Survey of Australian and Canadian Community Pharmacists' Experiences With Patients at Risk of Suicide.

OBJECTIVE: The study's objective was to examine Canadian and Australian community pharmacists' experiences with people at risk of suicide. METHODS: A survey was developed and administered online. Countries were compared by Fisher's exact and t tests. Multivariable logistic-regression analysis was used to identify variables associated with preparedness to help someone in a suicidal crisis. RESULTS: The survey was completed by 235 Canadian and 161 Australian pharmacists. Most (85%) interacted with someone at risk of suicide at least once, and 66% experienced voluntary patient disclosure of suicidal thoughts. More Australians than Canadians had mental health crisis training (p<0.001). Preparedness to help in a suicidal crisis was negatively associated with being Canadian, having a patient who died by suicide, lacking training and confidence, and permissive attitudes toward suicide. CONCLUSIONS: Several perceived barriers impede pharmacists' abilities to help patients who voluntarily disclose suicidal thoughts. Gatekeeper and related suicide prevention strategy training for community pharmacists is warranted.

Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania.

Addressing depression in young people is a health-care policy need in sub-Saharan Africa. There exists poor mental health literacy, high levels of stigma, and weak capacity at the community level to address this health-care need. These challenges are significant barriers to accessing mental health care for depression, soon to be the largest single contributor to the global burden of disease. We here describe an innovative approach that addresses these issues simultaneously while concurrently strengthening key mental health components in existing education and health-care systems as successfully applied in Malawi and replicated in Tanzania. Improving the pathway to care for young people with depression requires the following: improving mental health literacy (MHL) of communities, youth, and teachers; enhancing case identification and linking schools to community health clinics; improving the capacity of community health-care providers to identify, diagnose, and effectively treat depression in youth. Funded by Grand Challenges Canada, we developed and applied a program called "An Integrated Approach to Addressing the Challenge of Depression Among the Youth in Malawi and Tanzania" (IACD). This was an example of, a horizontally integrated pathway to care model designed to be applied in low-resource settings. The model is designed to 1) improve awareness/knowledge of mental health and mental disorders (especially depression) in communities; 2) enhance mental health literacy among youth and teachers within schools; 3) enhance capacity for teachers to identify students with possible depression; 4) create linkages between schools and community health clinics for improved access to mental health care for youth identified with possible depression; and 5) enhance the capacity of community-based health-care providers to identify, diagnose, and effectively treat youth with depression. With the use of interactive, youth-informed weekly radio programs, mental health curriculum training for teachers and peer educators in secondary schools, and a clinical competency training program for community-based health workers, the innovation created a "hub and spoke" model for improving mental health care for young people. Positive results obtained in Malawi and replicated in Tanzania suggest that this approach may provide an effective and potentially sustainable framework for enhancing youth mental health care, thus providing a policy ready framework that can be considered for application in sub-Saharan Africa.

Validation of the Kutcher Adolescent Depression Scale in a Caribbean student sample.

BACKGROUND: Research on depression among Caribbean children has been limited by a lack of valid and reliable measures. We addressed this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Kutcher Adolescent Depression Rating Scale (KADS) among a wide cross-section of the student population attending elementary schools in Jamaica and Barbados. METHODS: Students enrolled in grade 6 in a cross-section of schools in Jamaica and Barbados were invited to participate in the study. Schools included a balance of government-funded public schools and privately funded preparatory schools. All schools that were invited to participate accepted, and all grade 6 classrooms in each school were sampled. The following instruments were administered to the students during the fall semester of 2015: KADS, Adolescent Depression Rating Scale (ADRS), major depression disorder subscale of the Revised Children's Anxiety and Depression Scale (RCADS), and state and trait anxiety visual analogue scales. RESULTS: In total, 759 children (376 girls [49.5%] and 363 boys [47.8%]; in 20 cases [2.6%], sex was missing) with a mean age of 10.7 (standard deviation 0.66) years (median 11.0 yr) took part in the study. Overall, the KADS had an acceptable degree of reliability (α = 0.76). The instrument had reasonably good concurrent validity, as evidenced by strong correlations with scores on the ADRS (r = 0.62) and the major depression disorder subscale of the RCADS (r = -0.61). It had acceptable discriminant validity, as shown through low correlations with the state and trait anxiety visual analogue scales (r = 0.21 and 0.18, respectively). This pattern of results suggests that a large part (37%) of the variance underlying the KADS assesses depression, and a smaller degree of the variance (3%-4%) measures a conceptually similar but distinct concept. INTERPRETATION: The KADS is a reliable and valid measure for assessing depressive symptoms among Jamaican and Barbadian elementary school students. The sample may not be representative of all Caribbean children.

