Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials.

BACKGROUND: The lack of clinical guidelines for the treatment of primary psychodermatologic disorders (PPDs) hinders the delivery of optimal care to patients. The review aimed to identify, appraise, and summarize the currently available evidence about the safety and effectiveness of pharmacological management of PPDs through randomized controlled trials (RCTs). METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) statement and the Global Evidence Mapping Initiative guidance were followed. Medline, Embase, PsycInfo, Cochrane and Scopus were searched, and two reviewers independently completed article review, data extraction, and quality assessment. RESULTS: Among 2618 unique studies, full texts of 83 were reviewed and 21 RCTs were included. Five PDDs were identified: trichotillomania (n = 12), pathologic skin picking (n = 5), nail biting (n = 2), delusional parasitosis (n = 1), and dermatitis from compulsive hand washing (n = 1). Seven different classes of medications were investigated: SSRIs (i.e., fluoxetine, sertraline, and citalopram), tricyclic antidepressants (i.e., clomipramine and desipramine), antipsychotics (i.e., olanzapine and pimozide), anticonvulsant (i.e., lamotrigine), N-acetylcysteine, inositol, and milk thistle. RCT-derived evidence supports the use of antidepressants in trichotillomania (sertraline and clomipramine), pathologic skin picking (fluoxetine), pathologic nail biting and dermatitis from compulsive hand washing (clomipramine or desipramine); antipsychotics in trichotillomania (olanzapine) and delusional parasitosis (pimozide); N-acetyl cysteine in trichotillomania and skin picking. CONCLUSION: Few pharmacotherapies for primary psychodermatologic disorders are assessed through controlled trials in the literature. This review serves as a roadmap for researchers and clinicians to reach informed decisions with current evidence, and to build on it to establish guidelines in the future.

Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program.

BACKGROUND: Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. METHODS: A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. CONCLUSIONS: To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. TRIAL REGISTRATION: clinicaltrials.gov, NCT05133726 . Registered 24 November 2021.

Psychodermatology in Canada: A National Survey Assessment of Dermatologists' Perception, Practice Patterns, and Challenges.

OBJECTIVES: We aimed to assess the perception of psychodermatology, practice patterns, and challenges reported by Canadian dermatologists. METHODS: We designed an online questionnaire based on previous literature, including questions about practitioners' perceptions, practice patterns, training, and challenges in psychodermatology. We solicited their opinions on desired training, research needs, and clinical approach recommendations. Our survey was distributed nationally by the Canadian Dermatology Association (CDA). RESULTS: Of the total of 78 participating dermatologists, >75% reported treating patients with psychodermatological conditions, with higher frequencies of secondary than primary psychodermatological conditions. While practitioners had some confidence in their understanding of psychodermatology (median = 4 on a 5-point scale), their comfort levels to approach these patients were lower (median = 3), and their confidence in prescribing psychotropic medication was markedly low (median = 2). A total of 50% reported that a "multidisciplinary approach" would be best for these patients. Poor access to psychiatry was the most reported (26.9%) challenge, together with time constraints, lack of training, poor communication with patients, and lack of patient insight and resources. While 46.2% reported having never participated in psychodermatology training, 55.1% expressed interest in doing so. CONCLUSION: We identified several challenges with knowledge, awareness, and healthcare delivery in psychodermatological practice in Canada. Increasing dermatologists' access to psychiatric consultations/services, a multidisciplinary approach with dermatologists and psychiatrists co-providing care, and more specialized training in this area are recommended to narrow the identified gaps.

Estimated Frequency of Psychodermatologic Conditions in Alberta, Canada.

