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This paper has been substantially revised by the Canadian Psychiatric Association's Research Committee and approved for republication by the CPA's Board of Directors on May 3, 2017. The original policy paper1 was developed by the Scientific and Research Affairs Standing Committee and approved by the Board of Directors on November 10, 2008. [ABSTRACT FROM AUTHOR]

Discusses the efficacy of the psychotherapies in Canada. Skills needed by psychiatrists to be effective and competent; Role of psychotherapies in psychiatry; Economic impact of psychotherapy; Limitations of psychotherapy.

Objective: Previous research has evaluated the sources of post-secondary student stress, but has failed to explore whether stressors fluctuate over time. The purpose of this research was to use the Post-Secondary Student Stressors Index to examine whether stressors changed significantly and meaningfully over the course of an academic year. Due to the timing of data collection, results also provide context around students' experiences of stress during the COVID-19 pandemic. Method: Cross-sectional data was collected at 3 time points via online surveys over the course of the 2020–2021 academic year from >10,000 students. Participants attended 15 post-secondary institutions across Canada, representing 9 provinces and 1 territory. Validated instruments were used to assess levels of stress, distress and the severity of student-specific stressors. Kruskal–Wallis ranked tests and multiple pairwise comparison analyses were conducted to assess whether the mean severity of stressors changed over time. Standard effect sizes were calculated using Cohen's d. Results: Mean levels of stress and psychological distress were high at the start of the study and remained high across time points. A similarly high level of stress was observed on average for student-specific stressors. While significant differences in mean severity were observed over time for some stressors, standardized effect sizes were negligible, suggesting little meaningful change and consistent levels of chronic stress over the course of the academic year. Conclusions: This is the first paper to examine trends in student-specific stress using a nationwide sample of Canadian post-secondary students during the first year of the COVID-19 pandemic. Patterns observed in student-specific stressors reflected changes likely to be indicative of the pandemic, including the most severe stress associated with academics, finances and concerns for the future. Implications for future research are discussed, in particular, the importance of examining stressors related to COVID-19 and their impact on student mental health. [ABSTRACT FROM AUTHOR]

Provides guidelines for clinical care related to the practice of psychotherapies. Reflection on the clinical experiences of Canadian psychiatrists; Differentiation between psychiatric management and formal psychotherapies; Ethical guidelines for psychotherapies; Factors for effective therapeutic bond between the patient and the psychiatrist.

By 2020 mental illness will be one of the 5 most common illnesses causing morbidity, mortality and disability among youth. At least 20% of Canadian youth have a psychiatric disorder the impact of which can dramatically alter their life trajectory. Focus on the factors contributing to this problem is crucial. Lack of coordination between child and adolescent mental health systems (CAMHS) and adult mental health systems (AMHS) and consequent disruption of care during this vulnerable time of transition is one such factor. Reasons for and the impact of this divide are multilayered, many of which are embedded in outdated, poorly informed approaches to care for this population in transition. This paper considers the etiology behind these reasons as potential foci for change. The paper also briefly outlines recent initiatives ongoing in Canada and internationally that reflect appreciation of these factors in the attempt to minimize the gap in service provision for youth in transition. The need to continue with research and program development endeavours for youth with mental illness whereby access to services and readiness for transition is no longer determined by age is strongly supported. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample.Method: Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health.Results: Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys.Conclusions: Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders. [ABSTRACT FROM AUTHOR]

The article presents a paper, a part of a planned series of Elements of Care papers, focusing on identifying common elements which are important for providing appropriate psychiatric care in different models of care in Canada. It focuses on direct patient care or service for payment in traditional care model and also discusses indirect services involved in such models, like diagnostic assessment or patient management. It also focuses on involvement of family or caregivers in indirect services.

This position paper has been substantially revised by the Canadian Psychiatric Association's Professional Standards and Practice Committee and approved for republication by the CPA's Board of Directors on August 31, 2016. The original position paper1 was developed by the Professional Standards and Practice Council and approved by the Board of Directors on April 9, 1994. [ABSTRACT FROM AUTHOR]

This paper is an initial attempt to collate the literature on psychiatric inpatient recovery- based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery- oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada. [ABSTRACT FROM AUTHOR]

The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system. [ABSTRACT FROM AUTHOR]

