The prevalence of mental health and addiction concerns and factors associated with depression and anxiety during the COVID-19 pandemic in Ontario, Canada: A cross-sectional study.

OBJECTIVE: Higher than expected rates of mental health and/or addiction (MHA) concerns have been documented since the onset of the COVID-19 pandemic. A more up-to-date prevalence of MHA outcomes and the factors associated with the occurrence of MHA concerns remains unclear. This study examined the prevalence of MHA outcomes and factors associated with screening positive for symptoms of depression only, anxiety only, and both depression and anxiety two years into the COVID-19 pandemic in Ontario, Canada. METHOD: Ontario adults ≥18 years of age (n = 5000) reported on the presence of symptoms associated with depression, anxiety, and substance use between January and March 2022. Data were also collected on pandemic-related health variables, including COVID-19 infection fear, changes in socioeconomic status and mental health since pandemic onset, satisfaction with social supports, and MHA service needs. RESULTS: The prevalence of positive screening for depressive or anxiety symptoms only was 8% and 11%, respectively, while 36% screened positive for both. Moderate/high risk levels of substance use were found in 20% of participants for tobacco and 17% for both alcohol and cannabis. Moderate/high risk levels of alcohol use and certain pandemic-related factors (negative change in mental health, unmet MHA service needs) were associated with positive screening for symptoms of depression only, anxiety only, and both depression and anxiety. Satisfaction with social supports was associated with lower likelihoods of being in the depression only and both depression and anxiety groups, and non-White ethnicity was associated with depression only. CONCLUSIONS: There was a continued burden of MHA issues two years into the pandemic. These results underscore the ongoing need for timely and accessible MHA services.

Impact of the COVID-19 pandemic on perceived changes in responsibilities for adult caregivers who support children and youth in Ontario, Canada.

BACKGROUND: The COVID-19 pandemic has created long-lasting changes in caregiving responsibilities, including but not limited to increased demands, loss of support, worsening mental and physical health, and increased financial worries. There is currently limited evidence regarding factors associated with perceived changes in caregiving responsibilities. AIMS: This observational study aimed to investigate factors (sociodemographic characteristics of caregivers and mental health and/or addiction concerns of the caregiver and their youth) that predict perceived negative changes in caregiving responsibilities among adult caregivers (aged 18+ years) of children and youth (aged 0-25 years) in Ontario, Canada, during the COVID-19 pandemic. METHOD: Data were collected from 1381 caregivers of children and youth between January and March of 2022 through a representative cross-sectional survey completed online. Logistic regression was conducted to determine predictors contributing to perceived negative changes in caregiving responsibilities. RESULTS: Among the sociodemographic characteristics, only ethnicity significantly predicted outcome. Higher caregiver strain (odds ratio [OR] = 10.567, 95% CI = 6.614-16.882, P < 0.001), worsened personal mental health (OR = 1.945, 95% CI = 1.474-2.567, P < 0.001), a greater number of children/youth cared for per caregiver (OR = 1.368, 95% CI = 1.180-1.587, P < 0.001), dissatisfaction with the availability of social supports (OR = 1.768, 95% CI = 1.297-2.409, P < 0.001) and negative changes in mental well-being in at least one child/youth (OR = 2.277, 95% CI = 1.660-3.123, P < 0.001) predicted negative changes in caregiving responsibilities. CONCLUSION: These results support further exploration of the implications of negative perceptions of caregiving responsibilities and what processes might be implemented to improve these perceptions and the outcomes.

A Qualitative Exploration of Ontario Caregivers' Perspectives of Their Role in Navigating Mental Health and/or Addiction Services for Their Youth.

Many youth experiencing mental health and/or addiction (MHA) concerns rely on their caregivers to find and access services. Considering that caregivers often play a significant role in their youth's treatment trajectory, a descriptive qualitative study was used to explore how caregivers (n = 26) in the Greater Toronto Area perceive their role in navigating MHA care for their youth (ages 13 to 26). The Person-Environment-Occupation model was used to guide the thematic analysis. The findings reveal three main themes (1) the internal experience of caregiving, which describes caregivers' emotions and thought processes; (2) the external factors impacting the caregiver's ability to find and access youth MHA services, which explores systemic and social factors that impact navigation; and (3) the demands of the caregiving role. The discussion highlights the importance of supporting the wellbeing of caregivers as they navigate youth MHA services and can provide useful information for healthcare professionals and policy-makers to increase equitable access to youth MHA services.

