Background:Children with chronic physical illness are more likely to experience adverse mental health; however, the extent of their mental health service use is relatively unknown. Objectives:This study described the patterns of mental health service use over 24 months and identified sociodemographic and health-related factors associated with patterns of use among children with chronic physical illness. Methods:Data come from a longitudinal study of 263 children ages 2 to 16 years with chronic physical illness. Measures of mental health service use were parent-reported. Results:Approximately one quarter of parents reported that their child had some form of contact with a health professional for their mental health. Latent class analyses at baseline and 24 months determined a two-class model with one class reporting any service contact for their mental health (11.4-16.4%) while the second class reported no service use (88.6-83.7%). Child age (OR = 1.30 [1.15, 1.46]), comorbid mental health conditions (OR = 5.58 [2.19, 14.18]), elevated disability (OR = 1.09 [1.02, 1.17]), and higher parental educational attainment (OR = 3.12 [1.56, 6.26]) were associated with any service use class. Conclusion:Mental health service needs are common in children with chronic physical illness, and use of mental health services is related to sociodemographic and health-related factors. These results underscore the need to integrate physical and mental health services in this population. Future research among more diverse samples using data linkages to health records should be undertaken to mitigate the potential limitations of parent-reported service use.
Chronic school absenteeism is associated with adverse health and social outcomes for children and youth across development. The present paper analyzed data published by the Canadian Broadcasting Corporation in 2024 about rates of absenteeism in Canada pre-, mid-, and post-COVID-19. Data from a total of 11 regions in Canada, representing over 740,000 children in urban and rural public schools across the country, were analyzed. Non-parametric tests compared pre- and post-COVID-19 absenteeism rates, and correlations with the length of school closures were also explored. Data trends suggest that average chronic absenteeism rates increased significantly from pre- to post-COVID-19 for elementary students, but the increase for secondary students was not as marked. Elementary students living in regions with more school closures throughout the pandemic appear to have higher chronic absenteeism post-pandemic. This trend was not seen for secondary students. Although these results are exploratory in nature, the findings suggest that children, particularly those in the elementary grades, may be at risk of ongoing absenteeism as they develop. Results are discussed in the context of existing literature on absenteeism, Canada's response to the COVID-19 pandemic, and the global context.
Background:The COVID-19 pandemic raised concerns regarding increased youth suicidal behaviour. Trends in the volume and characteristics of hospital self-harm presentations may inform future suicide-prevention strategies. Objective:We compared the number and characteristics of pre - vs. intra-pandemic self-harm presentations to the Emergency Department (ED) of a major Canadian pediatric trauma centre. Method:Using time series analysis, we compared intra-pandemic (March 2020-February 2021) monthly self-harm presentation counts to forecasts based on the previous nine years. We compared the proportion of ED presentations for self-harm between the intra-pandemic period and the preceding three years. A detailed chart review of ED self-harm visits from March 2019 to February 2021 examined the demographic, clinical, and psychosocial features of pre- vs. intra-pandemic presentations. Results:Compared to pre-pandemic forecasts, ED self-harm presentation counts were decreased in March and May 2020 but increased in December 2020-January 2021. The self-harm proportion of ED presentations during the pandemic's first year was double that of the preceding three years (0.19% vs. 0.09%; OR=2.08, 95% CI=1.62-2.67). Compared to pre-pandemic self-harm presentations, patients presenting intra-pandemic were more likely to be seen for a psychiatry consultation in the ED or hospital ward (OR=2.38, 95% CI=1.04-5.43), to be admitted to a medical unit (OR=3.81, 95% CI=1.28-11.39), and to be living with parents (OR=2.58, 95% CI=1.09-6.09). Conclusions:The pandemic's association with the volume of self-harm visits to a pediatric ED appears to have varied throughout its duration. During the pandemic, self-harm visits had an increased representation among ED presentations and exhibited potential indicators of increased medical and psychiatric acuity.
