Continuity of mental disorders in children with chronic physical illness.

Data on the chronicity of mental disorder in children with chronic physical illness (CPI) are limited. We examined the prevalence and predictors of homotypic and heterotypic continuity of mental disorder in children with CPI. A sample of 263 children aged 2-16 years with physician-diagnosed CPI were recruited from outpatient clinics (e.g., dermatology, respiratory) at a Canadian pediatric academic hospital and followed for 24 months. Parent and child-reported mental disorders (mood, anxiety, behavioral, attention-deficit hyperactivity disorder [ADHD]) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline, 6, 12, and 24 months. Marginal regression models were computed to identify clinical, parent, and demographic factors associated with mental comorbidity over time. Mental disorder was observed in 24-27% of children with CPI based on child reports and 35-39% based on parent reports. Parent-reported models revealed significant homotypic continuity for all mental disorders (ORs = 4.2-9.5), and heterotypic continuity between mood and anxiety disorders (OR = 2.2), ADHD and behavioral disorders (OR = 5.1), and behavioral and each mental disorder (ORs = 6.7-8.4). Child-reported models revealed significant homotypic continuity for mood (OR = 8.8) and anxiety disorder (OR = 6.0), and heterotypic continuity between anxiety and mood disorders (OR = 12.4). Child disability (ORs = 1.3-1.5) and parent psychopathology (ORs = 1.2-1.8) were the most consistent predictors of both child- and parent-reported mental disorder over time. Mental comorbidity was prevalent and persistent in children with CPI with homotypic and heterotypic continuity common across informants. Child disability and parent psychopathology may be priority targets within integrated family-centered models of care to prevent mental comorbidity in children with CPI.

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.

Cognitive and Mental Health of Young Mothers' Offspring: A Meta-analysis.

BACKGROUND AND OBJECTIVES: The nature and magnitude of the cognitive and mental health risks among the offspring of young mothers is not fully understood. Our objective is to examine the risk of mental disorders in these offspring. METHODS: Five databases (Medline, Embase, Web of Science, PsycINFO, and CINAHL) were searched from their inceptions until February 2022. Studies were eligible if they assessed offspring of young mothers (<21 years), contained a control group, and assessed any cognitive and/or mental health outcomes. Random-effects meta-analysis was used to generate standardized mean differences (SMDs) in infants (0-3 years), children (4-9), adolescents (10-19), and adults (20+). Methodological bias was assessed using the Newcastle-Ottawa Scale. RESULTS: 51 outcomes were meta-analyzed. Levels of cognitive and learning problems were higher among the infants (SMD = 0.30 [95% confidence interval 0.0-0.55]) and adolescents (SMD = 0.43 [0.24 to 0.62]) of young mothers. Adolescents had more symptoms of delinquency (SMD = 0.24 [0.12 to 0.36]). As adults, they are more often convicted of violent crimes (SMD = 0.36 [0.22 to 0.50]). Internalizing symptoms were higher in these offspring in childhood (SMD = 0.29 [0.14 to 0.45]) and adulthood (SMD = 0.35 [0.34 to 0.36]). This review uses unadjusted data and is thus unequipped to infer causality. Studies have high attrition and rely heavily on self-report. CONCLUSIONS: Young mothers' offspring have more cognitive, externalizing, and internalizing problems across the lifespan than individuals born to mothers ≥21 years of age. They may benefit from early detection and support.

Young mothers' use of and experiences with mental health care services in Ontario, Canada: a qualitative descriptive study.

BACKGROUND: Despite the high prevalence of mental health issues among young mothers, their subsequent needs for mental health care support does not correlate with their access and use of services. The purpose of this study, grounded in the experiences of young mothers living in Ontario, Canada, was to describe their experiences of using mental health services during the perinatal period, and to identify the attributes of services and professionals that influenced their decision to engage with mental health services. METHODS: As the qualitative component of a sequential explanatory mixed methods study, the principles of qualitative description informed sampling, data collection, and analysis decisions. In-depth, semi-structured interviews were conducted with a purposeful sample of 29 young mothers (≤ 21 years) who met diagnostic criteria for at least one psychiatric disorder, and who were ≥ 2 months postpartum. Interview data were triangulated with data from ecomaps and a sub-set of demographic data for this purposeful sample from the survey conducted in the quantitative study component. Qualitative data were analyzed using both conventional content analysis and reflexive thematic analysis; the subset of survey data extracted for these 29 participants were analyzed using descriptive statistics. RESULTS: Young mothers identified the need to have at least one individual, either an informal social support or formal service provider who they could talk to about their mental health. Among participants deciding to seek professional mental health support, their hesitancy to access services was grounded in past negative experiences or fears of being judged, being medicated, not being seen as an active partner in care decisions or experiencing increased child protection involvement. Participants identified organizational and provider attributes of those delivering mental health care that they perceived influenced their use of or engagement with services. CONCLUSION: Organizations or health/social care professionals providing mental health services to young pregnant or parenting mothers are recommended to implement trauma-and violence-informed care. This approach prioritizes the emotional and physical safety of individuals within the care environment. Applying this lens in service delivery also aligns with the needs of young mothers, including that they are actively listened to, treated with respect, and genuinely engaged as active partners in making decisions about their care and treatment.

