder (ADHD; Adult ADHD Self-Report Scale V1.1), and psychosis (Early Recognition Inventory based on IRAOS) as well as previous black-market cannabis use patterns. Cannabis Use Disorder Identification Test Revised (CUDIT-R) was used to identify cannabis use disorder (CUD). To understand psychopathological symptom load related to cannabis consumption as well as cannabis use motives, multiple regression models were performed to identify psychopathological variables predicting cannabis use frequency and quantity. Linear regression and correlation analyses were conducted, adjusting for relevant covariates (age, gender, education, alcohol, other substance use). Results Three-hundred-sixty regular cannabis users interested in a study on regulated cannabis access in Basel, Switzerland were examined. In bivariate analysis, cannabis use frequency correlated with depressive (r(358) = 0.16, p = 0.003) and anxiety symptom load (r(358) = 0.11, p = 0.034). Cannabis quantity correlated with depressive (r(358) = 0.15, p = 0.005), ADHD (r(358) = 0.14, p = 0.008), and psychosis symptom load (r(358) = 0.16, p = 0.002). However, in the adjusted regression models only depressive and ADHD symptom loads were significantly associated with cannabis use frequency (p = 0.006 and p = 0.034, respectively) and quantity (p = 0.037 and p = 0.019, respectively). No significant correlations between cannabis consumption and anxiety or psychosis remained after adjustment. Conclusion ADHD and depressive symptoms correlate with increased cannabis use in a cohort of regular users, suggesting potential self-medication in nonclinical populations. With the rising availability of cannabis worldwide, these results highlight the necessity for longitudinal studies to disentangle the complex dynamics between cannabis consumption and mental health symptoms.
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Affiliation(s)
- Christoph Felix Mosandl
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | | | - Jens Kronschnabel
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Maximilian Meyer
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Adrian Guessoum
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Oliver Herrmann
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Vogel
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Walter
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Eva-Maria Pichler
- Clinic of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
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Jandac T, Stastna L. Analysis of the Relationship between Psychiatric and Addiction-Related Disorders in Patients of an Outpatient Addiction Treatment Clinic for Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:414. [PMID: 38671631 PMCID: PMC11049041 DOI: 10.3390/children11040414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Dual diagnosis is used in addiction medicine to refer to the co-occurrence of an addiction-related disorder and another psychiatric disorder in the same individual. Adolescence is a key period for the development of both mental disorders and addictions. OBJECTIVE The aim of this study is to describe the relationships between psychiatric and addiction-related disorders in patients of the Outpatient Addiction Treatment Clinic for Children and Adolescents at the 1st Faculty of Medicine, Charles University in Prague in 2015-2022. METHODS Data were retrospectively analyzed from the hospital's medical system, which collects basic diagnostic data on patients. Descriptive statistics and cluster analysis were performed to identify relationships between psychiatric and addiction-related disorders. RESULTS Of the 450 patients, 153 patients (34%) met the criteria for dual diagnosis. The most common addiction-related disorders were mental and behavioural disorders due to the use of cannabinoids (35%) and internet gaming disorder (35%). The most common psychiatric diagnoses were behavioural and emotional disorders with usual onset in childhood and adolescence (64%), with a lower prevalence in girls than in boys. CONCLUSIONS These findings may be important for the diagnosis and treatment of risky behaviours and addictions in children and adolescents.
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Affiliation(s)
- Tomas Jandac
- Department of Addictology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic;
- Department of Addictology, General University Hospital in Prague, 128 00 Prague, Czech Republic
| | - Lenka Stastna
- Department of Addictology, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic;
- Department of Addictology, General University Hospital in Prague, 128 00 Prague, Czech Republic
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Halladay J, Georgiades K, MacKillop J, Lipman E, Pires P, Duncan L. Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis. Eur Child Adolesc Psychiatry 2024; 33:739-747. [PMID: 36947251 PMCID: PMC10031175 DOI: 10.1007/s00787-023-02188-7] [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: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.
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Affiliation(s)
- Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia.
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada.
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada
| | - Ellen Lipman
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Paulo Pires
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Laura Duncan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
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Halladay J, Ogrodnik M, Farag Alla J, Sunderland M, Gardner LA, Georgiades K. Playing for more than winning: Exploring sports participation, physical activity, and belongingness and their relationship with patterns of adolescent substance use and mental health. Drug Alcohol Depend 2024; 254:111039. [PMID: 38043225 DOI: 10.1016/j.drugalcdep.2023.111039] [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: 06/18/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Promoting adolescent sports participation and physical activity may be effective low-barrier prevention strategies for co-occurring adolescent substance use (SU) and mental health symptoms (MH). The objectives of this study were to: 1) explore associations between profiles of SU/MH and sports participation; and 2) determine whether physical activity and belongingness account for these associations. METHODS Data came from a representative sample of 11,994 grade 9-12 Ontarian students (ages ~14-18) previously grouped into five SU/MH profiles based on patterns of use and symptoms. A series of multinomial logistic regressions, adjusted for socio-demographics and school clustering, were used to predict the risks of students belonging to SU/MH profiles based on: 1) school sports participation (>=weekly), 2) sports and physical activity (>=60minutes; 0-7 days), and 3) sports, physical activity, and school belongingness. RESULTS Greater school sports participation, physical activity, and belongingness were each associated with reduced risks of belonging to most profiles with elevations in SU and/or MH symptoms relative to the low SU/MH profile (Relative Risk Ratios: sports=0.62-0.87, physical activity=0.78-0.98, belonging=0.75-0.83). Frequency of physical activity accounted for ~32-60% of the associations between sports and SU/MH profiles, while school belongingness accounted for the remaining associations. Physical activity and belongingness remained independently associated with SU/MH profiles. CONCLUSIONS Findings suggest possible indirect associations between school sports participation and SU/MH profiles through physical activity and school belongingness, which may be promising prevention targets that have independent associations over and above sports. School sports participation may be one of a number of ways to achieve these goals.