Various medications used to treat psychiatric conditions are associated with prolongation of the QTc interval, which can lead to Torsades de Pointes, a deadly arrhythmia. Despite evidence of QTc prolongation, clinicians increasingly use psychiatric drugs in the pediatric population. Guidelines for prescribing many of these medications in children do not currently exist. To safely prescribe QTc prolonging drugs, especially in children with preexisting cardiovascular conditions, psychiatric providers, primary care physicians and/or pediatricians should conduct a detailed personal and family medical history, medication record, physical examination, and lab work, if clinically indicated, to rule out potential risk factors. Pharmacist input should be sought, if available. If risk factors are present and pre-treatment assessments identify cardiac risk factors, an assessment by a cardiologist may be necessary. To enhance treatment safety and mitigate QTc prolongation risks associated with psychiatric drug use in children, a standardized approach for drug prescribing that takes patient risk factors into account is proposed.
Background: Pathways linking income inequality and health have been hypothesized, with few studies identifying the role of potential mediators pertaining to children's health. Objective: This study examined whether the association between income inequality and children's physical aggression was mediated by maternal depression, anxiety, or social support. Methods: Data were drawn from the All Our Families (AOF) longitudinal cohort based in Calgary, Canada, was used (n = 1090 mother-child dyads). Neighbourhood income inequality was measured via the Gini coefficient derived from the 2006 Canadian Census. Mothers completed the Center for Epidemiologic Scales for Depression, Spielberger State Trait Anxiety Inventory, and the Medical Outcomes Study Social Support Scales, respectively at 3 months postpartum. Maternal and child demographic characteristics were measured at 3 years postpartum. Children's physical aggression was assessed using the Behavior Assessment System for Children, Second Edition at 5 years postpartum. Multilevel path models were used. Results: Mothers in neighbourhoods with moderate income inequality had higher depression symptoms (b = 0.49, 95% CI: 0.01, 0.97) compared to mothers in the most equal neighbourhoods (low-income inequality). Maternal depression was subsequently associated with physical aggression in children (b = 0.26, 95% CI: 0.04, 0.47). Maternal social support was lower (b = -2.51, 95% CI: -4.53, -0.49) among mothers in neighbourhoods with high income inequality compared to mothers in the most equal neighbourhoods. Conclusion: The association between income inequality, maternal mental health, social support, and child physical aggression is complex. More research comprising larger, diverse samples of mother-child dyads may be required to clarify these associations.
Objectives: The U.S. Surgeon General's Advisory recently highlighted (2023) the urgency to better understand the impacts of social media on youth mental health, emphasizing the need to distinguish normative from problematic social media use (PSMU). This study aims to investigate specific online behaviours in adolescents, examining their association with PSMU, depressive symptoms and past abuse. Methods: 247 adolescents (ages 12-17) completed online questionnaires; 124 were part of the community group (CG) and 123 were psychiatric inpatients (Hospitalized Group, HG). The Bergen Social Media Addiction Scale (BSMAS) and PHQ-9 were used to evaluate PSMU and depressive symptoms. Additionally, participants reported on cyberbullying victimization, sexting, accessing self-harm content online and past abuse. Logistic regression analyses were used to measure the strength of association of different score predictors (BSMAS, PHQ-9, abuse) on negative behaviours. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). Results: The prevalence rates of negative online behaviours were similar to those in the existing literature for cyber bullying victimization (20.5%), sexting (20.4%) and self-harm content seeking (27.6%). They were all more frequent in the hospitalized group. They were also associated with PSMU: cyber bullying victimization (OR 4.54, 95% CI [1.95-10.54]), sexting (OR 5.47, 95% CI [2.37-12.81]), and self-harm content seeking (OR 4.71, 95% CI [2.07-11.09]). Moreover, negative behaviours were associated with depressive symptoms as well as past physical and sexual abuse. Conclusions: Problematic social media use (PSMU) is associated with multiple negative online behaviours. Mental health professionals should include questions about social media use and online behaviours in their clinical assessment of adolescents.
