Worldwide Prevalence and Disability From Mental Disorders Across Childhood and Adolescence: Evidence From the Global Burden of Disease Study.

Importance: The period from childhood to early adulthood involves increased susceptibility to the onset of mental disorders, with implications for policy making that may be better appreciated by disaggregated analyses of narrow age groups. Objective: To estimate the global prevalence and years lived with disability (YLDs) associated with mental disorders and substance use disorders (SUDs) across 4 age groups using data from the 2019 Global Burden of Disease (GBD) study. Design, Setting, and Participants: Data from the 2019 GBD study were used for analysis of mental disorders and SUDs. Results were stratified by age group (age 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and sex. Data for the 2019 GBD study were collected up to 2018, and data were analyzed for this article from April 2022 to September 2023. Exposure: Age 5 to 9 years, 10 to 14 years, 15 to 19 years, and 20 to 24 years. Main Outcomes and Measures: Prevalence rates with 95% uncertainty intervals (95% UIs) and number of YLDs. Results: Globally in 2019, 293 million of 2516 million individuals aged 5 to 24 years had at least 1 mental disorder, and 31 million had an SUD. The mean prevalence was 11.63% for mental disorders and 1.22% for SUDs. For the narrower age groups, the prevalence of mental disorders was 6.80% (95% UI, 5.58-8.03) for those aged 5 to 9 years, 12.40% (95% UI, 10.62-14.59) for those aged 10 to 14 years, 13.96% (95% UI, 12.36-15.78) for those aged 15 to 19 years, and 13.63% (95% UI, 11.90-15.53) for those aged 20 to 24 years. The prevalence of each individual disorder also varied by age groups; sex-specific patterns varied to some extent by age. Mental disorders accounted for 31.14 million of 153.59 million YLDs (20.27% of YLDs from all causes). SUDs accounted for 4.30 million YLDs (2.80% of YLDs from all causes). Over the entire life course, 24.85% of all YLDs attributable to mental disorders were recorded before age 25 years. Conclusions and Relevance: An analytical framework that relies on stratified age groups should be adopted for examination of mental disorders and SUDs from childhood to early adulthood. Given the implications of the early onset and lifetime burden of mental disorders and SUDs, age-disaggregated data are essential for the understanding of vulnerability and effective prevention and intervention initiatives.

Early alcohol onset: clinical and demographic characteristics of service-seeking youth.

Background: Alcohol use in early adolescence is associated with increased health concerns and other negative consequences. Given the needs of this vulnerable population, it is critical to understand their risk factors and clinical characteristics. Objective: This cross-sectional study explores the clinical and demographic characteristics of service-seeking youth with and without early alcohol use onset. Method: 655 youth seeking services at a Canadian substance use and concurrent disorder service participated. Evaluations of mental health, substance use, demographic characteristics, and other risk factors were collected and compared among youth who reported an age of onset for alcohol use of under 14 years of age versus 14 years or older. Results: Youth who started using alcohol before age 14 were significantly more likely to report mental health difficulties, indicate use of a greater number of substances, and report experiencing more crime and violence problems. They also reported exposure to more types of trauma. Notably, more problems with crime and violence were significantly, and uniquely associated with an earlier age of alcohol use onset in a multivariate model. Conclusion: The present study identifies unique and clinically significant differences among youth who initiated alcohol use in early adolescence compared to later in adolescence. Stronger integrations between mental health and substance use services for youth with early alcohol use should be considered, given the vulnerability and concurrent difficulties they tend to face.