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Affiliation(s)
- J Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia.
| | - M Ogrodnik
- Department of Kinesiology and Health Sciences, University of Waterloo, Canada
| | - J Farag Alla
- Offord Centre for Child Studies, McMaster University, Canada
| | - M Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia
| | - L A Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia
| | - K Georgiades
- Offord Centre for Child Studies, McMaster University, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
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Quinlan-Davidson M, Shan D, Courtney D, Barbic S, Cleverley K, Hawke LD, Ma C, Prebeg M, Relihan J, Szatmari P, Henderson JL. Associations over the COVID-19 pandemic period and the mental health and substance use of youth not in employment, education or training in Ontario, Canada: a longitudinal, cohort study. Child Adolesc Psychiatry Ment Health 2023; 17:105. [PMID: 37679811 PMCID: PMC10486040 DOI: 10.1186/s13034-023-00653-4] [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: 05/05/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The economic shutdown and school closures associated with the COVID-19 pandemic have negatively influenced many young people's educational and training opportunities, leading to an increase in youth not in education, employment, or training (NEET) globally and in Canada. NEET youth have a greater vulnerability to mental health and substance use problems, compared to their counterparts who are in school and/or employed. There is limited evidence on the association between COVID-19 and NEET youth. The objectives of this exploratory study included investigating: longitudinal associations between the COVID-19 pandemic and the mental health and substance use (MHSU) of NEET youth; and MHSU among subgroups of NEET and non-NEET youth. METHODS 618 youth (14-28 years old) participated in this longitudinal, cohort study. Youth were recruited from four pre-existing studies at the Centre for Addiction and Mental Health. Data on MHSU were collected across 11 time points during the COVID-19 pandemic (April 2020-August 2022). MHSU were measured using the CoRonavIruS Health Impact Survey Youth Self-Report, the Global Appraisal of Individual Needs Short Screener, and the PTSD Checklist for DSM-5. Linear Mixed Models and Generalized Estimating Equations were used to analyze associations of NEET status and time on mental health and substance use. Exploratory analyses were conducted to investigate interactions between sociodemographic characteristics and NEET status and time. RESULTS At baseline, NEET youth were significantly more likely to screen positive for an internalizing disorder compared to non-NEET youth (OR = 1.92; 95%CI=[1.26-2.91] p = 0.002). No significant differences were found between youth with, and without, NEET in MHSU symptoms across the study time frame. Youth who had significantly higher odds of screening positive for an internalizing disorder included younger youth (OR = 1.06, 95%CI=[1.00-1.11]); youth who identify as Trans, non-binary or gender diverse (OR = 8.33, 95%CI=[4.17-16.17]); and those living in urban areas (OR = 1.35, 95%CI=[1.03-1.76]), compared to their counterparts. Youth who identify as White had significantly higher odds of screening positive for substance use problems (OR = 2.38, 95%CI=[1.72-3.23]) compared to racialized youth. CONCLUSIONS Our findings indicate that sociodemographic factors such as age, gender identity, ethnicity and area of residence impacted youth MHSU symptoms over the course of the study and during the pandemic. Overall, NEET status was not consistently associated with MHSU symptoms over and above these factors. The study contributes to evidence on MHSU symptoms of NEET youth.
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Affiliation(s)
| | - Di Shan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Darren Courtney
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Skye Barbic
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, the University of British Columbia, Vancouver, Canada
- Foundry British Columbia, Vancouver, BC, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew Prebeg
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - J L Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Burke CW, Firmin ES, Lanni S, Ducharme P, DiSalvo M, Wilens TE. Substance Use Disorders and Psychiatric Illness Among Transitional Age Youth Experiencing Homelessness. JAACAP OPEN 2023; 1:3-11. [PMID: 38239849 PMCID: PMC10795800 DOI: 10.1016/j.jaacop.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Objective Transitional age youth experiencing homelessness (TAY-EH) bear a high burden of substance use disorders (SUDs) and psychopathology. However, limited data exist on the co-occurrence and interactions between these diagnoses in this marginalized group. This study sought to identify rates of single and co-occurring SUDs and psychiatric diagnoses among a sample of TAY-EH and to investigate associations between psychopathology and prevalence and severity of SUDs in this group. Method TAY-EH accessing a low-threshold social service agency in a large metropolitan area completed psychosocial and diagnostic interviews to assess for SUDs and psychopathology. Analyses examined rates of single and co-occurring disorders and associations between burden of psychopathology and presence and severity of SUDs. Results The assessment was completed by 140 TAY-EH; the majority were youth of color (54% Black/African American, 16% Latinx), and 57% identified as male. Rates of single and co-occurring psychiatric disorders and specific SUDs (cannabis use disorder [CUD] and alcohol use disorder [AUD]) were notably high. An increasing number of psychiatric diagnoses was significantly associated with elevated CUD/AUD prevalence and severity. Mood, anxiety, attention-deficit/hyperactivity, and antisocial personality disorders were significantly associated with elevated CUD/AUD prevalence and severity, as was suicidality (all p < .05). Conclusion This study reveals a complex overlay of SUDs and psychopathology facing TAY-EH, with a significant association between co-occurring psychopathology and severity of CUD/AUD. To the authors' knowledge, this is the first study to examine associations between specific psychopathology and severity of SUDs among TAY-EH. Further research into the mechanistic and temporal links between these conditions is needed to inform tailored treatment interventions.
