Transforming healthcare delivery: a descriptive study of a novel provider-to-provider virtual care platform.

Introduction: Addressing challenges in access to specialty care, particularly long wait times and geographic disparities, is a pressing issue in the Canadian healthcare system. This study aimed to evaluate the impact and feasibility of provider-to-provider phone consultations between primary care providers (PCPs) and specialists using a novel virtual care platform in Nova Scotia (Virtual Hallway). Methods: We conducted a cross-sectional survey over 5 months, involving 211 PCPs and 34 specialists across Nova Scotia. The survey assessed the need for formal in-person referrals as well as clinician satisfaction. Statistical methods included descriptive statistics and the one-sample t-test. Results: We found that 84% of provider-to-provider phone consultations negated the need for an in-person specialist referral. It was also reported that 90% of patients that did require in-person consultation had enhanced care while they awaited an in-person appointment with a specialist. Very high levels of satisfaction were reported among both PCPs and specialists, and there was a noticeable increase in billing volumes related to these consultations as measured by provincial billing codes. Conclusion: The findings indicate that provider-to-provider phone consultations are feasible, well-accepted and also effective in reducing the need for in-person specialist visits. This approach offers a promising avenue for alleviating waitlist burdens, enhancing the quality of care, and improving the overall efficiency of healthcare delivery.

Posttraumatic Stress Disorder Symptoms and Coping Motives are Independently Associated with Cannabis Craving Elicited by Trauma Cues.

Cannabis use is common among individuals with posttraumatic stress disorder (PTSD), although its use can ultimately worsen PTSD outcomes. Cannabis-use coping motives may help explain the PTSD-cannabis relationship. Frequent pairing of trauma cues with substance use to cope with negative affect can lead to conditioned substance craving. For the present cue-reactivity study, we examined if PTSD symptoms were associated with cannabis craving elicited by a personalized trauma cue and explored whether coping motives mediated this hypothesized relationship; enhancement motives were included as a comparison mediator. Participants (N = 51) were trauma-exposed cannabis users who completed validated assessments on PTSD symptom severity and cannabis use motives. They were then exposed to a personalized audiovisual cue based on their own traumatic experience after which they responded to questions on a standardized measure regarding their cannabis craving. The results demonstrated that PTSD symptoms were associated with increased cannabis craving following trauma cue exposure, B = 0.43, p = .004, 95% CI [0.14, 0.72]. However, the results did not support our hypothesis of an indirect effect through general coping motives, indirect effect = .03, SE = .08, 95% CI [-.10, .21]. We found an independent main effect of general coping motives on trauma cue-elicited cannabis craving, B = 1.86, p = .002, 95% CI [0.72, 3.01]. These findings have important clinical implications suggesting that clinicians should target both PTSD symptoms and general coping motives to prevent the development of conditioned cannabis craving to trauma reminders in trauma-exposed cannabis users.

Oxygen Effect on the Properties of Epitaxial (110) La0.7Sr0.3MnO3 by Defect Engineering.

The multiferroic properties of mixed valence perovskites such as lanthanum strontium manganese oxide (La0.7Sr0.3MnO3) (LSMO) demonstrate a unique dependence on oxygen concentration, thickness, strain, and orientation. To better understand the role of each variable, a systematic study has been performed. In this study, epitaxial growth of LSMO (110) thin films with thicknesses ∼15 nm are reported on epitaxial magnesium oxide (111) buffered Al2O3 (0001) substrates. Four LSMO films with changing oxygen concentration have been investigated. The oxygen content in the films was controlled by varying the oxygen partial pressure from 1 × 10-4 to 1 × 10-1 Torr during deposition and subsequent cooldown. X-ray diffraction established the out-of-plane and in-plane plane matching to be (111)MgO ∥ (0001)Al2O3 and ⟨11̅0⟩MgO ∥ ⟨101̅0⟩Al2O3 for the buffer layer with the substrate, and an out-of-plane lattice matching of (110)LSMO ∥ (111)MgO for the LSMO layer. For the case of the LSMO growth on MgO, a novel growth mode has been demonstrated, showing that three in-plane matching variants are present: (i) ⟨11̅0⟩LSMO ∥ ⟨11̅0⟩MgO, (ii) ⟨11̅0⟩LSMO ∥ ⟨101̅⟩MgO, and (iii) ⟨11̅0⟩LSMO ∥ ⟨01̅1⟩MgO. The atomic resolution scanning transmission electron microscopy (STEM) images were taken of the interfaces that showed a thin, ∼2 monolayer intermixed phase while high-angle annular dark field (HAADF) cross-section images revealed 4/5 plane matching between the film and the buffer and similar domain sizes between different samples. Magnetic properties were measured for all films and the gradual decrease in saturation magnetization is reported with decreasing oxygen partial pressure during growth. A systematic increase in the interplanar spacing was observed by X-ray diffraction of the films with lower oxygen concentration, indicating the decrease in the lattice constant in the plane due to the point defects. Samples demonstrated an insulating behavior for samples grown under low oxygen partial pressure and semiconducting behavior for the highest oxygen partial pressures. Magnetotransport measurements showed ∼36.2% decrease in electrical resistivity with an applied magnetic field of 10 T at 50 K and ∼1.3% at room temperature for the highly oxygenated sample.

