Attention-Deficit/Hyperactivity Disorder and Alcohol and Other Substance Use Disorders in Young Adulthood: Findings from a Canadian Nationally Representative Survey.

AIM: (a) To document the prevalence and odds of (i) alcohol use disorders, (ii) cannabis use disorders, (iii) other drug use disorders and (iv) any substance use disorder (SUD), among young adults with and without ADHD, and (b) to investigate the degree to which the association between ADHD and SUDs is attenuated by socio-demographics, early adversities and mental health. METHOD: Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (CCHS-MH). The sample included 6872 respondents aged 20-39, of whom 270 had ADHD. The survey response rate was 68.9%. MEASUREMENTS: Substance Use Disorder: World Health Organization's Composite International Diagnostic Interview criteria, SUDs, were derived from lifetime algorithms for alcohol, cannabis and other substance abuse or dependence. ADHD was based on self-report of a health professional's diagnosis. FINDINGS: One in three young adults with ADHD had a lifetime alcohol use disorder (36%) compared to 19% of those without ADHD (P < 0.001). After adjusting for all control variables, those with ADHD had higher odds of developing alcohol use disorders (OR = 1.38, 95% CI: 1.05, 1.81), cannabis use disorders (OR = 1.46, 95% CI: 1.06, 2.00), other drug use disorders (OR = 2.07, 95% CI: 1.46, 2.95) and any SUD (OR = 1.69, 95% CI: 1.28, 2.23). History of depression and anxiety led to the largest attenuation of the ADHD-SUD relationship, followed by childhood adversities and socioeconomic status. CONCLUSIONS: Young adults with ADHD have a high prevalence of alcohol and other SUDs. Targeted outreach and interventions for this extremely vulnerable population are warranted.

The Dark Side of ADHD: Factors Associated With Suicide Attempts Among Those With ADHD in a National Representative Canadian Sample.

AIM: This study investigated the prevalence and odds of suicide attempts among adults with attention deficit hyperactivity disorder (ADHD) compared to those without and identified factors associated with suicide attempts among adults with ADHD. METHODS: Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (CCHS-MH) (n = 21,744 adults, of whom 529 had ADHD). Respondents were asked whether they received an ADHD diagnosis from a health care professional. Lifetime suicide attempt was based on self-report. RESULTS: Adults with ADHD were much more likely to have attempted suicide than those without (14.0% vs. 2.7%). One in four women with ADHD have attempted suicide. Sixty percent of the association between ADHD and attempted suicide was attenuated when lifetime history of depression and anxiety disorders were taken into account. Female gender, lower education attainment, substance abuse, lifetime history of depression, and childhood exposure to chronic parental domestic violence were found to be independent correlates of lifetime suicide attempts among those with ADHD. CONCLUSION: These findings can inform targeted screening and outreach to the most vulnerable adults with ADHD.

The positive impact of a telemedicine education program on healthcare workers during the COVID-19 pandemic in Ontario, Canada.

Context The impact of the COVID-19 pandemic on health care service and delivery has been profound. In addition to shifting and expanding clinical responsibilities, rapidly evolving information and guidelines during the COVID-19 pandemic has made it difficult for healthcare workers (HCWs) to synthesize and translate COVID-19 information into practice. Objective The objectives of this study are 1) to examine the impact of a telemedicine education program on HCW's self-efficacy and satisfaction and 2) to explore HCWs' experience in the program and context of practice during the COVID-19 pandemic. Study Design We conducted a prospective mixed methods parallel-design study among ECHO COVID participants using pre-post questionnaires and focus group discussions (FGDs). We examined questionnaire results for changes in HCWs' self-efficacy and satisfaction. We analyzed FGD data to explore HCWs' experience in ECHO and the context of their practice during the COVID-19 pandemic. Setting Project Extension for Community Healthcare Outcomes (ECHO) model is a virtual, telemedicine education model that provides longitudinal support and addresses the emerging needs of HCWs. "ECHO Ontario: Managing COVID-19 Patients in the Community" (ECHO) was launched in July 2020. The goal of the program was to disseminate best practices regarding COVID-19 as they emerged and to increase HCW confidence and knowledge of COVID-19. Population Studied The study population were practicing HCWs in the province of Ontario, Canada. 1) HCW self-efficacy 2) HCW satisfaction Results Of 299 HCWs registered in ECHO COVID, 114 (38.1%) participated in this analysis. Median self-efficacy scores increased from 5 (IQR 4 - 6) to 6 (IQR 6 - 6) (p < 0.0001), independent of profession, years in practice, age group, or type of practice environment. Participants were highly satisfied with the ECHO sessions with a median score of 4 (IQR 4 - 5). FGD data indicated that HCWs gained knowledge through ECHO, established the context of their practice, and revealed facilitators for ECHO program success, including the transition to virtual care, the practicability of knowledge provided, and a "perspective from the trenches." Conclusions This study demonstrated that a telemedicine education program aimed to support HCWs in managing patients with COVID-19 had a positive impact on self-efficacy and satisfaction, and that this impact was specifically mediated through the ECHO program.

