Pediatric psychoSocial Risk Index: Factor Analysis and Item Reduction Study.

OBJECTIVES: The Pediatric psychoSocial Risk Index (PSRI) is psychosocial risk screening instrument for health practitioners. The objective of this study was to confirm validity evidence of a truncated version of PSRI. METHODS: PSRI was completed initially by 100 parents of children aged 0 to 18 years admitted to a tertiary hospital; 50 parents repeated the PSRI 3 days later. Analysis includes principal component analysis (PCA) to include the least number of items that explain the most variance in a shortened version of PSRI as well as confirming test-retest reliability and internal consistency of the shortened instrument. RESULTS: PSRI originally had 86 items, 85 close-ended items were analyzed. Three items were excluded because of missing test-retest data. Item reduction resulted in truncation of 16 items; 66 items remained. A Kaiser-Mayer-Orkin test of sampling adequacy resulted in reduction of 14 items; 52 items remained. Initial PCA led to reduction of 26 items. The PCA was rerun on remaining items, resulting in reduction of 6 further items; 18 items remained. Two items with >10% missingness were removed leaving 16 items in the final PSRI. Test-retest reliability was 0.98 and mean within-person across-item reliability was 0.95. Cronbach α was 0.9. Remaining items represented 9 social risk themes: food insecurity, medical complexity, home environment, behavioral issues, financial insecurity, parenting confidence, parental mental health, social support, and unmet medical needs. CONCLUSIONS: PSRI was reduced from 86 to 16 items with high internal consistency and reliability. PSRI demonstrates adequate validity supporting practitioners to screen families about their psychosocial risk.

Evaluation of an automated matching system of children and families to virtual mental health resources during COVID-19.

BACKGROUND: Children and their families often face obstacles in accessing mental health (MH) services. The purpose of this study was to develop and pilot test an electronic matching process to match children with virtual MH resources and increase access to treatment for children and their families during COVID-19. METHODS: Within a large observational child cohort, a random sample of 292 families with children ages 6-12 years were invited to participate. Latent profile analysis indicated five MH profiles using parent-reported symptom scores from validated depression, anxiety, hyperactivity, and inattention measures: (1) Average Symptoms, (2) Low Symptoms, (3) High Symptoms, (4) Internalizing, and (5) Externalizing. Children were matched with virtual MH resources according to their profile; parents received surveys at Time 1 (matching process explanation), Time 2 (match delivery) and Time 3 (resource uptake). Data on demographics, parent MH history, and process interest were collected. RESULTS: 128/292 families (44%) completed surveys at Time 1, 80/128 families (63%) at Time 2, and a final 67/80 families (84%) at Time 3, yielding an overall uptake of 67/292 (23%). Families of European-descent and those with children assigned to the Low Symptoms profile were most likely to express interest in the process. No other factors were associated with continued interest or uptake of the electronic matching process. Most participating parents were satisfied with the process. CONCLUSIONS: The electronic matching process delivered virtual MH resources to families in a time-efficient manner. Further research examining the effectiveness of electronically matched resources in improving children's MH symptoms is needed.

Worldwide Prevalence and Disability From Mental Disorders Across Childhood and Adolescence: Evidence From the Global Burden of Disease Study.

