The InterSECT Framework: a proposed model for explaining population-level trends in substance use and emotional concerns.

Across high-income countries, adolescent emotional concerns have been increasing in prevalence over the past two decades and it is unclear why this is occurring, including whether and how substance use relates to these changing trends. On the other hand, substance use has been generally declining, and little is known about the role of emotional concerns in these trends. Several studies have explored the changes in co-occurring substance use and emotional concerns among adolescents over time, with mixed results and inconsistent messaging about the implications of the findings. In response, we developed a theoretical framework for exploring the intersection between trends in substance use and emotional concerns (InterSECT Framework). This framework includes a discussion and related examples for 3 core hypotheses: (1) strengthening of co-occurrence, or the "hardening" hypothesis; (2) co-occurrence staying the same, or the "consistency" hypothesis; and (3) weakening of co-occurrence, or the "decoupling" hypothesis. This framework seeks to guide the conceptualization, evaluation, and understanding of changes in the co-occurrence of substance use and emotional concerns over time, including outlining a research agenda informed by pre-existing research and youth perspectives.

Patient-reported outcome measures for medication treatment satisfaction: a systematic review of measure development and measurement properties.

BACKGROUND: Medication Treatment Satisfaction (M-TS) from the patients' perspective is important for comprehensively evaluating the effect of medicines. The extent to which current patient-reported outcome measures (PROMs) for M-TS are valid, reliable, responsive, and interpretable remains unclear. To assess the measurement properties of existing PROMs for M-TS and to highlight research gaps. METHODS: Using PubMed, Embase (Ovid), Cochrane library (Ovid), IPA (Ovid), PsycINFO, Patient-Reported Outcome and Quality of Life Questionnaires biomedical databases, and four Chinese databases, we performed a systematic search for studies addressing the development and validation of PROMs for M-TS. Based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline, pairs of reviewers independently assessed the measurement properties of the PROMs and rated the quality of evidence on the measurement properties of each PROM. (The Open Science Framework registration: https://doi.org/10.17605/OSF.IO/8S5ZM ). RESULTS: This review identified 69 PROMs for M-TS in 114 studies (four generic, 32 disease-specific, and 33 drug-specific) of which 60 were intended for adults. All provided limited or no information regarding interpretability. Most demonstrated appropriate construct validity including convergent validity (39/69) and discriminative or known-groups validity (40/69) (high to moderate quality of evidence). Only a few provided evidence of sufficient content validity (8/69), structural validity (13/69), and internal consistency (11/69). Of 38 PROMs reporting test-retest reliability, results in 24 provided evidence of satisfactory test-retest reliability (18 with high to moderate, 6 with low to very low quality of evidence). Few PROMs reported responsiveness (16/69). Two generic PROMs (Treatment Satisfaction Questionnaire for Medication initial Version 1.4, TSQM-1.4; Treatment Satisfaction with Medicines Questionnaire, SATMED-Q) and one drug-specific PROM (Insulin Treatment Satisfaction Questionnaire, ITSQ) demonstrated both satisfactory validity and reliability. CONCLUSIONS: Most existing PROMs for M-TS require further exploration of measurement properties. Reporting guidelines are needed to enhance the reporting quality of the development and validation of PROMs for M-TS.

Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis.

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.

COVID-19 impacts on drinking and mental health in emerging adults: Longitudinal changes and moderation by economic disruption and sex.

BACKGROUND: There are significant concerns that the COVID-19 pandemic may have negative effects on substance use and mental health, but most studies to date are cross-sectional. In a sample of emerging adults, over a two-week period during the pandemic, the current study examined: (1) changes in drinking-related outcomes, depression, anxiety, and posttraumatic stress disorder and (2) differences in changes by sex and income loss. The intra-pandemic measures were compared to pre-pandemic measures. METHODS: Participants were 473 emerging adults (Mage  = 23.84; 41.7% male) in an existing longitudinal study on alcohol misuse who were assessed from June 17 to July 1, 2020, during acute public health restrictions in Ontario, Canada. These intra-pandemic data were matched to participant pre-pandemic reports, collected an average of 5 months earlier. Assessments included validated measures of drinking, alcohol-related consequences, and mental health indicators. RESULTS: Longitudinal analyses revealed significant decreases in heavy drinking and adverse alcohol consequences, with no moderation by sex or income loss, but with substantial heterogeneity in changes. Significant increases in continuous measures of depression and anxiety were present, both of which were moderated by sex. Females reported significantly larger increases in depression and anxiety. Income loss >50% was significantly associated with increases in depression. CONCLUSIONS: During the initial phase of the pandemic, reductions in heavy drinking and alcohol consequences were present in this sample of emerging adults, perhaps due to restrictions on socializing. In contrast, there was an increase in internalizing symptoms , especially in females, highlighting disparities in the mental health impacts of the pandemic.