Associations of School Connectedness With Adolescent Suicidality: Gender Differences and the Role of Risk of Depression.

OBJECTIVE: Previous studies have not examined associations of school connectedness with adolescent suicidal behaviours stratified by gender, while including a measure of depression. We analyzed survey data to determine whether there are independent protective associations of higher school connectedness with suicidal behaviours in Canadian adolescents, while controlling for potential confounders, including risk of depression; and whether such associations differ by gender. METHOD: Using data from a stratified cluster sample of randomly selected classes of students in schools in 3 of Canada's Atlantic provinces, we used multiple logistic regression to examine whether associations of risk of depression, measured using the 12-item Center for Epidemiologic Studies-Depression scale, lessened protective associations of higher school connectedness with suicidal behaviours in grades 10 and 12 students, while stratifying by gender. RESULTS: After adjusting for risk of depression, higher school connectedness was independently associated with decreased suicidal ideation in both genders and with suicidal attempt in females. In males, higher connectedness was no longer protective for suicide attempt when risk of depression was included in the model. CONCLUSIONS: School connectedness, which is felt to have positive influences on many types of adolescent behaviour, appears to also be both directly and indirectly protective for suicidality. These effects may occur through different pathways in females and males. Given the protection it offers both genders, including those at risk and not at risk of depression, increasing school connectedness should be considered as a universal adolescent mental health strategy. Studies that examine school connectedness should include analyses that examine potential differences between males and females.

Long-term healthcare cost reduction with Intensive Short-term Dynamic Psychotherapy in a tertiary psychiatric service.

OBJECTIVE: To evaluate whether a mixed population of patients treated with Intensive Short-term Dynamic Psychotherapy (ISTDP) would exhibit reduced healthcare costs in long-term follow-up. METHODS: A quasi-experimental design was employed in which data on pre- and post-treatment healthcare cost were compared for all ISTDP cases treated in a tertiary care service over a nine year period. Observed cost changes were compared with those of a control group of patients referred but never treated. Physician and hospital costs were compared to treatment cost estimates and normal population cost figures. RESULTS: 1082 patients were included; 890 treated cases for a broad range of somatic and psychiatric disorders and 192 controls. The treatment averaged 7.3 sessions and measures of symptoms and interpersonal problems significantly improved. The average cost reduction per treated case was $12,628 over 3 follow-up years: this compared favorably with the estimated treatment cost of $708 per patient. Significant differences were seen between groups for follow-up hospital costs. CONCLUSIONS: ISTDP in this setting appears to facilitate reductions in healthcare costs, supporting the notion that brief dynamic psychotherapy provided in a tertiary setting can be beneficial to health care systems overall. CLINICALTRIALS. GOV IDENTIFIER NUMBER: NCT01924715.

Sex differences in associations of school connectedness with adolescent sexual risk-taking in Nova Scotia, Canada.

