Mental health of Canadian youth: A systematic review and meta-analysis of studies examining changes in depression, anxiety, and suicide-related outcomes during the COVID-19 pandemic.

OBJECTIVES: This systematic review and meta-analysis aims to describe Canadian youth mental health during the COVID-19 pandemic, focusing on changes in anxiety and depressive symptoms and suicidality. METHODS: We searched four databases up to February 2023 for longitudinal or repeated cross-sectional studies reporting on changes in depressive and anxiety symptoms, suicidality, or related services utilization among young people under 25 years old residing in Canada during the COVID-19 pandemic. Random-effects meta-analyses were performed for studies comparing depressive and anxiety symptoms from before to during the first, second, and third COVID-19 waves (up to June 2021), and between COVID-19 waves. Other studies were described narratively. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist. SYNTHESIS: Of the 7916 records screened, 35 articles met inclusion criteria for this review. Included studies were highly heterogeneous in design, population, and type of change investigated, and many had a high risk of bias. The meta-analyses found that depressive symptoms worsened minimally from pre-pandemic to wave 1 but returned to pre-pandemic levels by wave 2. Anxiety symptoms were broadly comparable from pre-pandemic to waves 1 and 2 but worsened from waves 1 to 3 and from pre-pandemic to wave 1 for girls. The narrative review included several studies that provided inconclusive evidence of increases in services utilization. CONCLUSION: The current evidence is limited and highly heterogeneous, making it insufficient to draw definitive conclusions regarding the short- to medium-term impact of the pandemic on youth mental health in Canada. Obtaining better mental health surveillance among Canadian youth is imperative.

RéSUMé: OBJECTIFS: Cette revue systématique et méta-analyse vise à décrire la santé mentale des jeunes Canadiens pendant la pandémie de COVID-19 en ce qui concerne les changements dans les symptômes d'anxiété et de dépression et la suicidalité. MéTHODES: Nous avons cherché dans quatre bases de données, jusqu'en février 2023, des études longitudinales ou transversales répétées portant sur l'évolution des symptômes dépressifs et anxieux, de la suicidalité ou de l'utilisation des services en santé mentale chez les jeunes de moins de 25 ans résidant au Canada pendant la pandémie de COVID-19. Des méta-analyses à effets aléatoires ont été réalisées pour les études comparant les symptômes dépressifs et anxieux avant et pendant les première, deuxième et troisième vagues du COVID-19 (jusqu'en juin 2021), ainsi qu'entre les vagues de COVID-19. Les autres études ont été décrites de manière narrative. Le risque de biais a été évalué à l'aide d'une liste de contrôle adaptée du Joanna Briggs Institute. SYNTHèSE: Sur les 7 916 dossiers examinés, 35 articles répondaient aux critères d'inclusion de la présente étude. Les études retenues sont très hétérogènes en termes de conception, de population et de type de changement étudié, et un grand nombre d'entre elles présentent un risque élevé de biais. Les méta-analyses révèlent que les symptômes dépressifs se sont légèrement aggravés entre la période prépandémique et la première vague, mais qu'ils sont revenus aux niveaux prépandémiques lors de la deuxième vague. Les symptômes d'anxiété sont globalement comparables entre la période prépandémique et les vagues 1 et 2, mais se sont aggravés entre les vagues 1 et 3 et entre la période prépandémique et la vague 1 pour les filles. La revue narrative porte sur plusieurs études qui ont fourni des preuves non concluantes de l'augmentation de l'utilisation des services en santé mentale. CONCLUSION: Les données actuelles sont limitées et très hétérogènes, ce qui ne permet pas de tirer des conclusions définitives quant à l'impact à court et moyen terme de la pandémie sur la santé mentale des jeunes au Canada. Il est impératif d'améliorer la surveillance de la santé mentale des jeunes Canadiens.

Depression, anxiety, and suicidal ideation in a population-based cohort of young adults before and during the first 12 months of the COVID-19 pandemic in Canada.

