OBJECTIVES:This study aimed to quantify associations between chronic conditions and mental illness; investigate potential moderating effects of child age, sex, health functioning, mental health service contact and household income on these associations; and explore the potential mediating effect of family functioning. METHODS:This study conducted secondary data analyses on a sample of 6242 children aged 4-17 years from the 2014 Ontario Child Health Study (OCHS). Chronic conditions were assessed using a standard list of conditions developed by the Statistics Canada. Mental illness was assessed with the Emotional Behavioural Scales (EBS). The Health Utility Index Mark III measured health functioning. Logistic regression models quantified associations between chronic conditions and mental illness. Moderating effects were tested with product-term interactions in logit models and interpreted using average marginal effects. Mediating effects were explored using the product of coefficients method. RESULTS:Having a chronic condition was associated with mood disorder (OR = 2.25 [95% CI: 1.36-3.74]). For children who have better health functioning, average marginal effects indicated that children with chronic conditions are 29% more likely to have any mental illness (p < 0.01), 21% more likely to have anxiety disorders (p < 0.05) and 21% more likely to have ADHD (p < 0.05) than children with no conditions. For children who have poorer health functioning, there was no association between chronic conditions and mental illnesses. Family functioning did not mediate any associations between chronic conditions and mental illness outcomes. CONCLUSION:The association between chronic conditions and mental illness in children is nuanced, with health functioning moderating this association for any mental illness, anxiety disorders and attention-deficit hyperactivity disorder specifically. Mental health screening programs should ensure children with chronic conditions who have better health functioning are routinely assessed and upstream interventions initiated early to reduce the incidence of physical-mental multimorbidity.

Background: Various liberalized approaches to drug possession, including decriminalization, depenalization, diversion, and legalization, carry distinct implications for policing practices, which can vary based on geographic variation, including urbanicity, as well as the contextual factors that may be unique to different spaces. Methods: We present findings from a scoping review that includes all peer-reviewed studies (quantitative, qualitative, mixed-methods) published in English that address the various liberalized policing approaches to drug possession. A qualitative coding process was used to organize the findings, and themes were chosen based on frequency, relevance, and significance. Results: The initial database searches included 1127 studies, after duplicates were removed. After abstract, title, and full-text screening was completed, 61 studies were considered eligible for inclusion in this review. Four overarching themes were identified including discrepancies, employment challenges, outcomes of policy changes, and urban and rural differences. Discussion: Several major challenges remain prevalent in the facilitation of drug liberalization globally, including inadequate training of policy changes and/or enforcement procedures, lack of options for diversion, unintended increases in workload, and overall conflicting duties of police as authoritative figures providing support services. Despite the potential of policy reform to lessen structural inequalities in policing, racial inequalities remained evident as a result of police discretion in drug law enforcement. Geographic contexts also play a key role in implementation of liberalization, as studies found mixed results related to police discretion in drug-related encounters across urban and rural settings. These findings underscore the need for liberalization strategies that consider improved police training, incorporate more resources dedicated to diversion, and address discriminatory behaviours that may occur during police work.

Suicide rates amongst Black young people are increasing and emerging as leading causes of death for various Black subgroups worldwide. Few studies exist examining the reliability and validity of current suicide risk instruments for assessing suicide risk amongst this vulnerable, diverse population internationally. This scoping review examined the psychometric properties of suicide risk assessments among young Black populations globally. We utilized Arksey and O’Malley’s scoping review framework and the PRISMA guidelines for reporting our results. Our inclusion criteria included psychometric studies with samples involving Black participants ages 10–34 years old. We identified 20 studies summarizing eight suicide scales and five mental health scales with embedded suicide risk scales. The Ask Suicide Screening Questionnaire was the most utilized scale amongst Black young people; most suicide psychometric studies were conducted in the USA followed by countries in Sub-Saharan Africa (Nigeria, Uganda and Ghana). ASQ Sensitivity ranged from 67 to 94

To estimate six-month prevalence of child mental health service contacts and quantify associations between child health status and mental health service contacts, including number of types of contacts. Data come from 6,242 children aged 4–17 years in the Ontario Child Health Study. A list of chronic conditions developed by Statistics Canada measured physical illness. The Emotional Behavioural Scales assessed mental illness. Child health status was categorized as healthy, physical illness only, mental illness only, and multimorbid (≥ 1 physical and ≥ 1 mental illness). Mental health service contact was aggregated to general medicine, urgent medicine, specialized mental health, school-based, alternative, and any contact (≥ 1 of the aforementioned contacts). Regression models quantified associations between health status and type of mental health contact, including number of types of contacts. Weighted prevalence estimates showed 261,739 (21.4