BACKGROUND: Associations of lower school connectedness have been seen with adolescent sexual risk behaviors, but little is known about gender differences with respect to these relationships. Understanding any such differences could contribute to better supporting the school environment to promote youth sexual health. METHODS: We used provincially representative cross-sectional data from 1415 sexually active students in grades 10 to 12 in Nova Scotia, Canada, to determine whether lower school connectedness was associated with students' sexual risk behaviors using multivariate logistic regression, stratifying by sex. RESULTS: In boys, lower connectedness was associated with three risk behaviors, having ≥ 2 partners in the previous year (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.13), no condom use at last intercourse (OR 1.06; 95% CI 1.01-1.12), and having unplanned intercourse due to substance use (OR 1.09; 95% CI 1.03-1.15). No such associations were seen in girls. CONCLUSIONS: These results demonstrate that gender differences may exist for associations of school connectedness and sexual risk behaviors; connectedness may be more important for boys than for girls in this area of adolescent health. Educators should consider gender differences when designing interventions to maximize youth sexual health through school-based interventions. Further research on school connectedness and risk-taking should examine genders separately.

Elevated depressive symptoms and adolescent injury: examining associations by injury frequency, injury type, and gender.

BACKGROUND: Key risk factors for adolescent injury have been well documented, and include structural, behavioural, and psychosocial indicators. While psychiatric distress has been associated with suicidal behaviour and related self-harm, very little research has examined the role of depression in shaping adolescent injury. This study examines the association of elevated depressive symptoms with injury, including total number of injuries and injury type. Gender differences are also considered. METHODS: Data were drawn in 2010-11 from a representative sample of 2,989 high school students (14 to18 years of age) from Nova Scotia, Canada. Self-reported injury outcomes were examined using the 17-item Adolescent Injury Checklist, which captures past six-month injuries. Elevated depressive symptoms were assessed using the Centers for Epidemiological Studies Depression scale. Associations of elevated depressive symptoms with total number of injuries were estimated with negative binomial regression, while associations with specific injury types were estimated with logistic regression. Analyses were conducted in 2012. RESULTS: Adolescents with elevated depressive symptoms experienced a 40% increase in the total number of injury events occurring in the past six months. The association of elevated depressive symptoms with injury was consistent across injury type; violence-related (OR 2.21, 95% CI 1.61 to 3.03), transport-related (OR 1.53, 95% CI 1.10 to 2.13), and unintentional injuries (OR 1.65, 95% CI 1.20 to 2.27). Gender differences were also observed. CONCLUSION: Elevated depressive symptoms play a role in shaping adolescent injury. Interventions aimed at reducing adolescent injury should look to minimize psychosocial antecedents, such as poor mental health, that put adolescents at an elevated risk.

Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: a meta-analysis of family high-risk studies.

OBJECTIVE: Offspring of parents with severe mental illness (SMI; schizophrenia, bipolar disorder, major depressive disorder) are at an increased risk of developing mental illness. We aimed to quantify the risk of mental disorders in offspring and determine whether increased risk extends beyond the disorder present in the parent. METHOD: Meta-analyses of absolute and relative rates of mental disorders in offspring of parents with schizophrenia, bipolar disorder, or depression in family high-risk studies published by December 2012. RESULTS: We included 33 studies with 3863 offspring of parents with SMI and 3158 control offspring. Offspring of parents with SMI had a 32% probability of developing SMI (95% CI: 24%-42%) by adulthood (age >20). This risk was more than twice that of control offspring (risk ratio [RR] 2.52; 95% CI 2.08-3.06, P < .001). High-risk offspring had a significantly increased rate of the disorder present in the parent (RR = 3.59; 95% CI: 2.57-5.02, P < .001) and of other types of SMI (RR = 1.92; 95% CI: 1.48-2.49, P < .001). The risk of mood disorders was significantly increased among offspring of parents with schizophrenia (RR = 1.62; 95% CI: 1.02-2.58; P = .042). The risk of schizophrenia was significantly increased in offspring of parents with bipolar disorder (RR = 6.42; 95% CI: 2.20-18.78, P < .001) but not among offspring of parents with depression (RR = 1.71; 95% CI: 0.19-15.16, P = .631). CONCLUSIONS: Offspring of parents with SMI are at increased risk for a range of psychiatric disorders and one third of them may develop a SMI by early adulthood.