Contexte: La consommation d'alcool au début de l'adolescence est associée à des problèmes de santé accrus et à d'autres conséquences négatives. Étant donné les besoins de cette population vulnérable, il est essentiel de comprendre leurs facteurs de risque et leurs caractéristiques cliniques. Objectif: La présente étude transversale explore ces caractéristiques cliniques et démographiques des jeunes à la recherche de services avec et sans consommation précoce d'alcool. Méthode: Six cent cinquante-cinq jeunes à la recherche de services ont participé à un service canadien d'utilisation de substances et de trouble concurrent. Des évaluations de la santé mentale, de l'utilisation de substances, de caractéristiques démographiques et d'autres facteurs de risque ont été recueillies et comparées parmi les jeunes qui déclaraient un âge de début de consommation d'alcool de moins de 14 ans contre 14 ans et plus. Résultats: Les jeunes qui commençaient à consommer de l'alcool avant l'âge de 14 ans étaient significativement plus susceptibles de déclarer des difficultés de santé mentale, d'indiquer l'utilisation d'un plus grand nombre de substances et de déclarer éprouver plus de problèmes de crime et de violence. Ils ont aussi déclaré une exposition à plus de types de trauma. Notamment, plus de problèmes de crime et de violence étaient significativement et uniquement associés à un âge précoce du début de consommation d'alcool dans un modèle multivarié. Conclusion: La présente étude identifie des différences uniques et cliniquement significatives chez les jeunes qui ont commencé la consommation d'alcool au début de l'adolescence comparé à plus tard dans l'adolescence. Des intégrations plus fortes entre les services de santé mentale et d'utilisation de substances pour les jeunes ayant une consommation d'alcool précoce devraient être envisagées étant donné la vulnérabilité et les difficultés concurrentes qu'ils ont tendance à éprouver.

Youth Wellness Hubs Ontario: Development and initial implementation of integrated youth services in Ontario, Canada.

AIM: The need for youth-friendly early intervention services to meet the mental health, substance use, primary care, and other social needs of adolescents and young adults is well-documented. This article describes Youth Wellness Hubs Ontario, a province-wide initiative in Ontario, Canada to build and implement a one-stop-shop model of integrated youth services. METHODS: We describe the development of Youth Wellness Hubs Ontario, in the context of global youth mental health system transformation, as well as pan-Canadian youth mental health system change. We also describe Youth Wellness Hubs Ontario's values and services. RESULTS: The demonstration phase of Youth Wellness Hubs Ontario was initiated in 2017-2018. Youth Wellness Hubs Ontario is co-created with youth for youth aged 12-25 years old across diverse community contexts. Youth Wellness Hubs Ontario centres engagement and equity, and offers developmentally-appropriate services in an integrated, community-based walk-in format. As an initiative committed to continuous learning and quality improvement, Youth Wellness Hubs Ontario offers evidence-based and evidence-generating services, and measurement-based care. Youth Wellness Hubs Ontario is supported by backbone resources with expertise in implementation science, health equity, Indigenous practices, youth and family engagement, evaluation, and knowledge translation. In 2020 Youth Wellness Hubs Ontario secured sustainable funding for the first 10 locations and scale-up began in 2021, with 10 additional locations in development. CONCLUSIONS: Youth Wellness Hubs Ontario demonstrates the feasibility of integrated mental health and substance use early intervention services, offered in the context of a broad range of health and social services.

Advancing Curriculum Development and Design in Health Professions Education: A Health Equity and Inclusion Framework for Education Programs.

ABSTRACT: The COVID-19 pandemic has exacerbated pre-existing health inequities in vulnerable and marginalized patient populations. Continuing professional development (CPD) can be a critical driver of change to improve quality of care, health inequities, and system change. In order for CPD to address these disparities in care for patient populations most affected in the health care system, CPD programs must first address issues of equity and inclusion in their education development and delivery. Despite the need for equitable and inclusive CPD programs, there remains a paucity of tools and frameworks available in the literature to guide CPD and broader education providers on how best to develop and deliver equitable and inclusive education programs. In this article, we describe the development and application of a Health Equity and Inclusion (HEI) Framework for education and training grounded in the Analyze, Design, Develop, Implement, and Evaluate model for instructional design. Using a case example, specifically a hospital-wide trauma-informed de-escalation for safety program, we demonstrate how the HEI Framework can be applied practically to CPD programs to support equity and inclusion in the planning, development, implementation, and evaluation phases of education program delivery. The case example illustrates how the HEI Framework can be used by CPD providers to respect learner diversity, improve accessibility for all learners, foster inclusion, and address biases and stereotypes. We suggest that the HEI Framework can serve as an educational resource for CPD providers and health professions educators aiming to create equitable and inclusive CPD programs.