Importance: The period from childhood to early adulthood involves increased susceptibility to the onset of mental disorders, with implications for policy making that may be better appreciated by disaggregated analyses of narrow age groups. Objective: To estimate the global prevalence and years lived with disability (YLDs) associated with mental disorders and substance use disorders (SUDs) across 4 age groups using data from the 2019 Global Burden of Disease (GBD) study. Design, Setting, and Participants: Data from the 2019 GBD study were used for analysis of mental disorders and SUDs. Results were stratified by age group (age 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and sex. Data for the 2019 GBD study were collected up to 2018, and data were analyzed for this article from April 2022 to September 2023. Exposure: Age 5 to 9 years, 10 to 14 years, 15 to 19 years, and 20 to 24 years. Main Outcomes and Measures: Prevalence rates with 95% uncertainty intervals (95% UIs) and number of YLDs. Results: Globally in 2019, 293 million of 2516 million individuals aged 5 to 24 years had at least 1 mental disorder, and 31 million had an SUD. The mean prevalence was 11.63% for mental disorders and 1.22% for SUDs. For the narrower age groups, the prevalence of mental disorders was 6.80% (95% UI, 5.58-8.03) for those aged 5 to 9 years, 12.40% (95% UI, 10.62-14.59) for those aged 10 to 14 years, 13.96% (95% UI, 12.36-15.78) for those aged 15 to 19 years, and 13.63% (95% UI, 11.90-15.53) for those aged 20 to 24 years. The prevalence of each individual disorder also varied by age groups; sex-specific patterns varied to some extent by age. Mental disorders accounted for 31.14 million of 153.59 million YLDs (20.27% of YLDs from all causes). SUDs accounted for 4.30 million YLDs (2.80% of YLDs from all causes). Over the entire life course, 24.85% of all YLDs attributable to mental disorders were recorded before age 25 years. Conclusions and Relevance: An analytical framework that relies on stratified age groups should be adopted for examination of mental disorders and SUDs from childhood to early adulthood. Given the implications of the early onset and lifetime burden of mental disorders and SUDs, age-disaggregated data are essential for the understanding of vulnerability and effective prevention and intervention initiatives.

The Distinction Between Social Connectedness and Support When Examining Depressive Symptoms Among Children and Adolescents During the COVID-19 Pandemic.

Childhood depression is associated with significant social and functional impairment, suicide risk, and persistence throughout adulthood. Recent evidence demonstrates that social connectedness and social support may serve as protective factors against the development of depression. The current study aimed to examine the effect of change in social connectedness and social support on depressive symptoms among children and adolescents during the COVID-19 pandemic. Hierarchical regression was performed. Results indicated that parent-reported measures of change in social connectedness were inversely associated with depressive symptom severity, and could significantly predict future depressive symptom severity. In contrast, parent-reported measures of social support (i.e., from family and friends) did not significantly predict future depressive symptom severity. The presence of a pre-COVID psychiatric and/or neurodevelopmental diagnosis and baseline depressive symptom severity were also important factors associated with future depressive symptom severity. The findings suggest that an awareness of the presence of social supports (i.e., family or friends) is not sufficient for children to feel connected, but rather the mechanisms of social relationships are crucial. As our approach to public health restrictions evolves, the risk transmission of COVID-19 should be carefully balanced with the risks associated with decreased connectedness among youth.

The role of parenting practices in parent and child mental health over time.

BACKGROUND: Parent and child mental health has suffered during the pandemic and transition phase. Structured and shared parenting may be intervention targets beneficial to families who are struggling with parent or child mental health challenges. AIMS: First, we investigated associations between structured and shared parenting and parent depression symptoms. Second, we investigated associations between structured and shared parenting and depression, hyperactivity/inattention and irritability symptoms in children. METHOD: A total of 1027 parents in two-parent households (4797 observations total; 85.1% mothers) completed online surveys about themselves and their children (aged 2-18 years) from April 2020 to July 2022. Structured parenting and shared parenting responsibilities were assessed from April 2020 to November 2021. Symptoms of parent depression, child depression, child hyperactivity and inattention, child irritability, and child emotional and conduct problems were assessed repeatedly (one to 14 times; median of four times) from April 2020 to July 2022. RESULTS: Parents who reported higher levels of shared parenting responsibilities had lower depression symptoms (ß = -0.09 to -0.32, all P < 0.01) longitudinally. Parents who reported higher levels of shared parenting responsibilities had children with fewer emotional problems (ages 2-5 years; ß = -0.07, P < 0.05), fewer conduct problems (ages 2-5 years; ß = -0.09, P < 0.01) and less irritability (ages 13-18 years; ß = -0.27, P < 0.001) longitudinally. Structured parenting was associated with fewer conduct problems (ages 2-5 years; ß = -0.05, P < 0.05). CONCLUSIONS: Shared parenting is beneficial for parent and child mental health, even under chaotic or inflexible life conditions. Structured parenting is beneficial for younger children.

Patterns of parent screen use, child screen time, and child socio-emotional problems at 5 years.

