Background The COVID-19 pandemic and associated stressors contributed to increased mental health concerns (e.g., anxiety and depression). Objective stress among expectant parents poses a risk for child development, with previous studies demonstrating that exposure to stress in-utero can have negative implications for social-emotional development. Objective To assess the association between pandemic-related objective hardship and psychological distress (i.e., anxiety and depression) during pregnancy and postpartum and child social-emotional development at 24 months. Study design Participants were from the longitudinal Pregnancy during the Pandemic (PdP) cohort. They were largely White, educated, and in married or common-law relationships. Pandemic-related objective hardship was assessed during pregnancy, psychological distress was assessed during pregnancy and postpartum, and child social-emotional development was assessed at 24 months of age. Serial Mediation Analysis was used to examine the strength of the association between objective hardship, psychological distress during pregnancy and postpartum, and child social-emotional outcomes. Results Participants who provided social-emotional development outcome data at 24 months were included in the analysis (n = 3889). Greater exposure to pandemic-related objective hardship was associated with worse social-emotional development at 24 months through the effects of prenatal and postpartum psychological distress (B=1.33; SE=0.22; p < .001). Conclusions Exposure to more pandemic-related objective hardship was associated with a higher likelihood of child social-emotional developmental concerns. Greater psychological distress following hardship in the prenatal and postpartum periods partially explains this association.

INTRODUCTION:For adolescents living with higher body weight, changing lifestyle behaviours can be met with challenges due to psychosocial factors, such as mental health and emotional challenges. Few behavioural interventions have included skill development to manage these mental health and emotional challenges. METHODS AND ANALYSIS:The feasibility of a dialectical behavioural therapy (DBT)-enhanced lifestyle intervention will be evaluated through a pilot randomised controlled trial. We will recruit 90 adolescents aged 14-17 years with a body mass index Z-score >1.4 and mild-to-moderate depressive symptoms to participate with a caregiver in the trial. Adolescents will be randomised 2:2:1 to one of the three study arms: (A) behavioural lifestyle intervention with DBT skills training, (B) behavioural lifestyle intervention alone (ie, without DBT skills training) or (C) control. The interventions will include two sessions weekly for 16 weeks that include (1) one modified DBT skills training with two facilitators, supervised by a clinical psychologist, combined with one behavioural lifestyle session delivered by a dietitian and/or a kinesiologist and (2) two behavioural lifestyle sessions alone. DBT skills training will consist of teaching mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness and walking the middle path modules. Behavioural sessions will be guided by evidence-based practices for goal setting, dietary counselling, improving sleep, reducing screen time and structured physical activity. The main outcomes are enrolment rates, adherence to the intervention and retention rates for follow-up measurements. The secondary outcome will be changes in the quality of life (Pediatric Quality of Life Inventory) and daily physical activity levels between baseline and immediately post-intervention. Adolescents will participate in a focus group incorporating photo elicitation to explore satisfaction, acceptability and perceived benefits of the study arms. ETHICS AND DISSEMINATION:This study has received ethical approval from the University of Manitoba's Biomedical Research Ethics Committee (HS24295-H2020:427), Hamilton Health Sciences & McMaster University (HiREB 18159) and The Conjoint Health Research Ethics Board (CHREB), University of Calgary (REB24-1084). Results will be disseminated through publication in peer-reviewed journals and be relevant to researchers and clinicians involved in paediatrics and paediatric weight management. TRIAL REGISTRATION NUMBER:NCT05338944.

