This study aimed to determine the psychometric properties and factor structure of the Brief Resilience Scale (BRS) among a cohort of first-year Canadian undergraduate students. A total of 2709 undergraduate students completed baseline surveys in fall 2021/2022; of these, 856 students completed follow-up surveys in spring 2022/2023. At baseline, most students identified as female (72.7%), White (60.3%) and Canadian (93.8%). The internal consistency and convergent and predictive validity of the BRS were explored and confirmatory factor analysis of three models was conducted. Multiple regression was used to examine if BRS scores modified the effect of stressors on depression and anxiety. In this cohort, the BRS had good internal consistency (alpha = 0.85) and a 2-factor structure based on positively and negatively worded items had the best fit. While higher BRS scores appeared to modify the negative effect of perceived stress on baseline depression and anxiety, there was insufficient evidence that BRS scores modified the effects of adverse childhood events on baseline anxiety scores. While the BRS is valid in this population, it may not fully capture student understanding of resilience.

Young adulthood is a critical period for identity formation, yet young adults with mental health-related disabilities often engage with care systems that erode rather than support selfhood. This qualitative study draws on critical realist metatheory, which aligns with interpretive inquiry while enabling layered explanation. Conducted in partnership with young adult co-researchers with lived experience of mental health-related disabilities from equity-deserving communities, the study treats participant narratives as situated meaning and as analytic entry points into the institutional, relational, and structural dynamics that generate persistent inaccessibility. Thirteen young adults with lived experience of mental health-related disabilities and unmet healthcare needs described extensive interactions with clinics, hospitals, and community services across Canada. Despite this, they remained unseen and unmet. Functional impairments collided with institutional demands for legibility, coherence, and compliance, producing recurring patterns of misrecognition, fragmentation, and withdrawal. Critical realism's stratified ontology distinguishes between what is experienced (empirical), what happens whether or not it is experienced (actual), and the underlying forces that generate those events (real). Through abductive and retroductive reasoning, the study identifies five explanatory clusters and presents the Rupture-Repair Roundabout, a model that illustrates how health systems can either destabilize or scaffold young adults' emerging selves. Participants described access as extractive rather than supportive, requiring strategic masking and self-erasure to remain eligible. Findings suggest that addressing unmet healthcare needs requires not only expanded services but also a structural and relational reorientation toward attuned, identity-holding care. Without this, healthcare risks functioning not as a site of healing but as a site of existential undoing.

OBJECTIVE:To estimate the minimal detectable change (MDC) for the Patient Health Questionnaire-9 (PHQ-9) and its eight item (PHQ-8) and two item (PHQ-2) versions including differences by participant and study characteristics. DESIGN:Individual participant data meta-analysis. DATA SOURCES:Medline, Medline In-Process and other non-indexed citations, PsycInfo, and Web of Science, 1 January 2000 to 9 May 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Datasets from articles in any language if participants were aged ≥18 years, were recruited from any non-psychiatric setting, and were not recruited because they were seeking mental healthcare. Eligible datasets had a classification for major depressive disorder or major depressive episode based on a validated semi-structured or fully structured interview conducted within two weeks of administering the PHQ-9, PHQ-8, or PHQ-2. RESULTS:Pooled MDCs across studies were estimated for the PHQ-9, PHQ-8, and PHQ-2 with random effects meta-analysis for 95% (MDC95), 90% (MDC90), and 67% (MDC67) confidence that change beyond measurement error occurred. PHQ-9, PHQ-8, and PHQ-2 analyses included 42 548 participants (94 studies), 42 592 participants (94 studies), and 44 085 participants (98 studies), respectively. Mean participant age was 49 years (standard deviation 17), and 60% of participants were women. Overall, 10% of participants had major depression (range 1-57% across studies). MDC95 was 5.72 points (95% confidence interval (CI) 5.54 to 5.90, 95% prediction interval (PI) 4.00 to 7.44) for the PHQ-9, 5.51 points (95% CI 5.33 to 5.68, 95% PI 3.87 to 7.15) for the PHQ-8, and 2.26 points (95% CI 2.15 to 2.37, 95% PI 1.20 to 3.32) for the PHQ-2. For the PHQ-9, MDC95 was highest in inpatient healthcare settings at 6.48 (95% CI 6.05 to 6.92) points. MDC95 for the PHQ-9 increased by 0.40 (95% CI 0.25 to 0.55) points for each 10% increase in the proportion of participants with major depression. Sex and age had minimal or no association. Subgroup and meta-regression findings were similar for the PHQ-8 and PHQ-2. CONCLUSIONS:Based on the pooled estimate, a six point difference on the PHQ-9, the PHQ version most used in clinical practice, could be an appropriate MDC threshold in general practice. A higher threshold may be preferred in specialty mental healthcare. MDC67 or MDC90 thresholds would provide less certainty that change has occurred. Alternative strategies, such as using the upper end of a prediction interval, would provide more certainty but a greater likelihood of not recognising change. STUDY REGISTRATION:PROSPERO CRD42014010673.