Mental and psychosocial health among youth after their first psychiatric hospitalization: a feasibility study.

OBJECTIVE: This pilot study investigated the feasibility of studying 12-month readmission of youth aged 10-16 years following their first psychiatric hospitalization and changes in youth mental and psychosocial health prospectively. RESULTS: Inpatient youth with a first psychiatric hospitalization and their parents were recruited from a regional hospital in Canada. Data were collected at recruitment, and at 3-, 6-, and 12-months post-discharge. Repeated measures ANOVA was performed to assess changes in health outcomes. Nineteen eligible youth were approached and 15 (78.9%) consented to participate (13.9 ± 2.0 years, 73.3% female). Eleven youth (73.3%) gave permission to contact their parents, all of whom participated (39.2 ± 7.6 years). Four youth dropped out of the study (26.7%) and six youth-parent dyads completed all four follow-ups. The readmission rate was 20.0% (n = 3) over 12 months. Significant changes in youth-reported symptoms of conduct disorder (F = 3.0, p = 0.06) and adverse childhood experiences (F = 3.4, p = 0.05) were found. Changes in parent-reported youth mental health symptoms (F = 3.1, p = 0.06), particularly among internalizing disorders, youth health-related quality of life (F = 11.3, p < 0.01), and youth disability (F = 2.7, p = 0.08) were significant. This preliminary work demonstrates the feasibility of, and need to, engage youth and their families to understand their mental and psychosocial health during this vulnerable period of time.

Evaluation of parent and youth experiences in advisory groups as part of a mental healthcare clinical trial: protocol for a mixed-method study.

INTRODUCTION: Patient engagement in healthcare research is a necessity to ensure that research objectives align with priorities, outcomes and needs of the population under study, and to facilitate ease of implementation and adoption of findings. In clinical trials, there is an increasing focus on patient engagement during the planning and conduct of clinical trials due to the potential for ethical and methodological benefits. As patient engagement in clinical trials increases, there is a need to evaluate the approaches of these activities to contribute evidence on what is most appropriate and successful. The purpose of this study is to evaluate patient engagement processes and the activities of patient partners during and after a paediatric mental healthcare trial. METHODS AND ANALYSIS: Using a mixed-methods study design, we will evaluate patient partners' engagement activities across set time-points during the trial and after trial completion. In this study, the term 'patient partner' is inclusive of two groups of people with lived experience: (1) caregivers (parents, formal/informal caregivers and family), and (2) youth (aged 15-24 years). Engagement will be evaluated using the participant and project questionnaires of the Public and Patient Engagement Evaluation Tool (PPEET), followed sequentially by semi-structured interviews. Quantitative data from the PPEET questionnaire will be analysed and reported using descriptive statistics. Data from open-ended questions from the PPEET questionnaires and semi-structured interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION: Approval from Athabasca University Research Ethics Board will be obtained for this project. Findings will be disseminated at both academic and public venues whether in-person or online, and using platforms that are caregiver and youth friendly. TRIAL REGISTRATION NUMBER: NCT04902391.

An Innovative Model of Pediatric Emergency Department Mental Health Care: Protocol for a Multicenter Type 1 Effectiveness-Implementation Cluster Randomized Trial.

Over the past decade, visits to American and Canadian emergency departments (EDs) for child and youth mental health care have increased substantially.1,2 Acute mental health crises can occur as a result of a variety of concerns, including those that are life threatening (eg, suicide attempts), pose safety concerns (eg, suicidal intentions, aggressive behaviors, alcohol and other drug use), and are physically distressing to the child or youth (eg, panic attacks). ED health care providers play a vital role in assessing the safety and well-being of the child or youth and referring them to services for ongoing care.3,4 During the ED visit, assessment and care should pinpoint risks, inform treatment, and consider family needs and preferences as part of a patient-centered approach. Yet, this approach to care is not widely adopted in EDs. Most EDs do not require the use of pediatric-specific mental health tools to guide assessments or have patient-centered procedures in place to guide the care of patients with mental health emergencies.5-7 Our team believes these limitations have led to the provision of acute mental health care that can lack sufficient quality and efficiency. This study protocol describes a trial designed to evaluate if a novel mental health care bundle that was co-designed with parents and youth results in greater improvements in the well-being of children and youth 30 days after seeking ED care for mental health and/or substance misuse concerns compared with existing care protocols. We hypothesize that the bundle will positively impact child and youth well-being, while also providing cost-effective health care system benefits.