BACKGROUND:Several studies showed strong evidence that the COVID-19 pandemic disrupted mental health service use, with changes in emergency department visits, and psychiatric hospital admissions. It is not clear, however, whether the pandemic caused an increase or decrease in use of services for people with different diagnoses and symptoms. METHODS:We used data from all individuals admitted to psychiatric units in Ontario, Canada (259,620 individuals) from January 1st 2015 to December 31st, 2020 and compared the number of admissions, length of stay, symptoms, and clinical characteristics of this population in 2020 to the average of those who were admitted between 2015 and 2019. RESULTS:Total number of admissions declined sharply (44%) during the first lockdown period but returned to pre-pandemic levels within about 2 months. This trend, however, was not observed for all types of mental health problems. Admissions for symptoms such as risk of harm to others and addictions were consistently higher after the first wave in May 2020 compared to the same month in the previous 5 years, while symptoms such as social withdrawal, and depression were consistently lower. CONCLUSION:Taken together, these results suggest that the impact of the pandemic on the use of mental health services were symptom-specific, which is likely a result of the heterogeneity of mental health problems within this population. This variation in the changes in psychiatry admissions for patients with different clinical profiles should be considered when preparing for future service interruptions.

This study investigated whether child psychopathology trajectories mediate the association between parent psychological distress/family functioning and mental health service use (MHSU) among children with a chronic physical illness (CPI). Data come from a longitudinal study of 263 children and youth aged 2–16 years diagnosed with a CPI and their parents assessed at baseline, six, 12, and 24 months. Parent psychological distress was measured by creating a composite score from the Centre for Epidemiological Studies Depression scale and Generalized Anxiety Disorder-7 scale, and family functioning was measured using the McMaster Family Assessment Device. Previous work identified three trajectories of psychopathology among children: low-stable, moderate-stable, and high-decreasing. Path analysis was used to estimate potential mediating effects. A significant indirect effect of parent psychological distress on healthcare professional contact through child psychopathology was found ( β = 0.001(0.001), p = 0.021). The indirect effect of family functioning was not significant ( β = − 0.001(0.001), p = 0.155). Addressing parent mental health may reduce child psychopathology and potentially decrease MHSU in children with CPI. Understanding these pathways is needed to develop family-centred interventions that support mental health in children with CPI and their parents.

There are rich data available from assessments like the interRAI Mental Health that may not be shared with patients in usable ways. We outline a co-design process as an example for health system providers interested in developing platforms for sharing interRAI information with care recipients. Persons with lived experience (current and past service users) identified design specifications for summaries of interRAI data over a series of co-design workshops, including visual and text representations of clinical information as well as processes for sharing summaries with patients. Graphic and text considerations were identified in workshops, including icons associated with key clinical issues and nuanced text summaries of assessment outputs and implications. Participants noted that persons in inpatient care should review this information once stable, and with assistance of a peer support specialist. This work affirms that it is not only desirable, but entirely achievable from an organizational perspective to prioritize and integrate patient voices in the design and use of clinical information.

BackgroundThis study examined whether youth transition between different mental health symptom profiles over time, and what factors predict these transitions. Understanding the stability and change in psychopathology helps discern whether certain behaviours are temporary or signs of persistent problems.MethodsData were drawn from a longitudinal study of 263 youth (ages 2-16) with chronic physical illness and their parents, assessed at baseline (T1), six months (T2), 12 months (T3), and 24 months (T4). Parents reported on youth psychopathology using the Emotional Behavioural Scales (EBS). Latent profile analysis identified psychopathology profiles, and latent transition analysis quantified the probability that youth remained or moved between groups over time.ResultsFour profiles were identified: low psychopathology (LP), primarily internalizing (PI), primarily externalizing (PE), and high psychopathology (HP). Homotypic continuity (i.e., remaining in the same profile over time) was lower for the PI, PE, and HP subgroups. Youth in the PI subgroup were more likely to transition to the LP, while those in HP showed greater stability, with many remaining in the high-symptom groups. Child age, parent psychopathology, and parent education significantly predicted profile transitions.ConclusionsMost youth showed changes in their mental health over time, but a small proportion with HP (<5%) had more persistent problems. Results demonstrate the need for early identification and intervention for youth at risk of chronic mental health difficulties.