In immune-mediated inflammatory diseases (IMID), females report elevated depressive symptoms more frequently than males. We examined clinical and sociodemographic factors associated with elevated depressive symptoms in IMID and whether endorsement of individual depressive symptoms differed by sex. This study included 652 individuals with an IMID from Manitoba, Canada. Depressive symptoms were measured using the PHQ-9 and HADS-D, with IMID-specific cut-offs to identify elevated depression. Elevated depressive symptoms were present in 234 participants (36%). Females did not show higher odds of elevated depression than males. Males were more likely to endorse the HADS-D item on cheerfulness. Smoking and anxiety symptoms, but not sex, were associated with elevated depressive symptoms. These findings may help identify high-risk individuals with an IMID and comorbid elevated depressive symptoms and guide intervention.

ObjectiveAddiction and mental health (AMH) disorders present significant psychosocial challenges among affected individuals. Previous research indicates a higher prevalence of AMH conditions among people experiencing homelessness (PEH). This study aims to determine the risk of mortality, suicide attempts, emergency department (ED) visits and hospitalizations among PEH with AMH conditions compared to individuals with AMH conditions who had not experienced homelessness in Alberta.MethodsThis retrospective cohort study used linked administrative data from Alberta Health Services from April 1, 2013 to March 31, 2023. We included adults residing in Alberta and diagnosed with any AMH condition within 5 years before the index date of April 1, 2018. Homelessness in the year prior to the index date was identified using relevant codes in records representing hospitalizations and ED visits. We used Cox Proportional Hazards models to evaluate the risk of ED visits, hospitalizations, suicide attempts, and all-cause mortality for up to 5 years, adjusted for age and sex. We also conducted matched propensity score analyses.ResultsAmong the 622,614 individuals with AMH conditions, 3,390 (0.54%) had an indicator of homelessness. In age and sex-adjusted analyses, PEH were at greater risk for ED visits for both AMH (HR = 8·75, 95% CI [8.37-9.16]) and non-AMH (HR = 2.56, HR = 2.47-2.63) reasons, and at greater risk of hospitalizations for AMH (HR = 8.34, 95% CI [7.73-9.00]) and non-AMH (HR = 6.03, 95% CI [5.73-6.35]) reasons. PEH were at greater risk of suicide attempts (HR = 9.18, 95% CI [8.43-10.01]) and all-cause mortality (HR = 8.15, 95% CI [7.56-8.79]). Findings were attenuated but still significant in the propensity-matched analyses.ConclusionsPEH are at much greater risk of ED visits, hospitalizations, suicide attempts and all-cause mortality. Given this population's high risk of adverse outcomes, PEH will likely need more intensive mental and physical healthcare, coordinated with housing and social support services. Further research is needed on the implementation of interventions tailored to the needs of PEH.