Prevalence and Correlates of Physical-mental Multimorbidity in Outpatient Children From a Pediatric Hospital in Canada.

OBJECTIVE: The aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity. METHOD: The sample included 263 children aged 2-16 years with a physician-diagnosed chronic physical illness recruited from the outpatient clinics at a pediatric hospital. Children were categorized by physical illness according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10. Parent and child-reported six-month mental illness was based on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). RESULTS: Overall, 101 (38%) of children had a parent-reported mental illness; 29 (25%) children self-reported mental illness. There were no differences in prevalence across ICD-10 classifications. Parent-child agreement on the MINI-KID was low (κ = 0.18), ranging from κ = 0.24 for specific phobia to κ = 0.03 for attention-deficit hyperactivity. From logistic regression modeling (odds ratio [OR] and 95% confidence interval), factors associated with multimorbidity were: child age (OR = 1.16 [1.04, 1.31]), male (OR = 3.76 [1.54, 9.22]), ≥$90,000 household income (OR = 2.57 [1.08, 6.22]), parental symptoms of depression (OR = 1.09 [1.03, 1.14]), and child disability (OR = 1.21 [1.13, 1.30]). Similar results were obtained when modeling number of mental illnesses. CONCLUSIONS: Findings suggest that six-month multimorbidity is common and similar across different physical illnesses. Level of disability is a robust, potentially modifiable correlate of multimorbidity that can be assessed routinely by health professionals in the pediatric setting to initiate early mental health intervention to reduce the incidence of multimorbidity in children.

COVID-19-Related Psychological and Psychosocial Distress Among Parents and Youth With Physical Illness: A Longitudinal Study.

Despite the initial thrust of research aimed at understanding the impact of the COVID-19 pandemic on youth with physical illness and their parents, knowledge gaps in the literature remain, providing the impetus for additional investigation. This study described changes in psychological distress from prior to during the COVID-19 pandemic for parents and youth with physical illness, compared parent-proxy and youth self-reported perceptions of COVID-19-related psychosocial health, and modeled factors associated with psychological and psychosocial distress. There were 147 parent-youth dyads (2-16 years) from MY LIFE-a longitudinal study of youth with physical illness. The Kessler-6 (K6) measured psychological distress for the time before the COVID-19 lockdown (December 19 to March 20) and during the pandemic (December 20 to March 21) among parents and youth. COVID-19-related psychosocial health was measured using the CRISIS. Parents and youth reported increases in K6 scores (d = 0.62 and 0.38). Parent-proxy reports on the K6 were lower vs. youth self-reports prior to and during the pandemic (d = 0.63 for both). In contrast, parents reported lower proxy CRISIS scores for worries (d = 0.38) and effects of social restrictions (d = 0.52). Pandemic parent K6 scores were associated with age, combined in-person and online schooling for youth, COVID-19-related worries, and effects of social restrictions. For youth, only COVID-19-related worries and effects of social restrictions were associated with K6 scores. Parent worries were associated with youth sex, parental stress, family functioning, online and combination learning, and social restrictions. Parental depression and worries were associated with effects of social restrictions. Youth worries were associated with online and combination learning, and social restrictions. Youth disability, online learning, and worries were associated with effects of social restrictions. Few clinical factors are associated with COVID-19-related psychological and psychosocial distress. Instead, parent/family factors and youth learning environment have prominent roles in predicting outcomes and have implications for the health, education, and social services systems.

Parent-Child Agreement on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).

OBJECTIVE: Multiple informants are often used in the assessment of child psychopathology; however, parent-child agreement is low in child psychiatry. The objective of this exploratory study was to assess informant agreement on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in a clinical sample of children with mental disorders and their parents, and to examine health and demographic factors associated with agreement. METHOD: MINI-KID results were analyzed for 88 parent-child dyads. Children were between 8-17 years old and were receiving in- or outpatient services for at least one mental disorder at a pediatric hospital. Kappas were calculated to assess parent-child agreement and logistic regression models were used to identify factors associated with agreement. RESULTS: Agreement was low to moderate (κ=0.19-0.41) across the MINI-KID modules. Household income was associated with agreement for major depression, generalized anxiety, and attention-deficit hyperactivity disorder. Recruitment setting and parent psychological distress were associated with agreement for generalized anxiety and separation anxiety, respectively. Age, sex, and child disability/impairment were not associated with agreement. CONCLUSIONS: Parent-child agreement on the MINI-KID was low to moderate, and few factors were associated with agreement. These initial findings reaffirm the need for multiple informants when assessing psychopathology in children and can be used by health professionals to facilitate parent-child discussions in clinical settings in child psychiatry.