OBJECTIVES: Findings from a birth cohort study indicated that the mental health of young adults had not worsened during the first wave of the COVID-19 pandemic, compared to 2018. This study examined longitudinal changes in mental health between March 2018 and June 2021 in the context of protracted public health mitigation measures about 12 months after the onset of the pandemic. METHODS: Participants from the Quebec Longitudinal Study of Child Development (n = 2120 at inception; n = 1461 during the COVID-19 pandemic), a population-based cohort of individuals born in 1997/1998, reported on their depressive and anxiety symptoms as well as suicidal ideation prior to the pandemic in 2018 (age 20), and during the pandemic in the summer of 2020 (age 22) and spring of 2021 (age 23). RESULTS: Depressive (Cohen's d = 0.15 [95% CI: 0.09 to 0.20]) and anxiety (Cohen's d = 0.33 [95% CI: 0.27 to 0.39]) symptoms increased between 2018 and 2021 for both males and females, but suicidal ideation did not change. There was also a significant increase in moderate to severe depressive (31.7% to 36.3%) and anxiety (14.7% to 24.8%) symptoms from 2018 to 2021. Youth who were students, those who were experiencing financial stress, food insecurity, and loneliness, and those without pre-existing poor mental health experienced the largest increase in depressive and anxiety symptoms over time. CONCLUSION: These findings highlight the mental health burden experienced by young adults during the COVID-19 pandemic, highlighting the need for preventive services and continued longitudinal follow-ups of these youths.

RéSUMé: OBJECTIFS: Les résultats d'une étude de cohorte de naissance ont indiqué que la santé mentale des jeunes adultes ne s'était pas détériorée au cours de la première vague de la pandémie de la COVID-19, en comparaison à 2018. La présente étude examine maintenant les changements longitudinaux de la santé mentale entre mars 2018 et juin 2021, dans le contexte de mesures prolongées de santé publique, environ 12 mois après le début de la pandémie. MéTHODES: Les participants de l'Étude longitudinale du développement des enfants du Québec (n = 2120 à la création; n = 1461 pendant la pandémie de COVID-19), une cohorte basée sur la population de personnes nées en 1997­98, ont rapporté leurs symptômes de dépression et d'anxiété ainsi que leurs idéations suicidaires avant la pandémie en 2018 (20 ans), pendant la pandémie à l'été 2020 (22 ans) ainsi qu'au printemps 2021 (23 ans). RéSULTATS: Les symptômes de dépression (d de Cohen = 0,15 [95% IC: 0,09 à 0,20]) et d'anxiété (d de Cohen = 0,33 [95% IC: 0,27 à 0,39]) ont augmenté entre 2018 et 2021 chez les hommes et les femmes, mais les idéations suicidaires n'ont pas changé. Une augmentation significative des symptômes dépressifs modérés à sévères (31,7 % à 36,3 %) et des symptômes d'anxiété (14,7 % à 24,8 %) a également été observée entre 2018 et 2021. Les jeunes qui étaient étudiants, ceux qui rapportaient un stress financier, de l'insécurité alimentaire et de la solitude, ainsi que ceux qui avaient une bonne santé mentale en prépandémie, ont connu la plus forte augmentation des symptômes de dépression et d'anxiété au fil du temps. CONCLUSION: Ces résultats mettent en évidence l'impact de la pandémie de la COVID-19 sur la santé mentale des jeunes adultes, et soulignent la nécessité de mettre en place des services de prévention et de poursuivre le suivi longitudinal de ces jeunes.

Prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysis.