ObjectivePrior research in Canada had only assessed suicide mortality rates through 2018, meaning that suicide trends during and beyond the COVID-19 pandemic are unknown. Thus, this study aimed to extend previous literature by characterizing trends of age- and sex-specific suicide mortality from 2000 to 2024.MethodsYearly rates of suicide in Canada were generated from 2000 to 2024 in overall, age- (by five-year age categorizations) and sex-stratified groups. Joinpoint regression analysis was then employed to determine annual percent change (APC) of defined trendlines, and nodes at which the direction or slope of the trendline changed (joinpoints).ResultsOverall rates of suicide in Canada have significantly declined from 2018 to 2024 by an APC of -4.85 (95% CI: -6.26, -3.68; p = 0.002). Most male age groups under 40 years of age saw significantly declining trends from 2018 to 2024. For example, males aged 15-19 years had an annual percent decline of 8.37 percentage points from 2018 to 2024 (95% CI: -17.86, -3.52; p = 0.01). However, females aged 10 to 14 years saw a significant increase of 2.40 percentage points per year (95%CI: 0.72, 4.39; p = 0.007) from 2000 to 2024, while 25-29-year-old females had an annual increase of 1.85 percentage points (95%CI: 1.00, 2.85; p < 0.001) during this same time. No other age/sex groups had significantly increasing trends through 2024.ConclusionsOverall trends and many Canadian age and sex groups have seen declining rates of suicide mortality beginning in 2018, though some young female groups have continued to have increasing rates of suicide from 2000 to 2024. Future literature should look to determine whether these changing suicide trends relate to changing patterns of mental disorder, particularly in young females, or whether other characteristics may better explain the different trends in suicide observed across distinct age and sex groups.

BACKGROUND:While prior research links income inequality to poor mental health, many studies suffer from methodological limitations. We aimed to examine the effect of income inequality on psychological distress, employing longitudinal, nationwide Canadian data. METHODS:Data were drawn from the Longitudinal and International Study of Adults (LISA), a large, nationwide sample of Canadians aged 15 years or older. We investigated the effect of income inequality at the Canadian census division level (measured by Gini coefficients) on psychological distress, using Kessler-10 scores over a 4-year follow-up (2016-2020). RESULTS:At baseline, the sample had a mean age of 47.7 years, and 50.6% were female, with a mean census division Gini coefficient of 0.33. Mixed effects multilevel regression revealed that residing in the more income-unequal census division quartiles was associated with increased psychological distress over the follow-up, even after adjusting for individual and area-level confounders. Notably, this association was more pronounced in male and lower-income participants. CONCLUSIONS:Leveraging a large, nationwide longitudinal sample and rigorous statistical analysis, our findings reveal a significant association between area-level income inequality and mental health trajectories.

BACKGROUND:Latent factor scoring may provide more precise score estimates than sum scores, but this has not been evaluated for the Hospital Anxiety and Depression Scale (HADS). We investigated whether latent factor scores could improve HADS depression screening accuracy. METHODS:We used a HADS screening accuracy individual participant data meta-analysis (IPDMA) database. We included 42 studies (7982 participants; 12 to 1143 per study) with a semi-structured interview reference standard. We randomly split the database into calibration and validation datasets. In calibration, we estimated latent scores using one-factor models (14-item HADS total scale [HADS-T], 7-item depression subscale [HADS-D]) plus HADS-T two-factor and bi-factor (general factor and two specific factors) models. We estimated cut-offs that maximized combined sensitivity and specificity for each method. In validation, we compared screening accuracy between latent variable approaches and the HADS-D sum score. The process was repeated 1000 times to estimate 95% confidence intervals for parameters. RESULTS:After removing iterations with failed models in confirmatory factor analysis (N = 304) or IPDMA (N = 31), aggregated results showed that confidence intervals for sensitivity, specificity, and combined sensitivity and specificity included 0 for all comparisons between factor scores and sum scores. Statistically significant but minimal advantages appeared in the receiver operating characteristic curve for the two-factor and bi-factor models (0.01, 95% CI [0.01, 0.02]; 0.02, 95% CI [0.01, 0.02]). Sensitivity analysis confirmed findings. CONCLUSIONS:Latent factor scoring did not meaningfully improve HADS screening accuracy compared with sum scores. Sum scores may be preferred in applied settings for their simplicity and feasibility.

