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Children's mental health: The numbers and the needs

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2022-05
Abstract: 

Background: Estimates of the number of children affected by mental disorders and the percent of them receiving treatment interventions are essential to guide planning for public mental health services.

Methods: We interpret findings from our recent systematic review and meta-analysis on the prevalence and impact of childhood mental disorders.

Results: We identified 14 high-quality epidemiological studies meeting all of our inclusion criteria, including representative sampling and use of rigorous diagnostic measures. This resulted in the inclusion of nearly 62,000 children aged four to 18 years from 11 high-income countries. Our meta-analysis found that 12.7% of children met diagnostic criteria for a mental disorder at any given time. Additionally, our analysis found that among children with mental disorders, only 44.2% received any services for these conditions.

Conclusions: Data show that there are serious mental health service shortfalls which represent a violation of children’s rights and prevent children from flourishing. We present a population health strategy to help address these deficits.

Document type: 
Article

Suboptimal Nonmedical Qualities of Primary Care Linked With Care Avoidance Among People Who Use Drugs in a Canadian Setting Amid an Integrated Health Care Reform

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2022-04-29
Abstract: 

Background:  People who use unregulated drugs (PWUD) often face significant barriers to—and thereby avoid seeking—health care. In Vancouver, Canada, a neighborhood-wide health care system reform began in 2016 to improve health care delivery and quality. In the wake of this reform, we sought to determine the prevalence of health care avoidance and its association with emergency department use among PWUD in this setting and examine patient-reported nonmedical qualities of health care (“responsiveness”).   Methods:  The study derived data from two prospective cohort studies of community-recruited PWUD in Vancouver in 2017–18. Responsiveness was ascertained by the World Health Organizations' standardized measurements and we evaluated seven domains of responsiveness (dignity, autonomy, communication, confidentiality, prompt attention, choice of provider, and quality of basic amenities). The study used Pearson chi-squared test to examine differences in responsiveness between those who did and did not avoid care. The study team used multivariable logistic regression to determine the relationship between care avoidance due to past mistreatment and emergency department use, adjusting for potential confounders.   Results:  Among 889 participants, 520 (58.5%) were male, 204 (22.9%) reported avoiding health care, most commonly for chronic pain (47.4%). Overall, 6.6% to 36.2% reported suboptimal levels (i.e., not always meeting the expected quality) across all seven measured domain of responsiveness. Proportions reporting suboptimal qualities were significantly higher among those who avoided care than those who did not across all domains, including care as soon as wanted (51.0% vs. 31.8%), listened to carefully (44.1% vs. 20.4%), and involved in health care decision-making (27.9% vs. 12.7%) (all p < 0.05). In multivariable analyses, avoidance of health care was independently associated with self-reported emergency department use (adjusted odds ratio = 1.49; 95% confidence interval:1.01–2.19).   Conclusion:  We found that almost a quarter of our sample of PWUD avoided seeking health care due to past mistreatment, and all seven measured domains of responsiveness were suboptimal and linked with avoidance. Individuals who reported avoidance of health care were significantly more likely to report emergency department use. Multi-level interventions are needed to remedy the suboptimal qualities of health care and thereby reduce care avoidance.

Document type: 
Article

Suboptimal Nonmedical Qualities of Primary Care Linked with Care Avoidance Among People Who Use Drugs in a Canadian Setting Amid an Integrated Health Care Reform

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2022-04-13
Abstract: 