'Just because we're younger doesn't mean our opinions should be any less valued': A qualitative study of youth perspectives on a Youth Advisory Council in a mental healthcare context.

INTRODUCTION: Recognition of the importance of youth engagement in youth mental health and/or addiction (MHA) service design and delivery is increasing. Youth Advisory Councils embedded in MHA organizations represent one strategy that allows youth to be involved in MHA at the individual, organization and systemic levels. This level of involvement can facilitate positive outcomes for both the youth and the organization. As these councils become more common, it is important that organizations are prepared to partner with the participating youth. This study uses a descriptive qualitative approach to understand the motivations and expectations of youth with lived experience with MHA concerns who were beginning to work on a Youth Advisory Council in an MHA setting in the Greater Toronto Area. METHODS: Semistructured interviews were conducted with each youth, ages 16-26, on the advisory council (N = 8) to understand their motivations, expectations and goals coming into the work. Interviews were transcribed verbatim and analysed using a reflexive thematic analysis. RESULTS: Analysis resulted in five overarching themes: providing opportunities for youth learning and growth, platforming youth, empowering youth, embracing youth leadership and promoting youth-driven change. The findings illustrate that these youth came into the Youth Advisory Council motivated to create positive change in the mental health system, take on leadership roles and had high expectations for organizational support. Our analyses provide insight for organizations planning and implementing Youth Advisory Councils in the MHA sector with the goal of best supporting youth in driving positive change across the system. CONCLUSION: Youth want to be provided authentic opportunities for their engagement to make a difference. MHA organizations must embrace youth leadership and move towards listening to youth experience and acting on youth recommendations to enhance service design and implementation to improve access and to better meet the needs of youth utilizing these services. PATIENT OR PUBLIC CONTRIBUTIONS: This study incorporated service users, including youth ages 16-26 with lived experience of MHA concerns who served on the Youth Advisory Council at the Family Navigation Project, Sunnybrook. Youth Advisory Council members contributed to two relevant research activities: (1) youth reviewed the draft interview guide before data collection, and their feedback was prioritized in the final version and (2) youth contributed to knowledge translation through contributing to academic conference presentations.

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators.

INTRODUCTION: Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care. METHODS: This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12-29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking). RESULTS: A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families' needs are met, barriers are mitigated, and facilitators are enhanced. CONCLUSION: This review provides essential contextual information regarding TAY with MHA concerns and their families' needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population's needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.

Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers.

BACKGROUND: Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. METHODS: This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. RESULTS: The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do." CONCLUSION: Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.

Predictors of barriers to accessing youth mental health and/or addiction care.

Background: It is estimated that 1.2 million Canadian youth are affected by mental health and/or addiction issues; yet only a small proportion of young people receive appropriate and specialized treatment. Given caregivers are often tasked with navigating the complex mental health and/or addiction care systems for their youth, it is important to identify and understand the characteristics, such as those related to youth and their families, that are associated with caregivers' perceived barriers to accessing youth mental health and/or addiction services. Objective: The objective of this cross-sectional survey study was to examine the unique predictors of caregivers' perceived barriers to accessing youth mental health and/or addiction services. Method: Participants were 259 caregivers of at least one youth, aged 4 to 29 years (M age = 16.7, SD = 5.3) with mental health and/or addiction issues in Ontario, Canada identified from a community-based online survey. Results: Regression results showed that caregivers' demographics (i.e., living in a rural area, having an education level of college/university degree or higher), youth having concurrent issues, and service use patterns (i.e., currently accessing and/or seeking services) significantly predicted a higher level of barriers to accessing mental health and/or addiction services. Conclusion: In order to improve access to care for youth with mental health and/or addiction issues, understanding the predictors of barriers to accessing appropriate services is an important step in making services more accessible for youth and families.