Is talk cheap? Correspondence between self-attributions about changes in drinking and longitudinal changes in drinking during the 2019 coronavirus pandemic.

BACKGROUND: There are concerns that the coronavirus disease 2019 (COVID-19) pandemic may increase drinking, but most accounts to date are cross-sectional studies of self-attributions about alcohol-related impacts and the accuracy of those perceptions has not been investigated. The current study examined the correspondence between self-attributions of pandemic-related changes in drinking and longitudinally-measured changes in drinking and alcohol-related consequences in a sample of emerging adults. METHODS: In an existing ongoing longitudinal study on alcohol misuse (≥1 heavy episodic drinking day/month) in emerging adults, 473 individuals (Mage  = 23.8; 41.7% male) received a supplemental assessment from June 17th to July 1st, 2020, during public health restrictions in Ontario, Canada. These intrapandemic data were matched to the most recent assessment prior to the pandemic (~8 months earlier). Self-attributions about changes in drinking were assessed globally (i.e., increases/decreases/no change) and with higher resolution questions clarifying the magnitude of changes. RESULTS: Global self-attributions about changes in drinking substantively paralleled longitudinal changes in weekly drinking days (DD). In the longitudinal data, individuals' who self-reported increases in drinking exhibited significant increases; individuals' who self-reported decreases exhibited significant decreases; and individuals who self-reported no change exhibited nonsignificant changes. Higher resolution items likewise revealed longitudinal patterns of weekly drinking that were substantively consistent with self-attributions. Heavy DD and alcohol-related consequences exhibited similar patterns, but only individuals who self-reported large increases in drinking exhibited increases on these outcomes. Individuals who reported large increases in drinking also exhibited significant increases in depression and posttraumatic stress disorder symptoms. CONCLUSIONS: Self-attributions about drinking closely corresponded to longitudinal changes in drinking, supporting the validity of self-attributions in population-level surveys, particularly in young adults. Notably, a subgroup was identified that exhibited pronounced increases for all alcohol-related outcomes and concurrent increases in internalizing psychopathology.

Latent Profile Analysis of Heavy Episodic Drinking in Emerging Adults: A Reinforcer Pathology Approach.

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.

Temporal Changes in the Cross-Sectional Associations between Cannabis Use, Suicidal Ideation, and Depression in a Nationally Representative Sample of Canadian Adults in 2012 Compared to 2002.

BACKGROUND: With the recent legalization of nonmedical cannabis in Canada, it is important to document previous associations between cannabis use and major depressive episode and suicidal ideation, as well as the extent to which these associations have changed over time. METHODS: This study uses pooled data from the 2002 and 2012 Canadian Community Health Survey's Mental Health Component, which are repeated cross-sectional surveys of nationally representative samples of Canadians 15 to 60 years of age (n = 43,466). Binary logistic regression was performed, applying weighting and bootstrapping, to examine the association between at least monthly use of cannabis and past 12-month suicidal ideation and major depressive episode (MDE). RESULTS: At least monthly nonmedical cannabis use was associated with an increased odds of MDE and suicidal ideation, and both associations strengthened in 2012 compared to 2002. Canadians using cannabis at least once a month in 2012 had 1.59 (95% confidence interval [CI], 1.11 to 2.27) times the odds of experiencing suicidal ideation and 1.55 (95% CI, 1.12 to 2.13) times the odds of experiencing MDE compared to those who used cannabis at least once a month in 2002. This temporal change remained after controlling for other substance use. CONCLUSIONS: Monthly cannabis use was consistently related to both suicidal ideation and MDE, and these associations were stronger in 2012 compared to 2002. The findings of this study provide a baseline for the association between cannabis use and suicide and depression in the Canadian population that should be reevaluated now that nonmedical cannabis has been legalized.

Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders.

