Psychological Health and Wellness and the Impact of a Supportive Text Messaging Program (Wellness4MDs) Among Physicians and Medical Learners in Canada: Protocol for a Longitudinal Study

BACKGROUND

Burnout, anxiety, and depression continue to affect physicians, postgraduate medical trainees, and medical students globally and in Canada particularly after the COVID-19 pandemic.

OBJECTIVE

The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program (Wellness4MDs, Global Psychological e-Health Foundation). The program aims to reduce the prevalence and severity of burnout, anxiety, and depression symptoms among physicians, postgraduate medical trainees, and medical students in Canada.

METHODS

This longitudinal study represents a multistakeholder, mixed methods, multiyear implementation science project. Project evaluation will be conducted through a quantitative prospective longitudinal approach using a paired sample comparison, a naturalistic cross-sectional controlled design, and satisfaction surveys. Prevalence estimates for psychological problems would be based on baseline data from self-completed validated rating scales. Additional data will be collected at designated time points for paired comparison. Outcome measures will be assessed using standardized rating scales, including the Maslach Burnout Inventory for burnout symptoms, the 9-item Patient Health Questionnaire for depression symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the World Health Organization-Five Well-Being Index.

RESULTS

The project launched in the last quarter of 2023, and program evaluation results will become available within 36 months. The Wellness4MDs program is expected to reduce the prevalence and severity of psychological problems among physicians in Canada and achieve high subscriber satisfaction.

CONCLUSIONS

The results from the Wellness4MDs project evaluation will provide key information regarding the effectiveness of daily supportive SMS text messages and links to mental health resources on these mental health parameters in Canadian physicians, postgraduate trainees, and medical students. Information will be useful for informing policy and decision-making concerning psychological interventions for physicians in Canada.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44368.

Effect of wildfire on the prevalence of opioid misuse through anxiety among young adults in the United States: a modeling study

BACKGROUND

Exposure to climate change events like wildfires can lead to health and mental health problems. While conceptual frameworks have been hypothesized describing the potential relationship between disaster exposure and substance use, the association remains under-researched and unquantified.

METHODS

We constructed a quantitative portrayal of one proposed conceptual framework that focuses on the intermediary role of anxiety. We used the Monte Carlo simulation to estimate the impact of wildfire exposure on opioid misuse outcomes through increased anxiety. We searched for and extracted prior empirical evidence on the associations between wildfire anxiety and anxiety-opioid misuse. Three scenarios were devised: in S1 the impact of wildfire on opioid misuse was limited to increasing anxiety incidence; in S2 we also considered the additive role of altered anxiety phenotype; and in S3 we further considered the role of increased opioid-related consequences of pre-existing anxiety due to wildfire exposure.

RESULTS

Models show that the prevalence of opioid misuse post-wildfire may rise to 6.0%-7.2% from a baseline of 5.3%. In S1, the opioid misuse prevalence ratio was 1.12 (95% uncertainty interval [UI]: 1.00 - 1.27). The two exploratory scenarios, with less stringent assumptions, yielded prevalence ratios of 1.23 (95% UI: 1.00 - 1.51) and 1.34 (95% UI: 1.11 - 1.63).

CONCLUSIONS

Our modeling study suggests that exposure to wildfires may elevate opioid misuse through increasing anxiety incidence and severity. This can lead to substantial health burdens, possibly beyond the duration of the wildfire event, which may offset recent gains in opioid misuse prevention.

2023 Wildfires in Canada: Living in Wildfire Regions in Alberta and Nova Scotia Doubled the Odds for Residents to Experience Likely Generalized Anxiety Disorder Symptoms