BACKGROUND: Psychodermatologic disorders are difficult to identify and treat. Knowledge about the prevalence of these conditions in dermatological practice in Canada is scarce. This hampers our ability to address potential gaps and establish optimal care pathways. OBJECTIVES: To provide an estimate of the frequencies of psychodermatologic conditions in dermatological practice in Alberta, Canada. METHODS: Two administrative provincial databases were used to estimate the prevalence of potential psychodermatological conditions in Alberta from 2014 to 2018. Province-wide dermatology claims data were examined to extract relevant International Classification of Disease codes as available. Claims were linked with pharmacy dispensation data to identify patients who received at least 1 psychoactive medication within 90 days of the dermatology claim. RESULTS: Of 243 963 patients identified, 28.6% had received at least 1 psychotropic medication (mean age: 47.9 years; 67.5% female). Rates of concurrent psychotropic medications were highest for pruritus and related conditions (46.7%), followed by urticaria (44.5%) and hyperhidrosis (32.8%). Among patients with psychotropic medications, rates of antidepressants were highest (56.3%), followed by anxiolytics (37.1%). Across billing codes, besides hyperhidrosis (71.2%), diseases of hair (61.4%) and psoriasis (59.1%) had the highest rates of antidepressant dispensations. Patients with atopic dermatitis had the highest rates for anxiolytic prescriptions (54.3%). CONCLUSION: In a 5-year window, more than a quarter of the identified dermatology patients in Alberta received at least 1 psychotropic medication, pointing to high rates of potential psychodermatologic conditions and/or concurrent mental health issues in dermatology. Diagnostic and care pathways should include a multidisciplinary approach to better identify and treat these conditions.

A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project.

BACKGROUND: Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families. METHODS: The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention. DISCUSSION: Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017).

Randomized controlled trial investigating web-based, therapist delivered eye movement desensitization and reprocessing for adults with suicidal ideation.

Introduction: Promising preliminary evidence suggests that EMDR may reduce suicidal ideation (SI) when used to treat Major Depressive Disorder, Posttraumatic Stress Disorder, and trauma symptoms in the context of acute mental health crises. EMDR has never been tested specifically for treating SI, and there is a lack of data regarding the safety and effectiveness of web-based, therapist-delivered EMDR in populations with known SI. The primary objective of this study was to investigate the impact of web-based, therapist-delivered EMDR, targeting experiences associated with suicidal thinking. Secondary objectives included examining the effect of EMDR treatment on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation, as well as safety and attrition. Methods: This randomized control trial (ClinicalTrials.gov ID number: NCT04181047) assigned adult outpatients reporting SI to either a web-based EMDR intervention or a treatment as usual (TAU) group. TAU included primary and mental health services available within the Canadian public health system. Participants in the EMDR group received up to 12 web-based EMDR desensitization sessions, delivered twice weekly during the COVID-19 pandemic (2021-2023). The Health Research Ethics Board at the University of Alberta approved the protocol prior to initiation of data collection for this study (protocol ID number: Pro00090989). Results: Forty-two adult outpatients received either EMDR (n=20) or TAU (n=22). Participants reported a high prevalence of early onset and chronic SI, and there was a high rate of psychiatric comorbidity. In the EMDR group, median SI, depression, anxiety, and posttraumatic symptom scale scores decreased from baseline to the four month follow-up. In the TAU group, only the median SI and posttraumatic symptom scale scores decreased from baseline to four month follow up. Although sample size precludes direct comparison, there were numerically fewer adverse events and fewer dropouts in the EMDR group relative to the TAU group. Conclusion: Study results provide promising preliminary evidence that web-based EMDR may be a viable delivery approach to address SI. In this complex population, a short treatment course was associated with reductions of SI and other symptoms across multiple diagnostic categories. Further investigation is warranted to verify and extend these results. Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04181047?id=NCT04181047&rank=1, identifier NCT04181047.

Leveraging neuroscience education to address stigma related to opioid use disorder in the community: a pilot study.

Opioid use disorder (OUD) and overdose deaths are a public health crisis. One contributing factor is stigma towards people who use opioids. We developed and conducted a public-facing, half-day educational event designed to challenge misperceptions about OUD from a contemporary neuroscience perspective. Participants engaged with three different resources on the neurobiology of addiction, and, at the end of the event, they rated its effectiveness. We also collected and compared pre- and post-event composite OUD stigma scales. Participants rated our approach and the overall event as highly effective. Additionally, OUD stigma scores were lower immediately following the event, and this decrease was primarily driven by decreased internalized stigma. Here, we demonstrate an effective proof-of-concept that an accessible, public-facing, neuroscience education event may reduce OUD stigma in the community.