Research and development of early intervention (EI) services for first-episode psychosis have brought much-needed transformation of service delivery for this serious mental disorder to many jurisdictions. The effectiveness of the EI model of service delivery is contingent on timely access to all evidence-informed treatment interventions, including a rational approach to pharmacotherapy. In this perspective paper, we present a brief review of the well-established effectiveness of clozapine in patients who clearly show lack of response to regular antipsychotic therapy. We concentrate, in particular, on the need to identify eligibility for clozapine therapy very early on following failure of treatment on 2 antipsychotic medications. We suggest that attention to the low use of clozapine in the very early phase of treatment of psychosis may be of particular value, as the response to clozapine at this stage is likely to produce larger benefits in other domains of outcomes because of the greater retention of patients' personal and social agency. [ABSTRACT FROM AUTHOR]

Objective: Studies from around the world point to differences in the rates of mental illnesses between immigrant, refugee, ethnocultural, and racialized (IRER) groups and host populations. Risk of illness depends on social contexts; therefore, to offer the best information for people aiming to develop and offer equitable services, local information on rates of mental illness in different population groups is required. Methods: We performed a literature review of peer-reviewed journals and the grey literature between 1990 and 2009 using standard techniques and identified primary research reporting the rates of mental illness and suicidality in IRER groups in Canada. Results: Among the 229 papers we reviewed, 17 were included. Most papers reported rates for depression. There was no clear pattern, with different IRER groups and different age groups reporting either elevated or lower rates, compared with white Canadians. Refugee youth in Quebec have higher rates of numerous mental health problems and illnesses. When immigrant groups were considered as a whole, suicide rates were low but different national origin groups reported different trajectories in rates across the generations. Conclusion: The literature on rates of mental illness and suicidality in IRER groups in Canada is diverse and not comprehensive. In addition, most research has been conducted in 3 provinces and, in particular, 3 major cities. The rates of mental illness seem to vary by national origin groups, age, and status in Canada. There is very little research on nonimmigrant, culturally diverse populations in Canada. This lack of information may undermine efforts to develop equitable mental health services for all Canadians. INSET: Abbreviations. [ABSTRACT FROM AUTHOR]

Objective: To systematically review the literature with respect to treatment-seeking rates for depression and associated mediating factors. This review focuses on adolescents and adults of all ages.Methods: A structured literature review using Medline and PsychInfo databases revealed 38 relevant papers. Two trained reviewers independently and blindly assessed each study according to 4 inclusion criteria. A total of 17 papers met all 4 criteria.Results: Between 17.0% and 77.8% of individuals with depressive episodes or disorders sought treatment in these studies. We could explain the range in rates by diverse measures of depression, mediating factors that influence treatment-seeking, varied years in which the studies were done, and different time periods over which treatment-seeking was assessed.Conclusions: Treatment-seeking rates for major depression appear to have increased over the years. Age, race, social supports, and clinical and psychiatric factors seem to influence treatment-seeking rates most. Public health initiatives can use this information to facilitate service access and delivery. [ABSTRACT FROM AUTHOR]

There is an increasing emphasis on quality and, relatedly, cost-effectiveness as it relates to the delivery of health care. Choosing Wisely is an initiative adopted by numerous specialties with the goal of starting a dialogue about efficient use of health care resources. People need to be able to access care to have an opportunity to choose wisely. There is a considerable amount of evidence that access to care is poor for specialty mental health care, particularly access to psychiatrists. Consequently, we suggest that psychiatrists and the broader mental health system need to consider working wisely, and in our paper outline key issues (for example, implementation of wait times and objective measures of need in a centralized referral management system; incorporation of performance indicators with longitudinal monitoring for continuous quality improvement) that need to be addressed to develop a mental health system that would allow people to access care to choose wisely. [ABSTRACT FROM AUTHOR]

Objectives: Community treatment orders (CTOs) for people with severe mental illnesses are used across most of Canada. It is unclear if they can reduce health service use, or improve clinical and social outcomes. This review summarizes the evidence from studies conducted in Canada.Method: A systematic literature search of PubMed and MEDLINE to March 2015 was conducted. Inclusion criteria were quantitative and qualitative studies undertaken in Canada that presented data on the effect of CTOs on outcomes.Results: Nine papers from 8 studies were included in the review. Four studies compared health service use before and after compulsory treatment as well as engagement with psychosocial supports. Three were qualitative evaluations of patients, family, or staff and the last was a postal survey of psychiatrists. Hospital readmission rates and days spent in hospital were all reduced following CTO placement, while outpatient attendance and participation in psychiatric services and housing all improved. Family members and clinicians were generally positive about the effect of CTOs but patients were ambivalent. However, the strength of the evidence was limited as many of the studies were small, only one included control subjects, and there was no adjustment for potential confounders using either matching or multivariate analyses. Only 2 qualitative studies included the views of patients and their families.Conclusions: The evidence base for the use of CTOs in Canada is limited and this lack of Canadian research is in marked contrast to other countries where there have been large studies that have used randomized or matched control subjects. Their use should be kept under review. [ABSTRACT FROM AUTHOR]