Contexte: On estime à 1,2 million le nombre de jeunes canadiens qui sont affectés par des problèmes de santé mentale et/ou de dépendance; et pourtant, seule une petite proportion de jeunes gens reçoit un traitement approprié et spécialisé. Étant donné que les soignants sont souvent chargés de naviguer dans les systèmes de soins complexes de santé mentale et/ou de dépendance pour leurs jeunes, il est important d'identifier et de comprendre les caractéristiques, comme celles qui sont liées aux jeunes et à leur famille, qui sont associées aux obstacles perçus par les soignants à l'accès aux services des jeunes en santé mentale et/ou dépendance. Objectif: L'objectif de la présente étude par sondage transversal était d'examiner les prédicteurs uniques des obstacles perçus par les soignants à l'accès aux services des jeunes en santé mentale et/ou dépendance. Méthode: Les participants étaient 259 soignants d'au moins un jeune âgé de 4 à 29 ans (M âge = 16,7, ET = 5,3) avec au moins des problèmes de santé mentale et/ou de dépendance en Ontario, Canada, identifiés depuis un sondage en ligne communautaire. Résultats: Les résultats de la régression ont montré que les données démographiques des soignants (c.-à-d., vivre en milieu rural, avoir un niveau d'instruction de diplôme collégial/universitaire ou mieux) des jeunes ayant des problèmes concurrents, et des modèles d'utilisation des services (c.-à-d., accéder et ou rechercher des services présentement prédisait significativement un niveau plus élevé d'obstacles à l'accès aux services de santé mentale et/ou de dépendance. Conclusion: Afin d'améliorer l'accès aux soins pour les jeunes ayant des problèmes de santé mentale et/ou de dépendance, comprendre les prédicteurs des obstacles à l'accès aux services appropriés est une étape importante pour rendre les services plus accessibles aux jeunes et aux familles.

Is the narrative the message? The relationship between suicide-related narratives in media reports and subsequent suicides.

OBJECTIVES: When journalists report on the details of a suicide, the way that they contextualize the meaning of the event (i.e. the 'narrative') can have significant consequences for readers. The 'Werther' and 'Papageno' narrative effects refer to increases and decreases in suicides across populations following media reports on suicidal acts or mastery of crises, respectively. The goal of this study was to investigate the impact of these different narrative constructs on subsequent suicides. METHODS: This study examined the change in suicide counts over time in Toronto, Canada. It used latent difference score analysis, examining suicide-related print media reports in the Toronto media market (2011-2014). Articles (N = 6367) were coded as having a potentially harmful narrative if they described suicide in a celebrity or described a suicide death in a non-celebrity and included the suicide method. Articles were coded as having potentially protective narratives if they included at least one element of protective content (e.g. alternatives to suicide) without including any information about suicidal behaviour (i.e. suicide attempts or death). RESULTS: Latent difference score longitudinal multigroup analyses identified a dose-response relationship in which the trajectory of suicides following harmful 'Werther' narrative reports increased over time, while protective 'Papageno' narrative reports declined. The latent difference score model demonstrated significant goodness of fit and parameter estimates, with each group demonstrating different trajectories of change in reported suicides over time: (χ2[6], N = 6367) = 13.16; χ2/df = 2.19; Akaike information criterion = 97.16, comparative fit index = 0.96, root mean square error of approximation = 0.03. CONCLUSION: Our findings support the notion that the 'narrative' matters when reporting on suicide. Specifically, 'Werther' narratives of suicides in celebrities and suicides in non-celebrities where the methods were described were associated with more subsequent suicides while 'Papageno' narratives of survival and crisis mastery without depictions of suicidal behaviours were associated with fewer subsequent suicides. These results may inform efforts to prevent imitation suicides.

Supporting Individuals with Mental Health and/or Addictions Issues Through Patient Navigation: A Scoping Review.

Pathways through the mental health care system can be complex and laden with barriers that prevent individuals from finding the most appropriate care. Navigation has been proposed as a solution for improving access to and transition through complex health care systems. While several MHA navigation programs have emerged in the past decade, no study has explored the core themes of MHA navigation, which was the goal of the current review. A scoping review was conducted; the search yielded 11,525 unique results, of which 26 were entered into extraction and subsequent descriptive and thematic analysis. Barrier reduction, client-centered support, and integrated care emerged as the distinct themes underlying MHA services, and overall, navigation significantly improved outcomes for individuals experiencing MHA issues. These findings may support evidence-based implementation of navigation services and point to a need for increased exploration and reporting of MHA navigation outcomes in the literature.