Motoric cognitive risk (MCR) syndrome, characterized by the coexistence of subjective cognitive complaints (SCCs) and slow gait speed, has been identified as a potential risk factor for objective cognitive impairment and dementia. This research article performs a systematic review and meta-analysis to analyze cross-sectional and longitudinal associations between MCR syndrome and objective cognitive impairment. Cross-sectional and longitudinal studies in cognitively unimpaired adults with SCCs were included. The risk associated with progression to mild cognitive impairment (MCI) or dementia was estimated, also for longitudinal studies specifically. An additional meta-analysis was conducted to explore the association with SCCs and gait speed independently. Random-effects meta-analyses were conducted to estimate pooled effects with 95

Objectives Providing peer support can benefit youth peer support workers (peers)et by supporting self-determination, recovery and resilience to self-stigma. There is a need to clarify the role of the organisation in providing benefits for peers. We aimed to identify the organisational contexts and mechanisms that result in the creation of healthy workplaces for peers.Design Rapid realist review guided by the Realist and Meta-Narrative Evidence Syntheses-Evolving Standards guidelines and Pawson's iterative approach.Data sources MEDLINE, CINAHL, PsycINFO, ERIC, SocINDEX, Google Scholar and Embase were searched from 1979 to 2025.Eligibility criteria We included qualitative and quantitative peer-reviewed studies and grey literature that captured characteristics of organisational practices and employment considerations in youth peer support programmes.Data extraction and synthesis Articles were screened independently by multiple reviewers. Inclusion criteria were adjusted to capture literature on organisational practices, and employment considerations for youth peer support programmes. Data were extracted and analysed retroductively to develop Context-Mechanism-Outcome Configurations (CMOCs).Results Five employment-related risks to peer well-being were identified: (1) difficulty entering the job market, (2) lack of role clarity, (3) pressure to live up to ideals, (4) retraumatisation and (5) stigma. Six CMOCs were developed; all focused on the creation of equitable employment and supporting peer development and empowerment were developed.Conclusions Community-based mental health organisations can facilitate equitable peer employment through strategies that reduce professional stigma, enhance peer resilience and promote professional and personal development. Policy reform that addresses precarious work conditions is needed to support healthy work environments.

OBJECTIVE:To examine the association between mental health symptoms in youth and their mothers, and youth incident migraine, using prospectively collected, longitudinal data from the "All Our Families" (AOF) cohort study. BACKGROUND:Internalizing mental health symptoms, such as anxiety and depression, whether experienced by a child or his/her parent(s), have been linked to migraine and chronic pain conditions, but causal inferences have been limited by gaps in the current literature. We hypothesized a priori that elevated youth and/or maternal internalizing symptoms across childhood would be associated with elevated odds of incident migraine in early adolescence, providing insights into the modifiable mental health contributors to incident migraine. METHODS:A community-recruited sample of urban youth (N = 1062, 48% female) living in Alberta, Canada were followed through the AOF prospective cohort study from 2008 to 2023. The study outcome, youth migraine, was ascertained through a validated migraine diagnostic questionnaire, administered to 12-year-old youth. The exposures of interest, anxiety and depressive symptoms in youth and mothers, were derived from multiple timepoints when these symptoms were measured, across youth ages 4-12 years. The analysis compared odds of incident migraine in youth with a history of elevated internalizing symptoms, and/or exposure to elevated maternal symptoms, versus unexposed youth. Covariates accounted for included age, sex, gender and racial identity, household income, and parental migraine status. RESULTS:The odds of incident migraine, diagnosed at a mean age of 12.9 years (standard deviation [SD] 0.8 years) were increased by ~29% with each additional timepoint when maternal anxiety symptoms were elevated across childhood (adjusted odds ratio [aOR] 1.29 per exposure, 95% confidence interval [CI] 1.02-1.64, p = 0.036). Similarly, the odds of incident migraine increased by ~29% with each additional exposure to significant youth depressive symptoms across childhood (aOR 1.29 per exposure, 95% CI 1.03-1.61, p = 0.026). Sex did not modify this association. CONCLUSION:Findings suggest that maternal anxiety and youth depressive symptoms have an antecedent role in youth migraine risk. Although certain migraine risk factors remain non-modifiable (e.g., genetic inheritance), child and parent mental health symptoms may be alleviated through evidence-based mental health treatments. Future clinical research should explore whether reducing exposure to child and parent mental health symptoms could prevent or delay the development of new migraine cases ("incident migraine").