BACKGROUND: Suicide in children is a pressing public health concern. The increasing number of deaths by suicide and emergency visits for suicidal ideation and self-harm in children might not be fully representative; it is likely that many more children are in distress but do not seek out help. We conducted a systematic review and meta-analysis of existing studies to quantify the prevalence of suicidal ideation and self-harm behaviours among children in the community aged 12 years and younger. METHODS: In this systematic review and meta-analysis, we searched PsycINFO, MEDLINE, and Web of Science via OVID from database inception to Feb 28, 2022, for articles published in French or English that reported estimates of prevalence of suicidal ideation (including suicide planning) and self-harm behaviours (namely, self-harm, suicide attempts, and non-suicidal self-injury) in children aged 12 years and younger. Reference lists were also searched; case studies, qualitative studies, and health-care visit studies were excluded. The outcomes were suicidal ideation, suicide plan or attempts, and self-harm. We used a random-effects model to calculate the overall pooled prevalence of suicidal ideation and self-harm behaviours for all timeframes combined and for ever versus the past 12 months for suicidal ideation. We used the Joanna Briggs Institute Critical Appraisal tool to evaluate the risk of bias in each study. This study is registered with PROSPERO, CRD42020179041. FINDINGS: 28 articles, encompassing 30 studies overall, met the inclusion criteria, aggregating findings from 98 044 children (of whom 46 980 [50·5%] were girls and 46 136 [49·5%] were boys; six articles did not report sex or gender) aged 6-12 years. The pooled prevalence estimate was 7·5% (95% CI 5·9-9·6) for suicidal ideation from 28 studies and 2·2% (2·0-2·5) for suicide planning from three studies. The pooled prevalence was 1·4% (0·4-4·7) for self-harm from four studies, 1·3% (1·0-1·9) for suicide attempt from six studies, and 21·9% (6·2-54·5) for non-suicidal self-injury from two studies. The prevalence of suicidal ideation was higher in studies that included child-reported outcomes (10·9% [95% CI 8·1-14·5] for child only and 10·4% [6·8-15·5] for child and parent combined) than for parent-only reported outcomes (4·7% [3·4-6·6]; p=0·0004). The prevalence of suicidal ideation and self-harm behaviours was similar in boys and girls (suicidal ideation, 7·9% [95% CI 5·2-12·0] for boys vs 6·4% [3·7-10·7] for girls; self-harm behaviours, 3·5% [1·6-7·2] for boys vs 3·0% [1·4-6·4%] for girls). Detailed ethnicity data were not available. High heterogeneity was identified across estimates (I2>90%), which was not well explained by the characteristics of the studies. INTERPRETATION: A high number of children in the general population can experience suicidal ideation and self-harm behaviours, thus underlining the need for more research on childhood suicide, including developmentally appropriate preventive strategies, such as youth-nominated support teams or dialectical behavioural therapy. FUNDING: Canada Research Chair in Youth Mental Health and Suicide Prevention.

Reasons and Determinants for Perceiving Unmet Needs for Mental Health in Primary Care in Quebec.

OBJECTIVE: To evaluate the mental health care needs perceived as unmet by adults in Quebec who had experienced depressive and (or) anxious symptomatology (DAS) in the previous 2 years and who used primary care services, and to identify the reasons associated with different types of unmet needs for care (UNCs) and the determinants of reporting UNCs. METHOD: Longitudinal data from the Dialogue Project were used. The sample consisted of 1288 adults who presented a common mental disorder and who consulted a general practitioner. The Hospital Anxiety and Depression Scale was used to measure DAS, and the Perceived Need for Care Questionnaire facilitated the assessment of the different types of UNCs and their motives. RESULTS: About 40% of the participants perceived UNCs. Psychotherapy, help to improve ability to work, as well as general information on mental health and services were the most mentioned UNCs. The main reasons associated with reporting UNCs for psychotherapy and psychosocial interventions are "couldn't afford to pay" and "didn't know how or where to get help," respectively. The factors associated with mentioning UNCs (compared with met needs) are to present a high DAS or a DAS that increased during the past 12 months, to perceive oneself as poor or to not have private health insurance. CONCLUSIONS: To reduce the UNCs and, further, to reduce DAS, it is necessary to improve the availability and affordability of psychotherapy and psychosocial intervention services, and to inform users on the types of services available and how to access them.

A psychometric evaluation of the French Canadian version of the Hospital Anxiety and Depression Scale in a large primary care population.