Longitudinal associations of importance of religion and frequency of service attendance with depression risk among adolescents in Nova Scotia.

OBJECTIVE: To examine the directionality of associations between self-reported religious importance or worship attendance and depression among adolescents, and to determine whether social supports or general self-efficacy are mechanisms of observed associations. METHOD: A cohort (n = 976) of Canadian high school students were surveyed in Grade 10 (2000 to 2001) and 2 years later (2002 to 2003). Logistic regression was conducted separately among adolescents with and without elevated depressive symptoms to examine associations between baseline religious attendance and religious importance with later depression, adjusting for confounding factors. Effects of reverse causation were also assessed, determining associations between baseline depression and follow-up religious attendance and importance. RESULTS: Girls who were not depressed at baseline and who attended religious services had lower odds of later depression (adjusted odds ratio [AOR] 0.46; 95% CI 0.22 to 0.95, P < 0.05), which was accounted for by general self-efficacy. Boys who were depressed at baseline who attended religious services had lower odds of still being depressed at follow-up (AOR 0.23; 95% CI 0.06 to 0.80, P < 0.01). Depression at baseline predicted lower attendance at follow-up among boys (AOR 0.26; 95% CI 0.09 to 0.75, P < 0.01). CONCLUSIONS: Religious attendance independently predicts lower depression at follow- up among girls, and may do so by increasing self-efficacy. Among boys with depression, religious attendance predicts a lower likelihood of still being depressed at follow-up. The relation between religious attendance and depression in boys is bidirectional.

Objectif : Examiner la directionnalité des associations entre l'importance auto-déclarée de la religion ou de la pratique du culte et la dépression chez les adolescents, et déterminer si les soutiens sociaux ou l'auto-efficacité générale sont des mécanismes des associations observées. Méthode : Une cohorte (n = 976) d'élèves du secondaire canadiens a été interrogée en 10e année (2000 à 2001) et 2 ans plus tard (2002 à 2003). La régression logistique a été menée séparément chez des adolescents présentant ou pas des symptômes dépressifs élevés afin d'examiner les associations entre la pratique religieuse de départ et l'importance de la religion avec la dépression ultérieure, en corrigeant les facteurs de confusion. Les effets de la causalité inverse ont aussi été évalués, en déterminant les associations entre la dépression au départ et la pratique et l'importance de la religion au suivi. Résultats : Les filles qui n'étaient pas déprimées au départ et qui pratiquaient leur religion avaient des probabilités plus faibles d'une dépression ultérieure (rapport de cotes corrigé [RCC] 0,46; IC à 95 % 0,22 à 0,95; P < 0,05), ce qui était attribué à l'auto-efficacité générale. Les garçons qui étaient déprimés au départ et qui pratiquaient leur religion avaient des probabilités plus faibles d'être encore déprimés au suivi (RCC 0,23; IC à 95 % 0,06 à 0,80; P < 0,01). La dépression au départ prédisait une pratique plus faible au suivi chez les garçons (RCC 0,26; IC à 95 % 0,09 à 0,75; P < 0,01). Conclusions : La pratique religieuse prédit indépendamment une dépression plus faible au suivi chez les filles, et ceci peut-être parce qu'elle accroît l'auto-efficacité. Chez les garçons souffrant de dépression, la pratique religieuse prédit une probabilité moindre d'être encore déprimé au suivi. La relation entre la pratique religieuse et la dépression chez les garçons est bidirectionnelle.

Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among Nova Scotia high school students.

OBJECTIVE: To examine associations of cannabis and other illicit drug use with depression, suicidal ideation and suicidal attempts over a two year period during adolescence. METHODS: Nine hundred and seventy-six school students in four high schools in northern Nova Scotia, Canada, were surveyed in grade 10 and followed up in grade 12. Assessments of past 30 day cannabis and illicit drug use as well as mental health variables (risk of depression, suicidal ideation and suicide attempts) were obtained at baseline (2000 and 2001) and follow-up two years later (2002 and 2003). Generalized estimating equations modelled depression, suicidal ideation and attempts among illicit drug users and non-users. RESULTS: Illicit drug use with or without cannabis use was significantly associated with higher odds of depression, suicidal ideation and suicide attempt. Heavy cannabis use alone predicted depression but not suicidal ideation or attempt. CONCLUSIONS: Illicit drug use, with and without accompanying cannabis use, among high school students increases the risk of depression, suicidal ideation and suicidal attempts. Heavy cannabis use alone predicts depression but not suicidal ideation or attempts.