Positive impact of a telemedicine education program on practicing health care workers during the COVID-19 pandemic in Ontario, Canada: A mixed methods study of an Extension for Community Healthcare Outcomes (ECHO) program.

INTRODUCTION: In addition to shifting and expanding clinical responsibilities, rapidly evolving information and guidelines during the COVID-19 pandemic has made it difficult for health care workers (HCW) to synthesise and translate COVID-19 information into practice. This study evaluated whether a COVID-19-specific telemedicine education program (ECHO COVID) would impact health care workers' self-efficacy and satisfaction in the management of patients with COVID-19. METHODS: A prospective mixed methods parallel-design study was conducted among ECHO COVID participants using pre-post questionnaires and a focus group discussion. Questionnaire results were examined for changes in health care workers' self-efficacy and satisfaction. Focus group discussion data were analysed to explore health care workers' experience in ECHO COVID and the context of their practice during the COVID-19 pandemic. RESULTS: 239 health care workers registered in ECHO COVID and 114 (47.7%) completed questionnaires and attended at least one ECHO COVID session. Median self-efficacy scores increased from 5 (IQR 4-6) to 6 (IQR 6-6) (p < 0.0001), independent of profession, years in practice, age group, or practice environment. Participants were highly satisfied with ECHO COVID sessions with a median score of 4 (IQR 4-5). Focus group discussion data indicated that health care workers gained knowledge through ECHO COVID and revealed facilitators for ECHO COVID program success, including the transition to virtual care, the practicability of knowledge provided, and a 'perspective from the trenches.' DISCUSSION: This study demonstrated that a telemedicine education program aimed to support health care workers in managing patients with COVID-19 had a positive impact on health care workers' self-efficacy and satisfaction. This impact was specifically mediated by the ECHO COVID program.

Black Older Americans Have Lower Prevalence of Hearing Loss Than Their White Peers: Findings From Two Large Nationally Representative Surveys.

PURPOSE: The purpose of this study was to investigate Black-White differences associated with hearing loss among older adults living in the United States. METHOD: Secondary data analysis was conducted using the 2017 American Community Survey (ACS) with a replication analysis of the 2016 ACS. The ACS is an annual nationally representative survey of Americans living in community settings and institutions. The sample size of older Americans (age 65+ years) in 2017 was 467,789 non-Hispanic Whites (NHWs) and 45,105 non-Hispanic Blacks (NHBs). In the 2016 ACS, there were 459,692 NHW and 45,990 NHB respondents. Measures of hearing loss, age, race/ethnicity, education level, and household income were based on self-report. Data were weighted to adjust for nonresponse and differential selection probabilities. RESULTS: The prevalence of hearing loss was markedly higher among older NHWs (15.4% in both surveys) in comparison with NHBs (9.0% in 2017 and 9.4% in 2016, both ethnic differences p < .001). In the 2017 ACS, the age- and sex-adjusted odds of hearing loss were 69% higher for NHWs compared with NHBs, which increased to 91% higher odds when household income and education level were also taken into account (OR = 1.91; 95% confidence interval [CI; 1.85, 1.97]). Findings from the 2016 ACS were very similar (e.g., 65+ fully adjusted OR = 1.81; 95% CI [1.76, 1.87]). CONCLUSIONS: NHWs have a much higher prevalence and almost double the odds of hearing loss compared with NHBs. Unfortunately, the ACS survey does not allow us to explore potential causal mechanisms behind this association.

The Toxic Triad: Childhood Exposure to Parental Domestic Violence, Parental Addictions, and Parental Mental Illness as Factors Associated With Childhood Physical Abuse.