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Hesse M, Jones S, Pedersen MM, Skov KBE, Thylstrup B, Pedersen MU. The predictive value of brief measures of externalizing behavior and internalizing problems in young people receiving substance use treatment: A secondary analysis. Addict Behav 2023; 139:107574. [PMID: 36565530 DOI: 10.1016/j.addbeh.2022.107574] [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: 08/17/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Identifying people at risk of poor outcomes following treatment for substance use disorders is important for developing tailored services. The aim of this study was to test whether a brief measure of internalizing and externalizing behavior could identify young adults at high risk of psychiatric care episodes and criminal offending up to four years after enrolment in treatment for substance use disorder. METHODS Clients aged 15-25 years from a randomized multicenter study were included (N = 457). At baseline, all completed the YouthMap12 screener, a measure of internalizing symptoms (IP6) and externalizing problems (EP6). We used accelerated failure time regression to assess time to psychiatric care and criminal offending, adjusting for baseline occurrence, gender, age, treatment group, and uptake area. Youden's J was used to assess optimal cut-points for risk of events. RESULTS The IP6 was associated with shorter time to psychiatric care following treatment enrolment (beta = -0.71, 95% confidence interval [CI] = -0.94 to -0.48; adjusted beta = -0.45, 95% CI = -0.66 to -0.25). The EP6 was associated with shorter time to criminal offending, coefficient = -0.32, 95% CI = -0.44 to -0.19; adjusted coefficient = -0.18, 95% CI = -0.30 to -0.06). Optimal cut-points were two or more for the IP6 and three or more for the EP6. CONCLUSIONS The IP6 and the EP6, two simple and easily administered instruments, can identify young adults who are at an increased risk of future criminal offending or in need of psychiatric care. The findings lend support to using the 12-item YouthMap, as it identifies relevant risks, is compatible with local service delivery needs, and is theoretically and empirically supported.
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Affiliation(s)
- Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, School of Business and Social Sciences, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Sheila Jones
- Department of Social Work, School of Health and Welfare, Dalarna University, Sweden.
| | | | | | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Aarhus University, School of Business and Social Sciences, Bartholins Allé 10, 8000 Aarhus C, Denmark.
| | - Mads Uffe Pedersen
- Department of Social Work, School of Health and Welfare, Dalarna University, Sweden.
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González-Roz A, Martínez-Loredo V, Aston ER, Metrik J, Murphy J, Balodis I, Secades-Villa R, Belisario K, MacKillop J. Concurrent validity of the marijuana purchase task: a meta-analysis of trait-level cannabis demand and cannabis involvement. Addiction 2023; 118:620-633. [PMID: 36305652 PMCID: PMC10020890 DOI: 10.1111/add.16075] [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: 02/11/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The Marijuana Purchase Task (MPT) is increasingly used to measure cannabis reinforcing value and has potential use for cannabis etiological and regulatory research. This meta-analysis sought to evaluate for the first time the MPT's concurrent validity in relation to cannabis involvement. METHODS Electronic databases and pre-print repositories were searched for MPT studies that examined the cross-sectional relationship between frequency and quantity of cannabis use, problems, dependence, and five MPT indicators: intensity (i.e. unrestricted consumption), Omax (i.e. maximum consumption), Pmax (i.e. price at which demand becomes elastic), breakpoint (i.e. first price at which consumption ceases), and elasticity (i.e. sensitivity to rising costs). Random effects meta-analyses of cross-sectional effect sizes were conducted, with Q tests for examining differences by cannabis variables, meta-regression to test quantitative moderators, and publication bias assessment. Moderators included sex, number of MPT prices, variable transformations, and year of publication. Populations included community and clinical samples. RESULTS The searches yielded 14 studies (n = 4077, median % females: 44.8%: weighted average age = 29.08 [SD = 6.82]), published between 2015 and 2022. Intensity, Omax , and elasticity showed the most robust concurrent validity (|r's| = 0.147-325, ps < 0.014) with the largest significant effect sizes for quantity (|r| intensity = 0.325) and cannabis dependence (|r| Omax = 0.320, |r| intensity = 0.305, |r| elasticity = 0.303). Higher proportion of males was associated with increased estimates for elasticity-quantity and Pmax -problems. Higher number of MPT prices significantly altered magnitude of effects sizes for Pmax and problems, suggesting biased estimations if excessively low prices are considered. Methodological quality was generally good, and minimal evidence of publication bias was observed. CONCLUSIONS The marijuana purchase task presents adequate concurrent validity to measure cannabis demand, most robustly for intensity, Omax , and elasticity. Moderating effects by sex suggest potentially meaningful sex differences in the reinforcing value of cannabis.
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Affiliation(s)
- Alba González-Roz
- Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Addictive Behaviors Research Group, Department of Psychology, University of Oviedo, Oviedo, Spain
| | | | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
- Providence VA Medical Center, Providence, RI, USA
| | - James Murphy
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Iris Balodis
- Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Roberto Secades-Villa
- Addictive Behaviors Research Group, Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Kyla Belisario
- Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Sheikhan NY, Hawke LD, Ma C, Courtney D, Szatmari P, Cleverley K, Voineskos A, Cheung A, Henderson J. A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario, Canada: An Exploratory Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:841-853. [PMID: 35635281 PMCID: PMC9157274 DOI: 10.1177/07067437221097906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges. OBJECTIVE This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges. METHOD A total of 168 youth aged 14-24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic's onset, then every two months between April 2020-2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics. RESULTS There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories. CONCLUSIONS While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.