OBJECTIVES: To quantify the strength of association between passive and active forms of screen time and adolescent major depressive episode and anxiety disorders. METHODS: Data from the 2014 Ontario Child Health Study, a representative sample of 2,320 adolescents aged 12-17 years in Ontario (mean age = 14.58, male = 50.7%) were used. Screen time was measured using adolescent self-report on time spent on screen-based activities. Past 6-month occurrence of DSM-IV-TR defined major depressive episode, social phobia, generalized anxiety disorder, and specific phobia which were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents. RESULT: Adolescents reporting 4 or more hours of passive screen time per day, compared to those reporting less than 2 h, were three times more likely to meet the DSM-IV-TR criteria for major depressive episode [OR = 3.28(95% CI = 1.71-6.28)], social phobia [OR = 3.15 (95% CI = 1.57-6.30)] and generalized anxiety disorder [OR = 2.92 (95% CI = 1.64-5.20)]. Passive screen time continued to be significantly associated with increased odds of disorders, after adjusting for age, sex, low income, active screen time use, sleep and physical activity. A small-to-moderate attenuation of the estimated ORs was observed in the fully adjusted model. In contrast, associations between active screen time use and depression and anxiety disorders were smaller in magnitude and failed to reach statistical significance. CONCLUSIONS: Passive screen time use was associated with mood and anxiety disorders, whereas active screen time was not. Further research is needed to better understand the underlying processes contributing to differential risk associated with passive versus active screen time use and adolescent mood and anxiety disorders.

Sex Differences in the Association Between Cannabis Use and Suicidal Ideation and Attempts, Depression, and Psychological Distress Among Canadians.

BACKGROUND: Depression, anxiety, and substance use disorders are leading causes of morbidity worldwide. The most commonly used illicit substance is cannabis and there is some evidence that the association between cannabis use and poor mental health is more pronounced among females compared with males. This analysis examines sex differences in the association between cannabis use and major depressive episode (MDE), suicidal thoughts and attempts, and psychological distress. METHODS: This study uses data from the 2002 and 2012 Canadian Community Health Survey's Mental Health Component, repeated cross-sectional surveys of nationally representative samples of Canadians 15 years of age and older ( n = 43,466). Linear and binary logistic regressions were performed, applying weighting and bootstrapping. RESULTS: There were significant sex differences in the strength of the association between cannabis use and suicidal thoughts and attempts and psychological distress, but not MDE. Females who reported using cannabis occasionally (defined as 1 to 4 times a month) reported higher levels of psychological distress than their male counterparts. Females who reported using regularly (defined as more than once per week) reported higher levels of psychological distress and were more likely to report suicidal thoughts and attempts. CONCLUSIONS: Future research is needed to further our understanding of the nature of these sex differences. Public health messaging should incorporate being female as a potential risk factor for the co-occurrence of cannabis use and emotional problems, particularly at higher frequencies of use. Clinicians should also be aware of this association to better inform integrated mental health and substance use screening, discussions, and care, particularly for female patients.

Early substance use and the school environment: A multilevel latent class analysis.

Background: Early substance use is associated with increased risks for mental health and substance use problems which are compounded when using several substances (i.e., polysubstance use). A notable increase in substance use occurs when adolescents transition from elementary to secondary schooling. Objective: This study seeks to characterize student and school classes of substance use. Methods: A cross-sectional multilevel latent class analysis and regression was conducted on a representative sample of 19,130 grade 6-8 students from 180 elementary schools in Ontario, Canada to: 1) identify distinct classes of student substance use; 2) identify classes of schools based on student classes; and 3) explore correlates of these classes, including mental health, school climate, belonging, safety, and extracurricular participation. Results: Two student and two school classes were identified. 4.1% of students were assigned to the high probability of early polysubstance use class while the remaining 95.9% were in the low probability class. Students experiencing depressive and externalizing symptoms had higher odds of being in the early polysubstance use class (Odds Ratio [OR]s=1.1-1.25). At the school level, 19% of schools had higher proportions of students endorsing polysubstance use. Perceptions of positive school climate, belonging, and safety increased the odds of students being in the low probability of early polysubstance use student-level class (ORs=0.85-0.93) and lower probability of early polysubstance use school-level class. Associations related to extracurricular participation were largely not statistically significant. Conclusions: Student and school substance use classes may serve as targets for tailored prevention and early interventions. Results support examining school-based interventions targeting school climate, belonging, and safety.