Childhood physical abuse can result in serious behavioral, mental health, and physical health conditions. There is a need for improved strategies to identify households in which childhood physical abuse occurs. This article explores three potential correlates of childhood physical abuse: childhood exposure to parental domestic violence, parental addictions, and parental mental illness. Secondary analyses were conducted using the regionally representative 2010 Brief Risk Factor Surveillance Survey (BRFSS) of adults (n = 9,241 men, n = 13,627 women) and the analyses were replicated in the 2012 BRFSS (n = 11,656 men, n = 18,145 women). Bivariate and logistic regression analyses were conducted. Approximately one-quarter of the sample was Hispanic and/or Non-White. In 2010, 78.3% of men who had been exposed to all three of these early adversities reported that they had experienced childhood physical abuse compared with 7.5% of males who did not experience these adversities. Women reported similar levels of childhood physical abuse (66.9% for those reporting all three factors, 5.9% for those with zero risk factors). The 2012 BRFSS analyses resulted in comparable findings. Domestic violence, even in the absence of parental addictions and mental illness, was associated with a high prevalence of childhood physical abuse (between 34% and 38%). Currently, the World Health Organization cautions against routine screening for child abuse due to the high rate of false positives. We propose a two-step strategy to improve targeting: first, identifying households in which two or more adversities exist, and subsequently screening children in these households. Our findings will help improve the targeting of screening and outreach efforts to children most at risk, thereby minimizing the risk of false positives. Our data provide support for universal screening for childhood physical abuse in cases of domestic violence, particularly for those families where parental addictions and/or parental mental illness also exist.

Refugee status is associated with double the odds of psychological distress in mid-to-late life: Findings from the Canadian Longitudinal Study on Aging.

Psychological distress is associated with a range of negative outcomes including lower quality of life and an increased risk of premature all-cause mortality. The prevalence of, and factors associated with, psychological distress among middle-aged and older Canadians are understudied. Using the Canadian Longitudinal Study on Aging (CLSA) baseline data, this study examined factors associated with psychological distress among adults between 45 and 85 years, including refugee status and a wide range of sociodemographic, health-related and social support characteristics. Psychological distress was measured by Kessler's Psychological Distress Scale-K10 scores. Bivariate and multivariable binary logistic regression analyses were conducted. The prevalence of psychological distress was significantly higher among the 244 refugees (23.8%), compared to 23,149 Canadian-born Canadians (12.8%) and 4,765 non-refugee immigrants (12.6%), despite the fact that the average time the refugees had lived in Canada was more than four decades. The results of the binary logistic regression analysis indicated refugees had twice the age-sex adjusted odds of psychological distress (OR = 2.31, 95% CI: 1.74, 3.07). Even after further adjustment for 16 potential risk factors, a significant relationship remained between refugee status and psychological distress (OR = 1.56; 95% CI = 1.12, 2.17). Other significant factors associated with psychological distress included younger age, female gender, visible minority status, lower household income, not having an undergraduate degree, multimorbidities, chronic pain, and lack of social support. Policies and interventions addressing psychological distress among Canadians in mid- to later life should target refugees and other vulnerable groups.

A Trio of Risk Factors for Childhood Sexual Abuse: Investigating Exposure to Parental Domestic Violence, Parental Addiction, and Parental Mental Illness as Correlates of Childhood Sexual Abuse.

Targeted screening for sexual abuse is needed for social workers to accurately identify those at risk. Drawing on a cumulative disadvantage framework, this study investigates how parental addictions, parental mental illness, and exposure to domestic violence, both individually and cumulatively, are associated with childhood sexual abuse (CSA). Two waves of regionally representative data were analyzed. Bivariate and logistic regression analyses were conducted using the 2010 Brief Risk Factor Surveillance Survey (BRFSS) (n = 9,241 men, n = 13,627 women) and replicated using the 2012 BRFSS (n = 11,656 men, n = 18,145 women). The 2010 data indicated that 8.5 percent of men who had endured all three childhood adversities reported that they had experienced CSA, compared with 0.6 percent of men who did not experience any of these adversities. Levels of CSA for women in 2010 were 28.7 percent for those experiencing all three risk indicators, and 2.1 percent for women with no risk indicators. Results were similar in the BRFSS 2012. Those with two or more risk factors had between five- and eightfold higher odds of CSA. Social workers may be able to decrease false positives if they screen for CSA based on the presence of two or more risk factors.