The impact of child maltreatment on mental health and substance use trajectories among adolescents.

AIM: There is robust evidence that child maltreatment is a significant risk factor and linked to negative psychological outcomes. However, few studies have examined the impact of child maltreatment on mental health and substance use trajectories across adolescence. METHODS: Data were drawn from a larger longitudinal project, in which participants were recruited starting in grade 7-8 and followed on two more occasions biennially. The final baseline sample was comprised of 765 youth (Mage  = 12.73, SD = 0.67, 49.7% female, 57.6% Caucasian/White). Multivariate multinomial logistic regressions were conducted to examine whether youth with maltreatment histories differed in their internalizing, externalizing, and substance use problems trajectories (based on previous studies) than youth without maltreatment histories. Moderation analyses using multinomial logistic regression were also conducted to examine perceived family support and school connectedness as protective factors against the impact of maltreatment. RESULTS: Youth who experienced maltreatment were more likely to display more severe internalizing, externalizing, and substance use problem trajectories than youth without such histories. While not significant as moderators, perceived family support and school connectedness were significantly associated with each of the trajectories, with lower levels of perceived family support and school connectedness linked to more severe problem trajectories. CONCLUSIONS: Results highlight the ongoing and significant harmful impact of maltreatment among youth. Results also support further prevention and intervention efforts for child maltreatment, particularly at the family and school level.

Impact Potpourri: A Multimethod Survey Study on Youth Substance Use During COVID-19.

Background: Given the important implications of youth substance use, it is essential to document and describe changes in substance use during the coronavirus disease 2019 pandemic. Methods: This multimethod survey study examines the impacts of the coronavirus disease 2019 pandemic on youth substance use among 149 Canadian youth who were using substances at a mid-pandemic period. Participants were 21.9 years of age on average (SD=2.2), including 99 girls/young women, 42 boys/young men, and 8 transgender or nonbinary individuals. The majority were Caucasian and born in Canada. Qualitative and quantitative findings are reported, with thematic analysis combined with descriptive and inferential statistical analyses. Results: Qualitatively, many youth reported increases or shifts in their substance use over the course of the pandemic. Youth reported using substances with limited numbers of peers, with family, or alone. Many reported using substances out of boredom and to cope. While legal substances remained highly accessible, illegal substances were reported to be more difficult to acquire and less trustworthy. Spending had increased. Quantitative findings suggested alcohol use has decreased, but other substance use has remained stable in the sample as a whole, although for each substance, some youth reported increases. Discussion: Despite minimal quantitative change, qualitative findings show that some youth increased their use of some substances during the pandemic, decreased others, changed their motivation to use, and decreased in safety behaviors. Youth-serving organizations should be aware of individual differences, the changing context of substance use, and the potential long-term impacts.