Contexte: L'utilisation précoce de substances est associée à des risques accrus pour la santé mentale et les problèmes liés à l'utilisation de substances qui sont aggravés lorsque plusieurs substances sont utilisées (c.-à-d. utilisation de polysubstances). Une augmentation notable de l'utilisation de substances se produit quand les adolescents passent du cours primaire au cours secondaire. Objectif: La présente étude cherche à caractériser l'utilisation de substances chez les classes d'élèves et d'écoles. Méthodes: Une analyse transversale et une régression des classes latentes multi-niveaux ont été menées sur un échantillon représentatif de 19 130 élèves de la 6e à la 8e année de 180 écoles primaires de l'Ontario, Canada, pour: 1) identifier les classes d'élèves distinctes utilisant des substances; 2) identifier les classes d'écoles d'après les classes d'élèves; et 3) explorer les corrélats de ces classes, notamment la santé mentale, le climat scolaire, l'appartenance, la sécurité, et la participation extrascolaire. Résultats: Deux classes d'élèves et deux classes d'écoles ont été identifiées. Des élèves au nombre de 4,1 % ont été assignés à la classe probabilité élevée d'une utilisation précoce de polysubstances alors que les 95,9 % restants étaient dans la classe probabilité faible. Les élèves souffrant de dépression et de symptômes externalisants avaient des probabilités plus élevées d'être dans la classe utilisation précoce de polysubstances (Rapport de cotes [RC] = 1,1­1,25). Au niveau des écoles, 19 % d'entre elles avaient des proportions plus élevées d'élèves approuvant l'utilisation de polysubstances. Les perceptions positives du climat scolaire, de l'appartenance et de la sécurité accroissaient les probabilités d'élèves étant dans la classe d'élèves faible probabilité d'utilisation précoce de polysubstances (RC = 0,85­0,93) et une probabilité plus faible de la classe d'écoles ayant une utilisation précoce de polysubstances. Les associations liées à une participation extrascolaire étaient largement non significatives statistiquement. Conclusions: Les classes d'utilisation de substances d'élèves et d'écoles peuvent servir de cibles pour une prévention adaptée et des interventions précoces. Les résultats soutiennent l'examen des interventions en milieu scolaire qui ciblent le climat scolaire, l'appartenance et la sécurité.

Past the tipping point: Understanding and addressing burnout among nursing students.

Burnout is a widespread concern in healthcare, with nurses bearing a disproportionate burden among healthcare professionals. This epidemic of occupational stress has also affected nursing students, who face the external demands inherent in the profession. In this call-to-action paper, we conducted an extensive literature review exploring strategies aimed at mitigating burnout among nursing students, and offer recommendations for academic institutions, healthcare leaders, research funders, and political leaders, including both the civil service and elected leaders to support the advancement and sustainability of the nursing profession and its workforce.

The association between teacher distress and student mental health outcomes: a cross-sectional study using data from the school mental health survey.

BACKGROUND: Few studies have examined the inter-relationships between teacher and student mental health. We aimed to examine associations between teacher distress and student mental health difficulties and if student perceptions of school safety moderate these associations. METHOD: Data from 23,568 students in grades 6-12 and 1,478 teachers from 268 schools participating in the School Mental Health Surveys in Ontario, Canada, were used. Three-level (student, classroom, school) multivariable linear regression models were fit to examine associations between teacher distress and student internalizing and externalizing symptoms by elementary (grades 6-8) and secondary (grades 9-12) school. Statistical interactions were used to evaluate effect modification. RESULTS: Small but statistically significant, positive associations were found between teacher distress and internalizing (b = 0.02; 95% CI [0.01, 0.04], p < 0.05) and externalizing symptoms (b = 0.03; 95% CI [0.01, 0.05], p < 0.001) among elementary students only. Student perceptions of school safety moderated the association between teacher distress and externalizing symptoms among elementary students, whereby the positive association was magnified among students reporting lower school safety. CONCLUSIONS: Findings from this study highlight the importance of concurrently addressing the mental health needs of educators and students. School safety represents a modifiable target for prevention and intervention efforts in schools that could serve to promote student mental health and mitigate potential risk factors in schools.

Diverging trends in alcohol use and mental health in Australian adolescents: A cross-cohort comparison of trends in co-occurrence.