Is Recovery from Cannabis Dependence Possible? Factors that Help or Hinder Recovery in a National Sample of Canadians with a History of Cannabis Dependence.

OBJECTIVES: To identify among Canadian adults who have ever been dependent upon cannabis, the prevalence of risk and protective factors associated with (1) cannabis remission, (2) the absence of psychiatric disorders or addictions in the past year (APD), and (3) positive mental health (PMH). METHOD: Data from Statistics Canada's nationally representative 2012 Canadian Community Health Survey-Mental Health (n = 20, 777, of whom 336 have a history of cannabis dependence) was used. Chi-square tests and logistic regression analyses were conducted. The World Health Organization Composite International Diagnostic Interview (WHO-CIDI) measures were used to determine lifetime cannabis dependence, past-year remission from cannabis depression, and the absence of psychiatric disorders in the past year (APD) (i.e., no suicidal ideation, depressive episodes, anxiety disorders, bipolar disorders, or any substance dependence). PMH is comprised of three factors: APD, happiness or life satisfaction and social and psychological well-being. RESULTS: Among those with a history of cannabis dependence, 72% were in remission from cannabis dependence. Although 53% were free of major psychiatric disorders and any substance dependence and 43% of respondents were in PMH, these percentages were dramatically lower than those without a history of cannabis dependence (92% and 74%, respectively). Positive outcomes were more common among women, older respondents, those with higher levels of social support, and those who had never had major depressive disorder or generalized anxiety disorder. CONCLUSION: Although many Canadians with a history of cannabis dependence achieve remission and a large minority are truly resilient and achieve PMH, many are failing to thrive. Targeted outreach is warranted for the most vulnerable individuals with a history of cannabis dependence (e.g., men, younger respondents, those with low social support and a history of mental illness).

Factors Associated with Recovery in Aboriginal People in Canada Who Had Previously Been Suicidal.

To explore factors associated with recovery from suicidal ideation among Aboriginal peoples living off reserve in Canada. Recovery is defined as being free of serious suicidal thoughts for the past year. Data for this study came from the 2012 Aboriginal Peoples Survey, a nationally representative sample of Aboriginal peoples in Canada who are living off-reserve. The sample consisted of those who had seriously considered suicide at some point in their life (n = 2,680). Those who had been suicidal in the past year were compared to those who were no longer suicidal using Pearson chi-square and logistic regression analyses. Several factors were associated with recovery among Aboriginal peoples living off-reserve in Canada who had previously been suicidal. Recovery was higher among women, individuals who were older, and those who were food secure, spoke an Aboriginal language, had a high school degree, had a confidant, and had no previous diagnosis of mood disorders or learning disability. Several sociodemographic factors appear to influence recovery from suicidality among Aboriginal peoples. Intervention approaches to promote recovery from suicidal ideation would benefit from targeted outreach, a strength-based, culturally-specific approach using traditional practices, and encouraging involvement of various community members to foster resilience and formation of relationships.

Aboriginal peoples in complete mental health: A nationally-representative Canadian portrait of resilience and flourishing.

This study aimed to document the prevalence and factors associated with complete mental health (CMH) among Aboriginal peoples living in Canada. CMH is comprised of three parts: 1) the absence of major depressive episode, anxiety disorders, bipolar disorder, serious suicidal thoughts, and substance dependence in the past year as measured by the World Health Organization (WHO) versions of the Composite International Diagnostic Interview (WHO-CIDI), 2) happiness and/or satisfaction with life in the past month, and 3) psychological and social well-being. The method involved secondary analysis of Statistics Canada's 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Responses from Aboriginal peoples living in Canada off-reserve (n = 965) were examined to determine what percentage were in CMH and what characteristics are associated with being in CMH. Data analysis involved both bivariate and multivariate analytic techniques to examine factors associated with CMH among Aboriginal peoples. Overall, two-thirds of Aboriginal peoples (67.9%) living in Canada were in CMH. Those with a post-secondary degree, who had a confidant, and those who were free of disabling chronic pain were more likely to be in CMH. Additionally, the odds of CMH were higher among those without a history of suicidal ideation, major depression, alcohol dependence, drug dependence, anxiety disorder, or difficulty sleeping. Findings from this study provide indications of substantial resiliency among Aboriginal peoples in Canada.