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Affiliation(s)
- Natasha Y Sheikhan
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, 274071University of Toronto, Ontario, Canada
| | - Lisa D Hawke
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Clement Ma
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, 274071University of Toronto, Ontario, Canada
| | - Darren Courtney
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Peter Szatmari
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Kristin Cleverley
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.,70379Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Aristotle Voineskos
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Amy Cheung
- 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Joanna Henderson
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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10
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Halladay J, MacKillop J, Munn C, Amlung M, Georgiades K. Individual- and school-level patterns of substance use and mental health symptoms in a population-based sample of secondary students: A multilevel latent profile analysis. Drug Alcohol Depend 2022; 240:109647. [PMID: 36244138 DOI: 10.1016/j.drugalcdep.2022.109647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND While substance use and mental health symptoms commonly co-occur among adolescents, few population-level studies have examined profiles of co-occurrence to inform tailored prevention and early interventions. METHODS A multilevel latent profile analysis was conducted on a representative sample of 11,994 students in 68 secondary schools to: 1) identify distinct profiles of co-occurring substance use and mental health symptoms; 2) identify types of schools based on student profiles; and 3) explore school correlates of student profiles and school types, including school climate, belonging, and safety. RESULTS Five student profiles and three school types were identified. Among students, 57.6 % were in a low substance use and mental health profile, 22.5 % were in a high mental health but low substance use profile, 9.7 % were in a heavy drinking and cannabis use profile, 3.7 % were in a heavy drinking and smoking profile, and 6.5 % were in a high substance use and mental health profile. Positive school climate, belonging, and safety increased the odds of students being in the low profile, with belonging yielding larger effects among females. Among schools, 28 % had low, 57 % had moderate, and 15 % had high levels of student substance use and comorbid mental health symptoms. Rural schools were disproportionately represented in higher risk school types. CONCLUSIONS The identified student substance use and mental health symptom profiles can serve as targets for tailored prevention and early interventions. Results support examining school-based interventions targeting school climate, belonging, and safety with potential benefits to both substance use and mental health.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4S4, ON, Canada.
| | - James MacKillop
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, Canada L8N 3K7; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - Catharine Munn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4S4, ON, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, Canada L8N 3K7.
| | - Michael Amlung
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, Ontario, Canada L8N 3K7; Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045, the United States of America.
| | - Katholiki Georgiades
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, L8S 4S4, ON, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Offord Centre for Child Studies, McMaster University, Canada.
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11
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Kourgiantakis T, Edwards T, Lee E, Logan J, Vicknarajah R, Craig SL, Simon-Tucker M, Williams CC. Cannabis use among youth in Canada: a scoping review protocol. BMJ Open 2022; 12:e061997. [PMID: 35725253 PMCID: PMC9214380 DOI: 10.1136/bmjopen-2022-061997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Canadian youth (aged 15-24) have the highest rates of cannabis use globally. There are increasing concerns about the adverse effects of cannabis use on youth physical and mental health. However, there are gaps in our understanding of risks and harms to youth. This scoping review will synthesise the literature related to youth cannabis use in Canada. We will examine the relationship between youth cannabis use and physical and mental health, and the relationship with use of other substances. We will also examine prevention strategies for youth cannabis use in Canada and how the literature addresses social determinants of health. METHODS AND ANALYSIS Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: MEDLINE, Embase, APA PsycInfo, CINAHL and Web of Science's Core Collection. We will include articles published between 2000 and 2021, and articles meeting the inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION This review will provide relevant information about youth cannabis use and generate recommendations and gaps in the literature. Updated research will inform policies, public education strategies and evidence-based programming. Results will be disseminated through an infographic, peer-reviewed publication and presentation at a mental health and addiction conference. Ethics approval is not required for this scoping review.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Travonne Edwards
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Judith Logan
- John P. Robarts Library, University of Toronto, Toronto, Ontario, Canada
| | | | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Monique Simon-Tucker
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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12
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Kaur N, Bastien G, Gagnon L, Graham J, Mongeau-Pérusse V, Bakouni H, Morissette F, Theriault C, Fischer B, Jutras-Aswad D. Variations of cannabis-related adverse mental health and addiction outcomes across adolescence and adulthood: A scoping review. Front Psychiatry 2022; 13:973988. [PMID: 36299544 PMCID: PMC9590692 DOI: 10.3389/fpsyt.2022.973988] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Evidence supporting associations between cannabis use and many health outcomes is growing, however it remains unclear how such associations vary across the lifespan. We therefore aim to answer the following questions: (1) Are the risks of cannabis's adverse effects on mental health and addiction-related outcomes different in adolescents than in adults? (2) What are the relationships between these cannabis's adverse effects and (a) an individual's age at first cannabis use, (b) age at assessment, and (c) duration of cannabis use? METHODS We searched Medline, Embase, CINAHL, and PsychINFO from inception to 18 October 2021. Two reviewers independently screened studies and descriptively synthesized results. RESULTS We included 140 studies. Cannabis effects on mental health and addiction-related outcomes were worse in adolescents, early cannabis initiators and cannabis users who consumed for longest periods. Evidence of worse long-term adverse effects in adolescents was substantial for psychosis, cannabis, and nicotine use disorders; mixed for depression, suicidality, other substance use and disorders; and limited for anxiety. Additionally, acute cannabis exposure had the opposite trend with adults more often reporting adverse effects than adolescents. CONCLUSION The available evidence suggests that cannabis use should be delayed as late as possible in adulthood and shortened in duration across the lifespan to decrease the risk of negative outcomes, while emphasizing the need for adapted harm reduction approaches. This scoping review provides evidence on the role of age and duration of exposure as determinants of cannabis-related adverse effects, which may inform prevention and harm reduction strategies. SYSTEMATIC REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/BYG72.