Supporting patients by family education in psychotic illness: a longitudinal pre-post study protocol.

INTRODUCTION: A lack of education, resources and support for family carers of young adults with psychotic illnesses leaves them ill-equipped to support their loved one. By equipping families with skills and knowledge, public healthcare harnesses a powerful ally to support community stabilisation. AIMS: The primary goal is to study the effect of a psychoeducation intervention for family carers supporting young adults with psychosis on family burden and stabilisation of service users. METHODS AND ANALYSIS: A longitudinal quantitative study with a pre-post design will be used to assess the long-term effectiveness of the psychoeducation intervention for family carers supporting a young adult with psychosis. 111 family carers will be recruited for the intervention and measures will be taken from family carer participants and their matched young adult service users. Nine evidence and family peer-informed and expert-reviewed psychoeducation modules are administered in 2-hour sessions over 9 weeks to family carers. Functional index measures are administered preintervention, and at 6-month, 12-month and 24-month follow-up. Service utilisation will be measured during a 12-month period preintervention, a 12-month period postintervention and during a 12-24-month period post-intervention. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the University of Alberta Research Ethics Board (Pro00110691). This novel methodological approach to studying family psychoeducation interventions addresses unique methodological challenges and limitations and will be disseminated through peer-reviewed publications and academic and medical conferences. TRIAL REGISTRATION NUMBER: NCT05500001; National Institutes of Health U.S. National Library of Medicine ClinicalTrials.gov.

Preexisting mental health disorders and risk of opioid use disorder in young people: A case-control study.

AIM: Opioid use disorder (OUD) is a leading cause of preventable mortality amongst young people worldwide. Early identification and intervention of modifiable risk factors may reduce future OUD risk. The aim of this study was to explore whether the onset of OUD is associated with preexisting mental health conditions such as anxiety and depressive disorders in young people. METHODS: A retrospective, population-based case-control study was conducted from 31 March 2018 until 01 January 2002. Provincial administrative health data were collected from Alberta, Canada. CASES: Individuals 18-25 years on 01 April 2018, with a previous record of OUD. CONTROLS: Individuals without OUD were matched to cases, on age/sex/index date. Conditional logistic regression analysis was used to control for additional covariates (e.g., alcohol-related disorders, psychotropic medications, opioid analgesics, and social/material deprivation). RESULTS: We identified N = 1848 cases and N = 7392 matched controls. After adjustment, OUD was associated with the following preexisting mental health conditions: Anxiety disorders, aOR = 2.53 (95% CI = 2.16-2.96); depressive disorders, aOR = 2.20 (95% CI = 1.80-2.70); alcohol-related disorders, aOR = 6.08 (95% CI, 4.86-7.61); anxiety and depressive disorders, aOR = 1.94 (95% CI = 1.56-2.40); anxiety and alcohol-related disorders, aOR = 5.22 (95% CI = 4.03-6.77); depressive and alcohol-related disorders, aOR = 6.47 (95% CI = 4.73-8.84); anxiety, depressive and alcohol-related disorders, aOR = 6.09 (95% CI = 4.41-8.42). DISCUSSION: Preexisting mental health conditions such as anxiety and depressive disorders are risk factors for future OUD in young people. Preexisting alcohol-related disorders showed the strongest association with future OUD and demonstrated an additive risk when concurrent with anxiety/depression. As not all plausible risk factors could be examined, more research is still needed.

Burnout among Residents: Prevalence and Predictors of Depersonalization, Emotional Exhaustion and Professional Unfulfillment among Resident Doctors in Canada.

