Preferences for virtual versus in-person mental and physical healthcare in Canada: a descriptive study from a cohort of youth and their parents enriched for severe mental illness.

BACKGROUND: Virtual care may improve access to healthcare and may be well suited to digitally connected youth, but experts caution that privacy and technology barriers could perpetuate access inequities. Success of virtual care will depend on its alignment with patient preferences. However, information on preferences for virtual and in-person healthcare is missing, especially for youth. We sought to quantify preferences for and barriers to virtual versus in-person mental and physical healthcare in youth and their parents, including in vulnerable segments of the population such as families with a parent with severe mental illness (SMI). METHODS: Participants were 219 youth and 326 parents from the Families Overcoming Risks and Building Opportunities for Wellbeing cohort from Canada, of which 61% of youth had at least one parent with SMI. Participants were interviewed about healthcare preferences and access to privacy/technology between October 2021 and December 2022. RESULTS: Overall, youth reported a preference for in-person mental (66.6%) and physical healthcare (74.7%) versus virtual care or no preference, and to a somewhat lesser degree, so did their parents (48.0% and 53.9%). Half of participants reported privacy/technology barriers to virtual care, with privacy being the most common barrier. Preferences and barriers varied as a function of parent SMI status, socioeconomic status and rural residence. CONCLUSIONS: The majority of youth and parents in this study prefer in-person healthcare, and the preference is stronger in youth and in vulnerable segments of the population. Lack of privacy may be a greater barrier to virtual care than access to technology.

Building mental health literacy: opportunities and resources for clinicians.

Youth mental health is increasingly recognized as a key concern with significant impact on youth and society. School is the one setting where professionals are consistently available to monitor how children are functioning and learning and intervene and support. School psychiatry has expanded beyond individual mental health problems to school-wide and community issues including school violence, sexual harassment, bullying, substance abuse, discrimination, and discipline. This article describes the importance of mental health literacy in health outcomes and research in school-based mental health programs to better position the clinician to advocate at the individual and/or system level.

Maximizing the uptake and sustainability of school-based mental health programs: commercializing knowledge.

Clear benefits of school-based interventions focusing on health and mental health promotion or illness have been documented. A number of permanent repositories that rate and list effective school-based programs have been established. However, efforts to implement programs on a mass scale have not succeeded. There is a need to balance program development and improvement with uptake and implementation. This article outlines what is known about knowledge exchange and mobilization and introduces a business lens for school-based mental health programs uptake and sustainability. Individual clinicians can have significant impact by promoting strategies for both patients and the whole school population.

Anxiety and separation disorders.

• Based on strong research evidence, anxiety disorders are the most common psychiatric illness in children and adolescents. • Based on some research evidence, the neurobiology of anxiety disorders is linked to dysregulation in the fear and stress response system in the brain. • Based on strong research evidence, separation anxiety disorder is one of the most common causes of school refusal, and addressing both the function of the behavior and returning to school as soon as possible is recommended. (7)• Based on strong research evidence, CBT is the first-line treatment for anxiety disorders in children and adolescents. • Based on strong research evidence, SSRIs are effective for treatment of moderate-to-severe anxiety disorders in children and adolescents.

Factorial validity of the Center for Epidemiological Studies Depression 10 in adolescents.

The Center for Epidemiological Studies-Depression (CES-D) Scale's 20-item version is well-validated and reliable for detecting depressive symptoms in adolescents in community samples. A shortened version, CES-D 10 has not been validated with adolescents, but has demonstrated strong psychometrics in other populations. The purpose of this study was to test the factorial validity and internal consistency of the CES-D 10 in adolescents. Using data from 156 adolescents in a previous community-based study, we tested three models of the underlying factors of the CES-D 10 using Structural Equation Modeling (SEM) based on factor models validated in other populations. A two-factor model comprised of depressive affect and positive affect was found to be the model that best fits the data (RMSEA = 0.016, CFI = 0.98, GFI = 0.95, AIC = 97.43, BIC = 191.98). These findings are consistent with other studies in adults and provide initial support for the use of the CES-D 10 as a depression screen for adolescents in the community. The utility of a brief screen for adolescents in the community is high, given that many adolescents do not know they need help or are reluctant to seek help. The CES-D 10 could be used as a depression screen for adolescents at a population level and in health clinics.

Adolescents' attitudes and opinions about depression treatment.

The purpose of this study was to determine adolescent preferences for depression treatment. Adolescents (n = 156) completed a survey that included: their preferences for type of depression treatment and the method of delivering it; their perception of the importance of side effects of depression treatments and a rating of their willingness to seek treatment if they were depressed. A screen for depressive symptoms (CES-D10) was also completed. Adolescents showed higher preference for psychotherapy than antidepressants. Greater severity of depression symptoms, perceived social support for the particular treatment modality, and general willingness to seek treatment predicted greater preference for psychotherapy than for antidepressants. Family doctors, psychiatrists, and psychologists were the preferred treatment providers, and adolescents preferred that treatment be delivered in a private office. Weight gain was the most deterring side effect of antidepressants for girls and loss of sex drive for boys. Adolescents' preference for psychological therapy suggests that broader availability of psychotherapy may enhance help-seeking and compliance in depression treatment in this vulnerable population.

Early temperament prospectively predicts anxiety in later childhood.

OBJECTIVE: To investigate the contribution of early childhood temperamental constructs corresponding to 2 subtypes of general negative emotionality-fearful distress (unadaptable temperament) and irritable distress (fussy-difficult temperament)-to later anxiety in a nationally representative sample. METHOD: Using multiple linear regression analyses, we tested the hypothesis that caregiver-reported child unadaptable temperament and fussy-difficult temperament scales of children aged 2 to 3 years (in 1995) would prospectively predict caregiver-reported child anxiety symptoms at ages 4 to 5, 6 to 7, 8 to 9, and 10 to 11 years, and child-reported anxiety at 10 to 11 years (controlling for sex, age, and socioeconomic status) in a nationally representative sample from Statistics Canada's National Longitudinal Survey of Children and Youth (initial weighted n = 768,600). RESULTS: Only fussy-difficult temperament predicted anxiety in children aged 6 to 7 years. In separate regressions, unadaptable temperament and fussy-difficult temperament each predicted anxiety at 8 to 9 years, but when both were entered simultaneously, only unadaptable temperament remained a marginal predictor. Temperament did not significantly predict caregiver- or child-reported anxiety at 10 to 11 years, suggesting that as children age, environmental factors may become more important contributors to anxiety than early temperament. CONCLUSION: Our results provide the first demonstration that early temperament is related to later childhood anxiety in a nationally representative sample.