Proof-of-concept randomized controlled trial of single-session nitrous oxide treatment for refractory bipolar depression: Focus on cerebrovascular target engagement.

BACKGROUND: There remain few efficacious treatments for bipolar depression, which dominates the course of bipolar disorder (BD). Despite multiple studies reporting associations between depression and cerebral blood flow (CBF), little is known regarding CBF as a treatment target, or predictor and/or indicator of treatment response, in BD. Nitrous oxide, an anesthetic gas with vasoactive and putative antidepressant properties, has a long history as a neuroimaging probe. We undertook an experimental medicine paradigm, coupling in-scanner single-session nitrous oxide treatment of bipolar depression with repeated measures of CBF. METHODS: In this double-blind randomized controlled trial, 25 adults with BD I/II and current treatment-refractory depression received either: (1) nitrous oxide (20 min at 25% concentration) plus intravenous saline (n = 12), or (2) medical air plus intravenous midazolam (2 mg total; n = 13). Study outcomes included changes in depression severity (Montgomery-Asberg Depression Rating Scale scores, primary) and changes in CBF (via arterial spin labeling magnetic resonance imaging). RESULTS: There were no significant between-group differences in 24-h post-treatment MADRS change or treatment response. However, the nitrous oxide group had significantly greater same-day reductions in depression severity. Lower baseline regional CBF predicted greater 24-h post-treatment MADRS reductions with nitrous oxide but not midazolam. In region-of-interest and voxel-wise analyses, there was a pattern of regional CBF reductions following treatment with midazolam versus nitrous oxide. CONCLUSIONS: Present findings, while tentative and based on secondary endpoints, suggest differential associations of nitrous oxide versus midazolam with bipolar depression severity and cerebral hemodynamics. Larger studies integrating neuroimaging targets and repeated nitrous oxide treatment sessions are warranted.

Deep brain stimulation of the subgenual cingulum and uncinate fasciculus for the treatment of posttraumatic stress disorder.

Deep brain stimulation (DBS) has been investigated for neuropsychiatric disorders. In this phase 1 trial, we treated four posttraumatic stress disorder (PTSD) patients with DBS delivered to the subgenual cingulum and the uncinate fasciculus. In addition to validated clinical scales, patients underwent neuroimaging studies and psychophysiological assessments of fear conditioning, extinction, and recall. We show that the procedure is safe and potentially effective (55% reduction in Clinical Administered PTSD Scale scores). Posttreatment imaging data revealed metabolic activity changes in PTSD neurocircuits. During psychophysiological assessments, patients with PTSD had higher skin conductance responses when tested for recall compared to healthy controls. After DBS, this objectively measured variable was significantly reduced. Last, we found that a ratio between recall of extinguished and nonextinguished conditioned responses had a strong correlation with clinical outcome. As this variable was recorded at baseline, it may comprise a potential biomarker of treatment response.

Navigation for youth mental health and addictions: protocol for a realist review and synthesis of approaches and practices (The NavMAP standards project).

INTRODUCTION: Mental health and/or addiction (MHA) concerns affect approximately 1.2 million children and youth in Canada, yet less than 20% receive appropriate treatment for these concerns. Youth who do not receive appropriate support may disengage from care and may experience lasting MHA issues. Families of these youth also support them in finding and accessing care. Thus, system supports are needed to help youth and their families find and equitably access appropriate care. Navigation is an innovation in MHA care, providing patient-centred support and care planning that helps individuals and families overcome barriers to care. Despite the increasing availability of navigation services for youth with MHA concerns, practices and models vary, and no single source has synthesised evidence regarding approaches and outcomes for this population into comprehensive standards. METHODS AND ANALYSIS: The proposed research will bring together evidence in youth MHA navigation, to establish this important system support as a factor that can enhance the integration and continuity of care for these youth. Our team, which includes researchers, administrators, clinical leads, an MHA navigator and youth and caregivers with lived experience, will be involved in all project stages. Realist Review and Synthesis methodology will be used, the stages of which include: defining scope, searching for evidence, appraising studies and extracting data, synthesising evidence and developing conclusions, and disseminating findings. ETHICS AND DISSEMINATION: Ethics approval is not required, as the study involves review of existing data. Dissemination plans include scientific publications and conferences and online products for stakeholders and the general public.