Community pharmacists' experiences and people at risk of suicide in Canada and Australia: a thematic analysis.

PURPOSE: To explore Canadian and Australian community pharmacists' practice experiences in caring for people at risk of suicide. METHODS: We conducted a thematic analysis of 176 responses to an open-ended extension question in an online survey. RESULTS: Four themes were identified and include referrals and triage, accessibility for confiding, emotional toll, and stigma. Subthemes included gatekeeping the medication supply, sole disclosure, planning for end of life, concerns of support people, assessing the validity of suicidality, gaps in the system, not directly asking, ill-equipped, resources in the pharmacy, relying on others to continue care, and attention seeking. CONCLUSIONS: Community pharmacists are caring for patients at risk of suicide frequently, and often with patients seeking the help of pharmacists directly. Pharmacists engage in activities and actions that would be considered outside of the traditional dispensing roles and provide support and intervention to people at risk of suicide through collaboration and other mechanisms. Further research to determine appropriate education and training and postvention supports is required.

Clinic outcomes of the Pathway to Care Model: A cross-sectional survey of adolescent depression in Malawi.

BACKGROUND: Depression is one of the leading contributors to the global burden of disease and often has an onset during adolescence. While effective treatments are available, many low-income countries, such as Malawi, lack appropriately trained health providers in community health settings, and this limits access to effective mental healthcare for young people with depression. To address this need, a Canadian-developed youth depression Pathway to Care Model, linking school-based mental health literacy interventions to training of community healthcare providers, was adapted for use in Malawi and successfully applied. METHODS: A sample of healthcare providers (N = 25) from community health clinics (N = 9) were trained in the use of comprehensive, systematic clinical interventions, addressing the identification, diagnosis, and treatment of depression in youth who had been referred from schools where mental health literacy interventions had been implemented. Referral outcomes were obtained using a standardised clinical record form. RESULTS: Over 120 clinical outcome forms were available for analysis. Seventy percent of youth referred by their teachers were diagnosed with depression. Most youth diagnosed with depression identified physical symptoms as their primary difficulty. Available standardised outcome measures applied by clinicians indicated that, overall, youth showed positive outcomes as a result of treatment. CONCLUSIONS: Community healthcare providers in Malawi were trained in the identification, diagnosis, and treatment of youth depression. When this training was applied in usual clinical care to youth referred from schools, it led to generally favourable clinical outcomes. To our knowledge, this is the first demonstration of a clinically feasible intervention that results in positive outcomes for young people with depression in Malawi, and it may provide a useful model to replicate elsewhere in sub-Saharan Africa.

Impact of a Mental Health Curriculum on Knowledge and Stigma Among High School Students: A Randomized Controlled Trial.

OBJECTIVE: This study evaluated the effectiveness of a school-based mental health literacy intervention for adolescents on knowledge and stigma. METHOD: A total of 24 high schools and 534 students in the regional area of Ottawa, Ontario, Canada participated in this randomized controlled trial. Schools were randomly assigned to either the curriculum or control condition. The curriculum was integrated into the province's grade 11 and 12 "Healthy Living" courses and was delivered by teachers. Changes in mental health knowledge and stigma were measured using pre- and posttest questionnaires. Descriptive analyses were conducted to provide sample characteristics, and multilevel modeling was used to examine study outcomes. RESULTS: For the curriculum condition, there was a significant change in stigma scores over time (p = .001), with positive attitudes toward mental illness increasing from pre to post. There was also a significant change in knowledge scores over time (p < .001), with knowledge scores increasing from pre to post. No significant changes in knowledge or stigma were found for participants in the control condition. A meaningful relationship was found whereby increases in knowledge significantly predicted increases in positive attitudes toward mental health (p < .001). CONCLUSION: This is the first large randomized controlled trial to demonstrate the effectiveness in mental health literacy of an integrated, manualized mental health educational resource for high school students on knowledge and stigma. Findings also support the applicability by teachers and suggest the potential for broad-based implementation of the educational curriculum in high schools. Replication and further studies are warranted. Clinical trial registration information-Impact of a Mental Health Curriculum for High School Students on Knowledge and Stigma; http://clinicaltrials.gov/; NCT02561780.