OBJECTIFS: De multiples informateurs sont souvent utilisés pour évaluer la psychopathologie de l'enfant; cependant, l'entente parent-enfant est faible en psychiatrie de l'enfant. L'objectif de la présente étude exploratoire était d'évaluer l'entente des informateurs à l'égard du mini-entretien neuropsychiatrique international pour enfants et adolescents (MINI-KID) dans un échantillon clinique d'enfants souffrant de troubles mentaux et de leurs parents, et d'examiner les facteurs de santé et démographiques associés à l'entente. MÉTHODE: Le résultats du MINI-KID ont été analysés pour 88 dyades parent-enfant. Les enfants avaient entre 8 et 17 ans et recevaient des services ambulatoires ou hospitalisés pour au moins un trouble mental dans un hôpital psychiatrique. Les kappas ont été calculés pour évaluer l'entente parent-enfant et des modèles de régression logistique ont servi à identifier les facteurs associés à l'entente. RÉSULTATS: L'entente était de faible à modérée (κ = 0,19­0,41) dans tous les modules du MINI-KID. Le revenu du ménage était associé à l'entente pour la dépression majeure, l'anxiété généralisée, et le trouble de déficit de l'attention avec hyperactivité. Les paramètres du recrutement et la détresse psychologique parentale étaient associés à l'entente pour l'anxiété généralisée et l'angoisse de séparation respectivement. L'âge, le sexe et la déficience/incapacité de l'enfant n'étaient pas associés à l'entente. CONCLUSIONS: L'entente parent-enfant au MINI-KID était faible à modérée, et peu de facteurs étaient associés à l'entente. Ces premiers résultats réaffirment le besoin de multiples informateurs pour évaluer la psychopathologie des enfants et peuvent être utilisés par les professionnels de la santé pour animer les discussions parent-enfant dans les milieux cliniques de psychiatrie de l'enfant.

LIVES for families psychological first aid training programme to address COVID-19 psychological distress: a mixed methods acceptability and feasibility protocol.

INTRODUCTION: Best practice approaches for addressing COVID-19-related psychological distress among young people (<25 years) and their families remain unclear. Psychological first aid (PFA) is promoted by public health authorities to provide psychological support in the context of extreme events; however, there is limited evidence for its effectiveness. As a prerequisite to conducting a randomised controlled trial to examine programme effectiveness, this project is evaluating the acceptability and feasibility of implementing and evaluating a PFA training programme ('LIVES for Families') for mental health (MH) practitioners to improve their ability to recognise and respond to COVID-19-related psychological distress among their clients. METHODS AND ANALYSIS: We are using a triangulation mixed methods research design; complementary strands of quantitative and qualitative data are being collected in parallel and will be merged at the interpretation phase of the project. The quantitative strand uses a repeated measures design; a consecutive sample of MH practitioners (n=80) providing MH support to young people or their families are being recruited to participate in the LIVES for Families PFA training programme and complete quantitative measures at baseline (pretraining), 2-week and 6-month follow-up time points. The qualitative strand uses fundamental description and semistructured interviews with a subset of practitioners (n=30), as well as managers of MH agencies (n=20). A mixed methods joint display and associated narrative will generate a comprehensive understanding regarding acceptability and feasibility. ETHICS AND DISSEMINATION: The Hamilton Integrated Research Ethics Board approved the study (project number: 11295). Results will be shared broadly with the policy and practice community through publications, presentations and public webinars. As a brief, evidence-informed intervention, the LIVES for Families PFA training programme is suitable in its mode of delivery across care settings. The outcomes of this study could have international implications for mitigating the MH impacts of viral pandemics.

Cohort Profile: Multimorbidity in Children and Youth Across the Life-course (MY LIFE) Study.

