A comparison of psychiatric inpatient admissions in youth before and during the COVID-19 pandemic.

Background: The current understanding of the effect of COVID-19 on child and youth admissions to psychiatric inpatient units over time is limited, with conflicting findings and many studies focusing on the initial wave of the pandemic. Objectives: This study identified changes in psychiatric inpatient admissions, and reasons for admission, including suicidality and self-harm, before and during the COVID-19 pandemic. Method: This time series study analyzed 3,723 admissions of youth (ages 0-18.88 years) admitted to four major psychiatry inpatient units in a large Canadian city between January 1st, 2016 and December 31st, 2021. Pre-pandemic (before March 11, 2020) and during-pandemic (after March 11, 2020) trends of admissions were explored using a Bayesian structural time series model (BSTS). Results: The model revealed that overall admissions during the pandemic period exceeded what would have been predicted in the absence of a pandemic, a relative increase of 29%. Additionally, a rise in the total number of admissions due to self-harm and suicidality (29% increase), externalizing/behavioral issues (69% increase), and internalizing/emotional issues (28% increase) provided strong evidence of increased admissions compared to what might have been expected from pre-pandemic numbers. Conclusions: There was strong evidence of increases in psychiatric inpatient admissions during the COVID-19 pandemic compared to expected trends based on pre-pandemic data. To ensure accessible and continuous mental health supports and services for youth and their families during future pandemics, these findings highlight the need for rapid expanse of inpatient mental health services, similar to what occurred in many intensive care units across Canada.

Contexte: La compréhension actuelle de l'effet de la COVID-19 sur les enfants et jeunes patients admis aux unités d'hospitalisation psychiatrique avec le temps est limitée, avec des conclusions contradictoires et des études portant sur la vague initiale de la pandémie. Objectifs: La présente étude a identifié les changements dans les admissions de patients hospitalisés en psychiatrie, et les raisons de l'admission, notamment la suicidabilité et l'automutilation, avant et durant la pandémie de la COVID-19. Méthode: Cette étude de séries chronologiques a analysé 3 723 admissions de jeunes (de 0 à 18,88 ans) admis à quatre grandes unités d'hospitalisation en psychiatrie dans une grande ville canadienne entre le 1er janvier 2016 et le 31 décembre 2021. Les tendances des admissions pré-pandémiques (avant le 11 mars 2020) et pendant la pandémie (après le 11 mars 2020) ont été explorées à l'aide d'un Modèle bayésien de séries chronologiques structurelles (BSTS). Résultats: Le modèle a révélé que globalement, les admissions durant la période pandémique excédaient ce qui aurait été prédit en l'absence d'une pandémie, une hausse relative de 29%. En outre, une hausse du nombre total d'admissions attribuables à l'automutilation et à la suicidabilité (hausse de 29%), à des problèmes de comportement/d'externalisation (hausse de 69%), et à des problèmes d'internalisation/émotionnels (hausse de 28%) a fourni des preuves solides des admissions accrues comparé à ce qu'on aurait pu attendre des chiffres pré-pandémiques. Conclusions: Il y avait des preuves solides des augmentations des admissions de patients hospitalisés en psychiatrie durant la pandémie de la COVID19 comparé aux tendances prévues selon les données pré-pandémiques. Afin d'assurer des soutiens et des services de santé mentale accessibles et continus pour les jeunes et leur famille durant les futures pandémies, ces résultats soulignent la nécessité d'une expansion rapide des services de santé mentale pour patients hospitalisés, pareillement à ce qui s'est produit dans de nombreuses unités de soins intensifs du Canada.

Prenatal mental health data and birth outcomes in the pregnancy during the COVID-19 Pandemic dataset.

The COVID-19 pandemic was a substantial stressor, especially for pregnant individuals. We aimed to understand the impact of COVID-19-related stresses on pregnant individuals and their infants and collected survey-based data across Canada as part of the Pregnancy during the COVID-19 Pandemic (PdP) project. The dataset described here provides baseline prenatal data and basic birth outcomes from PdP participants. This data includes information from pregnant individuals as well as their infants. At enrolment and time of completion of the baseline survey, participants were pregnant, ≥17 years of age, ≤35 weeks of gestation, living in Canada, and able to read and write in English or French. Baseline data were collected between April 2020-April 2021. Infant data were collected between May 2020-December 2021. All data were collected via self-report using online questionnaires in REDCAP. Questionnaires were available in both English and French. Data were checked for completeness and plausibility, and duplicates were removed. The dataset described here includes age, education, and household income of the pregnant individuals reported at the baseline/enrollment survey. Raw scores are provided for the Edinburgh Postnatal Depression Scale (EPDS) and the PROMIS Anxiety scale. Ratings are also given for three variables describing fear of the COVID-19 virus. Birth outcomes are provided for infants, including gestational age at birth, birthweight, length, mode of delivery, and whether the infant spent time in the neonatal intensive care unit (NICU). Delivery date is reported as month and year. These data will be beneficial for anyone interested in researching stress during pregnancy or birth outcomes in the context of the COVID-19 pandemic. They will also be useful to researchers interested in examining more general effects of prenatal distress on birth outcomes in children. Data could also be compared to other datasets from the COVID-19 pandemic to establish generalizability, or to pre-pandemic datasets to determine the extent of changes during the COVID-19 pandemic.