Digital media screens have become an essential part of our family life. However, we have insufficient knowledge about parental screen use patterns and how these affect children's socio-emotional development. In total, 867 Canadian parents of 5-year-old children from the TARGet Kids! Cohort (73.1% mothers, mean ± SD age = 38.88 ± 4.45 years) participated in this study from 2014 to the end of 2019. Parents reported parental and child time on television (TV) and handheld devices and completed the Strengths and Difficulties Questionnaire (SDQ). Latent profile analysis identified six latent profiles of parent screen use: low handheld users (P1, reference; n = 323), more TV than handheld (P2; n = 261), equal TV and handheld (P3; n = 177), more handheld than TV (P4; n = 57), high TV and handheld (P5; n = 38), and extremely high TV and handheld (P6; n = 11). Parents that were more likely to belong to P6 were also more likely to be living in single-parent households compared to P1 (estimate = -1.49 ± 0.70), p = .03). High membership probability for P2 (estimate = -0.67 ± 0.32, p = .04) and P4 (estimate = -1.42 ± 0.40, p < 0.001) was associated with lower household income compared to P1. Children of parents with higher P4 (χ2  = 12.32, p < 0.001) or P5 (χ2  = 9.54, p = .002) membership probability had higher total screen time compared to P1. Finally, a higher likelihood to belong to P6 (χ2  = 6.82, p = .009) was associated with a higher SDQ Total Difficulties Score compared to P1. Thus, patterns of parent screen use were associated with child screen use and child socio-emotional problems. The emerging link between parental screen use profiles and child behaviors suggests the need for more research on parent screen time.

CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions.

BACKGROUND: Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services. METHODS: Using a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups. RESULTS: Clustering revealed four subgroups. One subgroup-broad symptom worsening only (20%)-included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup. LIMITATIONS: Notable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic. CONCLUSIONS: Concomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.

Disruption to Education During COVID-19: School Nonacademic Factors Are Associated with Children's Mental Health.

OBJECTIVE: Few studies have examined aspects of the school environment, beyond modality, as contributors to child and youth mental health during the coronavirus pandemic. We investigated associations between nonacademic school experiences and children's mental health. METHODS: Parents of children ages 6 to 18 years completed online surveys about school experiences (November 2020) and mental health (February/March 2021). Parent-reported and child-reported school experiences (i.e., nonacademic factors) included school importance, adapting to public health measures, and school connectedness. Children's mental health symptoms of depression, anxiety, inattention, and hyperactivity were collected using standardized parent-reported measures. RESULTS: Children's (N = 1052) self-reported and parent-reported nonacademic factors were associated with mental health outcomes, after adjusting for demographics and previous mental health. Lower importance, worse adapting to school changes, and less school connectedness were associated with greater depressive symptoms ( B = -4.68, CI [-6.04, -3.67] to - 8.73 CI [-11.47, 5.99]). Lower importance and worse adapting were associated with greater anxiety symptoms ( B = - 0.83 , CI [-1.62, -0.04] to -1.04 CI [-1.60, -0.48]). Lower importance was associated with greater inattention (B = -4.75, CI [-6.60, -2.90] to -6.37, CI [-11.08, -7.50]). Lower importance and worse adapting were associated with greater hyperactivity (B = -1.86, CI [-2.96, -0.77] to -4.71, CI [-5.95, -3.01]). CONCLUSION: Schools offer learning opportunities that extend beyond curriculum content and are a primary environment where children and youth develop connections with others. These aspects of school, beyond academics, should be recognized as key correlates of child and youth mental health.

Measuring the association between behavioural services and outcomes in young children with autism spectrum disorder.

BACKGROUND: Children with autism spectrum disorder (ASD) receive a wide range of services. AIMS: To examine the association between behavioural services received by children with ASD between ages 2 and 5 years and outcomes during primary school years. METHODS: A total of 414 preschool-aged children diagnosed with ASD were enrolled at five Canadian sites and were assessed within four months of diagnosis (T1), six months later (T2), 12 months later (T3), at school entry (T4), and then annually (T5-T8) to 11 years of age. The association between the receipt of behavioural services during T1 to T3 and T8 outcomes related to adaptive behaviour and behavioural problems was modelled using linear regressions adjusted for immigrant status, family income, child's age at diagnosis, site, sex assigned at birth, and baseline (T1) outcome. RESULTS: Children who received behavioural services during at least one time period from T1 to T3 did not have significantly different outcomes at T8 than children who did not receive any behavioural services. IMPLICATIONS: Pre-school use of behavioural services was not found to affect outcomes during later childhood. Numerous challenges accompany studies of the association between pre-school service use and later outcomes in a heterogeneous ASD sample. Recommendations for study design are provided.