Protective associations of school connectedness with risk of depression in Nova Scotia adolescents.

OBJECTIVE: To determine whether school connectedness demonstrated an independent protective association with risk of depression in students in grades 10 to 12 attending a high school in a rural community in southwestern Nova Scotia. METHODS: Students at a high school in rural Nova Scotia participated in a self-completion survey in May 2009. Students were asked about a wide range of health-related factors to determine their needs for health services and promotion. Examining girls and boys separately, we used logistic regression to examine associations of an established measure of school connectedness with risk of depression as measured by the 12-item Center for Epidemiologic Studies Depression (CES-D) Scale, while including numerous potential confounding variables in our models. RESULTS: The response rate was 95.2% among registered students present in class during the survey. Four hundred eight students (216 girls and 192 boys) completed both the CES-D12 and the School Connectedness Scale. Higher school connectedness was independently protective of risk of depression in girls (OR 0.85; 95% CI 0.78 to 0.93, P < 0.01) and in boys (OR 0.81; 95% CI 0.71 to 0.91, P < 0.01). CONCLUSIONS: Among adolescents in rural Nova Scotia, higher school connectedness has protective associations with risk of depression in both girls and boys, independent of a wide range of factors known to be associated with depression in adolescents. School may be a key place for helping adolescents to develop positive mental health.

Exploring the relationship between religious service attendance, mental disorders, and suicidality among different ethnic groups: results from a nationally representative survey.

BACKGROUND: To date, sufficient data have not been available to examine ethnic differences in religiosity and mental health in the general population. However, evidence exists to suggest that the protective effects of religion may differ across ethnic groups. This study examined the relationship between religious attendance and mental health across ethnic groups. METHODS: The Collaborative Psychiatric Epidemiologic Survey (N = 20,130) is a large, ethnically diverse sample of adult, US respondents. Frequency of attendance at religious services was measured as: at least once per week (reference group), one to three times per month, less than once per month, or less than once per year. Multiple logistic regression analyses examined associations between religious attendance and mood, anxiety and substance use disorders, as well as suicidal ideation and attempts. Models adjusted for sociodemographics and comorbidity. RESULTS: Results differed when performed within each ethnicity. Infrequent religious attendance was associated with substance use disorders in Whites and Africans only (Adjusted Odds Ratio (AOR) = 2.30 [95% CI = 1.77-2.99]; AOR = 1.86 [1.25-2.79], respectively), and with anxiety and suicidal ideation in Whites (AOR = 1.44 [1.10-1.88]; AOR = 1.58 [1.24-2.01]) and Hispanics only (AOR = 2.35 [1.17-4.73]; AOR = 1.70 [1.15-2.52]). Asians were the only group in which religious attendance was associated with mood disorders (AOR = 4.90 [1.54-15.60]). Interaction terms were nonsignificant. CONCLUSIONS: The present study suggests that ethnicity is an important variable to consider in the relationship between religiosity and mental health. Future studies should attempt to either adjust for or stratify by ethnicity when examining these relationships.

Suicidal behaviours in adolescents in Nova Scotia, Canada: protective associations with measures of social capital.