Contexte: Compte tenu des implications importantes de la consommation de substances chez les jeunes, il est essentiel d'identifier, documenter et décrire l'évolution de la consommation de substances pendant la pandémie de COVID-19 afin d'élaborer des stratégies de prévention et des traitements efficaces. Méthode: Cette étude d'enquête multiméthodes examine les impacts de la pandémie de COVID-19 sur la consommation de substances chez 149 jeunes canadiens qui consommaient des substances au milieu de la période de la pandémie. Les participants avaient 21,9 ans en moyenne (ET=2,2), dont 99 filles/jeunes femmes, 42 garçons/jeunes hommes et 8 personnes transgenres ou non binaires. La majorité des participants étaient caucasien et née au Canada. Les résultats qualitatifs et quantitatifs sont rapportés avec une analyse thématique combinée à des analyses statistiques descriptives et analogiques. Résultats: Sur le plan qualitatif, de nombreux jeunes qui consommaient des substances pendant la pandémie ont signalé des augmentations ou des changements dans leur consommation de substances au cours de la pandémie. Les jeunes ont déclaré consommer des substances avec un nombre limité de pairs, en famille ou seul. De nombreux jeunes ont déclaré consommer des substances par ennui et pour faire face à la situation. Alors que les substances légales sont restées très accessibles, les substances illicites sont devenues plus difficiles à acquérir et moins dignes de confiance ce qui a entraîné une augmentation des dépenses. Les résultats quantitatifs suggèrent que la consommation d'alcool a diminué pour ces jeunes, mais la consommation d'autres substances est restée stable dans l'ensemble de l'échantillon, bien que pour chaque substance, certains jeunes ont signalé des augmentations. Analyse: Malgré un changement quantitatif minime, les résultats qualitatifs montrent que chez les jeunes qui consommaient des substances au milieu de la période de la pandémie, certains jeunes ont connu une augmentation de la consommation de certaines substances pendant la pandémie, une diminution de leur consommation d'autres substances, des changements dans leur motivation à consommer des substances et une diminution des comportements sécuritaires. Les organisations au service des jeunes doivent être conscientes des différences individuelles, du contexte changeant de la consommation de substances et des impacts potentiels à long terme. Les prestataires de services devraient travailler avec les jeunes de manière centrée sur la personne pour identifier des solutions dans le contexte des expériences vécues en lien avec la COVID-19.

Substance Use Problem Trajectories in Canadian Adolescents: A Longitudinal Study.

Background: Adolescents experience rapid changes and are more vulnerable for developing substance use problems than other age groups. Many studies have focused on the trajectories of adolescent substance use frequencies, rather than symptoms. Objective: The present study examined the trajectory of substance use disorder symptoms, particularly beginning in early adolescence and within a Canadian context. Methods: Data were drawn from a Canadian longitudinal project, in which a province-wide survey was administered to students across three biennial waves starting in grades 7-8. The final sample was comprised of 765 adolescents (baseline M age = 12.73, SD = 0.67, 49.7% female, 57.6% White). Latent class analysis was conducted to identify substance use disorder symptom classes based on participants' responses on a substance use disorder screener across the three waves. Group differences tests were also computed to examine if the substance use classes differed in participants' demographics. Results: Four classes were identified, labelled as low stable (n = 538, 70.3%), deteriorating (n = 169, 22.1%), recovered (n = 12, 1.6%), and high-risk relapse (n = 46, 6.0%) substance use. Among the demographic variables, non-White ethnicity, both parents being born outside of Canada, and parents' completion of post-secondary education were significantly associated with a less severe substance use class. Conclusions: Results fill a gap in the evidence on the trajectory of symptoms of substance use disorder among adolescents, using a Canadian sample, an area of limited study. Results highlight an at-risk group (i.e., high-risk relapse class) that warrants further tailored prevention and intervention efforts.

Contexte: Les adolescents connaissent des changements rapides et sont plus vulnérables de développer des problèmes d'utilisation de substances que d'autres groupes d'âge. De nombreuses études ont porté sur les trajectoires des fréquences d'utilisation de substances chez les jeunes, plutôt que des symptômes. Objectif: La présente étude a examiné la trajectoire des symptômes du trouble d'utilisation de substances, particulièrement lorsque le trouble commence au début de l'adolescence et dans un contexte canadien. Méthodes: Les données ont été tirées d'un projet longitudinal canadien, dans lequel un sondage à l'échelle provinciale a été administré à des élèves sur trois vagues biennales à partir de la 7e à la 8e année. L'échantillon final comptait 765 adolescents (à la base M âge = 12,73, ET = 0,67, 49,7 % féminin, 57,6 % Blancs). L'analyse de classe latente a été menée pour identifier les classes de symptômes du trouble d'utilisation de substances selon les réponses des participants à un dépisteur du trouble d'utilisation de substances dans les trois vagues. Les tests de différences des groupes ont aussi été calculés pour examiner si les classes d'utilisation de substances différaient dans les données démographiques des participants. Résultats: Quatre classes ont été identifiées, étiquetées comme faibles stables (n = 538, 70,3 %), se détériorant (n = 169, 22,1 %), rétablies (n = 12, 1,6 %), et à risque élevé de rechute (n = 46, 6,0 %) d'utilisation de substances. Parmi les variables démographiques, l'ethnicité non-blanche, les deux parents étant nés hors du Canada, et les parents ayant une utilisation de substances, terminé l'éducation post-secondaire, étaient significativement associés avec une classe moins grave d'utilisation de substances. Conclusions: Les résultats comblent un vide dans les données probantes sur la trajectoire des symptômes du trouble d'utilisation de substances chez les adolescents, à l'aide d'un échantillon canadien, un domaine d'étude limité. Les résultats présentent un groupe à risque (c.-à-d., une classe à risque élevé de rechute) qui justifie des efforts plus ciblés de prévention et d'intervention.