School and learning contexts during the COVID-19 pandemic: Implications for child and youth mental health.

Despite significant disruption to school during the COVID-19 pandemic, research on the impact on children is sparse. This study examines in-person and virtual learning contexts and the impact of school format on mental health (MH). Children and adolescents were recruited from community and clinical settings. Parents and children completed prospective online surveys about school experiences (November 2020) and MH symptoms (February/March 2021), including school format and activities. Standardized measures of depression, anxiety, inattention, and hyperactivity were collected. Hierarchical regression analyses tested associations between school format and MH. Children (N = 1011; aged 6-18 years) attending school in-person (n = 549) engaged in high levels of participation in COVID-19 health measures and low levels of social learning activities. Learning online in high school was associated with greater MH symptoms (B = -2.22, CI[-4.32,-.12] to B = -8.18, CI[-15.59,-.77]). Children with no previous MH condition that attended school virtually experienced a similar magnitude of MH symptoms as those with previous MH conditions. However, children who attended school in a hybrid in-person format, with no previous MH condition, experienced less hyperactivity as same-age peers with prior MH problems (B = -8.08, CI[1.58,14.58]). Children's learning environments looked very different compared to before the pandemic. Removing children from school environments and limiting opportunities that support their MH, such as social learning activities, is problematic. Efforts to address the learning contexts to protect the mental health of children are needed.

How much is enough? Considering minimally important change in youth mental health outcomes.

To make decisions in mental health care, service users, clinicians, and administrators need to make sense of research findings. Unfortunately, study results are often presented as raw questionnaire scores at different time points and regression coefficients, which are difficult to interpret with regards to their clinical meaning. Other commonly reported treatment outcome indicators in clinical trials or meta-analyses do not convey whether a given change score would make a noticeable difference to service users. There is an urgent need to improve the interpretability and relevance of outcome indicators in youth mental health (aged 12-24 years), in which shared decision making and person-centred care are cornerstones of an ongoing global transformation of care. In this Personal View, we make a case for considering minimally important change (MIC) as a meaningful, accessible, and user-centred outcome indicator. We discuss what the MIC represents, how it is calculated, and how it can be implemented in dialogues between clinician and researcher, and between youth and clinician. We outline how use of the MIC could enhance reporting in clinical trials, meta-analyses, clinical practice guidelines, and measurement-based care. Finally, we identify current methodological challenges around estimating the MIC and areas for future research. Efforts to select outcome domains and valid measurement instruments that resonate with youth, families, and clinicians have increased in the past 5 years. In this context, now is the time to define demarcations of changes in outcome scores that are clinically relevant, and meaningful to youth and families. Through the use of MIC, youth-centred outcome measurement, analysis, and reporting would support youth-centred therapeutic decision making.

Educators Describe the "Best Things" About Students with Autism at School.

This study examined educators' descriptions of the positive character traits of students with autism spectrum disorder at ages 7-8 and 10-11, using an adapted version of the Values in Action (VIA) Classification of Strengths. The most commonly endorsed strengths at both age intervals were kindness, specific skills, self-regulation, and perseverance. Higher scores for challenging behavior were associated with a lower likelihood of endorsement for Happiness and Courage traits. Higher autism symptom severity scores were associated with a lower likelihood of endorsement for Courage traits. Few significant differences were found for endorsement of trait categories by students' educational placement or the type of curriculum they received. Results may have implications for student-teacher relationships, educational assessments, and school-based interventions that emphasize strengths and resilience.

Participating in extracurricular activities and school sports during the COVID-19 pandemic: Associations with child and youth mental health.