Background Cognitive impairment (CI) is a common feature of multiple sclerosis (MS). Radiologically isolated syndrome (RIS) can demonstrate CI patterns similar to MS, providing an opportunity to explore the associations between CI and early stage disease pathology. Objectives To investigate myelin damage in RIS normal appearing white matter (NAWM) using the myelin heterogeneity index (MHI) and to determine the relationship between MHI and processing speed. Methods A total of 28 people with RIS and 22 controls completed an MRI, including multi-component T 2 mapping to calculate MHI for whole brain (WB), corpus callosum (CC), superior longitudinal fasciculus (SLF), and cingulum (CING) NAWM. The RIS cohort additionally completed the Processing Speed Test (PST), a measure of processing speed. Results CC NAWM MHI was higher in RIS versus controls (indicative of myelin damage, p = 0.0140), with similar trends seen in WB, SLF, and CING ( p > 0.05). A moderate correlation was found between CING NAWM MHI and PST scores ( ρ = –0.39, p = 0.040), with similar trends seen in WB, CC, and SLF ( p > 0.05). Conclusion Diffuse myelin damage was detected in RIS NAWM, along with associations between increased damage and slower processing speed, suggesting a potential pathological mechanism for RIS-related CI.

Community-based informal reciprocal interactions (natural supports) enhance individual and community well-being. Like social connections, natural supports aim to establish supportive and healthy environments, but with a greater focus on local surroundings. This study explored natural support approaches within communities in an urban Canadian center. Employing grounded theory, purposive and theoretical sampling identified participants familiar with the community and its opportunities and activities, referred to as community champions. These champions were interviewed about their perceptions of resident connectivity and the key facilitators and barriers related to natural supports approaches in their communities. Themes and categories emerged, leading to the development of a theory. The overarching theory posited "building a community's capacity to transition from disconnected to naturally supportive: the need for connectors, assets, and action to empower residents". Community connectors and assets facilitate natural support approaches within urban community settings. Limited access to space and challenges in recruiting and retaining volunteers were identified as barriers. The findings empower knowledge users, such as community planners, to invest in and promote community natural supports approaches to enhance resident and community well-being. Future directions for this study include the implementation and evaluation of natural support approaches within communities.

Background: Evidence concerning the association between cannabis use disorder and mortality remains limited and has primarily arisen from treatment-based, hospital-based, or administrative cohorts. We examined the association between lifetime cannabis use disorder and all-cause mortality in a nationally representative Canadian household cohort. Methods: We conducted a population-based cohort study of respondents aged 15 years or older from the 2012 Canadian Community Health Survey–Mental Health linked to the Canadian Vital Statistics Death Database. Lifetime cannabis use disorder was defined as DSM-IV cannabis abuse or dependence assessed using the World Mental Health Composite International Diagnostic Interview. Survey-weighted Cox proportional hazards models estimated associations with all-cause mortality through December 31, 2017. The primary model adjusted for age and sex. Results: Respondents with lifetime cannabis use disorder were younger and more likely to be male than respondents without the disorder. Crude mortality was lower among respondents with cannabis use disorder than among those without it (1.61% versus 3.69%). The unadjusted hazard ratio was 0.63 (95% CI 0.35–1.15). Adjustment for age reversed the direction of the association (HR 1.58, 95% CI 0.87–2.85). In the primary age- and sex-adjusted model, lifetime cannabis use disorder was associated with an HR of 1.32 (95% CI 0.71–2.43). Adjusted predicted probabilities of death were 4.59% (95% CI 2.13–7.06) among respondents with cannabis use disorder and 3.52% (95% CI 3.23–3.81) among those without it. Cause-specific estimates could not be released because event counts did not meet Statistics Canada disclosure requirements. Conclusions: Lifetime cannabis use disorder was not associated with a statistically distinguishable increase in all-cause mortality during approximately 5.5 years of follow-up, although the adjusted estimate remained compatible with a potentially meaningful elevation in risk. Differences from hospital-based estimates may reflect variation in disorder severity, recency, healthcare engagement, and case ascertainment.