"You can kind of just feel the power behind what someone's saying": a participatory-realist evaluation of peer support for young people coping with complex mental health and substance use challenges.

BACKGROUND: Youth peer support, as a practice that aligns youth engagement and participatory approaches, has become increasingly popular in the context of youth mental health services. However, there is a need for more evidence that describes how and why youth peer support practice might be effective. This study was designed to examine a peer support service for youth experiencing complex challenges with mental health, physical health and/or substance use to better understand key features and underlying mechanisms that lead to improved client outcomes. METHODS: We applied a hybrid realist-participatory approach to explore key issues and underlying theoretical assumptions within a youth peer support approach for young people (age 14-26) experiencing complex mental health and substance use challenges. We used semi-structured interviews and focus groups with staff, including peers (N = 8), clinical service providers and administrative staff (N = 15), to develop the theories and a client survey to validate them. Our qualitative thematic analysis applied a retroductive approach that involved both inductive and deductive processes. For the client survey (N = 77), we calculated descriptive statistics to examine participant profiles and usage patterns. Pearson correlations were examined to determine relationships among concepts outlined in the program theories, including context, mechanism and outcome variables. RESULTS: Our analyses resulted in one over-arching context, one over-arching outcome and four program theories. Program theories were focused on mechanisms related to 1) positive identity development through identification with peers, 2) enhanced social connections, 3) observational learning and 4) enhanced autonomy and empowerment. CONCLUSIONS: This study serves as a unique example of a participatory-realist hybrid approach. Findings highlight possible key components of youth peer practice and shed light on the functional mechanisms that underlie successful peer practice. These key components can be examined in other settings to develop more comprehensive theories of change with respect to youth peer support and can eventually be used to develop guidelines and standards to strengthen practice. This research contributes to an expanding body of literature on youth peer support in mental health and connects peer practice with several social theories. This research begins to lay a foundation for enhanced youth peer support program design and improved outcomes for young people experiencing complex mental health and substance use challenges.

How much is enough? Considering minimally important change in youth mental health outcomes.

To make decisions in mental health care, service users, clinicians, and administrators need to make sense of research findings. Unfortunately, study results are often presented as raw questionnaire scores at different time points and regression coefficients, which are difficult to interpret with regards to their clinical meaning. Other commonly reported treatment outcome indicators in clinical trials or meta-analyses do not convey whether a given change score would make a noticeable difference to service users. There is an urgent need to improve the interpretability and relevance of outcome indicators in youth mental health (aged 12-24 years), in which shared decision making and person-centred care are cornerstones of an ongoing global transformation of care. In this Personal View, we make a case for considering minimally important change (MIC) as a meaningful, accessible, and user-centred outcome indicator. We discuss what the MIC represents, how it is calculated, and how it can be implemented in dialogues between clinician and researcher, and between youth and clinician. We outline how use of the MIC could enhance reporting in clinical trials, meta-analyses, clinical practice guidelines, and measurement-based care. Finally, we identify current methodological challenges around estimating the MIC and areas for future research. Efforts to select outcome domains and valid measurement instruments that resonate with youth, families, and clinicians have increased in the past 5 years. In this context, now is the time to define demarcations of changes in outcome scores that are clinically relevant, and meaningful to youth and families. Through the use of MIC, youth-centred outcome measurement, analysis, and reporting would support youth-centred therapeutic decision making.