System struggles and substitutes: A qualitative study of general practitioner and psychiatrist experiences of prescribing antipsychotics to children and adolescents.

There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians' experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers' experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.

A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews.

OBJECTIVE: We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts. METHODS: Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings. RESULTS: No included review addressing school-based prevention (n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts (n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%. CONCLUSIONS: Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.

Contribution to the validation of the Kutcher Adolescent Depression Scale (KADS-6) in a Portuguese population / Contribuição para a validação da Kutcher Adolescent Depression Scale (KADS-6) para a população Portuguesa

The KADS-6 is a self-report assessment instrument known for its ease application in assessing depression in young people. This study aimed to contribute to the validation of the Portuguese version of this tool and analyze its psychometric characteristics in comparison with other self-report instruments for depression in adolescents, in Portugal. Two samples were collected, a non-clinical group of in school youth (n=773; 52.4% male) and a clinical sample (n=134 youth; 44% male). Comparisons also used the Beck Depression Inventory (BDI-II) and the Children's Depression Inventory (CDI). Results: The factor analysis revealed the unidimensionality of the measure. The KADS-6 demonstrated good internal consistency (Cronbach's alpha) in both clinical (.74) and school (.80) samples. Its convergent validity with the BDI-II and CDI was r=.44; r=.61, respectively in the clinical sample and r=.60; r=.57 in the school sample. The KADS-6, a short and time efficient instrument, showed good psychometric characteristics in terms of internal consistency and convergent validity in comparison with the BDI-II and the CDI. Given its ease of use and scoring, the KADS-6 could be considered for use in both school and clinical settings when addressing adolescent depression. (AU)

A Kutcher Adolescent Depression Scale (KADS-6) é uma medida de autorrelato, conhecida pela sua facilidade de aplicação na avaliação da depressão em jovens. Este estudo teve como objetivos contribuir para a validação da versão portuguesa desta ferramenta e analisar as suas características psicométricas em comparação com outros instrumentos de autorrelato para a avaliação da depressão em adolescentes, em Portugal. Foram recolhidas duas amostras, uma não clínica, formada por jovens em contexto escolar (n=773; 52,4% rapazes) e outra amostra clínica (n=134; 44% rapazes). Foram também utilizados o Beck Depression Inventory (BDI-II) e o Children's Depression Inventory (CDI). A análise fatorial revelou a unidimensionalidade da medida. A KADS-6 demonstrou boa consistência interna (alfa de Cronbach) nas amostras não clínica (.74) e clínica (.80). A validade convergente com a BDI-II e CDI foi, respetivamente, r = .44; r = .61 na amostra clínica e r = .60; r = .57 na amostra não clínica. Conclui-se que a KADS-6 mostrou boas características psicométricas em termos de consistência interna e validade convergente em comparação com o BDI-II e o CDI. Dada a sua facilidade de uso e interpretação, a KADS-6 pode ser considerada para uso em contexto escolar e em ambientes clínicos, para avaliar a depressão adolescente. (AU)

Evergreen: creating a child and youth mental health framework for Canada.

Mental disorders affect many young Canadians, and most do not access care, partly because of lack of health policy-driven programs and services. Recognizing this policy need, the Child and Youth Advisory Committee of the Mental Health Commission of Canada created Evergreen: A Child and Youth Mental Health Framework for Canada. Evergreen was designed as a framework to guide development, implementation, and review of child and youth mental health policies, plans, and services across Canada. This Open Forum report describes the framework and the innovative features used to create Evergreen, including the advisory committee structure, application of qualitative research methods and tools, informed public input, and use of online collaborative writing technologies.