Background: People who use unregulated drugs (PWUD) often face significant barriers to—and thereby avoid seeking—health care. In Vancouver, Canada, a neighborhood-wide health care system reform began in 2016 to improve health care delivery and quality. In the wake of this reform, we sought to determine the prevalence of health care avoidance and its association with emergency department use among PWUD in this setting and examine patient-reported nonmedical qualities of health care (“responsiveness”). Methods: The study derived data from two prospective cohort studies of community-recruited PWUD in Vancouver in 2017–18. Responsiveness was ascertained by the World Health Organizations’ standardized measurements and we evaluated seven domains of responsiveness (dignity, autonomy, communication, confidentiality, prompt attention, choice of provider, and quality of basic amenities). The study used Pearson chi-squared test to examine differences in responsiveness between those who did and did not avoid care. The study team used multivariable logistic regression to determine the relationship between care avoidance due to past mistreatment and emergency department use, adjusting for potential confounders. Results: Among 889 participants, 520 (58.5%) were male, 204 (22.9%) reported avoiding health care, most commonly for chronic pain (47.4%). Overall, 6.6% to 36.2% reported suboptimal levels (i.e., not always meeting the expected quality) across all seven measured domain of responsiveness. Proportions reporting suboptimal qualities were significantly higher among those who avoided care than those who did not across all domains, including care as soon as wanted (51.0% vs. 31.8%), listened to carefully (44.1% vs. 20.4%), and involved in health care decision making (27.9% vs. 12.7%) (all p<0.05). In multivariable analyses, avoidance of health care was independently associated with self-reported emergency department use (adjusted odds ratio=1.49; 95% confidence interval:1.01–2.19). Conclusion: We found that almost a quarter of our sample of PWUD avoided seeking health care due to past mistreatment, and all seven measured domains of responsiveness were suboptimal and linked with avoidance. Individuals who reported avoidance of health care were significantly more likely to report emergency department use. Multi-level interventions are needed to remedy the suboptimal qualities of health care and thereby reduce care avoidance.

Document type: 
Article

The Utility of Research Domain Criteria in Diagnosis and Management of Dual Disorders: A Mini-Review

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2022-03-01
Abstract: 

The Research Domain Criteria (RDoC) initiative has been considered a comprehensive alternative classification framework for understanding neuropsychiatric ailments, as opposed to the longstanding, traditional DSM framework. Where the DSM categorizes neuropsychiatric disorders as each being distinct and diagnostically defined by the presence of specified symptoms, RDoC provides a multidimensional conceptualization of psychiatric disorders with neurobiological roots. By taking a multidimensional approach, RDoC overcomes two major constraints of the DSM framework: that is, that the DSM is categorical in its approach to psychiatric disorders to the point of understating the intersectionality between concomitant disorders, and that the DSM focuses mainly on clinical features. RDoC seems to better account for the intersection between dual disorders and considers a range of factors, from the more microscopic (e.g., genetics or molecular functions) to the more macroscopic (e.g., environmental influences). The multidimensional approach of RDoC is particularly appealing in the context of dual disorders. Dual disorders refers to a concurrent psychiatric disorder with an addiction disorder. RDoC accounts for the fact that there is often overlap in symptoms across and bidirectional influence between various disorders. However, to date, there is limited research into the clinical utility of RDoC, and less so in the context of the clinical management of dual disorders. In this Mini-Review, we discuss how RDoC differs from the DSM, what outcomes have been reported in utilizing RDoC clinically, the utility of RDoC for the diagnosis, management, and monitoring of psychopathology, and the limitations of RDoC as well as avenues for future research.

Document type: 
Article
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Helping children with obsessive-compulsive disorder

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2022
Abstract: 

Background: An estimated 0.3% of children meet diagnostic criteria for obsessive-compulsive disorder (OCD) at any given time and are in need of treatment. Our previous systematic review, conducted nearly a decade ago, identified cognitive-behavioural therapy (CBT), fluoxetine and sertraline as effective interventions. We set out to update our review to identify any additional interventions for treating childhood OCD.

Methods:  We used systematic review methods to find recently published randomized controlled trials (RCTs) evaluating treatments for childhood OCD. We accepted 12 new RCTs, assessing both psychosocial interventions and medications, including innovative ways of delivering CBT.