On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who "clearly consents to the termination of life" and has a "grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering. [ABSTRACT FROM AUTHOR]

The National Trajectory Project examined longitudinal data from a large sample of people found not criminally responsible on account of mental disorder (NCRMD) to assess the presence of provincial differences in the application of the law, to examine the characteristics of people with serious mental illness who come into conflict with the law and receive this verdict, and to investigate the trajectories of NCRMD-accused people as they traverse the mental health and criminal justice systems. Our paper describes the rationale for the National Trajectory Project and the methods used to collect data in Quebec, Ontario, and British Columbia, the 3 most populous provinces in Canada and the 3 provinces with the most people found NCRMD. [ABSTRACT FROM AUTHOR]

Objective: Our paper presents findings from the first population survey of stigma in Canada using a new measure of stigma. Empirical objectives are to provide a descriptive profile of Canadian's expectations that people will devalue and discriminate against someone with depression, and to explore the relation between experiences of being stigmatized in the year prior to the survey among people having been treated for a mental illness with a selected number of sociodemographic and mental health-related variables. Method: Data were collected by Statistics Canada using a rapid response format on a representative sample of Canadians (n = 10 389) during May and June of 2010. Public expectations of stigma and personal experiences of stigma in the subgroup receiving treatment for a mental illness were measured. Results: Over one-half of the sample endorsed 1 or more of the devaluation discrimination items, indicating that they believed Canadians would stigmatize someone with depression. The item most frequently endorsed concerned employers not considering an application from someone who has had depression, Over one-third of people who had received treatment in the year prior to the survey reported discrimination In 1 or more life domains. Experiences of discrimination were strongly associated with perceptions that Canadians would devalue someone with depression, younger age (12 to 15 years), and self-reported poor general mental health. Conclusions: The Mental Health Experiences Module reflects an important partnership between 2 national organizations that will help Canada fulfill its monitoring obligations under the United Nations Convention on the Rights of Persons with Disabilities and provide a legacy to researchers and policy-makers who are interested in monitoring changes in stigma over time. [ABSTRACT FROM AUTHOR]

Objective: As part of its ongoing effort to combat stigma against mental illness among healthcare providers, the Mental Health Commission of Canada partnered with organizations conducting anti-stigma interventions. Our objective was to evaluate program effectiveness and to better understand what makes some programs more effective than others. Our paper reports the elements of these programs found to be most strongly associated with favourable outcomes. Methods: Our study employed a multi-phased, mixed-methods design. First, a grounded theory qualitative study was undertaken to identify key program elements. Next, each program (n = 22) was coded according to the presence or absence of the identified key program ingredients. Then, random-effects, meta-regression modelling was used to examine the association between program outcomes and the key ingredients. Results: The qualitative analysis led to a 6-ingredient model of key program elements. Results of the quantitative analysis showed that programs that Included all 6 of these ingredients performed significantly better than those that did not. Individual analyses of each of the 6 ingredients showed that including multiple forms of social contact and emphasizing recovery were characteristics of the most effective programs. Conclusions: The results provide a validation of a 6-ingredient model of key program elements for anti-stigma programming for health care providers. Emphasizing recovery and including multiple types of social contact are of particular importance for maximizing the effectiveness of anti-stigma programs for health care providers. [ABSTRACT FROM AUTHOR]

Objective: To present points of agreement and disagreement about antipsychotics. Since the appearance of 2nd generation long-acting antipsychotics (LAA), and given the high frequency of noncompliance with antipsychotics in psychotic disorders, LAAs have attracted more interest in psychiatriv literature. However, their use is suboptimal, globally, and is also subject to significant national disparities. ln this context, the Association des médecins psychiatres du Québec (AMPQ) has asked for a review of the evidence concerning LAA efficiency and tolerance, and has called for consensual clinical reflection on the benefits and obstacles of prescribing them, as weil as potential solutions, including administrative and judiciary dimensions. Methods: The AMPQ established an expert committee, from 4 Quebec universities, which was responsible for preparing the review paper. The committee intended to appropriately provide c1inicians with the different aspects of LAA use. The committee produced a qualitative and selective review. Results: Mean LAA prescription rates observed in Canada are around 6% and data to confirm this are scarce. A 15% to 25% rate could be suggested. Conclusion: The committee has submitted the Quebec long-acting antipsychotic algorithm (QAAPAPLE, derived from the French acronym) as a result of the consensus reached by the 4 university psychiatry departments. [ABSTRACT FROM AUTHOR]