OBJECTIVE: This manuscript serves to provide an overview of the methods of the Multimorbidity in Children and Youth across the Life-course (MY LIFE) study, profile sample characteristics of the cohort, and provide baseline estimates of multimorbidity to foster collaboration with clinical and research colleagues across Canada. METHOD: MY LIFE is comprised of 263 children (2-16 years) with a physical illness recruited from McMaster Children's Hospital, their primary caregiving parent, and their closest-aged sibling. Participants are followed with data collection at recruitment, 6, 12, and 24 months which includes structured interviews, self-reported measures, and biological samples and occur in a private research office or at participants' homes. Post-COVID-19, data collection transitioned to mail and telephone surveys. RESULTS: At recruitment, children were 9.4 (4.2) years of age and 52.7% were male. The mean duration of their physical illness was 4.5 (4.1) years; 25% represent incident cases (duration <1 year). Most (69.7%) had healthy body weight and intelligence in the average range (73.5%). Overall, 38.2% of children screened positive for ≥1 mental illness according to parent report (24.8% screened positive based on child self-report). Compared to 2016 Census data, the MY LIFE cohort overrepresents families of higher socioeconomic status. CONCLUSIONS: Multimorbidity is common among children and these baseline data will serve to measure relative changes in the mental health of children with physical illness over time. MY LIFE will provide new information for understanding multimorbidity among children, though underrepresentation of lower socioeconomic families may have implications for the generalizability of findings.

OBJECTIF: Le présent manuscrit sert à présenter un aperçu des méthodes de l'étude sur la multimorbidité chez les enfants et les jeunes tout au long de la vie (MA VIE), à esquisser des caractéristiques d'échantillon de la cohorte et à fournir des estimations de base de la multimorbidité pour faciliter la collaboration avec les collègues cliniques et chercheurs du Canada. MÉTHODE: MA VIE comprend 263 enfants (de 2 à 16 ans) souffrant d'une maladie physique recrutés à l'hôpital pour enfants de McMaster, leur principal parent aidant, et leurs frères et sœurs les plus rapprochés en âge. Les participants sont suivis par une collecte de données lors du recrutement, à 6, 12, et 24 mois, ce qui comporte des entrevues structurées, des mesures auto-déclarées, et des échantillons biologiques qui sont prélevés dans un bureau privé de la recherche ou au domicile de participants. La collecte de données post-COVID-19 a effectué une transition par la poste et les sondages par téléphone. RÉSULTATS: Lors du recrutement, les enfants avaient 9,4 (4,2) ans et 52,7 % étaient de sexe masculin. La durée moyenne de leur maladie physique était de 4,5 (4,1) ans; 25 % représentaient des cas incidents (durée < 1 an). La plupart (69,7 %) avait un poids corporel sain et une intelligence dans la moyenne (73,5 %). En général, 38,2 % des enfants avaient un dépistage positif pour ≥ 1 maladie mentale selon le rapport des parents (24,8 % avaient un dépistage positif selon l'auto-déclaration des enfants). Comparativement aux données du recensement de 2016, la cohorte MA VIE surreprésente les familles de statut socio-économique plus élevé. CONCLUSIONS: La multimorbidité est commune chez les enfants et ces données de départ serviront à mesurer les changements relatifs de la santé mentale des enfants souffrant de maladie physique avec le temps. MA VIE fournira de nouvelles informations pour comprendre la multimorbidité chez les enfants, quoique la sous-représentation des familles au faible statut socio-économique puisse avoir des implications pour la généralisabilité des résultats.

Mental Health Care Costs Among Youth with Comorbid Mental Disorders.

This exploratory study described the distribution of mental health service costs in youth with mental disorder and determined if costs differed for youth with comorbid internalizing and externalizing disorder compared to those with comorbid internalizing disorders. Data come from youth (8-17 years; n=75) receiving mental health services at a children's hospital in Canada. Billing amounts specified in the Health Insurance Act of Ontario were used to estimate costs. Overall, past-year service use costs were $7436.63. Hospitalizations represented the largest cost. Youth with comorbid internalizing and externalizing disorders had higher total (ß=0.81 [0.17, 1.45]), hospital (ß=0.93 [0.03, 1.84]), and professional (ß=0.87 [0.04, 1.69]) costs. These preliminary findings suggest that comorbidity type is associated with the costs of past-year mental health services used by youth. Research is needed to understand the reasons for elevated costs and whether the increased services used by youth with comorbid internalizing and externalizing disorders are effective.

Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis.