Background: Wildfires have become increasingly prevalent in various regions, resulting in substantial environmental and psychological consequences that have garnered increasing attention. Objective: This study aims to examine the prevalence of likely Generalized Anxiety Disorder (GAD) and explore the determinants of likely GAD during the wildfires in Alberta and Nova Scotia. Methods: Data were collected online through a cross-sectional survey from 14 May-23 June 2023. Alberta and Nova Scotia participants self-subscribed to the program by texting 'HopeAB' or 'HopeNS' to a short code, respectively. The GAD-7-validated tool was used to collect information on likely GAD. Results: This study included 298 respondents while one hundred and twelve respondents lived in a region of Alberta/Nova Scotia affected by the wildfires (37.7%). The prevalence of likely GAD among the respondents was 41.9%. Respondents who lived in a region of Alberta/Nova Scotia recently impacted by the wildfires were twice as likely to experience GAD symptoms (OR = 2.4; 95% C.I. 1.3-4.3). Conclusions: The study's identification of a statistically significant relationship between residing in a wildfire-impacted region and likely GAD shows the association between environmental and psychological well-being. However, the relatively small sample size and self-reported assessment of GAD symptoms may limit the generalizability of the findings. Further research involving a larger sample size delving into potential predictors could facilitate strategies for mitigating the mental health consequences of natural disasters.

Differences in Anxiety, Insomnia, and Trauma Symptoms in Wildfire Survivors from Australia, Canada, and the United States of America

Many survivors of wildfires report elevated levels of psychological distress following the trauma of wildfires. However, there is only limited research on the effects of wildfires on mental health. This study examined differences in anxiety, depression, insomnia, sleep quality, nightmares, and post-traumatic stress disorder (PTSD) symptoms following wildfires in Australia, Canada, and the United States of America (USA). One hundred and twenty-six participants from Australia, Canada, and the USA completed an online survey. The sample included 102 (81%) women, 23 (18.3%) men, and one non-binary (0.8%) individual. Participants were aged between 20 and 92 years (M age = 52 years, SD = 14.4). They completed a demographic questionnaire, the Disturbing Dream and Nightmare Severity Index (DDNSI), Generalized Anxiety Disorder Questionnaire (GAD-7), the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and PTSD Checklist (PCL-5). Results showed that participants from the USA scored significantly higher on the GAD-7 (p = 0.009), ISI (p = 0.003), and PCL-5 (p = 0.021) than participants from Australia and Canada. The current findings suggest a need for more international collaboration to reduce the severity of mental health conditions in Australia, Canada, and the USA.

Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge

(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.

Prevalence and correlates of cannabis abuse among residents in the community of Fort McMurray, a city in Northern Alberta which had endured multiple natural disasters

BACKGROUND

Cannabis is one of the widely used drugs for relaxation and may be abuse among users. Researchers have given attention to cannabis use among the general population while vulnerable populations who have experience multiple traumas may be at risk of cannabis abuse. Other factors may influence cannabis abuse among people exposed to traumas.

OBJECTIVE

The study aims to determine the prevalence and correlates of self-reported cannabis abuse among residents of Fort McMurray, a city in Northern Alberta, Canada.

METHODS

A cross-sectional survey was conducted using an online questionnaire. Sociodemographic data, trauma exposure, and clinical characteristics were collected to identify the possible risk factor of cannabis abuse. Data were analyzed with SPSS version 25 using a chi-square test and binary logistic regression analysis. Correlation analysis was also performed to ascertain likely cannabis abuse and the association with other mental health conditions.

RESULTS

Overall, participants who completed the survey were one hundred and eighty-sixed out of the two hundred and forty-nine residents who accessed the online survey, giving a response rate of 74.7%. The prevalence of self-reported cannabis abuse among participants was 14%. Most of the participants were females (159, 85.5%), more than 40 years of age (98, 52.7%), employed (175, 94.1%), owned their house (145, 78.0%), and 103 (60.6%) reported being exposed to at least a trauma (COVID-19, flooding, or wildfire). Regarding regression analysis results, participants living in a rented accommodation were nearly four times more likely to abuse cannabis (OR = 3.86; 95% CI: 1.34-11.14) than those owning their houses. Similarly, male participants were more than 6-folds more likely to abuse cannabis than the female gender (OR= 6.25; 95% CI: 1.89-20), and participants in a relationship were six times more likely to abuse cannabis than participants not in a relationship (OR = 6.33; 95% CI: 1.67-24.39). The study also found significant association of depressive symptoms (X ² = 4.561; p = 0.033) and anxiety symptoms (X ² = 4.700; p = 0.030) with likely cannabis abuse.

CONCLUSION

Demographic factors significantly predicted likely cannabis abuse in the Fort McMurray population, and cannabis abuse significantly correlated with presence of moderate to high anxiety and depression symptoms. It is essential to mobilized resources to support vulnerable communities and manage cannabis abuse.