Background: Several eHealth treatments, including the Building Emotional Awareness and Mental health (BEAM) program, are feasible and effective for mothers experiencing mental health concerns. However, little research examines these programs among mothers with mental health concerns and at-risk substance use (ARSU; ARSU+). Prior BEAM trials have identified high rates of alcohol and cannabis use among participants, despite not recruiting based on substance use. To date no studies have evaluated whether implementation and symptom change outcomes differ between mothers with ARSU+ and those without (ARSU-) when participating in BEAM (i.e., a mental health program that does not directly address substance use). This represents an important gap, as integrated treatments are often difficult to access, especially for postpartum mothers. Objectives: To address this gap, BEAM implementation (e.g., retention, perceived usefulness) and symptom outcomes (e.g., depression, anxiety) were compared between ARSU subgroups. Design: This was a secondary data analysis of two BEAM trials for mothers of infants (6-18 months) and toddlers (18-36 months). Methods: A total of 110 mothers (M age = 20.72) participated in BEAM. Implementation metrics were compared against a-priori benchmarks. Mental health symptom trajectories were examined across time using two-level mixed models. Results: Treatment adherence, safety, and questionnaire completion time benchmarks were met in both groups, while retention, perceived usefulness, and overall questionnaire completion benchmarks were not. Changes in mental health and parenting stress symptoms did not differ between ARSU subgroups. Conclusion: BEAM demonstrated similar feasibility and symptom change across ARSU subgroups. This study adds to literature examining single-focus eHealth treatments for mothers with ARSU+ and highlights refinements to enhance implementation metrics in future BEAM iterations.

OBJECTIVES:Despite the increasing prevalence of anxiety in the perinatal period, limited access to providers and mental health services continues to prevent affected persons from receiving necessary support. Peer support programs may provide timely, accessible support by connecting persons with others who share lived experiences. This study aimed to identify and examine perinatal peer support programs available in Canada, with particular focus on those addressing perinatal anxiety. METHODS:We conducted an online environmental scan to identify and examine existing peer support programs available in Canada for persons experiencing perinatal anxiety. Websites were screened according to the inclusion and exclusion criteria, and eligible programs were analyzed for core components such as cost, delivery format, duration, targeted outcomes, and evidence of evaluation. RESULTS:The scan identified 180 websites, of which 8 met the inclusion criteria. Overall, the scan revealed a lack of readily available peer support programs specifically for perinatal anxiety. Program characteristics varied: several were delivered virtually, most were free or offered low-cost options, and few specified durations. Only 1 program reported undergoing scientific evaluation, and none included participant testimonials. CONCLUSIONS:Findings highlight the limited availability of perinatal peer support programs in Canada, particularly those targeting perinatal anxiety. Expanding accessible, evidence-based peer support tailored to this population offers a meaningful way to strengthen perinatal mental health services while emphasizing the need for continued program development and broader availability.

The aim of this study was to understand associations between pandemic stressors and parents’ self-rated physical and mental health; symptoms of mental health problems, and at-risk substance use problems. Data were collected from February 2022 to March 2022 as part of Wave 2 of the Well-being and Experiences Study in Manitoba, Canada ( n = 749). Stressors frequently identified since the onset of the pandemic included inability to spend time with family and friends, worry about getting coronavirus disease-2019 (COVID-19), and travel restrictions. In the past month, the most frequently identified stressors were worry about getting COVID-19, travel restrictions, public health restrictions, and worry about the future. The stressors with the greatest number of associations with worse health outcomes included: job loss or financial burden; feeling lonely or isolated; disrupted or poor sleep; uncertainty about the future; accessing health care for any reason; increased conflict in relationships; cancellation of surgeries, caregiving for children; and inability to spend time with family. Understanding the COVID-19 stressors that were associated with health and substance problems can inform clinical approaches to respond to pandemic-related problems, as well as public health preparedness to mitigate declines in parents’ health and well-being in the context of future pandemics.

BackgroundClinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. ObjectiveThis preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. MethodsPatients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants’ impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. ResultsRecruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, “It was realistic to my past surgical experiences”), impacting their degree of preparedness and expectations for surgery (eg, “The sounds and sights and procedures give you a test run; they prepare you for the actual day”), and having a calming or relaxing effect (eg, “You feel more relaxed for the surgery”). ConclusionsThis preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. Trial RegistrationClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618