BACKGROUND: Burnout in the medical profession has garnered a lot of attention over recent years. It has been reported across all specialties and all stages of medical education; however, resident doctors in particular are at risk for burnout throughout their years of training. This study was aimed at evaluating the prevalence and correlates of burnout among resident doctors in Alberta. METHODS: Through a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident doctors at two medical schools in Alberta, Canada. The Maslach Burnout Inventory was used as the assessment tool. Chi-squared and multivariate binary logistic regression analyses were used. RESULTS: Overall burnout prevalence among residents was 58.2%, and for professional fulfilment index, it was 56.7% for work exhaustion and interpersonal disengagement and 83.5% for lack of professional fulfillment. Working more than 80 h/week (OR = 16.437; 95% CI: 2.059-131.225), being dissatisfied (OR = 22.28; 95% CI: 1.75-283.278) or being neither satisfied nor dissatisfied with a career in medicine (OR = 23.81; 95% CI: 4.89-115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR = 10.83; CI: 1.66-70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR = 5.14; CI: 1.33-19.94) were significantly associated with high emotional exhaustion. Working more than 80 h/week (OR = 5.36; CI: 1.08-26.42) and somewhat agreeing that the residency program has enough strategies aimed at resident well-being in place (OR = 3.70; CI: 1.10-12.46) were significantly associated factors with high work exhaustion and interpersonal disengagement. A young age of residents (≤30 years) (OR = 0.044; CI: 0.004-0.445) was significantly associated with low professional fulfillment. CONCLUSION: Burnout is a serious occupational phenomenon that can degenerate into other conditions or disrupt one's professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policymakers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of medical residents across Canada.

Leveraging neuroscience education to address stigma related to opioid use disorder (OUD) in the community: A pilot study.

Opioid use disorder (OUD) and overdose deaths are a public health crisis. One contributing factor is stigma towards people who use opioids. We developed and conducted a public-facing, half-day educational event designed to challenge misperceptions about OUD from a contemporary neuroscience perspective. Participants engaged with three different resources on the neurobiology of addiction; at the end of the event, they rated its effectiveness. We also collected and compared pre- and post-event composite OUD stigma scales. Participants rated our approach and the overall event as highly effective. Additionally, OUD stigma scores were lower immediately following the event, and this decrease was primarily driven by decreased internalized stigma. Here, we demonstrate an effective proof-of-concept that an accessible, public-facing, neuroscience education event may reduce OUD stigma in the community.

Clinicians' Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. OBJECTIVE: This study (1) explored clinicians' experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians' intentions to offer telepsychology after the COVID-19 pandemic. METHODS: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. RESULTS: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (ß=0.46; P<.001) and telephone services (ß=0.35; P<.001) after the pandemic. Social influence (ß=0.24; P=.004) and facilitating conditions (ß=0.19; P=.03) additionally predicted the intention to use telephone services. CONCLUSIONS: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities.

Psychiatric hospital experiences that support and frustrate emerging adults' psychological needs: A self-determination theory perspective.

AIM: There are international efforts to implement developmentally appropriate and youth-oriented mental health services for emerging adults to increase treatment engagement and the success of early intervention. While significant progress has been made in developing community service models, limited research has focused on how to design psychiatric inpatient settings that promote the recovery of emerging adults. The present study attempts to address this knowledge gap through a qualitative exploration of hospital experiences that influence psychological need satisfaction and frustration, as defined by self-determination theory (SDT). METHODS: Inpatients (N = 104) from an emerging adult psychiatry unit were interviewed regarding hospital experiences that related to satisfaction or frustration of SDT needs for autonomy, competence, and relatedness. RESULTS: A basic interpretative qualitative analysis highlighted six key aspects of the hospital experience relevant to these needs: (a) social interactions, (b) freedom of behaviour and access, (c) programs and activities, (d) treatment collaboration and choice, (e) restraining/unpleasant hospital practices, and (f) progress, symptoms, and functioning. The findings support SDT's emphasis on the importance of autonomy support, structure, and involvement for need satisfaction. CONCLUSIONS: The study sheds light on aspects of the hospital milieu that may be essential to recovery-oriented inpatient care and on experiences that may be distinctly important for emerging adults, such as support for independence and the opportunity to relate to same-age co-patients experiencing similar mental health problems and life circumstances.