In Ontario, Canada, school extracurricular activities and sports were modified or canceled for a prolonged period due to public health restrictions resulting from the COVID-19 pandemic. The present study aims to examine the association of changes to extracurricular and sport participation and child and youth mental health. Data were collected on child and youth mental health symptoms (n = 908) and participation in extracurricular activities and sports in the 2019-2020 and 2020-2021 academic years. Results indicated that pre-COVID (2019-2020) participation in either extracurricular activities or sports was associated with reduced anxiety, inattention, and hyperactivity during the pandemic (ß range -0.08 to -0.11, p < 0.05). Participation in either extracurricular activities or sports during-COVID (2020-2021) was associated with lower depressive symptoms (ß range -0.09 to -0.10, p < 0.05). Findings suggest that participation in extracurricular activities and/or school sports both before or during the COVID-19 pandemic were associated with better mental health outcomes in children and youth. Implications of this work consider future situations where restrictions on extracurricular and sport participation are reinstated and the impact of child and youth mental health.

An Innovative Model of Pediatric Emergency Department Mental Health Care: Protocol for a Multicenter Type 1 Effectiveness-Implementation Cluster Randomized Trial.

Over the past decade, visits to American and Canadian emergency departments (EDs) for child and youth mental health care have increased substantially.1,2 Acute mental health crises can occur as a result of a variety of concerns, including those that are life threatening (eg, suicide attempts), pose safety concerns (eg, suicidal intentions, aggressive behaviors, alcohol and other drug use), and are physically distressing to the child or youth (eg, panic attacks). ED health care providers play a vital role in assessing the safety and well-being of the child or youth and referring them to services for ongoing care.3,4 During the ED visit, assessment and care should pinpoint risks, inform treatment, and consider family needs and preferences as part of a patient-centered approach. Yet, this approach to care is not widely adopted in EDs. Most EDs do not require the use of pediatric-specific mental health tools to guide assessments or have patient-centered procedures in place to guide the care of patients with mental health emergencies.5-7 Our team believes these limitations have led to the provision of acute mental health care that can lack sufficient quality and efficiency. This study protocol describes a trial designed to evaluate if a novel mental health care bundle that was co-designed with parents and youth results in greater improvements in the well-being of children and youth 30 days after seeking ED care for mental health and/or substance misuse concerns compared with existing care protocols. We hypothesize that the bundle will positively impact child and youth well-being, while also providing cost-effective health care system benefits.

Mental health profiles of autistic children and youth during the COVID-19 pandemic.

Objectives: Canadian province-wide lockdowns have challenged children's mental health (MH) during the COVID-19 pandemic, with autistic children being at particular risk. The purpose of our study was to identify sub-groups of autistic children with distinct mental health change profiles, to understand the child-, parent-, and system-specific factors associated with such profiles in order to ultimately inform future interventions. Methods: Data were drawn from a large Canadian cohort (N=1,570) across Ontario, resulting in 265 autistic children (mean age=10.9 years, 76% male). K-means clustering analyses were employed to partition distinct MH profiles in six MH measures (mood, anxiety, OCD symptoms, irritability, inattention, hyperactivity) and group differences were examined with reference to the above factors. Additionally, we investigated the characteristics of children who accessed acute MH services. Results: The optimal number of clusters was two; one included those experiencing MH deterioration across all six MH measures (61.3%, 95% confidence interval [CI]=54.9 to 67.4), and a second included youth that did not experience MH changes (38.7%, 95%CI=32.6 to 45.1). Child-specific factors associated with MH deterioration included higher pre-existing internalizing symptoms, high levels of COVID stress. Parental MH challenges and system-specific factors, such as the loss of learning supports, access to physicians and material deprivation, were also associated with MH deterioration. Access to acute MH services were primarily associated with financial insecurity and loss of services. Conclusions: More than half of autistic children experienced MH deterioration, and person-specific (pre-existing MH, COVID related stress), parent-specific (Parent MH) and system-level (loss of services and material deprivation) characteristics were associated with such decline, providing clinical and policy opportunities for intervention at multiple levels.

Characterizing the ASD-ADHD phenotype: measurement structure and invariance in a clinical sample.