Young adults with anxiety and depression often experience mental health-related disabilities (MHRD) that impair social, academic, occupational and daily functioning. These impairments, while significant, are frequently invisible, episodic, or lacking formal recognition; factors that limit their acknowledgment within healthcare systems designed to respond to more visible or diagnostically stable conditions. As MHRD rates among young adults rise there remains limited evidence on how functional impairments shape access to care. This scoping review examines peer-reviewed research on healthcare access and utilization for young adults aged 18 to 30 with anxiety and/or depression, with particular attention to how disability and functional impairment are defined, measured, and operationalized. The review was guided by the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The finalized search strategy was applied across four major databases: MEDLINE, CINAHL, PsycINFO, and Embase, covering all available years from 2013 to February 27, 2025. Studies were eligible if they examined access or utilization of healthcare services for young adults with anxiety and/or depression and addressed disability or functional impairment either directly or through related constructs. Only peer-reviewed articles published in English were included. A total of 20 studies met the inclusion criteria and were analyzed using descriptive and pre-defined classifications. Findings reveal that while access barriers are consistently reported, disability and functional impairment are rarely examined through frameworks that center disability as a primary analytic focus. Instead of drawing on established tools or models designed to assess impairment and functioning, many studies relied on diagnostic categories or symptom scales as indirect proxies. This limited the conceptual clarity and comparability of findings across studies. The invisibility of MHRD was rarely named, but evident in how inconsistently impairments were defined, measured, or accommodated. Across studies, impairments were most commonly reported in relation to interpersonal functioning, learning, cognition, and emotional regulation. Despite the diversity of health system contexts represented, including universal and insurance-based models, access inequities persisted across settings. Notably, few studies engaged youth or young adults with lived experience in the research process, and very few applied social theories or disability frameworks to guide their analysis.This review highlights a disconnect between how MHRD is experienced and how it is represented in the research evidence. While there is growing awareness of these limitations, few studies have moved beyond identification of gaps. Advancing access for this population will require greater theoretical clarity, participatory approaches, and the deliberate inclusion of MHRD as a core analytic category in health research.

OBJECTIVE:This study seeks to understand the characteristics of individuals with addictions and other mental health (AMH) conditions who had a history of homelessness compared to those who did not experience homelessness. METHOD:This cross-sectional analysis used linked administrative data from Alberta, Canada on April 1, 2018. People with AMH who experienced homelessness in the year prior to index were identified using hospitalisations and emergency department (ED) visits. We used multivariable logistic regression to evaluate the association between a set of descriptive variables and homelessness, adjusted for age and sex. RESULTS:Among the 622,614 individuals with AMH conditions, 3,390 (0.54%) had an indicator of homelessness. People experiencing homelessness (PEH) were younger (mean = 39 vs. 42 years, p < .001) and more frequently male (66% vs. 41%, p < .001) than individuals not experiencing homelessness. PEH were also more likely to be diagnosed with multiple AMH disorders (44.8% diagnosed with ≥ 4 AMH conditions vs. 3.8% of individuals without homelessness). PEH were more likely to have a history of visiting a psychiatrist (adjusted odds ratio (AOR) = 8.11, 95% CI [7.47-8.80], having an ED visit for AMH reasons (AOR = 25.44, 95% CI [22.94-28.21], and to have been hospitalised for AMH reasons (AOR = 13.53, 95%CI [12.61-14.52]). CONCLUSIONS:Within the population of individuals with diagnosed AMH conditions, PEH demonstrated increased AMH complexity, greater healthcare utilisation and a greater likelihood of almost all AMH disorders. Given the complex mental health needs of this group, they will require more intensive mental health and general medical services that must be integrated with housing and additional social support systems.