The objectives of this study were to characterize 24-month trajectories of psychopathology, validate psychopathology groups, and identify youth, parent, family, and neighbourhood characteristics associated with each identified trajectory in a sample of youth with chronic physical illness (CPI). Data come from a longitudinal study of 263 youth aged 2–16 years diagnosed with CPI and their parents. Participants were recruited from outpatient clinics at a pediatric hospital in Canada and assessed at recruitment (baseline), 6, 12, and 24 months. Parents reported on youth psychopathology using the Emotional Behavioural Scales. Latent class growth analysis was used to identify trajectories of psychopathology. Baseline predictors of trajectory group membership were investigated using multinomial logistic regression. Three distinct psychopathology trajectories best fit the data; the model had a BIC of -3579.70 and average posterior probabilities of 0.97. The trajectories were classified as, low-stable (LS: n = 156, 58

BackgroundInpatient psychiatry is a critical service in a community-based care system for persons with serious mental illness (SMI). Currently, there are few generally accepted or widely used outcomes to assess the effectiveness of inpatient treatment.MethodFollowing a Donabedian Model of Health Care Quality, we utilized eight scales from the RAI Mental Health assessment to derive a clinician-scored outcome measure consisting of 4 domains (Psychosis, Depression, Impairment, and Aggression). We combined subscales measuring these domains into a Composite Measure. We used this measure to assess the entire population (N=719) of our large specialized mental health hospital at the beginning (T1) and end (T2) of three months in the hospital (or admission to discharge in shorter stays). We evaluated the content validity of the measure by comparing items and scales with a list of putative contributors to hospital admission (symptoms and complications). To evaluate concurrent validity, we compared mean scores among hospital units with varying lengths of stay and clinical complexity (acute versus chronic versus complex chronic). We used ROC analysis to evaluate the CIIMHS’s ability to predict discharge from the hospital. To evaluate construct validity, we examined the measure’s responsiveness to changes among patients after treatment in the hospital.ResultsWe found strong evidence for all four kinds of validity.ConclusionsThe composite measure represents a valid measure of inpatient mental health status and will serve as a valuable measure of the quality of care for inpatient psychiatry.

Psychological trauma is a prevalent mental health concern, with most individuals experiencing at least one traumatic event in their lifetime. Early leaves from inpatient settings are a pertinent challenge among persons who have experienced trauma and may reflect unmet care needs. This study examined patterns of early leaves among persons with trauma from inpatient care in Ontario, Canada. All records for individuals who have experienced trauma with an index admission of over 72 h between January 1, 2015 and December 31, 2019 were included (N = 11,043). Logistic regression using generalized equation estimation was used to assess the association between demographic and clinical characteristics, substance use, social relationships, staff dynamics, and control interventions with the outcome of early leaves. In the final model, alcohol (OR: 1.83, 95

Towards developing more effective interventions for fall-related injuries, this study analysed a novel database from six retirement home facilities over a 4-year period comprising 1,877 fallers and 12,445 falls. Falls were characterized based on location, activity, injury site, and type, and the database was stratified across four levels of care: Independent Living, Retirement Care, Assisted Care, and Memory care. Falls most occurred within the bedroom (62.8%), and during unknown (38.1%), walking (20.2%), and transfer tasks (14.6%). Approximately one in three (37%) of all falls resulted in an injury, most commonly involving the upper limb (31.8%), head (26.3%), and lower limb (22.2%), resulting in skin tears (35.3%), aches/pains (29.1%), or bruises (28.0%). While fall location, activity, and injury site were different across levels of care, injury type was not. The data from this study can assist in targeting fall-related injury prevention strategies across levels of care within retirement facilities.

ContextThe COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust.MethodsWe conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively).FindingsWe present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations.ConclusionsThis global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes.

BackgroundOntario stroke prevention clinics primarily held in-person visits before the COVID-19 pandemic and then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient experiences. ObjectiveThis study seeks to understand patient satisfaction with Ontario stroke prevention clinics’ rapid shift to a home-based teleconsultation delivery model used during the COVID-19 pandemic. The research question explores explanatory factors affecting patient satisfaction. MethodsUsing a cross-sectional service performance model, we surveyed patients who received telephone or video consultations at 2 Ontario stroke prevention clinics in 2021. This survey included closed- and open-ended questions. We used logistic regression and qualitative content analysis to understand factors affecting patient satisfaction with the quality of home-based teleconsultation services. ResultsThe overall response rate to the web survey was 37.2% (128/344). The quantitative analysis was based on 110 responses, whereas the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (adjusted odds ratio [AOR] 0.034, 95% CI 0.006-0.188; P<.001) and empathy (AOR 0.116, 95% CI 0.017-0.800; P=.03) were significant factors negatively associated with low satisfaction (scores of 1, 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision maker (AOR 6.592, 95% CI 1.452-29.927; P=.02). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same factors of service dissatisfaction (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high-satisfaction group offered more positive feedback on assurance, reliability, and empathy, as well as on having a competent clinician, appropriate patient selection, and excellent communication and empathy skills. ConclusionsThe insights gained from this study can be considered when designing home-based teleconsultation services to enhance patient experiences in stroke prevention care.