Background: Consensus-building approaches have seldom been used to develop research priorities informed by young adults and caregivers with lived eating disorder (ED) experience. Objective: To identify the most important research priorities among Canadian young adults and caregivers affectedby EDs. Method: Using the Nominal Group Technique (NGT), we recruited Canadian young adults (ages 18-29) with pediatric ED treatment experience and their caregivers to participate in two separate NGT panels. The panels consisted of four stages: silent generation, round robin sharing, discussion, and ranking of the generated priorities. Priorities were weighted using a points system and later added to produce a total score for young adults and caregivers. Informed by Qualitative Description, qualitative content analysis was conducted to analyze the discussion portion of the panels. Results: The young adult (n=9) and caregiver (n=10) panels generated 19 and 24 priorities, respectively. The most highly endorsed research priorities among young adults were to improve existing treatment models, to include underrepresented groups in ED research, and to provide more ED education for healthcare providers. Caregivers also endorsed the need for research to improve ED training for healthcare providers and for more robust standard operating procedures and best practices for EDs. In the discussion, participants shared high-level recommendations, frustrations with current ED care, and positive reflections on the NGT process. Conclusions: Future research opportunities based on these generated priorities have the potential to improve alignment and relevance between ED research being conducted and the needs of young adults and caregivers affected by EDs
Background:The literature indicates that the prevalence of loneliness is increasing among adolescents. The role of loneliness in cognitive function, appetite hormone regulation, and inflamatory pathways among typically developing adolescents remains unclear. Methods:We enrolled 78 adolescents without psychiatric disorders in our study. All participants underwent measurements of appetite hormone (e.g., insulin, leptin, and ghrelin) and inflammatory marker levels (e.g., C-reactive protein, interleukin [IL]-6, and tumour necrosis factor-α) as well as cognitive function assessments (e.g., the Wisconsin Card Sorting Test and working memory tasks). Loneliness was classified as mild (≤40) or moderate (41-60) based on the participants' total scores on the University of California, Los Angeles (UCLA) Loneliness Scale. Results:Adolescents with moderate loneliness exhibited higher IL-6 levels (p = .014) than did those with mild loneliness. We identified no significant associations between total UCLA Loneliness Scale scores and appetite hormone levels or cognitive function (all p > .05). Furthermore, cognitive function did not differ between groups (all p > .05). Self-reported depressive and anxiety symptoms were higher in the moderate loneliness group than in the mild loneliness group. Discussion:Our findings indicate that loneliness is significantly associated with elevated IL-6 levels among typically developing adolescents. Loneliness may be a clinical marker for systemic inflammation and for subthreshold depression and anxiety in healthy adolescents. Further longitudinal studies are required to investigate the temporal association between loneliness and systemic low-grade inflammation.
In this rejoinder we address 13 concerns elicited by our invited commentary "An update on the scientific evidence for and against the legal banning of disciplinary spanking." In addition to defending assertions made in the initial commentary, we make several new substantive arguments. In response to dissenters' equating of non-experimental evidence against spanking with non-experimental evidence against smoking, we demonstrate that the two are very dissimilar. We question the purpose of spanking bans, providing stronger evidence that they do not seem to prevent child abuse. We review Canada's association with the UN's Convention on the Rights of the Child (CRC) before and after the 2006 classification of all physical punishment as violence. We discuss the disciplining of children with disabilities. We encourage fellow researchers to avoid the scholar-advocacy bias, appropriately discriminating methodological evaluations of empirical evidence from personal convictions.