This study explores the associations between sociodemographic factors, unmet healthcare needs (UHN), and mental illness among Canadian young adults aged 18-30, employing a Critical Realist (CR) and patient-oriented research (POR) approach. Utilizing data from the 2017-2018 Canadian Community Health Survey, the analysis examines how structural, cultural, and agentic mechanisms influence self-reported UHN. Despite an unexpectedly low overall proportion of UHN (<5%), the results suggest significant disparities, with higher UHN likelihoods among equity-deserving subgroups, such as those experiencing food insecurity or identifying as non-heterosexual. The findings also indicate a difference from geographic disparities (e.g., where you are) and UHN to those tied to social identity (e.g., who you are) with mental illness, highlighting the role of mutable and immutable factors. The study introduces the See-Saw Model of young adults UHN, conceptualizing healthcare experiences as a dynamic balance between stabilizing forces (e.g., social networks) and destabilizing pressures (e.g., stigma). Central to this model is the distinction between "being saw" (utilization) and "being seen" (validation of identity and needs), emphasizing the critical role of person-centred care. The findings challenge assumptions that low UHN rates reflect system efficacy and underscore the need to rethink healthcare metrics and policies. By integrating CR's emphasis on causative mechanisms and POR's lived experience insights, the study provides actionable pathways for addressing inequities and improving healthcare access for young adults. This work calls for equity-focused interventions that prioritize structural reforms and culturally sensitive practices to bridge the gap between healthcare utilization and meaningful care.

Background/Objectives: Depressive disorders are diagnosed using categorical definitions provided by DSM-5 and ICD-11. However, categorization for diagnostic purposes fails to account for the inherently dimensional nature of depression. Artificial categorization may impede research and obstruct the achievement of optimal treatment outcomes. Methods: The current study utilized a Canadian historical dataset called the National Population Health Survey (NPHS) to explore a simple alternative approach that does not depend on categorization. The NPHS collected complete data from 5029 participants through biannual interviews conducted in 1994–2010. Data collection included the K6 Distress Scale as well as the Composite International Diagnostic Interview Short Form for Major Depression. Data from the National Population Health Survey (NPHS) were used to quantify vulnerability to depressive symptoms through longitudinal K6 Distress Scale assessments. Variability of symptoms across this dimension of apparent vulnerability was quantified using ordinal regression, adjusting for age and sex. Results: Predicted probabilities from these models were used in simulations to produce a visualization of the epidemiology and to explore clinical implications. Conclusions: Consideration of these two dimensional factors (estimated overall level of vulnerability to depression and variability over time) is already a component of clinical assessment and is also accessible to repeated measurement in settings adopting measurement-based care. More formal consideration of these elements may provide a complementary approach to categorical diagnostic assessment and an opportunity for greater personalization of care and improved clinical outcomes. Future studies should validate these findings in diverse clinical settings to ensure their applicability in real-world contexts.

Objective: There have been consistent concerns about a greater impact of COVID-19 on the mental health of younger people and females. We aimed to explore the potential synergistic effect of various pandemic-related stressors with age and sex on the mental health of the general Canadian household population during the COVID-19 pandemic. Methods: Using cross-sectional data from the Statistics Canada 2022 Mental Health and Access to Care Survey (MHACS), frequencies for major depressive episode (MDE), generalized anxiety disorder (GAD), general psychological distress, and various pandemic-related and demographic factors were estimated. Odds ratios were estimated using binary logistic regression models. These estimates used a replicate bootstrapping procedure recommended by Statistics Canada. Finally, Relative Excess Risk due to Interaction (RERI) models were used for each outcome to evaluate the interactions of each pandemic-related stressor with age and sex on an additive scale. Results: Past-12-month MDE and GAD, psychological distress, and the various COVID-19 stressors were more prevalent in young people and females. Overall, the stressors were confirmed to be associated with these outcomes. There were greater-than-additive interactions between age and difficulty accessing healthcare, loneliness, physical health problems, household relationship challenges, and work stress; and between sex and severe illness of a loved one, loneliness, work stress, LGBTQ2+ status, marital status, difficulty accessing healthcare, physical health problems, job/income loss, and financial difficulties. Generally, evidence of synergy was found between age and pandemic-related stressors and sex and pandemic-related stressors. Conclusions: Greater-than-additive interactions of pandemic-related stressors with age and sex may indicate synergistic vulnerabilities within females and young people. Future pandemics, via corresponding stressors, may be associated with increased mental health vulnerability in females, youth, and especially young females.