Effectiveness of training before unsedated MRI scans in young children: a randomized control trial.

BACKGROUND: Young children requiring clinical magnetic resonance imaging (MRI) may be given general anesthesia. General anesthesia has potential side effects, is costly, and introduces logistical challenges. Thus, methods that allow children to undergo awake MRI scans are desirable. OBJECTIVES: To compare the effectiveness of mock scanner training with a child life specialist, play-based training with a child life specialist, and home book and video preparation by parents to allow non-sedated clinical MRI scanning in children aged 3-7 years. MATERIALS AND METHODS: Children (3-7 years, n=122) undergoing clinical MRI scans at the Alberta Children's Hospital were invited to participate and randomized to one of three groups: home-based preparation materials, training with a child life specialist (no mock MRI), or training in a mock MRI with a child life specialist. Training occurred a few days prior to their MRI. Self- and parent-reported functioning (PedsQL VAS) were assessed pre/post-training (for the two training groups) and pre/post-MRI. Scan success was determined by a pediatric radiologist. RESULTS: Overall, 91% (111/122) of children successfully completed an awake MRI. There were no significant differences between the mock scanner (89%, 32/36), child life (88%, 34/39), and at-home (96%, 45/47) groups (P=0.34). Total functioning scores were similar across groups; however, the mock scanner group had significantly lower self-reported fear (F=3.2, P=0.04), parent-reported sadness (F=3.3, P=0.04), and worry (F=3.5, P=0.03) prior to MRI. Children with unsuccessful scans were younger (4.5 vs. 5.7 years, P<0.001). CONCLUSIONS: Most young children can tolerate awake MRI scans and do not need to be routinely anesthetized. All preparation methods tested, including at-home materials, were effective.

Changes in brain metabolite levels across childhood.

Metabolites play important roles in brain development and their levels change rapidly in the prenatal period and during infancy. Metabolite levels are thought to stabilize during childhood, but the development of neurochemistry across early-middle childhood remains understudied. We examined the developmental changes of key metabolites (total N-acetylaspartate, tNAA; total choline, tCho; total creatine, tCr; glutamate+glutamine, Glx; and myo-inositol, mI) using short echo-time magnetic resonance spectroscopy (MRS) in the anterior cingulate cortex (ACC) and the left temporo-parietal cortex (LTP) using a mixed cross-sectional/longitudinal design in children aged 2-11 years (ACC: N = 101 children, 112 observations; LTP: N = 95 children, 318 observations). We found that tNAA increased with age in both regions, while tCho decreased with age in both regions. tCr increased with age in the LTP only. Glx did not show linear age effects in either region, but a follow-up analysis in participants with ≥3 datapoints in the LTP revealed a quadratic effect of age following an inverted U-shape. These substantial changes in neurochemistry throughout childhood likely underlie various processes of structural and functional brain development.

Caregivers' experiences and perceptions of suicidality among their children and youth with fetal alcohol spectrum disorder.

Individuals with Fetal Alcohol Spectrum Disorder (FASD) experience a range of biopsychosocial vulnerabilities that can increase the possibility of adverse life outcomes, including a heightened risk of suicidality. In this study, we explored the lived experiences of caregivers of children and youth with FASD and suicidality, including their perceptions of their child and youth's suicidal experiences. Between March and June 2021, six comprehensive, semi-structured interviews were conducted with five caregivers of children and youth with FASD (Mage = 14.5 years, range 11-22) who were currently experiencing suicidality or had a history of suicidality. Data were analyzed using interpretative phenomenological analysis and then developed into a composite vignette informed and organized by the social-ecological suicide prevention model (SESPM). The composite vignette revealed the narratives of families living with and caring for children and youth with FASD who experience suicidality in relation to the complex and intersectional individual, relational, community, and societal level contextual and protective factors. Findings from this study highlight the critical need for comprehensive FASD-informed suicide prevention and intervention approaches to promote the mental health and wellbeing of children and youth with FASD and their caregivers.