PURPOSE: Few studies of adolescent suicidality have examined its associations with social capital. We explored associations of measures of individual level social capital with self-reported suicide ideation and suicide attempt in adolescents in Cape Breton, Nova Scotia, Canada, controlling for other factors known to be associated with adolescent suicidality. METHODS: We surveyed 1,597 grade 10-12 students at three high schools in 2006 using self-completion questionnaires. Both sexes were combined for analysis. Outcome measures were suicidal ideation and attempt in the previous year. Measures of social capital included perceptions of trustworthiness and helpfulness of others at school, frequency of religious attendance and participation in extracurricular activities. Logistic regressions were carried out to determine associations of social capital with suicidality while controlling for other factors. RESULTS: Perceived trustworthiness and helpfulness were protective for suicidal ideation and suicide attempt in the previous year. In adjusted analyses, there were interactions of gender and social capital-females reporting more social capital were more protected from suicide attempt relative to males with similar levels of social capital. CONCLUSIONS: This study provides initial evidence of protective associations of individual level social capital with adolescent suicidality. Our findings suggest that among adolescents low social capital as measured by perceptions of trust and helpfulness of others at school may be a warning sign for suicidality, particularly for females. It may be helpful to inquire of young people how they perceive the trustworthiness and helpfulness of their school environment as a measure of how supportive that environment might be to them when they are facing challenges to their mental health.

Protective associations of importance of religion and frequency of service attendance with depression risk, suicidal behaviours and substance use in adolescents in Nova Scotia, Canada.

PURPOSE: We examined relationships of measures of personal importance of religion and frequency of attendance at religious services with risk of depression and risk behaviours in high school students in Cape Breton, Canada. We examined the impact of confounding and explanatory factors on these relationships. METHODS: Data were drawn from self-report surveys of adolescents aged 15-19 (N=1615) at three high schools in May, 2006. We used logistic regression to assess associations of religious importance and religious service attendance with risk of depression, suicidal behaviour, binge drinking and frequent marijuana use, controlling in multivariate models for sociodemographic factors, family structure and social capital. RESULTS: Among females, higher personal importance of religion was associated with decreased odds of depression, suicidal ideation, drinking and marijuana use, while more religious attendance was protective for substance use behaviours and suicidal ideation. In males, both measures of religiosity were associated with decreased substance use. In multivariate models, religious importance had weak protective effects for depression and suicidal thinking in females, which were respectively modified by social trust and substance use. Attendance was protective for suicidal thinking in females, and was modified by depression. These associations were not seen in males. Attendance was consistently associated with less substance use in females, while importance was not. Importance was consistently protective for marijuana use and attendance was protective for binge drinking in males. LIMITATIONS: This was a cross-sectional self-report survey and causality cannot be inferred. CONCLUSION: Protective associations of measures of religiosity are seen in Canadian adolescents, as they are elsewhere.

Longitudinal relationships of religious worship attendance and spirituality with major depression, anxiety disorders, and suicidal ideation and attempts: findings from the Baltimore epidemiologic catchment area study.

We present findings on the longitudinal relationships of religious worship attendance and seeking spiritual comfort with subsequent major depression, anxiety disorders and suicidal ideation/attempts using data from Waves 3 and 4 of the Baltimore Epidemiologic Catchment Area Study (N = 1091). Respondents who attended religious services at least once per year had decreased odds of subsequent suicide attempts compared with those who did not attend religious services (AOR = 0.33, 95% CI: 0.13-0.84). Seeking spiritual comfort at baseline was associated with decreased odds of suicidal ideation (AOR = 0.55, 95% CI: 0.31-0.99). These finding were independent of the effects of the presence of the suicidal ideation/attempts, comorbid mental disorders, social supports and chronic physical conditions at baseline. These results suggest that religious attendance is possibly an independent protective factor against suicide attempts.

Time trends in mortality associated with depression: findings from the Stirling County study.

OBJECTIVE: to address the question of whether a mortality risk associated with depression in a 1952 representative sample of Stirling County adults changed in a new sample in 1970, and whether there was a change in associations with cigarette smoking and alcoholism. METHOD: sample members were interviewed about depression and cigarette smoking. General physicians were interviewed by psychiatrists regarding alcoholism. Information about death as of December 31, 1992, was provided by Statistics Canada. Proportional hazards models were fitted in the 2 samples to assess the mortality risks associated with depression among men and women during 20 years of follow-up, and additionally among men with heavy smoking and alcoholism. Specific causes of death were investigated. RESULTS: hazard ratios representing the association between depression and premature death among men were 2.6 (95% CI 1.4 to 4.9) and 2.8 (95% CI 1.5 to 5.1), respectively, in the 1952 and 1970 samples for the first 10 years of follow-up. Hazard ratios for women were 1.4 (95% CI 0.6 to 3.2) and 1.2 (95% CI 0.5 to 2.9). The risk associated with depression among men was independent of alcoholism and heavy smoking. Depression and alcoholism were significantly associated with death by external causes and circulatory disease; heavy smoking was significantly associated with malignant neoplasms. CONCLUSION: the mortality associated with depression did not change during the period from 1952 to 1970. Depressed men experienced a significant mortality risk that was not matched among depressed women and also was not due to alcoholism and heavy smoking.