Youth, caregiver, and prescriber experiences of antipsychotic-related weight gain.

Objectives. To explore the lived experience of youth, caregivers, and prescribers with antipsychotic medications. Design. We conducted a qualitative interpretive phenomenology study. Youth aged 11 to 25 with recent experience taking antipsychotics, the caregivers of youth taking antipsychotics, and the prescribers of antipsychotics were recruited. Subjects. Eighteen youth, 10 caregivers (parents), and 11 prescribers participated. Results. Eleven of 18 youth, six of ten parents, and all prescribers discussed antipsychotic-related weight gain. Participants were attuned to the numeric weight changes usually measured in pounds. Significant discussions occurred around weight changes in the context of body image, adherence and persistence, managing weight increases, and metabolic effects. These concepts were often inextricably linked but maintained the significance as separate issues. Participants discussed tradeoffs regarding the perceived benefits and risks of weight gain, often with uncertainty and inadequate information regarding the short- and long-term consequences. Conclusion. Antipsychotic-related weight gain in youth influences body image and weight management strategies and impacts treatment courses with respect to adherence and persistence. In our study, the experience of monitoring for weight and metabolic changes was primarily reactive in nature. Participants expressed ambiguity regarding the short- and long-term consequences of weight and metabolic changes.

The science of brain and biological development: implications for mental health research, practice and policy.

OBJECTIVE: This article provides a summary of the complex interaction between genetics and experience which shapes the development of neurobiological systems, particularly in the prenatal/early childhood and adolescent periods. METHOD: Key factors that influence brain structure and function, and mechanisms through which experience impacts risk for mental health disorders presented in this Special Issue are linked with suggestions for future directions in child and youth mental health research, policy and practice. RESULTS: SUGGESTED AREAS TO APPLY EVIDENCE PRESENTED IN THIS SPECIAL ISSUE INCLUDE: enhancing research in the differential impact of psychoactive drugs on the developing brain; introducing content on brain and biological development to professional development and post-secondary curriculum; increased involvement of the family in recognition, prevention and treatment of mental health disorders; and, creation of evidenced-informed child and youth mental health policies. CONCLUSIONS: As more evidence accumulates on how early experience impacts the structure and function of the developing brain, these findings should be applied to how mental illness may be better prevented, recognized and treated in child and adolescent populations.

Before and after conception . . . Engaging parents of today and parents of tomorrow.

OBJECTIVE: This paper describes a unique relationship and engagement of a leading NGO Family Organization (The FORCE); a highly respected and extensively distributed magazine directed towards parents (Today's Parent) and an academic institution (The Sun Life Financial Chair in Adolescent Mental Health: Dalhousie University and the IWK Health Center in a project that was able to take the national pulse of parent perspectives on child and youth mental health. METHOD: A survey was co-created by parents, academia and media and went live in June 2009 on the Today's Parent website. Such a survey had not been done before. RESULTS: The national survey resulted in a response from almost 4,500 parents. Some of the preliminary findings included: parents do think about mental health concerns of children, including parents of children who don't have any problems and it is often media coverage often prompts parents to think about these issues. One quarter of the respondents were not aware of mental health programs and services for children and youth in their community. Many families waited for more than a year to obtain services. The respondents believed that schools should become more active in addressing mental health needs for children and youth. CONCLUSION: Partnerships involving parent organizations, media and academia have the potential to collaboratively develop processes and methods that can provide a unique window on how to understand various aspects of child and youth mental health. Such partnerships should be considered for future research and information gathering activities.

Problems with access to adolescent mental health care can lead to dealings with the criminal justice system.

Mental disorders collectively constitute the largest burden of disease in young people. They have substantial negative short- and long-term outcomes across many domains, yet early identification and effective intervention can improve outcomes and can often lead to recovery. Unfortunately, many young people do not receive the mental health care they require and may consequently enter the justice system. Studies of incarcerated youths show that up to 70% of them have mental disorders. Many of these youth receive primarily custodial care. A variety of social, legal and medical interventions can and should be implemented to ensure that young people suffering from mental disorders do not inappropriately enter the justice system due to lack of access to health care and other services.