In 2004, the Canadian Supreme Court upheld the right of Canadian parents to use open-handed swats to a child's buttocks to correct child misbehavior, but only as developmentally appropriate (i.e., between the ages of 2 and 12). Some social scientists believe that the Canadian Supreme Court did not go far enough. These researchers support total bans on physical discipline. Other social scientists support Canada's existing age-specific legislation. This commentary provides a concise overview of physical discipline research since 2004, emphasizing the methodological rigor of the research used to argue for and against total spanking bans. Advocates of total bans primarily cite reviews based on bivariate correlations and non-randomized methods known to be inherently biased against disciplinary actions (i.e., methods known to make all disciplinary responses to defiance appear harmful). In contrast, those who support Canada's existing legislation have systematically compared methods known to be inherently biased in opposite directions (i.e., harmful- and beneficial-looking), to demonstrate that the true average effect size of customary spanking on child outcomes is likely very near zero. These researchers also emphasize four randomized clinical trials in which spanking increased compliance in defiant preschoolers. Other issues discussed in this commentary are: the developmental trajectories for children who do not learn to comply with parental directives while they are young; and children's risk of assault in countries with and without total bans. We conclude that the most rigorous empirical studies and available crime statistics validate the appropriateness of Canada's existing legislation on disciplinary spanking.
Background:Parents play an essential role in helping an adolescent who has a mental health concern; however, there are no measures of parental mental health literacy for parents of adolescents. Few measures of mental health literacy assess the underlying components of the construct, and measures that assess facets of mental health literacy in parents are limited in psychometric quality. Objective:To develop and psychometrically evaluate a theoretically informed measure of parental mental health literacy, the Parental Mental Health Literacy (ParM-Lit) scale. Method:The ParM-Lit was developed through the generation of items across key domains, expert review of items, and parental feedback. Parents of adolescents (N = 698) completed an online survey including the ParM-Lit and measures of parental attitudes toward help-seeking and knowledge of mental health disorders. Results:Exploratory and confirmatory factor analyses supported a 4- and 5-factor model; however, a 31-item, 4-factor model showed slightly superior fit. Internal consistency of the overall ParM-Lit scale was very good (α = .89), and test-retest reliability was moderate (ICC = .68; 95% CI = .61-.75). The ParM-Lit was strongly associated with parental attitudes towards help-seeking and moderately associated with knowledge of mental health disorders. Conclusions:The ParM-Lit is the first measure of parental mental health literacy, and our findings support its psychometric properties. This final 31-item measure holds promise for advancing measurement of parental mental health literacy in clinical and research settings.
Objective:We examined the mediating role of positive coping skills in the relationship between community belonging and flourishing mental health among Canadian youth, while investigating variations across ethnoracial backgrounds. Methods:Utilising data from the Canadian Community Health Survey-Mental Health Component 2012 cycle, we conducted a mediation analysis using a counterfactual framework on a nationally representative sample of 5,338 youth aged 15-29. The primary outcome, flourishing mental health, was measured using Keyes' Mental Health Continuum. The mediating effect of positive coping skills on the relationship between community belonging and mental health was quantified, and subgroup analyses to compare this relationship in two subgroups of youth identifying as White versus those who do not identify. Results:Positive coping skills accounted for 13.9% of the mediation pathway from community belonging to flourishing mental health. Notably, youth who did not identify as White demonstrated a stronger association between community belonging and flourishing, with a comparatively smaller portion of their pathway mediated by positive coping. The total, direct, and indirect effects indicated a significant positive relationship between community belonging and positive mental health, mediated by positive coping skills. Conclusion:Positive coping skills significantly mediated the relationship between community belonging and flourishing mental health in Canadian youth. However, the strength and nature of this relationship varied across ethnoracial backgrounds, suggesting a potential need for tailored interventions. These findings have implications for clinicians in adopting strategies that not only foster positive coping skills but also promote community engagement and respect for cultural diversity, thereby supporting the mental health of all youth in Canada.