BACKGROUND: Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) have considerable overlap, supporting the need for a dimensional framework that examines neurodevelopmental domains which cross traditional diagnostic boundaries. In the following study, we use factor analysis to deconstruct the ASD-ADHD phenotype into its underlying phenotypic domains and test for measurement invariance across adaptive functioning, age, gender and ASD/ADHD clinical diagnoses. METHODS: Participants included children and youth (aged 3-20 years) with a clinical diagnosis of ASD (n = 727) or ADHD (n = 770) for a total of 1,497 participants. Parents of these children completed the Social Communication Questionnaire (SCQ), a measure of autism symptoms, and the Strengths and Weaknesses of ADHD and Normal Behaviour (SWAN) questionnaire, a measure of ADHD symptoms. An exploratory factor analysis (EFA) was performed on combined SCQ and SWAN items. This was followed by a confirmatory factor analysis (CFA) and tests of measurement invariance. RESULTS: EFA revealed a four-factor solution (inattention, hyperactivity/impulsivity, social-communication, and restricted, repetitive, behaviours and interests (RRBI)) and a CFA confirmed good model fit. This solution also showed good model fit across subgroups of interest. CONCLUSIONS: Our study shows that a combined ASD-ADHD phenotype is characterized by two latent ASD domains (social communication and RRBIs) and two latent ADHD domains (inattention and hyperactivity/impulsivity). We established measurement invariance of the derived measurement model across adaptive functioning, age, gender and ASD/ADHD diagnoses.

Ontario COVID-19 and Kids Mental Health Study: a study protocol for the longitudinal prospective evaluation of the impact of emergency measures on child and adolescent mental health during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has impacted the mental health (MH) of children, adolescents and parents. Whereas youth with MH disorders and neurodevelopmental disorders (NDD) may be at higher risk for exacerbations in emotional and behavioural distress, children and adolescents without pre-existing MH disorders or NDD may also experience MH deterioration due to increases in stress, changes in health behaviours, loss of activities/school closures or loss of resources. Little is known about the impact of the COVID-19 emergency measures (EMs) on children's MH over the course of the pandemic. METHODS AND ANALYSIS: Longitudinal study of four well-established, pre-existing cohorts in Ontario (two recruited in clinical settings, two recruited in community settings). Primary outcomes include the impact of EMs on six MH domains: depression, anxiety, irritability, inattention, hyperactivity and obsessive-compulsive behaviours. Risk and protective factors related to youth MH profiles and trajectories will be identified. In addition, the effects of school mitigation strategies, changes in MH services and family factors (ie, parental MH, economic deprivation and family functioning) on children's MH will be examined. Data will be collected via repeated online survey measures selected to ensure reliability and validity for the proposed populations and distributed through the pandemic periods. ETHICS AND DISSEMINATION: The study was approved by institutional research ethics boards at participating research sites. Results will be disseminated through a robust knowledge translation partnership with key knowledge users. Materials to inform public awareness will be co-developed with educators, public health, and MH and health service providers. Connections with professional associations and MH advocacy groups will be leveraged to support youth MH policy in relation to EMs. Findings will further be shared through conference presentations, peer-reviewed journals and open-access publications.

Food intake reporting bias among adolescents with depression.

There is a growing body of research supporting adjunctive dietary interventions to improve depressive symptoms. Quantifying the level of dietary intake reporting accuracy is important when assessing dietary intervention efficacy. The current study assesses dietary intake reporting accuracy among children and adolescents clinically diagnosed with depression. Forty-six participants (87.0% female) with clinically diagnosed depression were included in this analysis with a mean age of 15.04 ± 1.52 years. The reporting accuracy of energy intake was determined using a single dietary recall and the McCrory equations. Thirty (64.8%) participants were categorized as plausible reporters, 16 (35.2%) as under-reporters and none were over-reporters. Mean energy estimates were misreported by -1192.618 ± 817.87 kcal and were proportional to caloric intake. The only covariate significantly associated with misreporting was obesity/overweight. Misreporting was not associated with depressive symptom burden. Depressive symptomology was not associated with under-reporting, indicating that adolescents with clinically diagnosed depression are able to report dietary intake at accuracy levels comparable to adolescents in community samples.