Objectives: Epidemiologic studies have confirmed that major depression (MD) is an extremely common condition, but also one that is associated with an unexpectedly broad spectrum of morbidity. It is no longer a tenable position to regard MD as being a simple indicator of treatment need, nor is a one-size-fits-all approach to treatment likely to be an effective guide to health care delivery. The objective of this commentary is to explore the implications of these new epidemiologic findings for policy and practice in Canada.Method: This paper is a selective review and commentary.Results: Whereas the acute and long-term treatment needs of a subset of individuals with MD have received much attention in the literature, the needs of other groups have not. A sizable proportion of individuals with episodes meeting the Diagnostic and Statistical Manual of Mental Disorders-fourth edition definition in community populations may not need the intensive treatment emphasized by current Canadian practice guidelines. The strategy of watchful waiting may have a role in primary care. On the policy front, guided and perhaps self-guided management strategies deserve greater emphasis than they have received. Stepped-care strategies are an appealing option, but how best to effectively implement these in the Canadian context is unclear.Conclusions: The spectrum of morbidity among individuals with MD in community populations is much wider than has been previously appreciated. The health system should respond with an appropriate spectrum of services, but many questions remain about how to facilitate this. [ABSTRACT FROM AUTHOR]

It is time to move beyond education about qualitative research theory and methods to using them to understand and improve psychiatric practice. There is a good fit between this agenda and current thinking about research use that broadens definitions of evidence beyond the results of experiments. This paper describes a qualitative program evaluation to illustrate what kind of useful knowledge is generated and how it can be created through a clinician-researcher partnership. The linkage and exchange model of effective knowledge translation described involves interaction between clinicians and researchers throughout the research process and results in mutual learning through the planning, disseminating, and application of existing or new qualitative research in decision making. [ABSTRACT FROM AUTHOR]

Objective: Structured diagnostic interviews are very time-consuming and therefore increase both the expense and the respondent burden in epidemiologic surveys. A 2-staged interview that screens potential cases before the full diagnostic instrument is administered has the potential to greatly reduce the average interview length. In this paper, we evaluate 2 measures of psychological distress (the Kessler 6- and 10-Item Psychological Distress Scales [K6 and K10]) as potential screening instruments for depression.Methods: We use data from Cycle 1.2 of the Canadian Community Health Survey and receiver operator characteristic analysis to examine the agreement between the K6 and K10 and the World Mental Health Composite International Diagnostic Interview module for major depression (1-month and 12-month estimates).Results: Of the respondents, 823 were positive for 1-month depression (2.0%; 95% confidence interval [CI], 1.8% to 2.2%), and 1930 were positive for 12-month depression (4.8%; 95%CI, 4.5% to 5.1%). Both the K6 and K10 performed very well as predictors of 1-month depression, with areas under the curve (AUC) of 0.929 (95%CI, 0.908 to 0.949) for the K10 and 0.926 (95%CI, 0.905 to 0.947) for the K6. For 12-month depression, the AUCs remained good at 0.866 (95%CI, 0.848 to 0.883) for the K10 and 0.858 (95%CI, 0.840 to 0.876) for the K6.Conclusions: Both the K6 and the K10 appear to be excellent screening instruments, especially for current depression. Although performance of the 2 instruments is similar, the K6 is more attractive for use as a screening instrument because of the lower response burden. [ABSTRACT FROM AUTHOR]

Objective: Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy.Method: We searched the literature for economic analyses of CBT in the treatment of mental disorders.Results: We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use.Conclusions: International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada. [ABSTRACT FROM AUTHOR]

Objective: Studies suggest that non-European immigrants to Canada tend to under use mental health services, compared with Canadian-born people. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse. This paper explores the reasons for underuse of conventional mental health services in a community sample of immigrants with identified emotional and somatic symptoms. Method: Fifteen West Indian immigrants in Montreal with somatic symptoms and (or) emotional distress, not currently using mental health services, participated in a face-to-face in-depth interview exploring health care use. Interviews were analyzed thematically to discern common factors explaining reluctance to use services. Results: Across participants' narratives, we identified 3 significant factors explaining their reluctance to use mental health services. First, there was a perceived overwillingness of doctors to rely on pharmaceutical medications as interventions. Second, participants perceived a dismissive attitude and lack of time from physicians in previous encounters that deterred their use of current health service. Third, many participants reported a belief in the curative power of nonmedical interventions, most notably God and to a lesser extent, traditional folk medicine. Conclusion: The above factors may highlight important areas for intervention to reduce disparities in immigrant use of mental health care. We present our framework as a model, grounded in empirical data, that further research can explore. [ABSTRACT FROM AUTHOR]