Background: In recent years, psychological distress in Western countries has rapidly increased among older adolescents while alcohol use has declined, though little is known about younger adolescents. It is also unclear if and how these trends relate to co-occurring alcohol use and distress. This study sought to examine temporal changes in the prevalence of distress, alcohol use, and their co-occurrence among young Australians. Methods: This study used data from 13,388 youth in their early teens (aged 12-14). Differences in the prevalence of high psychological distress (Kessler-6 ≥ 13), any alcohol use (standard drink in past 3/6 months), and their co-occurrence across cohorts (2007, 2012, 2014, 2019) were tested through log-binomial regression models. Changes in co-occurrence across cohorts were tested with cohort-by-alcohol interactions predicting distress, and vice-versa. Differential trends by sex were evaluated. Results: From 2007 to 2019, the prevalence of high distress more than doubled (4.6%-13.5%) while alcohol use decreased by ∼90% (11.8%-3.1%). Distress increased more-so among females, while alcohol use decreased more-so among males. The prevalence of high distress was significantly greater among adolescents who used alcohol compared to those who had not (>2 times higher), with this co-occurrence remaining consistent across cohorts. Conclusions: Psychological distress appears to be increasing similarly among youth in their early teens who do and do not use alcohol. At the same time, alcohol use is decreasing similarly among youth with and without distress. While alcohol use does not appear to be a driver of increases in distress, rates of co-occurring alcohol use and distress remain high. Addressing co-occurrence and distress-specific mechanisms remain necessary.

Measuring and understanding "quality of life" among emerging adults in a substance use program.

OBJECTIVE: This work focuses on understanding quality of life and evaluating a brief quality of life measure in an outpatient emerging adult (17-25 years of age) substance use program. METHOD: Mixed methods were used including: (a) psychometric evaluation of the adapted MyLifeTracker (MLT) based on assessments completed four times throughout treatment (n = 100) and (b) qualitative interviews with 12 emerging adults in the program. The study was codesigned, cofacilitated, and cointerpreted with emerging adults with lived experience. RESULTS: At intake, emerging adults reported quality of life scores of 3.7/10 on average and significantly improved (change M = 2.1 points, d = 0.86, p < .001) at the ∼12-week follow-up demonstrating program effects and sensitivity to change. Factor analysis suggested unidimensionality of the measure and internal consistency was high (ω = 0.81). MLT scores correlated in expected directions with other measures of quality of life, functioning, and mental health symptoms and demonstrated incremental validity in explaining variability in these measures over and above World Health Organization quality of life items. Emerging adults thought the five items (i.e., general well-being, day-to-day activities, relationships with friends, relationships with family, coping) generally captured the most important aspects of quality of life to them and had positive impressions regarding the use of this measure for measurement-based care. Other important aspects of quality of life included feeling a sense of meaning, purpose, motivation, and independence. CONCLUSION: Overall, the MLT demonstrated evidence of psychometric and content validity among emerging adults in substance use treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Refining the Universal, School-Based OurFutures Mental Health Program to Be Trauma Informed, Gender and Sexuality Diversity Affirmative, and Adherent to Proportionate Universalism: Mixed Methods Participatory Design Process.

BACKGROUND: Mental disorders are the leading cause of disease burden among youth. Effective prevention of mental disorders during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders, such as depression and anxiety. OBJECTIVE: This study aims to report the adaptation process of an established, universal, school-based prevention program for depression and anxiety, OurFutures Mental Health. Using a 4-stage process; triangulating quantitative, qualitative, and evidence syntheses; and centering the voices of young people, the revised program is trauma-informed; lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, and otherwise gender and sexuality diverse (LGBTQA+) affirmative; relevant to contemporary youth; and designed to tailor intervention dosage to those who need it most (proportionate universalism). METHODS: Program adaptation occurred from April 2022 to July 2023 and involved 4 stages. Stage 1 comprised mixed methods analysis of student evaluation data (n=762; mean age 13.5, SD 0.62 y), collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of 3 focus groups with high school students (n=39); regular meetings with a purpose-built, 8-member LGBTQA+ youth advisory committee; and 2 individual semistructured, in-depth interviews with LGBTQA+ young people via Zoom (Zoom Video Communications) or WhatsApp (Meta) text message. Stage 3 involved a clinical psychologist providing an in-depth review of all program materials with the view of enhancing readability, improving utility, and normalizing emotions while retaining key cognitive behavioral therapy elements. Finally, stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health. RESULTS: Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers, sourced from stages 1 to 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualized program content, classroom activities, and weekly student and teacher lesson summaries. CONCLUSIONS: The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings on universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster randomized controlled trial with up to 1400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate in universal school-based prevention of common mental disorders and ultimately improve the mental health and well-being of young people in schools.