Learning Through a Pandemic: Youth Experiences With Remote Learning During the COVID-19 Pandemic.

The objective of this paper was to examine the school-related experiences of youth during the COVID-19 pandemic. Participants represented both clinical and community youth aged 14 to 28 who were sampled as part of a larger study. Feedback from youth attending school during the pandemic was qualitatively examined and youth who planned to attend school prior to the pandemic and did (n = 246) and youth who planned to attend but did not (n = 28) were compared quantitatively. Youth appreciated the flexibility of online learning and some also reported experiencing a lack of support from their school and the need for instructor training on how to deliver virtual classes effectively. Future studies should examine what factors influence student engagement with virtual learning, what strategies could improve supports for student in their long-term career development, and the longitudinal experiences of youth who may have chosen not to go back to school due to the pandemic. This survey was conducted in Ontario, Canada. A more diverse sample collected outside of Ontario would improve generalizability. Qualitative data were based on survey responses and not interviews. Thus we were unable to discern the reasons youth decided to attend school, or not, during the COVID-19 pandemic.

The Longitudinal Youth in Transition Study (LYiTS) Cohort Profile: Exploration by Hospital- Versus Community-Based Mental Health Services.

OBJECTIVES: Youth face numerous challenges in receiving coordinated and continuous mental health services, particularly as they reach the age of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). The Longitudinal Youth in Transition Study (LYiTS) follows youth prospectively as they cross this transition boundary to better understand their transition pathways and resulting symptoms and health service use outcomes. The current paper presents the baseline profile description for the LYiTS cohort and additionally examines differences in symptoms and functioning and health service utilization between youth receiving services at hospital- versus community-based CAMHS. METHODS: A cross-sectional design was used. A sample of 237 16-18-year-old youth recruited from outpatient CAMHS at two hospitals and two community sites completed self-report measures at their first of four annual assessments. A latent profile analysis was conducted to identify symptomology profiles, and youth were compared on symptoms and health service use between hospital- and community-based sites. RESULTS: Four distinct symptomology profiles were identified (subclinical, moderate internalizing, moderate externalizing, and high symptomology). Symptom profiles and functioning levels reported by youth were no different across both types of organization, although there were differences detected in health service utilization, such as type of provider seen and use of medications. CONCLUSIONS: These findings suggest that there is little difference in symptomology between youth accessing hospital versus community-based CAMHS. With growing interest in understanding the effectiveness and cost-effectiveness of different models of mental health care, these findings provide a new understanding of the clinical and service use profiles of transition-aged youth that will be explored further as this cohort is followed across the CAMHS to AMHS transition boundary.

Intervention outcome preferences for youth who are out of work and out of school: a qualitative study.

BACKGROUND: While interventions have been developed and tested to help youth who have become disconnected from work and school, there is a paucity of research on young people's intervention preferences. This study aims to understand young people's preferred intervention outcomes and approaches for youth who are out of work and school. METHODS: Thirty youth participated in virtual focus groups. Transcripts were analyzed using thematic analysis. RESULTS: Youth want interventions and approaches that support them in (1) vocational readiness, (2) securing a job, and (3) mental health and well-being, while providing them with (4) high-contact, individualized, and integrated support. CONCLUSIONS: Young people want interventions to be individualized and integrated, providing a high level of support for their educational and employment pursuits as well as their mental health and well-being. Incorporating youth's perspectives when designing interventions can increase intervention relevance and potentially service uptake, helping youth continue to pursue their educational and vocational goals.

A qualitative study exploring how young people perceive and experience substance use services in British Columbia, Canada.