Objectives: With the release of data from the Canadian Community Health Survey: Mental Health and Well-Being (Cycle 1.2), researchers have, for the first time, information on several psychiatric disorders from a nationally representative sample of Canadians residing in households. This survey used the Composite International Diagnostic Interview (CIDI) to identify persons with one or more psychiatric disorders. In this paper, our primary purpose was to evaluate the evidence supporting the validity of the CIDI--that is, the extent to which the depression diagnoses generated by the CIDI reflect true cases of depression.Method: We conducted a critical review of the CIDI, focusing on the depression module.Results: Reliability studies indicate that the CIDI performs reliably, as measured by interrater reliability. However, the use of different versions of the CIDI and the occasional exclusion of the Depression module from studies suggest that the reliability of the CIDI Depression module remains unconfirmed. The most critical issue in regard to the CIDI's performance is that clinical samples are used to test validity. A clinical sample has a higher prevalence of depression than a community sample.Conclusion: The results generated by the CIDI in a community setting likely will have a high false-positive rate, resulting in a falsely elevated prevalence rate. Given the widespread application of the CIDI internationally, addressing the outstanding concerns about validity with proper validation studies should become an international priority. [ABSTRACT FROM AUTHOR]

As part of the Canadian Community Health Survey (CCHS) biennial strategy, the provincial survey component of the first CCHS cycle (Cycle 1.2) focused on different aspects of the mental health and well-being of Canadians living in private dwellings. Moreover, the survey collected data on prevalences of specific mental disorders and problems, use of mental health services, and economic and personal costs of having a mental illness. Data collection began in May 2002 and extended over 8 months. More than 85% of all interviews were conducted face-to-face and used a computer-assisted application. The survey obtained a national response rate of 77%. This paper describes several key aspects of the questionnaire content, the sample design, interviewer training, and data collection procedures. A brief overview of the CCHS regional component (Cycle 1.1) is also given. [ABSTRACT FROM AUTHOR]

Over the past quarter-century, Canadian researchers, clinical practitioners, and policy specialists have made several notable contributions to the broad field of violence risk assessment and management. In part, these contributions have been fostered by major changes in law over this period; in part, they have been spurred by findings from large-scale Canadian prediction--outcome studies. This paper offers references for a range of Canadian-inspired assessment schemes designed to evaluate psychopathy and potential for violence against others. [ABSTRACT FROM AUTHOR]

Background: Major depression makes an important contribution to disease burden in Canada. In principle, the burden of major depression can be reduced by the provision of treatment within the health care system. In a previous data analysis, the National Population Health Survey (NPHS) reported an increase in antidepressant (AD) use between 1994 and 1998. In this paper, the analysis is extended to 2000, and additional aspects of health care utilization are described.Methods: The NPHS provides a unique source of longitudinal data concerning major depression and its treatment in Canada. In this survey, probable cases of major depression were identified using a brief predictive instrument; health care utilization was evaluated using additional survey items; and the latest data release from Statistics Canada (that is, 2000) was used to make weighted estimates of the frequency of health care utilization in relation to major depression status.Results: The use of ADs has continued to escalate. These increases have been largest in men and in persons aged under 35 years. There has been an increase in polypharmacy: in 2000, almost 9% of persons taking an AD reported taking more than 1 AD medication-a tripling since 1994. The frequency of consultations with alternative practitioners has also grown. Although the overall proportion of persons with major depression who report consulting with health professionals about their mental health has not increased, the number of persons with major depressive disorder reporting 6 or more visits to nurses, social workers, and psychologists may have.Conclusion: The provision of AD treatment continues to expand in Canada. This probably represents a changing pattern of practice, because the frequency of professional consultation has not increased. More detailed data are required to evaluate the extent to which treatment needs are being met. [ABSTRACT FROM AUTHOR]

This paper investigates the influence of integrative factors on psychotherapy education. The broad relevance of integrative psychotherapy to residency training and continuing mental health education is discussed. Following a review of the existing literature on the education of integrative psychotherapists, the article systematically examines the integrative and pedagogic issues to be considered in planning psychotherapy training informed by integrative principles. The integrative issues are organized into 5 categories: attitudinal set, knowledge base, clinical techniques and skills, developmental tasks and challenges, and systemic institutional factors. The educational issues can be divided into 4 categories: content, format and process, sequence, and faculty development. Brief descriptions of actual educational interventions illustrate the implementation of such ideas. Specific recommendations are made regarding the development of integrative educational initiatives and future study of unresolved questions. [ABSTRACT FROM AUTHOR]