OBJECTIVE: Primary care practitioners determine access to care for many preschool children with mental health (MH) problems. This study examined rates of mental health (MH) problem identification in preschoolers within primary healthcare settings, related service use, and MH status at follow-up. The findings may inform evidence-based policy and practice development for preschool MH. METHOD: For this systematic review, MEDLINE®, EMBASE®, PsycInfo®, and ERIC ® were searched from inception to March 7, 2018 for reports in which a screening measure was used to identify MH problems in children aged 24-72 months, seen in primary and community health care settings. Meta-analyses, using random effects models to provide pooled estimates, were used when three or more studies examined identification rates. Findings on service use and persistence of disorders are summarized. RESULTS: Thirty-five publications representing 21 studies met the inclusion criteria. MH problems were identified in 17.6% of preschoolers (95% Confidence Interval (CI): 11.1-24.1), Q = 4.9, p > 0.1 by primary/community healthcare practitioners. Psychiatric diagnoses were identified in 18.4% of preschoolers (95% CI: 12.3 - 24.4), Q= 1.6, p > 0.1. Based on three studies, parents of 67-72% of identified children received advice and 26-42% received specialist referrals. In the subset of studies examining persistence of MH disorders, 25-67% of identified children had MH disorders after one to three years. CONCLUSION: While the identification rate by primary/community practitioners is similar to the diagnostic rate, these may not consistently be the same children. Substantial variability in management and outcomes indicate need for more rigorous evaluation of primary care services for this population.

OBJECTIF: Les praticiens des soins primaires déterminent l'accès aux soins pour de nombreux enfants d'âge préscolaire souffrant de problèmes de santé mentale (SM). La présente étude a examiné les taux d'identification des problèmes de SM chez les enfants d'âge préscolaire dans le contexte de soins primaires, de l'utilisation des services connexes et de l'état de la SM au suivi. Les résultats peuvent éclairer l'élaboration des politiques et des pratiques fondées sur des données probantes pour la SM préscolaire. MÉTHODE: La recherche pour cette revue systématique a été menée dans MEDLINE®, EMBASE®, PsycInfo®, et ERIC ® du début au 7 mars 2018, et ciblait des études utilisant une mesure de dépistage pour identifier les problèmes de santé mentale chez les 24 à 72 mois, vus dans les soins primaires et communautaires. Les méta-analyses, utilisant des modèles à effets aléatoires pour produire des estimations regroupées, ont été utilisées quand trois ou plusieurs études examinaient les taux d'identification. Les résultats de l'utilisation des services et de la persistance des troubles sont résumés. RÉSULTATS: Trente-cinq publications représentant 21 études satisfaisaient aux critères d'inclusion. Des problèmes de SM ont été identifiés chez 17,6% des enfants d'âge préscolaire (intervalle de confiance IC à 95%: 11,1 à 24,1; Q = 4,9, p > 0,1) par des praticiens des soins primaires/communautaires. Des diagnostics psychiatriques ont été posés chez 18,4 % des enfants d'âge préscolaire (IC à 95%: 12,3 à 24,4; Q = 1,6; p > 0,1). Selon trois études, les parents de 67 à 72% des enfants identifiés recevaient des conseils, 26 à 42 % étaient adressés à des spécialistes. Dans le sous-ensemble des études qui examinaient la persistance des troubles de SM, 25% à 67% des enfants identifiés avaient des troubles de SM d'ici 1 à 3 ans. CONCLUSION: Même si le taux d'identification par les praticiens des soins primaires /communautaires est semblable au taux de diagnostics, il ne s'agit peut-être pas constamment des mêmes enfants. La variabilité substantielle de la prise en charge et des résultats indique le besoin d'une évaluation plus rigoureuse des services de soins primaires pour cette population.

The Mental Health of Young Canadian Mothers.

PURPOSE: Although many young mothers (aged <21 years) are exposed to multiple adversities that increase their risk for mental illness, prevalence data are largely limited self-report questionnaires estimating only the prevalence of postpartum depression. Gaining a greater understanding of the burden of a broader range of common mental illnesses affecting these young women has the potential to improve their health as well as the development and functioning of their children. METHODS: The Young Mothers Health Study recruited 450 mothers aged <21 years and 100 comparison mothers (aged >20 years old at first delivery) living in urban and rural central-west Ontario. Age-matched young mothers were also compared with 15- to 17-year-old women without children (N = 630) from the 2014 Ontario Child Health Study. The prevalence of current mental disorders was assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. RESULTS: Nearly 2 of 3 young mothers reported at least one mental health problem, and almost 40% had more than one. Young mothers were 2 to 4 times as likely to have an anxiety disorder (generalized anxiety disorder, separation anxiety disorder, social phobia, and specific phobia), attention-deficit/hyperactivity disorder, oppositional defiant disorder, or conduct disorder and were 2 to 4 times more likely to have more than one psychiatric problem than older comparison mothers or women aged 15-17 years. CONCLUSIONS: Given the high rates of mental health problems and complex needs of young mothers in Canada and the possible adverse effects of maternal psychopathology on their children, further efforts should be directed at engaging and treating this high-risk group.

Predictors of mentoring relationship quality: Investigation from the perspectives of youth and parent participants in Big Brothers Big Sisters of Canada one-to-one mentoring programs.