Countertransference in child and adolescent psychiatry-a forgotten concept?

OBJECTIVES: The purpose of this paper is to review the evolution of the concept of countertransference, its clinical utility and unique features in the child and adolescent psychiatry setting. METHODS: This article employs a selective literature review of papers relevant to countertransference in general and in child and adolescent psychiatry. RESULTS: Reviewed papers indicate that countertransference is a ubiquitous phenomenon in child and adolescent psychiatric practice and that it can have important clinical implications. CONCLUSIONS: Recognition and management of countertransference is a crucial skill in child and adolescent psychiatry. Recommendations are made regarding its incorporation in residency training and psychiatric practice.

Spirituality, religion and suicidal behavior in a nationally representative sample.

BACKGROUND: Studies show that religion and spirituality are associated with decreased rates of mental illness. Some studies show decreased rates of suicide in religious populations, but the association between religion, spirituality and suicidal behaviors in people with mental illness are understudied. Few studies have examined the influence of social supports in these relationships. METHODS: Data were drawn from the Canadian Community Health Survey 1.2. Logistic regression was used to examine the relationship between spiritual values and religious worship attendance with twelve-month suicidal ideation and attempts. Regressions were adjusted for sociodemographic factors and social supports. Interaction variables were then tested to examine possible effect modification by presence of a mental disorder. RESULTS: Identifying oneself as spiritual was associated with decreased odds of suicide attempt (adjusted odds ratio-1 [AOR-1]=0.65, CI: 0.44-0.96) but was not significant after adjusting for social supports. Religious attendance was associated with decreased odds of suicidal ideation (AOR-1=0.64, 95% CI: 0.53-0.77) but not after adjusting for social supports. Religious attendance was associated with decreased odds of suicide attempt and remained significant after adjusting for social supports (AOR-2=0.38, 95% CI: 0.17-0.89). No significant interaction effects were observed between any of the tested mental disorders and religion, spirituality and suicidal behavior. LIMITATIONS: This was a cross-sectional survey and causality of relationships cannot be inferred. CONCLUSIONS: Results suggest that religious attendance is associated with decreased suicide attempts in the general population and in those with a mental illness independent of the effects of social supports.

Cancer, mental disorders, suicidal ideation and attempts in a large community sample.

PURPOSE: To determine the association between cancer diagnosis, mental disorders and suicidal behavior among community dwelling adults. METHODS: Data were drawn from the nationally representative Canadian Community Health Survey Cycle 1.2 (N=36 984, response rate 77%, age 15+). Respondents were grouped into three age groups (15-54, 55-74, and 75+ years), and multiple regression analyses were conducted to examine the relationship between cancer and mental disorders: unadjusted and adjusted for sociodemographics, social supports and other mental disorders. RESULTS: Among respondents aged 15-54, cancer was associated with increased odds of major depression (odds ratio [OR]=3.18; 95% confidence interval [CI]: 1.69-5.96), panic attacks (OR=2.15; 95% CI: 1.22-3.77) and any mental disorder. Among respondents aged 55-75, cancer was associated with increased odds of agoraphobia (OR=5.94; 95% CI: 1.68-21.03) and decreased odds of social phobia (OR=0.22; 95% CI: 0.06-0.80). Cancer was not associated with any mental disorder in the 75+ age group. Results persisted after adjustments for the covariates. Suicidal ideation was associated with cancer in the 55-74 age group (OR=5.07; 95% CI: 1.25-20.47) in unadjusted models; however, this relationship became non-significant when adjusting for the other covariates. CONCLUSION: Clinicians should consider screening for depression and panic disorder in young, community dwelling patients with cancer.