Psychosocial interventions addressing suicidality in inpatient psychiatry: a scoping review protocol.

OBJECTIVE: The objective of this review is to provide an overview of the existing literature on psychosocial interventions aimed at addressing suicidality among adults in the context of an inpatient psychiatric admission. INTRODUCTION: For individuals admitted to a psychiatric inpatient unit, their risk of suicide in the period following discharge is significantly higher compared with the prevalence of death by suicide in the general population. During an inpatient admission, there is opportunity for supportive interventions that may lead to reduced risks of suicide. Yet, interventions that directly address suicidality have primarily been studied in outpatient settings. A broader understanding of inpatient interventions will assist clinicians in understanding key considerations when implementing suicide-related interventions in this setting. INCLUSION CRITERIA: Studies involving adult patients (≥18 years) that describe psychosocial interventions aiming to address suicidality in the context of inpatient psychiatry will be considered. Studies that only describe pharmacological interventions will be excluded, as will studies that describe psychosocial interventions initiated in the context of an outpatient setting. METHODS: We will search MEDLINE (Ovid), CINAHL (EBSCO), APA PsycINFO (EBSCOhost), the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science for studies in English and Spanish. Gray literature and materials will also be searched for using Google and websites relevant to the review topic. No date limit will be set. Two independent reviewers will screen titles and abstracts from studies that meet the inclusion criteria and review eligible studies at full text. Data will be extracted and synthesized and then presented in tabular and graphical formats accompanied by a narrative summary. DETAILS OF THE REVIEW AVAILABLE AT: Open Science Framework https://osf.io/5cwhx.

Is the association between psychological distress and risky alcohol consumption shifting over time? An age-period-cohort analysis of the Australian population.

This study explored age, period, and cohort effects associated with trends in psychological distress and risky alcohol consumption. Data came from 108,536 Australians aged 14-79 years old from birth cohorts between 1925-2005, endorsing past year alcohol use in the 2004-2019 Australian National Drug Strategy Household Surveys. Risky alcohol consumption was split into exceeding weekly national drinking limits (>10 drinks per week) or daily limits (>4 drinks per day). An extended hierarchical age-period-cohort model was used to investigate differential effects on trends in psychological distress. Psychological distress showed an inverse U-shape throughout the lifespan with a peak in distress at age 60. Exceeding weekly alcohol limits was positively related to psychological distress prior to age 40 while exceeding daily alcohol limits remained positively related across the lifespan. There were relatively flat period effects, with no alcohol-related changes in psychological distress across years. Lastly, psychological distress gradually increased across birth cohorts until a notable spike among Australians born from 1980-2005 alongside weakening alcohol-related cohort effects. Overall, the recent increases in psychological distress did not appear to be meaningfully explained by risky alcohol consumption though risky alcohol consumption remained an important factor to consider alongside psychological distress.

Initial insights from a quality improvement initiative to develop an evidence-informed young adult substance use program.

High rates of substance misuse during emerging adulthood (~17-25 years of age, also referred to as young adulthood) require developmentally appropriate clinical programs. This article outlines: 1) the development of an evidence-informed young adult outpatient substance use program that takes a biopsychosocial patient-centred approach to care; 2) a quality improvement process and protocol; and 3) the patient characteristics of an initial cohort. Literature reviews, program reviews, environmental scans, and consultations with interested parties (including individuals with lived expertise) were used to develop the program. A 12-week measurement-based care program was developed comprising: 1) individual measurement-based care and motivational enhancement therapy sessions; 2) group programming focused on cognitive behavioural therapy, mindfulness, distress tolerance, and emotional regulation; 3) clinical consultations for diagnostic clarification and/or medication review; and 4) an independent Community Reinforcement Approach Family Training (CRAFT) group for loved ones. A measurement system was concurrently created to collect clinical and program evaluation data at six time points. In the first 21 months of the program, 152 young adults enrolled in the program (mean age = 21 years old, 47% female gender) primarily reporting treatment targets of cannabis (68%) and alcohol (63%) and almost all presenting with co-occurring mental health concerns (95%). The initial cohort who completed the program showed symptom improvements. Collectively, the program demonstrates the feasibility of developing an evidence-informed young adult substance use program using measurement-based care, but also the need for flexibility and ongoing monitoring to meet local needs.