AIMS: This study examined predictors of mentoring relationship quality (MRQ) as reported by youth and parents participating in Big Brothers Big Sisters (BBBS) of Canada one-to-one mentoring programs. METHODS: Mentoring program capacity and other external supports, youth personal and environmental risk, youth and parent attitudes and motives, and mentoring relationship processes and attributes were examined as predictors of MRQ at 18 months following youth referral to the program using data from a longitudinal study of the Canadian BBBS mentoring programs. RESULTS: For youth (n = 335), significant predictors of MRQ included: minimal difficulties pairing youth and mentors, perceptions of shared attributes with their mentor, mentor emotional engagement and support, and longer relationships. For parents (n = 356) higher MRQ was correlated with parent report of minimal difficulties pairing youth and mentors, a high-quality relationship with the youth's mentor, and longer relationships. CONCLUSION: Implications for program and policy development are discussed.

Multimorbidity in Children and Youth Across the Life-course (MY LIFE): protocol of a Canadian prospective study.

INTRODUCTION: Multimorbidity, the co-occurrence of a chronic physical condition and mental disorder, affects a substantial number of children and youth and can lead to compromised quality of life, hardship for families, and an increased burden on the healthcare system. We are conducting a study to document the course of mental disorder in children and youth diagnosed with a chronic physical condition; identify predictors of child and youth multimorbidity; examine whether the effects of these predictors are moderated by relevant psychosocial and biological factors; explore potential inflammatory and stress biomarkers that mediate the onset of child and youth multimorbidity; and, assess whether multimorbidity in children and youth alters patterns of mental health service use. METHODS AND ANALYSIS: Multimorbidity in Children and Youth Across the Life-course (MY LIFE) is a prospective study. Two hundred and fifty children and youth aged 2-16 years diagnosed with a chronic physical condition along with one parent will be recruited from the outpatient clinics at a paediatric tertiary care centre. Data will be collected using a multi-informant, multimethod design at four time-points (at recruitment, and at 6, 12 and 24 months postrecruitment). Parents will provide reports for all children/youth. In addition, youth ≥10 years will self-report. Mental disorder will be assessed using structured interviews. On completion of data collection, participant-reported data will be linked to provincial health records to identify mental health services use. Multilevel analyses (survival, proportional hazard, structural equation modelling) will be used to address MY LIFE objectives. ETHICS AND DISSEMINATION: This study has been approved by the University of Waterloo Human Research Ethics Board and the Hamilton Integrated Research Ethics Board. Findings will be disseminated to key stakeholders using a number of outlets (peer-reviewed publications and conferences, lay informational pamphlets, social media).

Trends and Predictors of Repeat Mental Health Visits to a Pediatric Emergency Department in Hamilton, Ontario.

OBJECTIVE: From 2007-2017, pediatric emergency department (ED) visits for mental health concerns increased by 66% in Canada, with repeat visits accounting for a significant proportion of all visits. Our objective was to examine patient and visit characteristics associated with repeat visits to a tertiary care pediatric ED for mental health concerns. METHOD: Data were obtained from the administrative records of McMaster Children's Hospital ED for mental health-related visits from February 2013-December 2017. Data on 9,018 ED visits made by 4,976 unique patients were included in this study. Logistic regression analysis was used to examine characteristics associated with repeat visit within six months of index presentation. RESULTS: 22% (n=1,088) of individuals returned to the ED for a mental health concern within six months following their index visit. A repeat visit within six months was associated with female sex (OR=1.19, p=0.019), age of 14-17 years (OR=1.42, p=0.016), receiving a risk assessment by the emergency psychiatry team (OR=1.63, p<0.001) and having an inpatient psychiatric admission (OR=1.67, p<0.001) at the index visit. Receiving anxiety-related discharge diagnoses at an index visit reduced the odds of a repeat visit within 6 months (OR=0.76, p=0.035), while receiving depression-related discharge diagnoses increased the odds of a repeat visit, but only for females (OR=1.3, p=0.011 vs. OR=0.93, p=0.589 for males). CONCLUSIONS: We found that approximately one in five patients presenting to the ED for a mental health concern have a repeat visit within six months, consistent with previous studies. This study provides support for previously identified risk factors for repeat visits and offers information on interactions between patient sex and diagnosis.