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Affiliation(s)
- Navdeep Kaur
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Gabriel Bastien
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Lea Gagnon
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Johann Graham
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Violaine Mongeau-Pérusse
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Hamzah Bakouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Florence Morissette
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Camille Theriault
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Benedikt Fischer
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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13
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Hawke LD, Szatmari P, Cleverley K, Courtney D, Cheung A, Voineskos AN, Henderson J. Youth in a pandemic: a longitudinal examination of youth mental health and substance use concerns during COVID-19. BMJ Open 2021; 11:e049209. [PMID: 34716160 PMCID: PMC8561825 DOI: 10.1136/bmjopen-2021-049209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This study analyses longitudinal data to understand how youth mental health and substance use are evolving over the course of the COVID-19 pandemic, which is critical to adjusting mental health response strategies. SETTING Participants were recruited from among existing participants in studies conducted in an urban academic hospital in Ontario, Canada. PARTICIPANTS A total of 619 youth aged 14-28 years participated in the study (62.7% girls/young women; 61.4% Caucasian). MEASURES Data on mood, substance use and COVID-19-related worries were collected over four time points, that is, every 2 months beginning in the early stages of the pandemic in April 2020. Latent class analyses were conducted on the longitudinal data to identify distinct groups of youth who have different trajectory profiles of pandemic impact on their mood, substance use and COVID-19-related worries. RESULTS For the majority of participants, mood concerns increased early in the pandemic, declined over Canada's summer months and subsequently increased in autumn. Among the youth with the highest level of mood symptoms at the beginning of the pandemic, increases in mental health concerns were sustained. Substance use remained relatively stable over the course of the pandemic. COVID-19-related worries, however, followed a trajectory similar to that of mood symptoms. Girls/young women, youth living in urban or suburban areas, in larger households, and with poorer baseline mental and physical health are the most vulnerable to mental health concerns and worries during the pandemic. CONCLUSIONS Youth mental health symptom levels and concerns are evolving over the course of the COVID-19 pandemic, in line with the evolution of the pandemic itself, and longitudinal monitoring is therefore required. It is also essential that we engage directly with youth to cocreate pandemic response strategies and mental health service adaptations to best meet the needs of young people.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Darren Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amy Cheung
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Yonek JC, Velez S, Satre DD, Margolis K, Whittle A, Jain S, Tolou-Shams M. Addressing adolescent substance use in an urban pediatric federally qualified health center. J Subst Abuse Treat 2021; 135:108653. [PMID: 34840042 DOI: 10.1016/j.jsat.2021.108653] [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: 02/23/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Screening, brief intervention, and referral to treatment (SBIRT) is a systematic approach to identification and intervention for individuals at risk for substance use disorders. Prior research indicates that SBIRT is underutilized in pediatric primary care. Yet few studies have examined procedures for identifying and addressing substance use in clinics that serve publicly insured adolescents (i.e., federally qualified health centers [FQHC]). This descriptive, multi-method study assessed adolescent substance use frequency and provider perspectives to inform SBIRT implementation in an urban pediatric FQHC in California. METHODS A medical record review assessed substance use frequency and correlates among publicly insured adolescents aged 12-17 years who completed a well-child visit in pediatric primary care between 2014 and 2017 (N = 2252). Data on substance use (i.e., alcohol, illicit drugs, and tobacco) were from a health assessment tool mandated by Medicaid. Semi-structured interviews with 12 providers (i.e., pediatricians, nurse practitioners, behavioral health clinicians) elicited information about the current clinic workflow for adolescent substance use and barriers and facilitators to SBIRT implementation. RESULTS Of 1588 adolescents who completed the assessment (70.5%), 6.8% reported current substance use. Self-reported use was highest among non-Hispanic Black (15.2%) adolescents and those with co-occurring depressive symptoms (14.4%). Provider-reported challenges to implementing SBIRT included a lack of space for confidential screening and a lack of referral options. Providers favored implementing technology-based tools such as tablets for adolescent pre-visit screening and electronic medical record-based decision support to facilitate brief intervention and treatment referrals. CONCLUSIONS This study fills a substantial research gap by examining factors that impede and support SBIRT implementation in pediatric FQHC settings. Successful SBIRT implementation in these settings could significantly reduce the unmet need for substance use treatment among uninsured and publicly insured adolescents. Pediatric primary care and urgent care providers perceived SBIRT to be feasible, and health information and digital technologies may facilitate the integration of SBIRT into clinic workflows. Ensuring confidentiality for screening and expanding referral options for adolescents in need of community-based addiction treatment are also critical to increasing SBIRT uptake.
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Affiliation(s)
- Juliet C Yonek
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Sarah Velez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States.