Lifespan Volume Trajectories From Non-harmonized T1-Weighted MRI Do Not Differ After Site Correction Based on Traveling Human Phantoms.

Multi-site imaging consortiums strive to increase participant numbers by pooling data across sites, but scanner related differences can bias results. This study combines data from three research MRI centers, including three different scanner models from two vendors, to examine non-harmonized T1-weighted brain imaging protocols in two cohorts. First, 23 human traveling phantoms were scanned twice each at all three sites (six scans per person; 138 scans total) to quantify within-participant variability of brain volumes (total brain, white matter, gray matter, lateral ventricles, thalamus, caudate, putamen and globus pallidus), and to calculate site-specific correction factors for each structure. Sample size calculations were used to determine the number of traveling phantoms needed to achieve effect sizes for observed differences to help guide future studies. Next, cross-sectional lifespan volume trajectories were examined in 856 healthy participants (5-91 years of age) scanned at these sites. Cross-sectional trajectories of volume versus age for each structure were then compared before and after application of traveling phantom based site-specific correction factors, as well as correction using the open-source method ComBat. Although small systematic differences between sites were observed in the traveling phantom analysis, correction for site using either method had little impact on the lifespan trajectories. Only white matter had small but significant differences in the intercept parameter after ComBat correction (but not traveling phantom based correction), while no other fits differed. This suggests that age-related changes over the lifespan outweigh systematic differences between scanners for volumetric analysis. This work will help guide pooling of multisite datasets as well as meta-analyses of data from non-harmonized protocols.

Prenatal Care Disruptions and Associations With Maternal Mental Health During the COVID-19 Pandemic.

As the novel coronavirus (COVID-19) spread across Canada in March 2020, provinces imposed restrictions. These changes impacted how pregnant individuals received prenatal care and experienced childbirth. The stress caused by these changes may negatively affect the well-being of pregnant individuals with impacts on the developing child. This study investigated the impact of the pandemic on prenatal care and birth plans of pregnant individuals in Canada and potential associations with maternal mental health. Data from 4,604 participants was collected from English- and French-speaking Canadians between April 5 and June 1, 2020 as part of the Canada-wide Pregnancy During the COVID-19 Pandemic study. Symptoms of maternal depression, general anxiety, and pregnancy-related anxiety were assessed. Participants also answered questions about disruptions and changes to prenatal care and their birth plans due to the COVID-19 pandemic. Logistic regression was used to estimate associations between prenatal care disruptions and maternal mental health. Cancellation of prenatal appointments and birth plan changes (specifically changes to childcare during birth and change of support person attending the birth) were significantly associated with greater odds of experiencing clinically elevated depression, anxiety, and/or pregnancy-related anxiety symptoms. These results highlight the need for reliable and accessible prenatal care during the pandemic, such as the integration of mental health screenings and co-ordination of prenatal care providers.

Alcohol and substance use in pregnancy during the COVID-19 pandemic.

BACKGROUND: The impact of the COVID-19 pandemic on alcohol and substance use has been a topic of concern. Pregnant women are currently experiencing elevated anxiety and depression symptoms, which may increase risk of substance use, and potentially result in poor perinatal and neurodevelopmental outcomes for children. METHODS: Survey results were analyzed from an ongoing study of 7470 pregnant individuals in Canada: Pregnancy during the COVID-19 Pandemic. Participants were asked about current use of alcohol and substances, symptoms of depression and anxiety, and COVID-19 concerns: how much they worry about COVID-19 threatening their baby's life, threatening their own life, care for themselves or the baby, feelings of social isolation, and financial difficulties. RESULTS: The percentage of participants who reported use during pregnancy was 6.7 % for alcohol, 4.3 % for cannabis, 4.9 % for tobacco, and 0.3 % for illicit drugs; 2.6 % were using multiple substances. Higher depression symptoms and financial difficulties were associated with more cannabis and/or tobacco use as well as the co-use of substances. There were no associations between alcohol use and mental health or COVID-19 concerns. CONCLUSIONS: Self-reported rates of use and co-use were lower or comparable to previous research, perhaps reflecting pandemic-related circumstances or the demographics of this sample. Depression symptoms and pandemic-related financial difficulties were associated with more tobacco use, cannabis use, and substance co-use. It remains important to maintain access to perinatal, mental health, and financial supports during the pandemic to mitigate prenatal alcohol and substance use and prevent poor perinatal and long-term neurodevelopmental outcomes for children.

Prenatal Exposure And Child brain and mental Health (PEACH) study: protocol for a cohort study of children and youth with prenatal alcohol exposure.