OBJECTIF: De 2007 à 2017, les visites au service d'urgence (SU) pédiatrique pour des problèmes de santé mentale ont augmenté de 66 % au Canada, les visites répétées représentant une proportion significative de toutes les visites. Notre objectif était d'examiner les caractéristiques des patients et des visites associées aux visites répétées à un SU pédiatrique de soins tertiaires pour les problèmes de santé mentale. MÉTHODE: Les données ont été obtenues des dossiers administratifs du SU de l'Hôpital pour enfants McMaster pour les visites liées à la santé mentale de février 2013 à décembre 2017. Les données de 9 018 visites au SU faites par 4 976 patients uniques ont été incluses dans l'étude. L'analyse de régression logistique a servi à examiner les caractéristiques associées aux visites répétées en dedans de six mois de la première visite. RÉSULTATS: 22 % (n = 1 088) des personnes sont revenues au SU pour un problème de santé mentale en dedans de six mois de leur première visite. Une visite répétée en dedans de six mois était associée au sexe féminin (RC = 1,19, p = 0,019), à l'âge de 14 à 17 ans (RC = 1,42, p = 0,016), à la réception d'une évaluation du risque par l'équipe psychiatrique de l'urgence (RC = 1,63, p < 0,001) et à une hospitalisation psychiatrique (RC = 1,67, p < 0,001) à la première visite. Recevoir des diagnostics liés à l'anxiété au congé de la première visite réduisait les probabilités d'une visite répétée en dedans de 6 mois (RC = 0,76, p = 0,035), alors que recevoir des diagnostics liés à la dépression au congé augmentait les probabilités d'une visite répétée, mais seulement pour les femmes (RC = 1.3, p = 0,011 c. RC = 0,93, p = 0,589 pour les hommes). CONCLUSIONS: Nous avons constaté qu'environ un patient sur cinq qui se présente au SU pour un problème de santé mentale a une visite répétée en dedans de six mois, conformément aux études précédentes. Cette étude apporte un appui aux facteurs de risque précédemment identifiés pour les visites répétées, et offre de l'information sur les interactions entre le sexe des patients et le diagnostic.

The 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) Part II: Psychometric Adequacy for Categorical Measurement of Selected DSM-5 Disorders.

OBJECTIVES: To compare the reliability and convergent validity of parent assessments from the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID-a structured diagnostic interview) and the Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) symptom checklist for classifying conduct disorder (CD), conduct disorder or oppositional defiant disorder (CD-ODD), attention-deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and separation anxiety disorder (SAD) based on DSM-5 criteria. METHODS: Data came from 283 parent-youth dyads aged 9 to 18 years. Parents and youth completed the assessments separately on 2 different occasions 7 to 14 days apart. After converting the OCHS-EBS scale scores to binary disorder classifications, we compare test-retest reliability estimates and use structural equation modelling (SEM) to compare estimates of convergent validity for the same disorders assessed by each instrument. RESULTS: Average test-retest reliabilities based on κ were 0.71 (MINI-KID) and 0.67 (OCHS-EBS). The average ß coefficients for 3 latent measures comprising the following indicators-parent perceptions of youth mental health need and impairment, diagnosis of specific disorders based on health professional communications and youth taking prescribed medication, and youth classifications of disorder based on the MINI-KID-were 0.67 (MINI-KID) and 0.69 (OCHS-EBS). CONCLUSION: The OCHS-EBS and MINI-KID achieve comparable levels of reliability and convergent validity for classifying child psychiatric disorder. The flexibility, low cost, and minimal respondent burden of checklists for classifying disorder make them well suited for studying disorder in the general population and screening in clinical settings.

The 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) Part I: A Checklist for Dimensional Measurement of Selected DSM-5 Disorders.

OBJECTIVES: To describe the development and psychometric properties of the 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) for dimensional measurement of 7 disorders based on criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS: Scale items were selected by agreement among 19 child psychologists and psychiatrists rating the correspondence between item descriptions and DSM-5 symptoms. Psychometric evaluation of the item properties and parent/caregiver and youth scales came from a general population study of 10,802 children and youth aged 4 to 17 years in 6537 families. Test-retest reliability data were collected from a subsample of 280 children and their caregivers who independently completed the OCHS-EBS checklist on 2 occasions 7 to 14 days apart. Structural equation modelling was used to assess internal and external convergent and discriminant validity-the latter tested against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). RESULTS: Confirmatory factor analyses exhibited adequate item fit to all scales. Except for conduct disorder and youth-assessed separation anxiety disorder, internal (Cronbach's α) and test-retest reliability (Pearson's r) for scale scores were 0.70 or above. Except for youth-assessed conduct disorder, the OCHS-EBS met criteria for internal and convergent and discriminant validity. Compared with the MINI-KID, the OCHS-EBS met criteria for external convergent and discriminant validity. CONCLUSIONS: The OCHS-EBS provide reliable and valid dimensional measurement of 7 DSM-5 disorders assessed by caregivers and youth in the general population. Part II describes use of the OCHS-EBS as a categorical (present/absent) measure of disorder.