Results: There is strong evidence for using a variety of forms of CBT to treat childhood OCD, including in person with children alone and with their families as well as by phone or online. Positive Family Interaction Therapy also proved to be a helpful supplement to CBT among families with indicators predictive of a limited response to CBT alone. In contrast, the medications riluzole and d-cycloserine failed to produce benefits.

Conclusions: All children diagnosed with OCD need timely access to effective treatment. CBT should be a starting point for treatment, with fluoxetine and sertraline being considered with careful monitoring when CBT does not succeed.

Women Healthcare Workers' Experiences During COVID-19 and Other Crises: A Scoping Review

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2022-02-05
Abstract: 

Background Throughout the COVID-19 pandemic, as measures have been taken to both prevent the spread of COVID-19 and provide care to those who fall ill, healthcare workers have faced added risks to their health and wellbeing. These risks are disproportionately felt by women healthcare workers, yet health policies do not always take a gendered approach.

Objectives The objective of this review was to identify the gendered effects of crises on women healthcare workers’ health and wellbeing, as well as to provide guidance for decision-makers on health systems policies and programs that could better support women healthcare workers.

Methods A scoping review of published academic literature was conducted. PubMed, EMBASE, and CINAHL were searched using combinations of relevant medical subject headings and keywords. Data was extracted using a thematic coding framework. Seventy-six articles met the inclusion criteria.

Results During disease outbreaks women healthcare workers were found to experience: a higher risk of exposure and infection; barriers to accessing personal protective equipment; increased workloads; decreased leadership and decision-making opportunities; increased caregiving responsibilities in the home when schools and childcare supports were restricted; and higher rates of mental ill-health, including depression, anxiety, and post-traumatic stress disorder. There was a lack of attention paid to gender and the health workforce during times of crisis prior to COVID-19, and there is a substantial gap in research around the experiences of women healthcare workers in low- and middle-income countries during times of crises.

Conclusion COVID-19 provides an opportunity to develop gender-responsive crisis preparedness plans within the health sector. Without consideration of gender, crises will continue to exacerbate existing gender disparities, resulting in disproportionate negative impacts on women healthcare workers. The findings point to several important recommendations to better support women healthcare workers, including: workplace mental health support, economic assistance to counteract widening pay gaps, strategies to support their personal caregiving duties, and interventions that support and advance women's careers and increase their representation in leadership roles.

Document type: 
Article
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The Impact of Clinical and Population Strategies on Coronary Heart Disease Mortality: An Assessment of Rose’s Big Idea

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2022-01-06
Abstract: 

Background: Coronary heart disease (CHD), the leading cause of death worldwide, has declined in many afuent countries but it continues to rise in industrializing countries.

Objective: To quantify the relative contribution of the clinical and population strategies to the decline in CHD mortality in afuent countries.

Design: Meta-analysis of cross-sectional and prospective studies.

Data sources: PubMed and Web of Science from January 1, 1970 to December 31, 2019.

Method: We combined and analyzed data from 22 cross-sectional and prospective studies, representing 500 million people, to quantify the relative decline in CHD mortality attributable to the clinical strategy and population strategy.

Result: The population strategy accounted for 48% (range=19 to 73%) of the decline in CHD deaths and the clinical strategy accounted for 42% (range=25 to 56%), with moderate inconsistency of results across studies.

Conclusion: Since 1970, a larger fraction of the decline in CHD deaths in industrialized countries was attributable to reduction in CHD risk factors than medical care. Population strategies, which are more cost-efective than clinical strategies, are under-utilized.