Background: Antipsychotic-induced weight gain occurs in a substantial percentage of treated persons. There remains a paucity of naturalistic data that describe relative weight-gain liability with the available novel atypical antipsychotics (NAPs). This investigation describes comparative NAP-induced weight gain in a prospective naturalistic cohort of persons with schizophrenia and related psychotic disorders.Methods: The Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS) is an ongoing prospective, longitudinal, naturalistic study involving 32 academic and community sites across Canada. Persons with DSM-IV-defined schizophrenia, schizophreniform or schizoaffective disorder, and psychosis not otherwise specified were consecutively enrolled. The overarching objectives of this initiative were to collect and compare global effectiveness, tolerability, safety, and humanistic outcomes in persons receiving commercially available NAPs in Canada. This analysis reports only weight change with the respective NAPs. Other outcomes were reported in separate companion papers.Results: A spectrum of weight-gain liability was noted with quetiapine (QUE) (mean 7.55 kg, SD 9.20; P = 0.28), olanzapine (OLZ) (mean 3.72 kg, SD 0.56; P = 0.15), and risperidone (RIS) (mean 1.62 kg, SD 7.72; P = 0.43). Categorically defined weight gain (that is, over 7% of baseline weight) was observed in 55.6% of QUE patients, 24.1% of OLZ patients, and 23.7% of RIS patients. Adjusting for demographic and disease-specific confounding factors, QUE patients had greater odds of gaining over 7% of their baseline weight compared with RIS patients (odds ratio [OR] 3.62; 95% CI, 1.02 to 12.83; P = 0.05). No statistical difference was detected between OLZ patients and RIS patients for over 7% of baseline weight (OR 1.54; 95% CI, 0.63 to 3.75; P = 0.12) or over 10% weight gain (OR 1.44; 95% CI, 0.50 to 4.13; P = 0.58).Conclusion: Clinicians are reminded to monitor anthropometric and metabolic parameters in all NAP-treated persons. Clinically significant differences in weight gain liability exist among the available NAPs. [ABSTRACT FROM AUTHOR]

Objective: Several papers have reported higher prevalence of diabetes mellitus (DM) type 2 in patients suffering from bipolar disorder (BD). The possible links between these 2 disorders include treatment, lifestyle, alterations in signal transduction, and possibly, a genetic link. To study this relation more closely, we investigated whether there are any differences in the clinical characteristics of BD patients with and without DM.Method: We compared the clinical data of 26 diabetic and 196 nondiabetic subjects from The Maritime Bipolar Registry. Subjects were aged 15 to 82 years, with psychiatric diagnoses of BD I (n = 151), BD II (n = 65), and BD not otherwise specified (n = 6). The registry included basic demographic data and details on the clinical course of bipolar illness, its treatment, and physical comorbidity. In a subsequent analysis using logistic regression, we examined the variables showing differences between groups, with diabetes as an outcome variable.Results: The prevalence of DM in our sample was 11.7% (n = 26). Diabetic patients were significantly older than nondiabetic patients (P < 0.001), had higher rates of rapid cycling (P = 0.02) and chronic course of BD (P = 0.006), scored lower on the Global Assessment of Functioning Scale (P = 0.01), were more often on disability for BD (P < 0.001), and had higher body mass index (P < 0.001) and increased frequency of hypertension (P = 0.003). Lifetime history of treatment with antipsychotics was not significantly associated with an elevated risk of diabetes (P = 0.16); however, the data showed a trend toward more frequent use of antipsychotic medication among diabetic subjects.Conclusions: Our findings suggest that the diagnosis of DM in BD patients is relevant for their prognosis and outcome. [ABSTRACT FROM AUTHOR]

Objectives: Research on the mental health and service needs of homeless seniors has been scant. This paper reviews the available literature and presents findings of a Toronto survey in an effort to describe the demographics of homeless seniors, their level of impairment, and their mental and physical health needs.Methods: We searched the Medline, AgeLine, and PsycINFO databases, using the following key words: elderly homeless, elderly hostel users, and urban geriatrics. To better describe the service needs of the elderly homeless, we obtained demographic data from the Community and Neighbourhood Services Department and distributed a survey questionnaire to 11 Toronto hostel directors. The questionnaire elicited data relating to reasons for shelter use, problem behaviours, and mental health needs of those over age 65 years.Results: Although seniors represent a small percentage of the homeless population, their numbers are growing. The available literature suggests a high prevalence of psychiatric disorders and cognitive impairment in this population, with a greater proportion of older women than men having severe mental illness. Further, our survey suggests that the service needs of elderly hostel users in Toronto differ from those of their younger counterparts.Conclusion: The homeless elderly are the most vulnerable of this impoverished population. Although more research is needed to define their mental and physical health needs and ways of meeting them, their characteristics appear to be unique. Geriatric psychiatrists could play a significant role in evaluating and treating this population more comprehensively. [ABSTRACT FROM AUTHOR]