| | - Kathryn Margolis
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Amy Whittle
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Shonul Jain
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
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15
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Hawke LD, Monga S, Korczak D, Hayes E, Relihan J, Darnay K, Cleverley K, Lunsky Y, Szatmari P, Henderson J. Impacts of the COVID-19 pandemic on youth mental health among youth with physical health challenges. Early Interv Psychiatry 2021; 15:1146-1153. [PMID: 33047495 PMCID: PMC7675347 DOI: 10.1111/eip.13052] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 09/26/2020] [Indexed: 12/28/2022]
Abstract
AIM To examine mental health in conjunction with physical health during the COVID-19 pandemic among youth with physical health conditions compared to those without. METHODS A cross-sectional survey of 622 youth aged 14 to 28 was conducted. Analyses were conducted to understand the changes in mental and physical health among youth in four groups: (a) participants with a friend or family member diagnosed with COVID-19, (b) participants with symptoms associated with COVID-19, (c) participants with atopic conditions (asthma and allergies), and (d) participants with other preexisting physical health conditions. RESULTS Many participants with physical health concerns met screening criteria for an internalizing disorder, which was significantly higher than the rate found among participants without physical health conditions. Significantly greater declines in self-reported mental health were observed during the COVID-19 period compared to 3 months earlier among youth reporting physical health concerns compared to those without physical health concerns. Substance use does not appear to have been affected. CONCLUSIONS Mental health concerns are highly prevalent among youth with physical health concerns, and also appear to be exacerbated by the COVID-19 pandemic. Physical health concerns appear to constitute risk factors for heightened mental health responses to the pandemic situation. System planners striving to adapt mental health services to meet social/physical distancing recommendations are urged to consider youth with physical health conditions and ensure that adequate integrated mental health and physical health supports are available to them.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Suneeta Monga
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Daphne Korczak
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Em Hayes
- Centre for Addiction and Mental Health, Toronto, Canada
| | | | | | | | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Canada.,University of Toronto, Toronto, Canada
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16
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Halladay J, Horricks L, Amlung M, MacKillop J, Munn C, Nasir Z, Woock R, Georgiades K. The CAMP study: feasibility and clinical correlates of standardized assessments of substance use in a youth psychiatric inpatient sample. Child Adolesc Psychiatry Ment Health 2021; 15:48. [PMID: 34517903 PMCID: PMC8439003 DOI: 10.1186/s13034-021-00403-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To determine: (a) the feasibility and acceptability of administering a standardized electronic assessment of substance use and other mental health concerns to youth admitted to an inpatient psychiatric unit, and (b) the prevalence and clinical correlates of substance use in this sample. METHODS The sample included 100 youth between the ages of 13 to 17 years admitted to an inpatient psychiatric unit in Ontario, Canada between September and November 2019 (78% response rate). Youth data were comprised of electronic self-reported assessments (during hospitalization and 6-months following) and chart reviews (99% consented; historical and prospective). Frontline staff completed a self-report survey assessing their perceptions of the need for standardized substance use assessments, training, and interventions on the unit (n = 38 Registered Nurses and Child and Youth Workers; 86% response rate). Analyses included descriptive statistics, correlations, regression, and qualitative content analysis. RESULTS Feasibility of standardized youth self-reported mental health and substance use assessments was evident by high response rates, little missing data, and variability in responses. 79% of youth had used at least one substance in their lifetime; 69% reported use in the last 3 months. Substance use was positively correlated with severity of psychiatric symptoms (τb 0.17 to 0.45) and number of psychiatric diagnoses (τb 0.17 to 0.54) at index. Based on prospective and retrospective data, substance use was also positively related to mental health symptom severity at follow-up and repeat mental health related hospital visits. Frontline staff reported a need for standardized assessment, training, and interventions on the unit, indicative of acceptability. CONCLUSIONS This study demonstrated the feasibility, acceptability and clinical importance of administering a standardized mental health and substance use assessment among youth experiencing psychiatric hospitalization.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, ON, L8S 4S4, Hamilton, Canada. .,Child and Youth Mental Health Program, McMaster Children's Hospital, 1200 Main St W, ON, L8N 3Z5, Hamilton, Canada.
| | - Laurie Horricks
- grid.422356.40000 0004 0634 5667Child and Youth Mental Health Program, McMaster Children’s Hospital, 1200 Main St W, ON L8N 3Z5 Hamilton, Canada
| | - Michael Amlung
- grid.266515.30000 0001 2106 0692Department of Applied Behavioral Science, Cofrin Logan Center for Addiction Research and Treatment, Addictions Lab at The University of Kansas, 1000 Sunnyside Avenue, KS 66045 Lawrence, United States ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - James MacKillop
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada ,grid.25073.330000 0004 1936 8227Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton, 100 West 5th St, ON L8N 3K7 Hamilton, Canada ,grid.25073.330000 0004 1936 8227Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Canada
| | - Catharine Munn
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, ON L8S 4S4 Hamilton, Canada ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada ,grid.25073.330000 0004 1936 8227Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton, 100 West 5th St, ON L8N 3K7 Hamilton, Canada ,grid.25073.330000 0004 1936 8227Resident Affairs, Postgraduate Medical Education (PGME), McMaster University, 1280 Main Street West, ON L8S 4S4 Hamilton, Canada
| | - Zil Nasir
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, ON L8S 4S4 Hamilton, Canada ,grid.413615.40000 0004 0408 1354Hamilton Health Sciences, 1200 Main St W, ON L8N 3Z5 Hamilton, Canada
| | - Rachel Woock
- grid.413615.40000 0004 0408 1354Hamilton Health Sciences, 1200 Main St W, ON L8N 3Z5 Hamilton, Canada
| | - Katholiki Georgiades
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, ON L8S 4S4 Hamilton, Canada ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada ,grid.25073.330000 0004 1936 8227Offord Centre for Child Studies, McMaster University, McMaster Innovation Park, Suite 201A, 1280 Main Street West, ON L8S 4K1 Hamilton, Canada
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17
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Jenkins MC, Kelly L, Binger K, Moreno MA. Cyber-ethnography of cannabis marketing on social media. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:35. [PMID: 33902649 PMCID: PMC8074195 DOI: 10.1186/s13011-021-00359-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
Background Since 2012, several states have legalized non-medical cannabis, and cannabis businesses have used social media as a primary form of marketing. There are concerns that social media cannabis exposure may reach underage viewers. Our objective was to identify how cannabis businesses cultivate an online presence and exert influence that may reach youth. Methods We chose a cyber-ethnographic approach to explore cannabis retailers on social media. We searched cannabis retailers with Facebook and Instagram presence from Alaska, Oregon, Colorado, and Washington, and identified 28 social media business profiles. One year of content was evaluated from each profile. In-depth, observational field notes were collected from researchers immersed in data collection on business profiles. Field notes were analyzed to uncover common themes associated with social media cannabis marketing. Results A total of 14 businesses were evaluated across both Facebook and Instagram, resulting in 14 sets of combined field notes. A major theme was Normalization of Cannabis, involving both Broad Appeal and Specific Targeting. Conclusions It is concerning that Normalization of Cannabis by cannabis businesses may increase cannabis acceptability among youth. In a digital world where the majority of youth are spending time online, it is important for policymakers to examine additional restrictions for cannabis businesses marketing through social media. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00359-w.