Document type: 
Article
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Using Social Media as a Survey Recruitment Strategy for Post-Secondary Students During the COVID-19 Pandemic

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-12-13
Abstract: 

The COVID-19 pandemic rapidly forced Canadian post-secondary students into remote learning methods, with potential implications on their academic success and health. In recent years, the use of social media to promote research participation and as a strategy for communicating health messages has become increasingly popular. To better understand how the pandemic has impacted this population, we used social media platforms to recruit students to participate in a national bilingual COVID-19 Health Literacy Survey. The purpose of the survey was to assess the health literacy levels and online information-seeking behaviors of post-secondary students in relation to the coronavirus. This paper outlines the social media recruitment strategies used for promoting participation in the survey among Canadian post-secondary students during the pandemic. Facebook, Twitter, and Instagram accounts were created to promote the online survey. The objective of this paper is to examine the use of Instagram, Facebook, and Twitter as survey recruitment strategies tailored to students. Data analytics from these platforms were analyzed using descriptive statistics. We found that the most commonly used platform for survey dissemination was Twitter, with 64800 total impressions recorded over 3 months. The use of social media as a survey recruitment strategy showed promise in the current context of COVID-19 where many students are participating in online learning and for a study population that actively uses these platforms to seek out information.

Document type: 
Article
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Using Google Trends to Inform the Population Size Estimation and Spatial Distribution of Gay, Bisexual, and Other Men Who Have Sex With Men: Proof-of-concept Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-11-29
Abstract: 

Background:We must triangulate data sources to understand best the spatial distribution and population size of marginalized populations to empower public health leaders to address population-specific needs. Existing population size estimation techniques are difficult and limited. Objective:We sought to identify a passive surveillance strategy that utilizes internet and social media to enhance, validate, and triangulate population size estimates of gay, bisexual, and other men who have sex with men (gbMSM). Methods:We explored the Google Trends platform to approximate an estimate of the spatial heterogeneity of the population distribution of gbMSM. This was done by comparing the prevalence of the search term “gay porn” with that of the search term “porn.” Results:Our results suggested that most cities have a gbMSM population size between 2% and 4% of their total population, with large urban centers having higher estimates relative to rural or suburban areas. This represents nearly a double up of population size estimates compared to that found by other methods, which typically find that between 1% and 2% of the total population are gbMSM. We noted that our method was limited by unequal coverage in internet usage across Canada and differences in the frequency of porn use by gender and sexual orientation. Conclusions:We argue that Google Trends estimates may provide, for many public health planning purposes, adequate city-level estimates of gbMSM population size in regions with a high prevalence of internet access and for purposes in which a precise or narrow estimate of the population size is not required. Furthermore, the Google Trends platform does so in less than a minute at no cost, making it extremely timely and cost-effective relative to more precise (and complex) estimates. We also discuss future steps for further validation of this approach.

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Article
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Why Canada Is in Court to Protect Healthcare for All: Global Implications for Universal Health Coverage

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-11-16
Abstract: 

Countries worldwide are currently endeavoring to safeguard the long-term health of their populations through implementing Universal Health Coverage (UHC), in line with the United Nation's 2015-30 Sustainable Development Goals (SDGs). Canada has some of the world's strongest legislation supporting equitable access to care for medically necessary hospital and physician services based on need, not ability to pay. A constitutional challenge to this legislation is underway in British Columbia (BC), led by a corporate plaintiff, Cambie Surgeries Corporation (CSC). This constitutional challenge threatens to undermine the high bar for UHC protection that Canada has set for the world, with potential adverse implications for equitable international development. CSC claims that BC's healthcare law—the Medicare Protection Act (MPA)—infringes patients' rights under Canada's constitution, by essentially preventing physicians who are enrolled in BC's publicly-funded Medicare plan from providing expedited care to patients for a private fee. In September 2020, after a trial that ran for 3.5 years and included testimony by more than 100 witnesses from around the world, the court dismissed the plaintiffs' claim. Having lost their case in the Supreme Court of BC, the plaintiffs' appealed in June 2021. The appellate court's ruling and reasons for judgment are expected sometime in 2021. We consider the evidence before the court from the perspective of social epidemiology and health inequalities, demonstrating that structural features of a modern society that exacerbate inequalities, including inequitable access to healthcare, can be expected to lead to worse overall societal outcomes.

Document type: 
Article
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