Objective: To provide an overview of the results of the Canadian Psychiatric Association (CPA) practice profile survey (PPS), a national survey of psychiatrists and psychiatric practice.Method: Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day.Results: Psychiatrists work 10 hours daily on average and take calls for 5 hours. Sixty percent of the overall work time is in the provision of direct patient care, and fee-for-service payments account for 55% of hours worked. Forty percent of the clinical work is provided in a hospital setting, and 34% is in a private office. Agency work accounted for only 6% of clinical hours worked. Relatively few practitioners provide services to children, older, or forensic patients. The average patient seen is female, aged 40 years, unmarried or with a marital disruption, significantly impaired in multiple areas of functioning, and likely to suffer from depression (21%), schizophrenia (14%), an anxiety disorder (13%), or bipolar disorder (12%). Comorbid Axis I and Axis II disorders are common (each over 30%) and fairly high rates of suicidal (15% to 30%) and homicidal (10% to 20%) risk are present.Conclusions: This paper suggests a wide diversity of practice in psychiatry in Canada, with services being provided to a wide range of individuals with many different conditions. [ABSTRACT FROM AUTHOR]

Objective: To describe a program that integrates mental health counsellors within primary care settings, to present data on the program's impact, and to discuss lessons learned that may apply in other communities.Methods: This paper describes a Canadian program that brings counsellors and psychiatrists into the offices of 87 family physicians in 36 practices in a community of 460,000 in Southern Ontario. It describes the goals and organization of the program and the activities of counsellors when working in primary care. In addition, it summarizes data from the program's evaluation, including demographic data and the individual problems seen and services delivered (all from the program's database) as well as data on patient outcomes using the General Health Questionnaire (GHQ), the Centre for Epidemiological Studies Depression (CESD) Rating Scale, and consumer-satisfaction questionnaires.Results: Each counsellor sees an average of 161 new cases yearly. The major problems are depression, anxiety, and family problems. In fact, over 70% of individuals who are seen show significant improvements in outcomes. The program has led to a significant increase in access to mental health services, a reduction in the use of traditional mental health services, high levels of satisfaction with counsellors and family physicians, and significant improvements in symptoms and functioning of individuals seen.Conclusion: This program has effectively integrated counsellors within primary care settings, increasing the capacity of primary care to handle mental health problems, strengthening links between providers from different sectors, and making mental health care more accessible. [ABSTRACT FROM AUTHOR]

This paper reviews some recent research on the mental health of the First Nations, Inuit, and Métis of Canada. We summarize evidence for the social origins of mental health problems and illustrate the ongoing responses of individuals and communities to the legacy of colonization. Cultural discontinuity and oppression have been linked to high rates of depression, alcoholism, suicide, and violence in many communities, with the greatest impact on youth. Despite these challenges, many communities have done well, and research is needed to identify the factors that promote wellness. Cultural psychiatry can contribute to rethinking mental health services and health promotion for indigenous populations and communities. [ABSTRACT FROM AUTHOR]

The article offers information related to the position paper developed by the Canadian Psychiatric Association Committee related to psychiatric professional standards and practice, approved by the CPA's board of directors on September 12, 2014. Topics discussed include fundamental freedom of conscience and religion for Canadians under the Canadian Charter of Rights and Freedoms, health care conflicts and cultural sensitivity.

Objective: To estimate the financial burden of schizophrenia in Canada in 1996.Method: Using a prevalence-based approach, all direct health care costs, administrative costs of income assistance plans, and costs of incarceration attributable to schizophrenia were determined. Also included was the value of lost productivity associated with premature mortality and morbidity. In addition to using published papers and documents, direct contact was made with representatives from various provincial and federal programs for estimates of the direct health care and non-health care costs.Results: The estimated number of persons with schizophrenia in Canada in 1996 was 221,000, with equal distribution between males and females. The direct health care and non-health care cost was estimated to be $1.12 billion in 1996. In addition, another $1.23 billion in lost productivity associated with morbidity and premature mortality was attributable to schizophrenia.Conclusions: The total financial burden of schizophrenia in Canada was estimated to be $2.35 billion in 1996. The largest category of cost was morbidity (52%), followed by acute care and psychiatric hospital admissions (14% and 10% respectively). Given the magnitude of these cost estimates, there are large potential cost savings with more effective management and control of this debilitating disease. [ABSTRACT FROM AUTHOR]