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Affiliation(s)
- Marina C Jenkins
- Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, USA.
| | - Lauren Kelly
- Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, USA
| | - Kole Binger
- Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, USA
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, USA
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18
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Hawke LD, Henderson J. Legalization of cannabis use in Canada: Impacts on the cannabis use profiles of youth seeking services for substance use. J Subst Abuse Treat 2021; 126:108340. [PMID: 34116825 DOI: 10.1016/j.jsat.2021.108340] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/17/2020] [Accepted: 02/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cannabis is a highly used substance among youth, but has the potential to negatively impact the developing brain. Recreational cannabis use was legalized in Canada in October 2018. This exploratory study examines cannabis use profiles of high-risk youth before and after the national legalization of recreational cannabis use. METHOD This cross-sectional cohort study examines the cannabis use profiles of two cohorts of youth, one recruited prior to legalization (N = 101) and one recruited after legalization (N = 168). RESULTS This study found few changes in cannabis use patterns after legalization. The rate of high-frequency cannabis use, polysubstance use, social circles of use, and mental health and substance use challenges showed no change, and the study found no associations with age. Exceptions were that youth were more likely to report purchasing cannabis from a legal source after legalization. Concealment of cannabis use from legal authorities declined after legalization among youth over the age of majority (19+ years), but not among younger youth (<19 years). CONCLUSIONS Minimal changes have occurred in the cannabis use patterns of service-seeking youth in the short term following legalization. This holds true both for youth who have reached the age of majority and those who have not. Nevertheless, this population has overlapping substantial mental health and substance use challenges. Integrated services should address cannabis use and other concurrent challenges and be sensitive to the postlegalization social climate.
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Affiliation(s)
- Lisa D Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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19
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Hogue A, Bobek M, MacLean A. Core Elements of CBT for Adolescent Conduct and Substance Use Problems: Comorbidity, Clinical Techniques, and Case Examples. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:426-441. [PMID: 34103883 PMCID: PMC8184115 DOI: 10.1016/j.cbpra.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This article describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (1) Functional Analysis of Behavior Problems; (2) Prosocial Activity Sampling; (3) Cognitive Monitoring and Restructuring; (4) Emotion Regulation Training; (5) Problem-solving Training; (6) Communication Training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.
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Affiliation(s)
- Aaron Hogue
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Molly Bobek
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Alexandra MacLean
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
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20
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Halladay J, Woock R, El-Khechen H, Munn C, MacKillop J, Amlung M, Ogrodnik M, Favotto L, Aryal K, Noori A, Kiflen M, Georgiades K. Patterns of substance use among adolescents: A systematic review. Drug Alcohol Depend 2020; 216:108222. [PMID: 32971420 DOI: 10.1016/j.drugalcdep.2020.108222] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/10/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This review characterizes empirically derived patterns of multiple (multi-) substance use among adolescents. A secondary objective was to examine the extent to which mental health symptomatology was included in the empirical analyses examining substance use patterns. METHODS Eligible studies included those that used cluster-based approaches, included the assessment of at least two different substances, and were based on study samples with mean ages between 11 and 18 years. 4665 records were screened including 461 studies for full-text screening. RESULTS 70 studies were included with common clusters being: low use, single or dual substance use, moderate general multi-use, and high multi-use. The most common patterns of single or multi-substance use were: alcohol only, alcohol with cannabis and/or tobacco, and use of alcohol, tobacco, and cannabis with and without other drugs. Lower socioeconomic status, older age, and male gender were consistent predictors of multi-use clusters. Only 37 % of studies compared differences in levels of mental health across clusters with symptoms consistently associated with a greater likelihood of multi-use. Only 29 % of studies included mental health indicators in cluster-based analyses, with over half identifying distinct mental health and substance use clusters. Fit indices in cluster analyses and measurement properties of substance use were heterogeneous and inconsistently reported across studies. CONCLUSIONS Distinct patterns of substance use were derived but methodological differences prevented direct comparison and reduced capacity to generalize across studies. There is a need to establish standardized methodological approaches to identify robust patterns of substance use to enhance etiological, prognostic, and intervention research.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - R Woock
- Department of Social Sciences, McMaster University, Canada.
| | - H El-Khechen
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - C Munn
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - J MacKillop
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - M Amlung
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - M Ogrodnik
- NeuroFit Lab, Department of Kinesiology, McMaster University, Canada.
| | - L Favotto
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - K Aryal
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - A Noori
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - M Kiflen
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Population Health Research Institute, Hamilton, ON, Canada.
| | - K Georgiades
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Offord Centre for Child Studies, McMaster University, Canada.