Adolescents and young adults have been particularly vulnerable to disruptions caused by the COVID-19 pandemic. The objectives were to identify youth's self-reported pandemic-related stressors and examine how these stressors were related to six negative health outcomes: self-perceived, fair-to-poor physical, and mental health, depression, anxiety, and at-risk alcohol and cannabis use. Data were from the Well-Being and Experiences Study (The WE Study) from Manitoba, Canada (17–22 years old; n = 587; collected from November 2021 to January 2022). The COVID-19 stressors reported most frequently since pandemic onset included: (1) not being able to spend time with friends (78.5%); (2) feeling lonely or isolated (69.9%); and (3) remote learning for school, college, or university (68.4%). In reference to the “past month”, frequently reported stressors were (1) remote learning (42.6%); (2) feeling lonely or isolated (41.2%); and (3) uncertainty about the future (41.1%). Overall, 26.1% of the sample perceived their physical health as fair-to-poor and 59.1% perceive their mental health as fair-to-poor. A number of stressors were related to fair-to-poor mental health, depression, and anxiety; fewer were related to fair-to-poor physical health and at-risk alcohol and cannabis use. These findings can inform future pandemics and recovery efforts to improve pandemic-related health risks among youth.

Parents are reporting a rise in mental health concerns, particularly in parents of young children. Unfortunately, only half of those with a mental health diagnosis report accessing services, and many report that current supports do not adequately address the extent of their needs. Social determinants of health, such as economic stability and education, are related to mental health outcomes in parents and children. The World Health Organization has highlighted the need for innovative parenting interventions that support overall parental and child wellbeing. One proposed strategy is the implementation a systems navigator role which connects families to services that address social determinants related to mental health. In this study, we hosted a knowledge exchange event where frontline service workers came together to discuss the barriers and facilitators to accessing and providing quality care, as well as the feasibility and acceptability of a proposed systems navigator role embedded within an evidence-based online mental health program called Building Emotional Awareness and Mental Health (BEAM). Focus group discussions were analyzed using thematic analysis. Five themes emerged which inform the relevance and implementation facilitators of a successful systems navigator role: (1) Hopes for Families; (2) Barriers to Service Access and Provision; (3) Facilitators to Service Access; (4) Fit of a Systems Navigator Role; and (5) Identified Support Need. These discussions highlighted that a supportive systems navigator role should connect families to services beyond mental health care to address social determinants contributing to their overall wellbeing. Navigators should foster long-term relationships with diverse community agencies to effectively support families. Finally, providers expressed a preference towards a hybrid online and in-person systems navigator, which could function depending on the family's needs. This research is a first step to implementing a navigation role who supports families and collaborates with providers across settings.

Emotional knowledge (EK) refers to the ability to identify and understand emotions. EK is seldom explored in toddlerhood, when many of its facets begin to develop, nor in the context of online assessments. To address this gap, a sample of 98 toddlers (age:18-36-months, 55 female and 43 male) and their mothers (Mage= 32.5 years; 89.8% Caucasian) participated in this exploratory study investigating child and maternal characteristics associated with toddlers’ receptive and expressive EK abilities, which were evaluated using an online modified version of the Affective Knowledge Task (AKT). Results support the feasibility of assessing toddler EK online, as most of the toddlers (68.3%) were able to partially complete the task. Stronger receptive and expressive EK were both associated with older child age, yet receptive abilities were inversely related to maternal depression severity. Methodological strengths and suggestions are discussed to facilitate research including online assessments with younger cohorts.

Objective: Preoperative distress is commonly experienced by surgical patients and is associated with adverse health-related outcomes. Research suggests preoperative distress may be elevated among cancer surgery patients relative to other surgical groups and there appears to be greater recognition of the adverse impacts of distress for these patients. This study examined associations between preoperative distress and postoperative healthcare -related correlates (e.g., length of stay, re-hospitalization) among a large, mixed surgical sample, and separately among cancer surgery patients with active cancer. Methods: We analyzed secondary data from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study - Mental Health Supplement (N = 997; n = 370 active cancer/cancer surgery). The Kessler 6-item Psychological Distress Scale assessed preoperative distress on the day of surgery. Multivariable regressions examined associations between distress and healthcare-related correlates. For significant relationships, we examined associations between anxiety and depressive subscales of distress with the correlates of interest. Results: Among the full surgical sample, after adjustment, preoperative distress was associated with a greater length of stay (b = 0.01, 95% CI [0.00-0.02], R-2 = 0.15, f(2) = 0.18) and increased odds of re-hospitalization (AOR = 1.07, 95%CI [1.01-1.13]). Results were comparable among cancer surgery patients (length of stay: b = 0.02, re-hospitalization: AOR = 1.11). Post-hoc analyses revealed associations between anxiety symptoms and re-hospitalization (AOR range: 1.13-1.26) and between depressive symptoms and length of hospital stay (b range: 0.02-0.04, R-2 range: 0.07-0.15, f(2) range: 0.07-0.18). Conclusions: Findings suggest preoperative distress may be associated with greater postoperative healthcare needs. Results support the importance of screening for distress in the perioperative period.