Confusion regarding definitions and standards of prevention and promotion programs is pervasive, as revealed by a review of such programs in Canada. This paper examines how a discussion of scientific paradigms can help clarify models of prevention and mental health promotion and proposes the complementary development of prevention and promotion programs. A paradigm shift in science contributed to the emergence of the transactional model, advocating multiple causes and dynamic transactions between the individual and the environment. Consequently, the view of prevention applying over a linear continuum and of single stressful events causing mental disorders may no longer be appropriate. It is the author's belief that the new science of chaos theory, which addresses processes involved in the development of systems, can be applied to child development and thus to the heart of prevention and promotion programs. Critical moments followed by transitions or near-chaotic behaviours lead to stable states better adapted to the environment. Prevention programs would focus on the critical moments and target groups at risk to reduce risk factors. Promotion programs would focus on stable states and target the general population to develop age-appropriate life skills. The concept of sensitive dependence on initial conditions and certain empirical studies suggest that the programs would have the greatest impact at the beginning of life. It is hoped that this effort to organize knowledge about conceptual models of prevention and mental health promotion programs will foster the development of these programs to meet the urgent needs of Canadian children. [ABSTRACT FROM AUTHOR]

Objectives: First-responder mental health, especially in Canada, has been a topic of increasing interest given the high incidence of poor mental health, mental illness, and suicide among this cohort. Although research generally suggests that resiliency and stigma reduction programs can directly and indirectly affect mental health, little research has examined this type of training in first responders. The current paper examines the efficacy of the Road to Mental Readiness for First Responders program (R2MR), a resiliency and anti-stigma program.Methods: The program was tested using a pre-post design with a 3-month follow-up in 5 first-responder groups across 16 sites.Results: A meta-analytic approach was used to estimate the overall effects of the program on resiliency and stigma reduction. Our results indicate that R2MR was effective at increasing participants' perceptions of resiliency and decreasing stigmatizing attitudes at the pre-post review, which was mostly maintained at the 3-month follow-up.Conclusions: Both quantitative and qualitative data suggest that the program helped to shift workplace culture and increase support for others. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses various papers published within the issue, including one on adolescent distress following a separation period from their fathers, one on the effects of bullying on adolescent victims, and another on the prevalence of attention-deficit hyperactivity disorder (ADHD) in young adults.

This article provides an overview of papers presented at the 2004 Canadian Academy of Psychiatric Epidemiology meeting. Canada has been a major player in the development of diagnostic criteria, methodology and structured interviews to determine the prevalence of treated and untreated mental disorders. However, most studies in Canadian psychiatric epidemiology were conducted in a specific region. As a consequence, researchers do not have any national estimates of the prevalence of major psychiatric conditions in the country. The Canadian Community Health Survey Cycle 1.2. remedies this, being a study of the entire country. At the meeting, representatives from Statistics Canada outlined the design of the Canadian Community Health Survey Cycle 1.2., whose major focus was on factors that predisposed people to or protected them from psychological problems.

The article comments on the paper which discusses the partnership between psychiatry and public health system to ensure addiction care in Canada. The author mentions the need to reassess the role of psychiatrist to achieve successful outcomes in resolving the prevalence of addiction. He states the significance of financial support in encouraging psychiatrists to assume the responsibility and accountability for the prevention and care of addiction. Furthermore, the author stresses that physicians, including psychiatrists, should develop emphatic relationship with addiction sufferers to initiate effective treatment of addiction.

The article comments on the paper which discusses the implication of societal domains on the treatment of addiction in Canada. The author contemplates on the disciplines concerning the prevention and care of addictions as well as the allocation of treatment resources. He stresses the significance of addiction medicine in dealing with the management of addiction. Furthermore, the author believes that the collaborative efforts among those in public health, addiction medicine, and mental health services may be the best option to initiate addiction care for Canadians.

This article focuses on the issues published in "The Canadian Journal of Psychiatry," which comprised either clinical reports or expressions of opinions related to the field of psychiatry. Most published issues shed light on the understanding and treatment of mental disorders, and a general psychiatry journal does not publish many basic science papers. The review section contains articles that examines a broad range of research on clinically relevant topics on psychiatry.

This article focuses on the new editor and new policy of the "Canadian Journal of Psychiatry." With the change of editorship. The journal will introduce several other changes. The journal's mission is to publish papers of the highest scientific quality that are relevant for the theory and practice of psychiatry. All the articles in the journal are either empirical studies or systematic reviews. As a result, our impact factor has steadily gone up. While Canada is small in relation to its larger neighbor country, one do not see why one cannot have an impact similar to that of journals from Britain and Scandinavia.