A Strong Graded Relationship between Level of Obesity and COPD: Findings from a National Population-Based Study of Lifelong Nonsmokers.

Factors associated with chronic obstructive pulmonary disease (COPD) among never-smokers have received little research attention. One potential risk factor for COPD is obesity, which is of particular importance in light of the global obesity epidemic. The objective of this study was to investigate the association between COPD and levels of obesity in a nationally representative sample of non-Hispanic white never-smokers. Data were drawn from the 2012 Center for Disease Control's Behavioral Risk Factor Surveillance System (BRFSS). Pearson's chi-square tests and logistic regression analyses were conducted in a large nationally representative sample of non-Hispanic white respondents aged 50 and over (76,004 women; 37,618 men) who reported that they had never smoked. A dose-response relationship was observed for both men and women: the prevalence of COPD increased from 2.5% in men and 3.5% in women who were of a healthy weight (BMI < 25) to 7.6% in men and 13.4% in women who had a BMI of 40 or higher. Even after adjusting for 7 potential confounds (e.g., age, education, and income), the odds of COPD were 3.21 higher for men (95% CI = 2.46, 4.20) and 4.00 higher for women with class III obesity (95% CI = 3.52, 4.55) in comparison with those of healthy weight. Regular screening for COPD is warranted in never-smoking obese patients who are aged 50 and over. Future research is needed to investigate plausible mechanisms for this association, including (1) the role of chronic inflammation associated with obesity and (2) the impact of central obesity on respiratory system mechanics.

Untangling the Association Between Migraine, Pain, and Anxiety: Examining Migraine and Generalized Anxiety Disorders in a Canadian Population Based Study.

OBJECTIVE: The aims of this study were to investigate: (1) the prevalence and unadjusted and adjusted odds of 12-month generalized anxiety disorder (GAD) among adults with migraine in comparison to those without migraine; (2) If debilitating pain and/or limitations in instrumental activities of daily living (IADLs) are mediators of the migraine-GAD association; and (3) Factors associated with past year GAD among adults with migraine. METHODS: Secondary data analysis of the nationally representative 2012 Canadian Community Health Survey-Mental Health (CCHS-MS), a population-based survey of community dwellers with a response rate of 68.9%. The first subsample included those with (n = 2232) and without migraine (n = 19,270), and the second subsample was restricted to those with migraine (n = 2232). GAD was based on the WHO-CIDI scale. RESULTS: Fully, 6% of those with migraines had past year GAD in comparison of 2.1% of those without migraine (P < .001). The socio-demographically adjusted odds of past year GAD were two and a half times higher among those with migraine than those without (OR= 2.46; 95% CI = 2.00, 3.02). A path analysis indicated that debilitating pain and limitations in IADLs were mediators in the relationship between migraine and GAD. In the sample restricted to migraineurs, the factors associated with higher odds of 12-month GAD included having a university degree, having low income, being without a confidant, and being male. CONCLUSIONS: Generalized anxiety disorder is robustly associated with migraine and targeted outreach and interventions are warranted.

Flourishing after depression: Factors associated with achieving complete mental health among those with a history of depression.

This study investigated factors associated with complete mental health among a nationally representative sample of Canadians with a history of depression by conducting secondary analysis of the 2012 Canadian Community Health Survey- Mental Health (n=20,955). Complete mental health was defined as 1) the absence of mental illness, substance abuse, or suicidal ideation in the past year; 2) happiness or life satisfaction almost every day/past month, and 3) social and psychological well-being. The prevalence of complete mental health among those with and without a history of depression was determined. In a sample of formerly depressed respondents (n=2528), a series of logistic regressions were completed controlling for demographics, socioeconomic status, health and lifetime mental health conditions, health behaviours, social support, adverse childhood experiences, and religiosity. Two in five individuals (39%) with a history of depression had achieved complete mental health in comparison to 78% of those without a history of depression. In comparison to the formally depressed adults who were not in complete mental health, those in complete mental health were more likely to be female, White, older, affluent, married, with a confidant, free of disabling pain, insomnia, and childhood adversities and without a history of substance abuse. They were also more likely to exercise regularly and use spirituality to cope.