Cross-sectional survey of the Mental health and Addictions effects, Service impacts and Care needs of children, youth and families during the COVID-19 pandemic: the COVID-19 MASC study protocol.

INTRODUCTION: The COVID-19 pandemic has had a tremendous negative effect on the mental health and well-being of Canadians. These mental health challenges are especially acute among vulnerable Canadian populations. People living in Canada's most populous province, Ontario, have spent prolonged time in lockdown and under public health measures and there is a gap in our understanding of how this has impacted the mental health system. This protocol describes the Mental health and Addictions Service and Care Study that will use a repeated cross-sectional design to examine the effects, impacts, and needs of Ontario adults during the COVID-19 pandemic. METHODS AND ANALYSIS: A cross-sectional survey of Ontario adults 18 years or older, representative of the provincial population based on age, gender and location was conducted using Delvinia's AskingCanadians panel from January to March 2022. Study sample was 2500 in phases 1 and 2, and 5000 in phase 3. The Alcohol, Smoking and Substance Involvement Screening Test and Diagnostic Statistical Manual-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult were used to assess for substance and mental health concerns. Participants were asked about mental health and addiction service-seeking and/or accessing prior to and during the pandemic. Analyses to be conducted include: predictors of service access (ie, sociodemographics, mental illness and/or addiction, and social supports) before and during the pandemic, and χ2 tests and logistic regressions to analyse for significant associations between variables and within subgroups. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Sunnybrook Research Ethics Board. Dissemination plans include scientific publications and conferences, and online products for stakeholders and the general public.

Youth voices and experiences regarding a school-based cognitive behavioral therapy skills intervention: lessons for future engagement and adaptation.

BACKGROUND: The Cognitive Behavioral Therapy Skills Intervention (or CBTSI) aims to build mental health literacy and knowledge, allowing youth to build resilience and improve mental health broadly. In Ontario, Canada, youth voice is scant and European studies have largely reported on youth factors supporting stigma reduction, help-seeking intentions and overall satisfaction with a given intervention. Process evaluations and implementation that underpin what youth require to embrace mental health literacy interventions, particularly those that embed key learning principles in the everyday curriculum, have not been broached. The goal of this study is to understand both barriers and facilitators to engagement with the CBTSI (an intervention novel in itself because of the combined mental health plus cognitive behavior therapy (CBT) skills principles embedded in literacy) and the resources and structures that students report requiring, to fully engage with such an intervention. METHODS: Student focus groups were conducted utilizing qualitative interviews that were analyzed thematically. Analysis was informed using principles of pragmatism and analyzed inductively using thematic analysis (Braun and Clarke, Qual Res Psychol 3:77-101, 2006), first looking at the whole and then coding for themes, within an interpretivist framework. Youth were in middle school (grade 7 and 8) in Toronto, Canada who had received the CBTSI. Face to face interview guides with iterative questioning were conducted in February of 2020, and these interviews were audio-recorded and professionally transcribed. Teachers randomly chose a subset of youth whose parents consented to the research to ensure ethno-racial similarity to classroom demographics. RESULTS: There were eight groups with sixty students who participated. Students were 12 to 14 years of age. Major themes were identified: maximizing the opportunities for involvement and self-determination created an atmosphere where confidence and self-compassion could flourish, signalling to the students that they understood and were able to deploy the strategies they were taught; students expressed that the intervention needs to be adapted to enhance personal dignity, respecting both individual wishes and goals in light of the variability in student reported mental health. A model explains the structures and adaptations required to maximize learning based on youth feedback. INTERPRETATION: Mental health literacy incorporating CBT is a promising population-based health promotion intervention. Future adaptations and implementation decisions regarding the CBTSI need to address the wishes and experiences of these youth. Youth voice in this study explored factors that prevent and promote the uptake of the key lessons within the context of existing variability in student mental health that is often found within the context of a regular classroom. The results should be used to adapt the CBTSI as it is disseminated more broadly.