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21
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Hawke LD, Barbic SP, Voineskos A, Szatmari P, Cleverley K, Hayes E, Relihan J, Daley M, Courtney D, Cheung A, Darnay K, Henderson JL. Impacts of COVID-19 on Youth Mental Health, Substance Use, and Well-being: A Rapid Survey of Clinical and Community Samples: Répercussions de la COVID-19 sur la santé mentale, l'utilisation de substances et le bien-être des adolescents : un sondage rapide d'échantillons cliniques et communautaires. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:701-709. [PMID: 32662303 PMCID: PMC7502874 DOI: 10.1177/0706743720940562] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The current novel coronavirus disease of 2019 (COVID-19) pandemic presents a time-sensitive opportunity to rapidly enhance our knowledge about the impacts of public health crises on youth mental health, substance use, and well-being. This study examines youth mental health and substance use during the pandemic period. METHODS A cross-sectional survey was conducted with 622 youth participants across existing clinical and community cohorts. Using the National Institute of Mental Health-developed CRISIS tool and other measures, participants reported on the impacts of COVID-19 on their mental health, substance use, and other constructs. RESULTS Reports of prepandemic mental health compared to intrapandemic mental health show a statistically significant deterioration of mental health across clinical and community samples (P < 0.001), with greater deterioration in the community sample. A total of 68.4% of youth in the clinical sample and 39.9% in the community sample met screening criteria for an internalizing disorder. Substance use declined in both clinical and community samples (P < 0.001), although 23.2% of youth in the clinical sample and 3.0% in the community sample met screening criteria for a substance use disorder. Participants across samples report substantial mental health service disruptions (48.7% and 10.8%) and unmet support needs (44.1% and 16.2%). Participants report some positive impacts, are using a variety of coping strategies to manage their wellness, and shared a variety of ideas of strategies to support youth during the pandemic. CONCLUSIONS Among youth with histories of mental health concerns, the pandemic context poses a significant risk for exacerbation of need. In addition, youth may experience the onset of new difficulties. We call on service planners to attend to youth mental health during COVID-19 by bolstering the accessibility of services. Moreover, there is an urgent need to engage young people as coresearchers to understand and address the impacts of the pandemic and the short, medium, and long terms.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Skye Pamela Barbic
- Foundry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Lawrence S Bloomberg Faculty of Nursing, and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Em Hayes
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Mardi Daley
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Darren Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amy Cheung
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Karleigh Darnay
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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22
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Minhas M, Oshri A, Amlung M, Dennhardt A, Ferro M, Halladay J, Munn C, Tucker J, Murphy J, MacKillop J. Latent Profile Analysis of Heavy Episodic Drinking in Emerging Adults: A Reinforcer Pathology Approach. Alcohol Clin Exp Res 2020; 44:2130-2140. [PMID: 32965723 DOI: 10.1111/acer.14438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/12/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Heavy episodic drinking (HED) is a major public health problem among emerging adults (individuals 18 to 25), but with considerable heterogeneity in concurrent substance use and psychopathology. The current study used latent profile analysis (LPA) to detect discrete subgroups of HED based on alcohol, other drug severity, and concurrent psychopathology. A reinforcer pathology approach was used to understand motivational differences among the latent subgroups. METHODS Participants were 2 samples of emerging adults reporting regular HED, 1 Canadian (n = 730) and 1 American (n = 602). Indicators for the LPA were validated dimensional self-report assessments of alcohol severity, cannabis severity, other drug severity, nicotine dependence, depression, anxiety, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder. Reinforcer pathology indicators were measures of alcohol demand, proportionate substance-related reinforcement, and discounting of future rewards. RESULTS The LPA yielded parallel 3-class solutions in both samples. The largest subgroup was characterized by comparatively low substance severity and psychopathology (Low overall severity). The second largest subgroup was characterized by comparatively high alcohol and other drug severity (excluding tobacco) and high levels of psychopathology (Heavy alcohol & high psychiatric severity). The third subgroup exhibited high alcohol, smoking and intermediate levels of other substance use and psychopathology (Heavy alcohol, smoking, & intermediate psychiatric severity). The Heavy alcohol & high psychiatric severity and Heavy alcohol, smoking, & intermediate psychiatric severity subgroups exhibited significantly higher alcohol demand, greater proportionate substance-related reinforcement, and steeper delay discounting. CONCLUSIONS Parallel latent subgroups of emerging adults engaging in HED were present in both samples, and the high-risk subgroups were significantly differentiated by the reinforcer pathology indicators. These latent profiles may ultimately inform heterogeneity in the longitudinal course of HED in emerging adults.
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Affiliation(s)
- Meenu Minhas
- From the, Peter Boris Centre for Addictions Research, (MM, MA, CM, JMa), St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Assaf Oshri
- Department of Human Development and Family Sciences, (AO), University of Georgia, Athens, Georgia
| | - Michael Amlung
- From the, Peter Boris Centre for Addictions Research, (MM, MA, CM, JMa), St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada.,Department of Applied Behavioral Science, (MA), University of Kansas, Lawrence, Kansas.,Cofrin Logan Center for Addiction Research and Treatment, (MA), University of Kansas, Lawrence, Kansas
| | - Ashley Dennhardt
- Department of Psychology, (AD, JMu), University of Memphis, Memphis, Tennessee
| | - Mark Ferro
- School of Public and Health Systems, (MF), University of Waterloo, Waterloo, ON, Canada
| | - Jillian Halladay
- Offord Centre for Child Studies, (JH), McMaster University, Hamilton, ON, Canada
| | - Catharine Munn
- From the, Peter Boris Centre for Addictions Research, (MM, MA, CM, JMa), St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Jalie Tucker
- Department of Health Education & Behavior, (JT), Center for Behavioral Economic Health Research, University of Florida, Gainsville, Florida
| | - James Murphy
- Department of Psychology, (AD, JMu), University of Memphis, Memphis, Tennessee
| | - James MacKillop
- From the, Peter Boris Centre for Addictions Research, (MM, MA, CM, JMa), St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
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