BACKGROUND: Substance use among youth (ages 12-24) is troublesome given the increasing risk of harms associated. Even more so, substance use services are largely underutilized among youth, most only accessing support when in crisis. Few studies have explored young people's help-seeking behaviours to address substance use concerns. To address this gap, this study explored how youth perceive and experience substance use services in British Columbia (BC), Canada. METHODS: Participatory action research methods were used by partnering with BC youth (under the age of 30) from across the province who have lived and/or living experience of substance use to co-design the research protocol and materials. An initial focus group and interviews were held with 30 youth (ages 12-24) with lived and/or living experience of substance use, including alcohol, cannabis, and illicit substances. The discussions were audio-recorded, transcribed verbatim, and analyzed thematically using a data-driven approach. RESULTS: Three main themes were identified and separated by phase of service interaction, starting with: Prevention/Early intervention, where youth described feeling unworthy of support; Service accessibility, where youth encountered many barriers finding relevant substance use services and information; and Service delivery, where youth highlighted the importance of meeting them where they are at, including supporting those who have milder treatment needs and/or do not meet the diagnosis criteria of a substance use disorder. CONCLUSIONS: Our results suggest a clear need to prioritize substance use prevention and early interventions specifically targeting youth and young adults. Youth and peers with lived and/or living experience should be involved in co-designing and co-delivering such programs to ensure their relevance and credibility among youth. The current disease model of care leaves many of the needs of this population unmet, calling for a more integrated youth-centred approach to address the multifarious concerns linked to young people's substance use and service outcomes and experiences.

A Longitudinal Cohort Study of Youth Mental Health and Substance use Before and During the COVID-19 Pandemic in Ontario, Canada: An Exploratory Analysis.

BACKGROUND: Youth mental health appears to have been negatively impacted by the COVID-19 pandemic. The impact on substance use is less clear, as is the impact on subgroups of youth, including those with pre-existing mental health or substance use challenges. OBJECTIVE: This hypothesis-generating study examines the longitudinal evolution of youth mental health and substance use from before the COVID-19 pandemic to over one year into the pandemic among youth with pre-existing mental health or substance use challenges. METHOD: A total of 168 youth aged 14-24 participated. Participants provided sociodemographic data, as well as internalizing disorder, externalizing disorder, and substance use data prior to the pandemic's onset, then every two months between April 2020-2021. Linear mixed models and Generalized Estimating Equations were used to analyze the effect of time on mental health and substance use. Exploratory analyses were conducted to examine interactions with sociodemographic and clinical characteristics. RESULTS: There was no change in internalizing or externalizing disorder scores from prior to the pandemic to any point throughout the first year of the pandemic. Substance use scores during the pandemic declined compared to pre-pandemic scores. Exploratory analyses suggest that students appear to have experienced more mental health repercussions than non-students; other sociodemographic and clinical characteristics did not appear to be associated with mental health or substance use trajectories. CONCLUSIONS: While mental health remained stable and substance use declined from before the COVID-19 pandemic to during the pandemic among youth with pre-existing mental health challenges, some youth experienced greater challenges than others. Longitudinal monitoring among various population subgroups is crucial to identifying higher risk populations. This information is needed to provide empirical evidence to inform future research directions.

Interventions to Reduce Opioid Use in Youth At-Risk and in Treatment for Substance Use Disorders: A Scoping Review.

BACKGROUND: Youth and young adults have been significantly impacted by the opioid overdose and health crisis in North America. There is evidence of increasing morbidity and mortality due to opioids among those aged 15-29. Our review of key international reports indicates there are few youth-focused interventions and treatments for opioid use. Our scoping review sought to identify, characterize, and qualitatively evaluate the youth-specific clinical and pre-clinical interventions for opioid use among youth. METHOD: We searched MedLine and PsycInfo for articles that were published between 2013 and 2021. Previous reports published in 2015 and 2016 did not identify opioid-specific interventions for youth and we thus focused on the time period following the periods covered by these prior reports. We input three groups of relevant keywords in the aforementioned search engines. Specifically, articles were included if they targeted a youth population (ages 15-25), studied an intervention, and measured impacts on opioid use. RESULTS: We identified 21 studies that examined the impacts of heterogeneous interventions on youth opioid consumption. The studies were classified inductively as psycho-social-educational, pharmacological, or combined pharmacological-psycho-social-educational. Most studies focused on treatment of opioid use disorder among youth, with few studies focused on early or experimental stages of opioid use. A larger proportion of studies focused heavily on male participants (i.e., male gender and/or sex). Very few studies involved and/or included youth in treatment/program development, with one study premised on previous research about sexual minority youth. CONCLUSIONS: Research on treatments and interventions for youth using or at-risk of opioids appears to be sparse. More youth involvement in research and program development is vital. The intersectional and multi-factorial nature of youth opioid use and the youth opioid crisis necessitates the development and evaluation of novel treatments that address youth-specific contexts and needs (i.e., those that address socio-economic, neurobiological, psychological, and environmental factors that promote opioid use among youth).

Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion.

Nearly all young people use the internet daily. Many youth with mental health concerns, especially since the Covid-19 pandemic, are using this route to seek help, whether through digital mental health treatment, illness prevention tools, or supports for mental wellbeing. Videogames also have wide appeal among young people, including those who receive mental health services. This review identifies the literature on videogame interventions for young people, ages 12-29, and maps the data on game use by those with mental health and substance use problems, focusing on evidence for the capacity of games to support treatment in youth mental health services; how stakeholders are involved in developing or evaluating games; and any potential harms and ethical remedies identified. A systematic scoping review methodology was used to identify and assess relevant studies. A search of multiple databases identified a total of 8,733 articles. They were screened, and 49 studies testing 32 digital games retained. An adapted stepped care model, including four levels, or steps, based on illness manifestation and severity, was used as a conceptual framework for organizing target populations, mental health conditions and corresponding digital games, and study results. The 49 selected studies included: 10 studies (20.4%) on mental health promotion/prevention or education for undiagnosed youth (Step 0: 7 games); 6 studies (12.2%) on at-risk groups or suspected mental problems (Step 1: 5 games); 24 studies (49.0%) on mild to moderate mental conditions (Steps 2-3: 16 games); and 9 studies (18.4%) focused on severe and complex mental conditions (Step 4: 7 games). Two interventions were played by youth at more than one level of illness severity: the SPARX game (Steps 1, 2-3, 4) and Dojo (Steps 2-3 and 4), bringing the total game count to 35 with these repetitions. Findings support the potential integration of digital games in youth services based on study outcomes, user satisfaction, relatively high program retention rates and the potential usefulness of most games for mental health treatment or promotion/prevention. Most studies included stakeholder feedback, and involvement ratings were very high for seven games. Potential harms were not addressed in this body of research. This review provides an important initial repository and evaluation of videogames for use in clinical settings concerned with youth mental health.

The Youth Wellness Quest: A Comprehensive Online Mental Health Literacy and Self-Advocacy Resource Developed by Youth for Youth.

A lack of mental health literacy may impact youths' ability to advocate for themselves as they seek to access and navigate the mental healthcare system. Recognizing this, members of the National Youth Action Council at the Centre for Addiction and Mental Health in Toronto, ON, developed the Youth Wellness Quest resource. This health literacy resource informs youth of possible available services, increasing their capacity to make informed mental healthcare decisions. The youth-led process of creating this resource, from development to dissemination, is described within this paper, showcasing how youth can lead the development of tools designed for youth.

Let's Talk Gender: Ten Things Transgender and Nonbinary Youth Want All Researchers to Know.

BACKGROUND: Youth view gender as a spectrum of experiences, not the cis-binary framework of girls/women versus boys/men. However, research has historically focused on cisgender people, without considering the rich experiences of transgender and non-binary people. Method. To address gaps in the inclusion of transgender and gender non-binary youth in research, a group of transgender and non-binary youth came together through a research-based youth engagement initiative to discuss what they wanted researchers to know about gender. Results. Youth propose ten guidelines and principles that they ask researchers to acknowledge, respect, and apply. These guidelines and principles focus on acknowledging and accepting diverse experiences situated on a gender spectrum, committing to learning more about gender, incorporating gender appropriately in their research initiatives, and engaging with transgender and non-binary youth in the research they conduct. Funders, research ethics boards, and publishers are also responsible for attending to gender. Conclusions. Researchers are called on to consider these guidelines and principles and to engage in dialogue around them in order to better capture the experiences of transgender and non-binary youth in the new evidence base as it emerges.