Background: Trauma is commonly overlooked or undiagnosed in clinical care settings. Undetected trauma has been associated with elevated substance use highlighting the need to prioritize identifying individuals with undetected trauma through common characteristics. Objective: The purpose of this study is to identify classifications of traumatic life experiences and substance use among persons admitted to inpatient psychiatry in Ontario and to identify covariates associated with classification membership. Study design: A population-based retrospective cohort study was conducted using interRAI Mental Health (MH) assessment data. Individuals were included who experienced traumatic life events (N = 10,125), in Ontario, Canada between January 1, 2015, to December 31, 2019. Results: Eight latent classes were identified that ranged from low (i.e., Class 1: Interpersonal Issues, Without Substance use) to high (i.e., Class 8: Widespread Trauma, Alcohol & Cannabis Addiction) complexity patterns of traumatic life events and substance use indicators. Classifications with similar trauma profiles were differentiated by patterns of substance use. For example, individuals in Class 2: Safety & Relationship Issues, Without Substance use and Class 3: Safety & Relationship Issues, Alcohol & Cannabis both had many estimates centered around the experience of victimization (e.g., victim of sexual assault, victim of physical assault, victim of emotional abuse). Multinomial logistic regression models highlighted additional factors associated with classifications such as homelessness, where those who were homeless were 2.09-4.02 times more likely to be in Class 6: Widespread Trauma & Substance Addiction. Interpretation: Trauma exposures are complex and varied among persons in inpatient psychiatry and can be further differentiated by substance use patterns. These findings provide a population-based estimate of the trauma experiences of persons in inpatient settings in Ontario, Canada. Findings demonstrate the importance of using comprehensive assessment to support clinical decision making in relation to trauma and substance.

IntroductionThis study explores the attitudes of psychologists towards psychedelics and psychedelic-assisted therapy (PAT) following the world-first regulatory changes in 2023 in Australia which permitted psilocybin and 3,4-methylenedioxy-methamphetamine (MDMA) to be used in clinical services.MethodsA purposive sample of 20 Australian psychologists was recruited using snowball sampling. Semi-structured interviews were conducted which explored participants' attitudes, knowledge and concerns about PAT. Data were coded and analysed to identify and develop theme categories.ResultsMost psychologists exhibited positive attitudes towards psychedelics and their therapeutic potential, viewing them as promising for addressing chronic mental health conditions like depression. However, there was a notable concern regarding the limited evidence on efficacy and potential adverse experiences, as well as the complexity of the individualised treatment protocol. Despite enthusiasm, many psychologists had limited detailed knowledge about the interventions themselves. The need for comprehensive education and training programs, including exposure to psychedelic experiences and credible higher education institutions, was emphasised to ensure competence in administering PAT.Discussion and ConclusionsPsychologists displayed notably positive attitudes towards PAT, likely reflecting both shifting perceptions of psychedelics and self-selection bias within the sample. Despite this optimism, concerns were raised about psychiatric risks and the necessity for comprehensive and reputable training and supervision. The cohort showed openness to both novel treatments and innovative training methods, underscoring the importance of enhancing educational frameworks to ensure effective implementation of PAT.

Objective: This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last >= 6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., >= 1 physical illness and >= 1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. Methods: Data come from 10,303 youth aged 4-17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. Results: Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose-response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05). Conclusion: Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health.

Ontario stroke prevention clinics primarily held in-person visits before the COVID-19 pandemic and then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient experiences.This study seeks to understand patient satisfaction with Ontario stroke prevention clinics' rapid shift to a home-based teleconsultation delivery model used during the COVID-19 pandemic. The research question explores explanatory factors affecting patient satisfaction.Using a cross-sectional service performance model, we surveyed patients who received telephone or video consultations at 2 Ontario stroke prevention clinics in 2021. This survey included closed- and open-ended questions. We used logistic regression and qualitative content analysis to understand factors affecting patient satisfaction with the quality of home-based teleconsultation services.The overall response rate to the web survey was 37.2% (128/344). The quantitative analysis was based on 110 responses, whereas the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (adjusted odds ratio [AOR] 0.034, 95% CI 0.006-0.188; P<.001) and empathy (AOR 0.116, 95% CI 0.017-0.800; P=.03) were significant factors negatively associated with low satisfaction (scores of 1, 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision maker (AOR 6.592, 95% CI 1.452-29.927; P=.02). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same factors of service dissatisfaction (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high-satisfaction group offered more positive feedback on assurance, reliability, and empathy, as well as on having a competent clinician, appropriate patient selection, and excellent communication and empathy skills.The insights gained from this study can be considered when designing home-based teleconsultation services to enhance patient experiences in stroke prevention care.

The Article by Indhu Rammohan and colleagues1 adds to a growing body of literature showing positive outcomes from supervised consumption services (SCS). To date, the focus of SCS research has been on individual experiences, health outcomes, and perspectives regarding the structuration of such services,2–4 with fewer studies on the broader population health implications of these services.5 Using a comprehensive spatial analysis, this study addresses the spillover outcomes of SCS location by showing that proximity to SCS is associated with reductions in overdose deaths.