Treatment options and shared decision-making in the treatment of opioid use disorder: A scoping review.

BACKGROUND: Shared decision-making (SDM) is an approach to clinical decision-making that includes patients' values and preferences during health-related decisions. Previous research suggests that SDM may be beneficial in the treatment of substance use disorders; however, the impact of SDM in the treatment of opioid use disorder (OUD) remains unclear. OBJECTIVES: To identify relevant peer-reviewed literature related to SDM in the treatment of adults with OUD, and to summarize the main findings according to patient outcomes. METHODS: The research team conducted a scoping review. The team searched five electronic health databases from database inception until September 2019 using MeSH and keywords related to SDM. The team included only peer-reviewed studies where adults (≥18 years) with OUD were provided a choice and/or allowed input into their treatment plan. Two independent reviewers screened, extracted, and assessed the quality of included studies. RESULTS: Fourteen studies (n = 1748 participants) met inclusion criteria, including seven randomized controlled trials, three non-randomized controlled trials, two observational studies, and one qualitative study. Treatment options included: patient regulated methadone dosing vs. fixed dosing (n = 4 studies), optional vs. mandatory counseling (n = 4 studies), home vs. office buprenorphine inductions (n = 2 studies), and inpatient vs. outpatient treatment (n = 1 study). None of the studies measured SDM with a validated instrument. Seven of 14 studies reported at least one improved patient outcome. CONCLUSIONS: The review found few studies that explored whether providing treatment options and/or encouraging participation in decision-making are beneficial for adults with OUD. Preliminary evidence suggests that SDM may be promising for this population. However, the field needs more research on person-centered care and SDM.

Prevalence and Correlates of Likely Major Depressive Disorder among Medical Students in Alberta, Canada.

BACKGROUND: Medical students are exposed to multiple factors during their academic and clinical studies that contribute to depression. AIMS: This study aims to examine the prevalence and correlates of likely major depressive disorder (MDD) among medical students. METHODS: This study utilized a descriptive cross-sectional design. Data were collected through a self-administered online survey, which included questions on sociodemographic characteristics and likely MDD using the PHQ-9. Data were analyzed using a descriptive, Chi-square test and logistic regression model. RESULTS: There were 246 medical students who participated in the survey. The majority were females, 155 (65.1%); Caucasian, 158 (66.4%); and in a relationship, 168 (70.5%). The prevalence of likely MDD was 29.1%. Respondents who did not feel supported and respondents who were neutral about their social support, friends, and family, were 11 and 4 times more likely to experience MDD than those who felt well supported (OR = 11.14; 95% CI: 1.14-108.80) and (OR = 4.65; 95% CI: 1.10-19.56), respectively. CONCLUSIONS: This study suggests a high prevalence of likely MDD among medical students who do not feel they have sufficient social support from friends and family. Social adjustments, including talking to friends and family and participating in leisure activities, could reduce the level of depression among medical students.

The relation between psychological need satisfaction in acute psychiatric hospital and recovery among emerging adults: A self-determination theory approach.

OBJECTIVE: Mental illness and addiction are prevalent during emerging adulthood and are associated with poorer functioning and quality of life. Research supports early intervention for enhancing recovery, though emerging adults frequently disengage from services, reducing effectiveness of early care. Research on self-determination theory shows healthcare climates that support psychological needs for autonomy, competence, and relatedness foster sustained engagement in treatment and health-promoting behaviors. The present study hypothesized that more need satisfying (and less frustrating) psychiatric hospital experiences would relate to various indicators of recovery among emerging adults. METHODS: One-hundred four emerging adults from an acute psychiatric inpatient unit completed an adapted questionnaire measuring need satisfaction in the hospital and surveys of treatment attitudes, illness identity, and wellness during the 3rd week of their hospital stay. Six-month postdischarge service utilization data were obtained through electronic health databases. RESULTS: A more need satisfying hospital experience was associated with greater autonomous motivation for treatment, more positive attitudes toward medications and services, more adaptive illness identification, and greater well-being. Greater need frustration was related to less autonomous and more controlled motivation for treatment, less positive attitudes toward medications and services, less adaptive illness identification, and lower well-being. While neither need satisfaction nor frustration related to subsequent visits to the emergency department or rehospitalization, a need frustrating hospital experience related to fewer attended community appointments during the 6 months following discharge. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Hospital experiences that satisfy (and do not frustrate) the psychological needs of emerging adults may promote recovery and treatment engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Identification of psychiatric inpatient recovery trajectories using routine outcome monitoring with emerging adults.