INTRODUCTION: Fetal alcohol spectrum disorder (FASD), which is caused by prenatal alcohol exposure (PAE), affects an estimated 4% of North Americans, and is the most common preventable cause of intellectual disability. Mental health problems, including anxiety and depression, are experienced by nearly all individuals with FASD. However, there is very limited knowledge about effective mental health treatments for individuals with FASD; effective treatments are hindered in part due to a lack of understanding of the basic neurobiology underlying internalising disorders in youth with FASD. METHODS AND ANALYSIS: The Prenatal Exposure And Child brain and mental Health (PEACH) study includes children aged 7-18 years. We will use longitudinal neuroimaging (anatomical T1-weighted, diffusion and passive viewing function MRI) and mental health assessments (Behaviour Assessment Scale for Children, Multi-dimensional Anxiety Scale for Children, Children's Depression Inventory (CDI-2), Kiddie Scale of Affective Disorders) to: (1) characterise brain development trajectories in youth with FASD, (2) determine whether brain alterations mediate increased anxiety and depression in youth with FASD and (3) identify baseline brain features that predict changes of anxiety and depression symptoms over the next 2 years. All of this will be done while considering sex and adverse postnatal experiences, which can significantly impact mental health and brain outcomes. This project will forge new understanding of FASD and mental health from a neurobiological perspective, highlighting key time periods (ie, sensitive windows) and brain regions (ie, that may be susceptible to neurostimulation), while identifying factors that predict individual trajectories of anxiety and depression symptoms. ETHICS AND DISSEMINATION: This study was approved by the University of Calgary Conjoint Health Research Ethics Board and the University of Alberta Health Research Ethics Board. Study results will be disseminated in peer-reviewed journals, at relevant conferences and in conjunction with our knowledge mobilisation partners.

Protocol for the Pregnancy During the COVID-19 Pandemic (PdP) Study: A Longitudinal Cohort Study of Mental Health Among Pregnant Canadians During the COVID-19 Pandemic and Developmental Outcomes in Their Children.

BACKGROUND: The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. OBJECTIVE: The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. METHODS: The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. RESULTS: Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. CONCLUSIONS: This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/25407.

Grey and white matter volumes in early childhood: A comparison of voxel-based morphometry pipelines.

Early childhood is an important period of sensory, motor, cognitive and socio-emotional maturation, yet relatively little is known about the brain changes specific to this period. Voxel-based morphometry (VBM) is a technique to estimate regional brain volumes from magnetic resonance (MR) images. The default VBM processing pipeline can be customized to increase accuracy of segmentation and normalization, yet the impact of customizations on analyses in young children are not clear. Here, we assessed the impact of different preprocessing steps on T1-weighted MR images from typically developing children in two separate cohorts. Data were processed with the Computational Anatomy Toolbox (CAT12), using seven different VBM pipelines with distinct combinations of tissue probability maps (TPMs) and DARTEL templates created using the Template-O-Matic, and CerebroMatic. The first cohort comprised female children aged 3.9-7.9 years (N = 62) and the second included boys and girls aged 2.7-8 years (N = 74). We found that pipelines differed significantly in their tendency to classify voxels as grey or white matter and the conclusions about some age effects were pipeline-dependent. Our study helps to both understand age-associations in grey and white matter volume across early childhood and elucidate the impact of VBM customization on brain volumes in this age range.

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic.

BACKGROUND: Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. METHODS: We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support. RESULTS: We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms. CONCLUSION: This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.

Calgary Preschool magnetic resonance imaging (MRI) dataset.

The Calgary Preschool MRI Dataset in the Developmental Neuroimaging Lab at the University of Calgary uses magnetic resonance imaging (MRI) techniques to study brain structure and function in early childhood [1-3]. The dataset aims to characterise brain development in early childhood (2-8 years), and to understand links to cognitive and behavioral development, as well as provide a baseline from which to identify atypical development in children with diseases, disorders, or brain injuries. MRI data are provided for 126 children (61 males, 65 females). Children ranged from 1.95 to 6.22 years (mean = 3.98 ± 1.06 years) at the time of their first scan and were initially scanned at six month intervals, and now continue to be followed annually (1-20 scans per child, 431 total datasets; datasets do not always have all scan modalities available). All MRI scans were acquired on the same General Electric 3T MR750w system and 32-channel head coil (GE, Waukesha, WI) at the Alberta Children's Hospital in Calgary, Canada. The MRI protocols provided in this dataset include: T1-weighted images acquired using a FSPGR BRAVO sequence; arterial spin labeling (ASL) images acquired with the vendor supplied pseudo continuous 3D ASL sequence; diffusion tensor imaging data acquired using single shot spin echo echo-planar imaging; and passive viewing resting state functional MRI data acquired with a gradient-echo echo-planar imaging sequence.