Des taux élevés d'abus de substances durant la vie d'adulte émergente (~17­25 ans d'âge, aussi nommé jeune âge adulte) nécessitent des programmes cliniques appropriés au développement. Cet article présente: 1) le développement d'un programme fondé sur des données probantes sur l'utilisation de substances des jeunes patients ambulatoires qui adopte une approche biopsychosociale axée sur les patients; 2) un processus et un protocole d'amélioration de la qualité; et 3) les caractéristiques du patient d'une cohorte initiale. Les revues de la littérature, les examens de programme, les analyses de l'environnement, et les consultations avec les parties intéressées (notamment les personnes ayant une expertise vécue) ont servi à élaborer le programme. Un programme de soins de 12 semaines basés sur la mesure a été élaboré qui comprend: 1) ides soins individuels basés sur la mesure et des séances de thérapie d'amélioration de la motivation; 2) une programmation de groupe axée sur la thérapie cognitivo-comportementale, la pleine conscience, la tolérance à la détresse, et la régulation émotionnelle; 3) les consultations cliniques pour la clarification du diagnostic et/ou la revue des médicaments; et (4) un groupe indépendant d'Approche de renforcement communautaire Formation familiale (ARCFF) pour les êtres chers. Un système de mesure a été créé simultanément pour recueillir les données cliniques et d'évaluation du programme à six points dans le temps. Dans les 21 premiers mois du programme, 152 jeunes adultes s'y sont inscrits (âge moyen = 21 ans, 47 % de sexe féminin) et déclaraient principalement que les cibles du traitement étaient le cannabis (68 %) et l'alcool (63 %) et presque tous présentaient des problèmes de santé mentale co-occurrents (95 %). La cohorte initiale qui a terminé le programme présentait des améliorations des symptômes. Collectivement, le programme démontre la faisabilité de développer un programme d'utilisation de substances pour jeunes adultes fondé sur des données probantes et utilisant des soins basés sur la mesure, mais également le besoin de flexibilité et de surveillance constante pour répondre aux besoins locaux.

Development and psychometric evaluation of a teacher version of the Ontario child health study emotional behavioural scales (OCHS-EBS-T) for measuring selected DSM-5 disorders in elementary school-aged children.

This paper describes the development and psychometric properties of a teacher version of the Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS-T) for dimensional measurement of six psychiatric disorders in elementary school-aged children based on DSM-5 criteria. Psychometric evaluation of the item and scale properties was conducted in a large, general population study of elementary teacher assessments of 3,072 children aged 4 to 13 years in 2,354 families in Ontario, Canada. Content validity, internal construct validity and internal consistency reliability of the six disorder subscales were assessed. Structural equation modelling was used to assess measurement invariance, internal and external convergent and discriminant validity. Confirmatory factor analyses confirmed unidimensionality of subscales and adequate item-fit to all scales. Measurement equivalence was demonstrated fully for four subscales and partially for two. Internal consistency reliability for all subscales exceeded 0.78, except for the conduct disorder scale in 12- to 13-year-olds. Evidence of internal convergent validity was demonstrated in all cases. Discriminant validity was demonstrated in 27 out of 30 correlation comparisons. External convergent and discriminant validity was demonstrated when comparing the OCHS-EBS-T to a parent/caregiver measure of disorders in 48 out of 60 correlation comparisons. All subscales independently predicted child mental health-related service contact.

Professor Hippo-on-Campus: Developing and evaluating an educational intervention to build mental health literacy among university faculty and staff.

Objective: The development and evaluation of the Professor Hippo-on-Campus Student Mental Health Education Program, a mental health literacy intervention for post-secondary faculty and staff, is described. It includes 3-hour virtual, asynchronous e-modules and an optional 2-hour, synchronous workshop. Participants: All faculty and staff in a single university were invited to participate (February 2020-January 2021). Methods: Pre-and post-module and post-workshop surveys were conducted, assessing knowledge, attitudes, stigma, behavioral intentions, and confidence. Paired t-tests and regressions assessed change. Satisfaction was assessed through closed and open-ended questions, analyzed descriptively and through qualitative content analysis. Results: Four hundred and fifty staff and faculty completed the pre-survey, 262 completed the post-survey, and 122 completed a workshop survey. Participation resulted in improvements in knowledge, attitudes, stigma, and confidence with high levels of satisfaction. Conclusion: The program provides tailored student mental health training to post-secondary staff and faculty, which appears to increase their mental health literacy.