Background Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions. Objective The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness. Methods A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. Results In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected. Conclusions eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954

Background. Disruptive behavior disorders have increased during the pandemic and are associated with family conflict and child risk of child maltreatment. While parent training interventions are a best-practice intervention to treat a range of disruptive behavior disorders and family dysfunction concerns, there are limited and mixed findings on the efficacy of telehealth or digital parent training interventions. As the field of digital therapeutics continues to expand, it is imperative we seek to understand the program and client factors linked to differential efficacy. Objective. Our objective was to compare digital therapies to their “best-practice” in-person counterparts (i.e. non-inferiority trials), as well as comparing the relative benefits of a given program to waitlists, other ehealth programs, or treatment as usual. Furthermore, we aimed to interrogate which types and components of digital therapeutics are most efficacious and for whom.Methods. We conducted a systematic review and meta-analysis (k = 24, total number of intervention participants = 1654 and control participants = 1001) of the impact of digital parent training interventions on parent skill, parent mental health, and child externalizing outcomes from 2000 to 2021, among children 2-12 years old, across four databases. Exclusionary criteria include programs targeted for parents of children with intellectual disabilities, autism, brain injury, nutrition/health/dental needs or primary medical diagnosis. Results. Across outcomes, digital parent training interventions had a modest effect size (g = .27 to .33), compared to controls. The effects of digital parent training on parent skills and child outcomes were stronger if the intervention was evidence-based, combined interactive platforms with a therapist and was compared to an inactive control. Conclusions. Together, these findings suggest digital parent training interventions are an effective approach linked to modest improvements in reducing child disruptive behavioral symptoms and improving parenting skills. Such scalable and accessible approaches hold high potential to reduce burdens of child and adolescent mental illness, particularly when applied in a stepped care model. We call on future studies to provide standardized sociodemographic reporting to aide in future knowledge synthesis work that can inform tailored interventions to different populations and provide templates for shared measurement. Preregistration and open data files: https://osf.io/e35bt/.

Despite substantial research emphasizing the role of chronic stress on children’s brain function, remarkably little is known about the more immediate effects of acute stress on brain activity. Here, we analyzed changes in power spectra of the electroencephalogram (EEG) during a Go/No-go task collected both before and after a laboratory psychosocial stressor validated for preschool children. Significant increases in EEG power were observed broadly across bandwidths and electrode sites from pre- to post- manipulation measurements. Follow-up comparisons illustrate that pre- to post- increases in EEG power were more pronounced for the Stressor group than the Control group, particularly for the delta (1-3 Hz), high alpha (9-12 Hz) and beta (12-20 Hz) bandwidths. While exploratory, these results are amongst the first pieces of evidence documenting the effects of acute psychosocial stress on brain activity in young children.

As the evidence base for dialectical behavior therapy (DBT) grows, so too does the need for well-trained DBT clinicians, especially in practice settings that serve populations at high-risk for self-injurious behavior or suicide. Despite the increased availability of resources for learning and applying DBT to such high-risk individuals, comparatively little has been written about initiating DBT training for new therapists in settings where DBT services are being established for the first time. The purpose of this paper is to bridge the gap between existing DBT resources and their high-fidelity application in training clinics by focusing on the consultation team as a key component to training therapists in the model. First, a conceptual overview of DBT and the role of a consultation team to support trainee therapists are presented. Second, elements of the consultation team are reviewed and unique considerations for trainee therapists are highlighted. Finally, the challenges, key strategies for overcoming obstacles, and benefits of initiating DBT training with a consultation team for trainee therapists are discussed via a series of reflections from a new DBT team, which we present as a case example of shared learning on a training team within a university clinic. We address four conceptual and practical domains of the training: the distinction between supervision and consultation, therapist identity development and competency, DBT in clinical training contexts, and embodying a dialectical stance within the university clinic. The implications of these observations for DBT theory and research are discussed.