Navigating inequities in the delivery of youth mental health care during the COVID-19 pandemic: perspectives of youth, families, and service providers.

OBJECTIVES: There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers. METHODS: Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data. RESULTS: The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic. CONCLUSION: At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services.

RéSUMé: OBJECTIFS: Les effets indésirables de la pandémie de COVID-19 sur les jeunes (16 à 24 ans) du Canada suscitent des inquiétudes, car ce sont les jeunes qui présentent les taux les plus élevés de problèmes de santé mentale. Nous avons voulu explorer les expériences de jeunes aux prises avec des problèmes de santé mentale et/ou de toxicomanie et de leurs familles durant la pandémie, et à déterminer si les services de santé mentale sont suffisants et équitables pour les jeunes et leurs familles du point de vue de jeunes, de parents et de prestataires de services. MéTHODE: À l'aide d'un plan de recherche qualitative descriptive et d'un partenariat entre les milieux universitaire et associatif, nous avons mené des entretiens individuels avec des jeunes, des parents et des prestataires de services. Vingt-cinq personnes ont participé à l'étude (n = 15 utilisateurs et utilisatrices de services, n = 10 prestataires de services). Parmi les utilisateurs et utilisatrices de services, 11 étaient des parents et 4 étaient des jeunes. Nous avons eu recours à l'analyse thématique pour analyser les données des entretiens. RéSULTATS: Trois thèmes se sont dégagés de l'analyse thématique des données : 1) les problèmes de santé mentale des jeunes augmentent, tandis que les mesures d'aide diminuent, 2) ce sont les familles qui finissent par constituer l'équipe de traitement, ce qui représente un fardeau accru, peu de soutien et un manque de reconnaissance, et 3) l'insuffisance et l'iniquité des services de santé mentale offerts aux jeunes et à leurs familles ont été amplifiées durant la pandémie. CONCLUSION: Alors que les besoins en santé mentale étaient plus élevés, le système de soins de santé mentale a offert moins de soutien aux jeunes et à leurs familles. Pour une intervention plus équitable face à la pandémie, nous avons besoin d'un système de soins de santé mentale accessible et intégré, manifestement engagé à aborder les déterminants sociaux et à réduire les disparités d'état de santé et les iniquités d'accès aux services de santé mentale.

Factors associated with symptom severity in Canadian youth with mental health and/or addictions concerns accessing service navigation.

This study investigated the factors associated with clinical symptoms and level of functioning at baseline and after 4 months of navigation, in youth with mental health and/or addiction concerns involved with a family navigation service. Participants in this pre-post study were caregivers who accessed a mental health and addictions navigation service between March 2018 and July 2019 on behalf of their youth aged 13-26 who had mental health and/or addiction concerns. Evaluations were conducted at baseline and at 4 months after entering navigation. The dependent variable, youth mental health symptoms and functioning, was assessed by caregivers using the Symptoms and Functioning Severity Scale. The sample included 345 caregivers of youth (youth: mean age 18 years, 57% male). At intake, using multiple linear regression, caregiver strain (ß = 0.481, p < 0.001), youth completion of ADLs (ß = -0.156, p = 0.002) and youth motivation (ß = -0.110, p = 0.021) contributed significantly to variance in symptoms and functioning (R2  = 0.373, p < 0.001). Using ANOVA to compare complete pre/post data (n = 115), there was a significant main effect of time on the youth symptoms and functioning score (F[1, 107] = 9.278, p = 0.003). Furthermore, the interaction of time, youth completion of ADLs (low vs. high at baseline) and youth motivation (low vs. high at baseline) was significant (F[1, 107] = 4.699, p = 0.032). Youth with low motivation and low completion of ADLs at baseline experienced the largest improvements in symptoms and functioning after 4 months of navigation. These findings suggest that this group of youth should be a primary target in mental health and addiction navigation.

Youth mental health and/or addiction concerns and service needs during the COVID-19 pandemic: a qualitative exploration of caregiver experiences and perspectives.