Early intervention for emerging adults with addiction and mental health disorders is beneficial for long-term recovery. The present study investigated the utility of routine outcome monitoring during acute inpatient hospitalization for identifying emerging adults at risk of poor outcomes. This is a retrospective study using latent class growth analysis (LCGA) to identify patient groups with different recovery trajectories, with additional analyses to clarify the characteristics of these trajectory groups. The results identified four patient groups: Rapid responders (38%), gradual responders (34%), high distress non-responders (9%), and low distress non-responders (19%). The high distress non-responding group is characterized by behaviours and disorders associated with ambivalent care seeking: Voluntary admission, longer length of stay, lower service satisfaction, higher outpatient service utilization, elevated risk of emergency department presentation and hospital readmission, and depression/personality disorder diagnosis. The low distress group is characterized by behaviours and disorders associated with treatment rejection: Involuntary admission, shorter length of stay, reduced post-discharge service utilization, and psychotic disorder diagnosis. The results have implications for identifying at-risk youth and developing stepped-care models for more effective and efficient inpatient care.

Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial.

BACKGROUND: Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. OBJECTIVE: The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. METHODS: In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. RESULTS: The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. CONCLUSIONS: The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30711.

COVID-19 Pandemic: Demographic Predictors of Self-Isolation or Self-Quarantine and Impact of Isolation and Quarantine on Perceived Stress, Anxiety, and Depression.

Introduction: With the sudden onset and global dispersal of the SARS-CoV-2 virus, many nations including Canada attempted to reduce spread of the resultant COVID-19 syndrome with self-isolation and quarantine, while seeking a cure or vaccine for this disease. Understanding impacts of self-isolation and self-quarantine on stress, anxiety, and depression will help us to mitigate these issues through appropriate development of mental health services. Methods: The sample was drawn from individuals who self-subscribed to Text4Hope, a service that delivers text messages based on a cognitive behavioral therapy framework. Text4Hope was developed to support Albertans during the COVID-19 pandemic. Subscribers were asked for demographic information and if they had to self-isolate or self-quarantine during the pandemic via a survey link. Mental health was assessed using the validated instruments: Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 item scale (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics and Chi-Square test results were derived using Statistical Package for Social Sciences (SPSS) version-26. Results: 6,041 of 32,805 Text4Hope subscribers (18.4%) completed the survey. Of these respondents, 19.2% had self-isolated or self-quarantined in Alberta as of March 31, 2020 during the COVID-19 pandemic. Post-hoc analysis using adjusted residuals suggested that individuals aged 60 years of age or older, and retirees had a higher likelihood of self-isolation or self-quarantine, compared to respondents with other age or employment characteristics. One-week prevalence rates for self-reported measures of moderate to high stress, likely Generalized Anxiety Disorder (GAD), and likely Major Depressive Disorder (MDD) were 84.9, 46.7, and 41.4%, respectively. Respondents who had to self-isolate or self-quarantine during the COVID-19 pandemic were significantly more likely to present with moderate to high stress, significant anxiety symptomatology, and significant depressive symptomatology. Conclusions: Older age and employment status were significantly associated with the likelihood of self-isolation or self-quarantine. We found elevated self-reported levels of anxiety and depression associated with self-reported COVID-19 pandemic-related self-isolation and self-quarantine activity. These findings have mental health implications both during and after the pandemic and demonstrate the need for greater focus on psychological complications of self-isolation and self-quarantine, and development of optimal ways to manage these pandemic consequences.