BACKGROUND: The aims of this study were to: (1) evaluate the psychometric properties of a French Canadian version of the Hospital Anxiety and Depression Scale (HADS-FC) in a large population of primary care patients in Quebec, Canada; (2) conduct a transcultural validation of the original HADS in a subsample of English-speaking patients; (3) explore HADS properties in subgroups with or without multimorbidity. METHODS: A sample of 14,833 adults recruited in 64 primary care clinics completed the HADS, including 3,382 patients at elevated risk of mental disorders that also completed the Composite International Diagnostic Interview-Simplified (CIDIS). The HADS' internal consistency and discriminant validity were assessed, its factor structure was evaluated, and receiver operating characteristic (ROC) analyses were undertaken to evaluate its case finding abilities. RESULTS: The HADS-FC had good reliability (Cronbach's alphas ranging from 0.79 to 0.89 depending on language version and subscales) and discriminant validity, and a two-factor structure reflecting anxiety and depression factors. Results were similar in patient subgroups with or without multimorbidity. Optimal cut-off values were calculated: HADS: ≥ 16 (sensitivity 62%, specificity 77%), HADS-A: ≥ 10 (sensitivity 66%, specificity 73%) and HADS-D:≥ 7 (sensitivity 65%, specificity 75%). LIMITATIONS: Our cohort selection process and use of the CIDIS as a gold standard may have contributed to the limited case-finding performance of the HADS-FC. CONCLUSIONS: The HADS-FC and English HADS presented good psychometric properties in primary care patients, including patients with and without multimorbidity. However, its performance as a screening instrument in these settings with patients of varying clinical profiles requires more scrutiny.

Adjustment among mothers reporting same-gender sexual partners: a study of a representative population sample from Quebec Province (Canada).

We examined the well-being of mothers and non-mothers reporting exclusive opposite-gender sexual partners (OG), same-gender sexual partners (SG), or both (BI) in a representative sample of 20,773 participants (11,034 women) 15-years-old or older from the population of Quebec province in Canada. Participants completed a self-administered questionnaire and SG and BI women (n = 179) were matched to a sample of OG women (n = 179) based on age, income, geographical area, and children (having at least one 18-year-old or younger biological or adopted child at home). We assessed social milieu variables, risk factors for health disorders, mental health, and quality of mothers' relationship with children. The findings indicated a sexual orientation main effect: Mothers and non-mothers in the SG and BI group, as compared to their OG controls, were significantly less likely to live in a couple relationship, had significantly lower levels of social support, higher prevalence of early negative life events, substance abuse, suicide ideation, and higher levels of psychological distress. There were no Sexual Orientation X Parenthood status effects. The results further indicated that sexual orientation did not account for unique variance in women's psychological distress beyond that afforded by their social milieu, health risk factors, and parenthood status. No significant differences were found for the quality of mothers' relationship with children. SG-BI and OG mothers with low levels of social integration were significantly more likely to report problems with children than parents with high levels of social integration. We need to understand how marginal sexualities and their associated social stigma, as risk indicators for mothers, interact with other factors to impact family life, parenting skills, and children's adjustment.

Reliability and validity of the Revised Children's Manifest Anxiety Scale in a French-Canadian sample.

The aim of this study was to examine the reliability and validity of a French version of the Revised Children's Manifest Anxiety Scale (RCMAS). A sample of 2,666 school-age French-Canadian children completed the questionnaire. With regard to factor structure, the 5-factor model found in U.S. normative samples was confirmed. The internal consistency of the 5 scales and of the 2 global scales was good to excellent. Test-retest reliabilities after a 6-month period were also similar to those of the original version. Finally, the concurrent validity, assessed by a correlation with the State-Trait Anxiety Inventory for Children, was also found to be good. Results of the present study show that the French version of the RCMAS is a good instrument to assess anxiety in children.

Conflict, social support, and relationship quality: an observational study of heterosexual, gay male, and lesbian couples' communication.

Data from 42 heterosexual, 46 gay male, and 33 lesbian couples were used to assess the contribution of conflict and support discussions to relationship quality. Couples completed questionnaires, and videotaped discussions were coded for levels of negative and positive behaviors. Correlations showed that behaviors were associated with relationship quality in the expected directions. Hierarchical linear modeling analyses assessed the unique contributions of individual and dyadic behaviors to the variability of relationship quality. The findings indicated that, beyond the contribution of individual negative behaviors in the conflict task, the variables of dyadic positive behaviors in the conflict task, individual positive behaviors in the support task, and perceived help accounted for unexplained variance in relationship quality. There were no differences between types of couples on levels of behaviors or on their contributions to relationship quality.