Background: Clinical characteristics of children with school refusal may differ depending on whether school refusal onset occurs during childhood or adolescence. Objective: To determine variations in clinical characteristics of Japanese psychiatric outpatients with school refusal by age. Method: Participants were patients (aged <15 years) who consulted the Department of Child and Adolescent Psychiatry, Kohnodai Hospital, between January 1, 2016 and December 31, 2022. The proportion of diagnoses according to the ICD-10 classification grouped into "developmental and psychological domains" were calculated at each age of school refusal onset. Additionally, clinical characteristics of patients with school refusal onset during adolescence (11-15 years) were compared with child-onset (6-10 years). Results: Of 3,119 patients who had their initial consultation at Kohnodai Hospital, 36.7% (n=1,145) had school refusal. At age 7, 75.9% were classified as having a diagnosis in the "developmental domains," a proportion which subsequently declined with age. In contrast, 36.2% of 7-year-olds had a diagnosis in the "psychological domains," and the proportion subsequently increased with age. Based on a logistic regression model, students with psychological domain diagnoses and suicide-related behaviors had higher odds ratios of school refusal onset during adolescence, whereas those with developmental domain disorders had lower odds ratios, compared to child-onset. Conclusions: Gaining insight into the differences between child and adolescent school refusal may help develop targeted interventions and preventive strategies tailored to different developmental stages. Further research encompassing diverse populations and longitudinal studies could deepen our understanding and clarify causal relationships.
Catatonia is a severe psychomotor syndrome that can be life-threatening if not promptly diagnosed and treated. While benzodiazepines and electroconvulsive therapy (ECT) are established treatments for catatonia in adults, there is limited literature on their efficacy and safety in adolescents. Additionally, the use of N-methyl-D-aspartate (NMDA) antagonists, such as memantine, has been explored as a potential treatment option; however, there is a lack of extensive research in the pediatric population. We report the case of a 16-year-old boy who presented with refractory catatonia. The patient initially appeared to respond to lorazepam but experienced adverse effects, necessitating a switch to clonazepam. Despite some improvement, his condition deteriorated, leading to the initiation of ECT, which was associated with significant improvements. However, stagnation in clinical progress prompted the introduction of memantine, an NMDA antagonist. Memantine was well tolerated and appeared to contribute to further symptom resolution. The patient achieved full remission of catatonia in approximately 2 months and sustained well-being 19 weeks post-discharge with a treatment regimen of olanzapine, memantine and clonazepam. This case highlights the potential efficacy of combining benzodiazepines, ECT, and NMDA antagonists in treating refractory catatonia in adolescents. Our findings support considering NMDA antagonists in treatment protocols, particularly when conventional therapies are ineffective or inaccessible. Further research is needed to validate these results and establish comprehensive guidelines for managing pediatric catatonia.
Background:It is crucial to prioritize mental health (MH) promotion among adolescents, as the initial onset of mental illnesses commonly occurs during this developmental stage. Adopting a multi-pronged approach to mental health literacy (MHL) may help promote adolescent mental well-being. Objective:We aimed to determine baseline adolescents' knowledge and attitudes on mental illness and any changes following a multidimensional MHL program. Method:A pre-post study was conducted among 600 adolescents in grades 10-12 recruited by multistage sampling in southwest Nigeria. MHL training was implemented using multidimensional tools which included peer-led education, MH booklets, posters, and role plays over a six-week period. Pre- and post-intervention questionnaire data on the knowledge and attitudes of respondents on MH issues were collected and analyzed. Results:Of 600 students, 594 (99%) [mean age of 14.87 (SD 1.44), a range of 11-21 years, and a female: male ratio of 1.3:1] completed the study. Post-intervention there were significant improvements in some but not all domains assessed. Participants' views on care seeking and willingness for friendship improved post-intervention with a significant reduction in the concern for personal safety as a reason for unwillingness for friendship. Mean knowledge scores significantly increased from 11.89 (SD 2.56) to 13.51 (SD 2.62). Conclusions:The findings suggest that school-based multidimensional interventions may improve MHL. However, additional studies are needed to more rigorously assess their impact to inform effective integration of MHL into school curricula to enhance adolescent MHL.