The COVID-19 pandemic has undoubtedly had a significant impact on youth mental health and/or addiction concerns and exacerbated pre-existing gaps in access to mental health and/or addiction care. Caregivers can support their youth in seeking and participating in care, however, their experiences in doing so in the pandemic and their perspectives of their youth's care needs are not well-understood. A descriptive qualitative study was conducted to better understand youth's and caregivers' experiences accessing care during the pandemic, from the caregivers' standpoint. Participants completed semi-structured qualitative interviews that focused on experiences seeking and accessing mental health and/or addiction services, with specific questions regarding their experiences accessing services during the pandemic. A total of 46 interviews were included in the thematic analysis of the data. Study findings highlight the impacts of the pandemic on everyday life, on youth mental health and/or addiction needs, on caregiver's experiences seeking and accessing services for their youth, and on service access, including perceptions of virtual care modalities. The discussion highlights the importance of focusing on factors that enable youth's participation in care, to ensure accessibility of appropriate and timely care that meets youth's and families' needs. Also highlighted is the frustration and despair experienced by caregivers seeking critical mental health and addictions supports for their youth during the pandemic, as well as the sense of isolation and of being left behind by the system. Identifying caregiver perspectives of youth mental health and addiction needs and service access during the COVID-19 pandemic provided important insights that can help inform approaches to youth mental health and addictions care during the pandemic and beyond.

Public health guideline compliance and perceived government effectiveness during the COVID-19 pandemic in Canada: Findings from a longitudinal cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has imposed enormous adversity worldwide. Public health guidelines have been a first line of defense but rely on compliance with evolving recommendations and restrictions. This study sought to characterize adherence to and perceptions of public health guidelines over a one-year timeframe during the pandemic. METHODS: Participants were 1435 community adults in Ontario who completed assessments at five time points (April 2020, July 2020, October 2020, January 2021, and April 2021; 92% retention). Participants were assessed for self-reported adherence to government protocols and perceptions of government response (importance, compliance, and effectiveness). Analyses used general linear mixed-effects modelling of overall changes by time and examined differences based on age and sex. FINDINGS: Over time, participants reported high or increasing behavioural engagement in public health guidelines, including physical distancing, restricting activity, and masking. In contrast, participants exhibited significant reductions in perceived importance and compliance, with evidence of more negative changes in younger participants. The largest changes were a substantial reduction in perceived government effectiveness, from predominantly positive perceptions to predominantly negative perceptions. INTERPRETATION: These results illuminate evolving trends in public health compliance and perceptions over the course of the pandemic in Canada, revealing the malleability of public perceptions of public health recommendations and government effectiveness. FUNDING: This research was funded by a grant from the Canadian Institutes of Health Research (CIHR). CIHR had no role in study design, data collection, data analysis, interpretation, or writing of the report.

Predictors of strain for Canadian caregivers seeking service navigation for their youth with mental health and/or addictions issues.

Caring for youth with mental health and/or addictions (MHA) concerns is associated with caregiver strain, which may lead to negative consequences for youth and their caregivers. These consequences may be mitigated by caregivers and/or youth receiving assistance in navigating the healthcare system. Understanding what factors are associated with caregiver strain may be important in developing and implementing navigation services for such families; nonetheless, limited evidence currently exists regarding the predictors of strain in caregivers seeking navigation support. This study aimed to determine whether (a) the mental health profile of youth and (b) the home and family situation for youth with MHA concerns contribute significantly to strain in caregivers engaged in navigation. Data were collected from 66 adults caring for at least one youth with MHA issues accessing navigation service in Toronto, Ontario, between March and August 2018. Multiple linear regressions were conducted to determine which factors were associated with caregiver strain. The first regression model exploring youth-specific independent variables (adjusted r2  = .478, F6,47  = 9.086, p < .001) demonstrated that lower levels of caregiver-rated youth health (ß = -0.577, p = .001) and higher levels of youth mental health symptom severity (ß = 0.077, p < .001) significantly predicted higher levels of strain. The second regression model (adjusted r2  = .348, F5,54  = 7.287, p < .001) showed that lower levels of family functioning (ß = -0.089, p < .001) significantly predicted higher levels of strain. Higher levels of caregiver strain in caregivers of youth with MHA concerns who are accessing navigation services are associated with lower levels of caregiver-rated youth health, higher levels of youth mental health symptom severity, and lower levels of family functioning. These predictors may be potential targets for providers aiming to reduce caregiver strain, as part of navigation or other healthcare services.