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Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.

Indigenous populations, compared with majority populations, have a reduced likelihood of receiving professional help for mental health, contributing to health disparities. To increase use of and access to mental health services for Indigenous people, specific factors that affect service use need to be examined. An integrative review was undertaken of the barriers to and facilitators of help seeking and service use for Indigenous populations in Canada, the United States, Australia, and the Pacific Islands.Five databases-PsycINFO, PubMed, Web of Science, Social Services Abstracts, and Bibliography of Native North Americans-and gray literature were searched to identify original studies with data specific to Indigenous people. A qualitative analysis of common themes among the studies was conducted, along with a quality appraisal of included articles. Of the 1,010 records identified, the final synthesis included 41 articles.Six main themes emerged: informal supports, which were often used as a first choice for help seeking compared with formal services; structural obstacles and supports; stigma and shame; self-reliance and uncertainty about services; cultural factors and mistrust of mainstream services; and the need for outreach and information regarding mental illness and services.Policy implications include needed structural changes to decrease mistrust of mainstream systems and services and increased funding and resource availability. Along with technology-facilitated treatment, programs for Indigenous people, families, and communities that enhance education and foster positive relationships can serve as a first step toward Indigenous people becoming comfortable with the idea of talking about mental health and with seeking treatment.

First Nations adults continue to experience significant health disparities compared to non-First Nations adults in Canada. Ongoing difficulties associated with intergenerational trauma among First Nations peoples may be examined using the adverse childhood experiences (ACEs) model, which measures various forms of abuse, neglect, and household dysfunction. We examined prevalence rates of ACEs and physical and mental health outcomes within a predominately First Nation sample of clients seeking substance use treatment from a First Nations-led treatment facility. The prevalence of ACEs was higher than national averages and previous data collected with broader Indigenous samples in Canada. Descriptive analyses of ACEs and health outcomes for those seeking First Nations-led substance use treatment showed these participants had more chronic health difficulties co-morbid with clinical levels of problematic substance use. To improve ongoing best-treatment options for those seeking substance use treatment, continued assessment and promotion of broader aspects of health and wellbeing are required, including the balance of physical, emotional, spiritual, and mental health and wellbeing across a lifespan.

There has been a significant disruption in the transmission of parenting practices across generations of Canadian Indigenous communities (Truth and Reconciliation Commission of Canada [TRC], 2015). As a result, there is a pressing need for effective and culturally appropriate programs for Indigenous parents (TRC, 2015). Review of currently available parenting programs in Canada may help by synthesizing Indigenous and non-Indigenous parenting knowledge. To that end, a scoping review of sources that described parenting programs for Indigenous families was completed using 11 databases and available grey literature. All programs integrated cultural components into treatment, though specific activities, content, and structure varied. Recommendations for clinical practice and future research are provided.

Alcohol use is common among individuals attending university and frequent use is associated with several negative effects. It is therefore important to assess individual difference factors preceding alcohol use. Materialism, a value one holds that prioritizes status through the acquisition of money and possessions, has received minimal research focus in relation to alcohol use and has predominantly been examined using cross-sectional designs (i.e., data collected at one time point). The present study was the first to test the association between materialism, risky drinking motives (i.e., motives preceding alcohol use associated with increased consumption and related problems), and risky personality traits (i.e., stable characteristics associated with frequent substance use and related problems) using a short-term longitudinal design. Undergraduate student drinkers (N = 317) completed self-report questionnaires at baseline and follow-up (2 weeks later). Hierarchical regression analyses found that greater levels of materialism significantly predicted each drinking motive while controlling for risky personality traits. Materialism significantly predicted drinking to cope with depression when controlling for trait hopelessness (β = .16, p = .014), drinking to cope with anxiety while controlling for anxiety sensitivity (β = .11, p = .024), and drinking for enhancement while controlling for sensation seeking (β = .24, p < .001). Results provide evidence that materialism is associated with risky drinking motives, which may inform prevention and treatment efforts for problematic use among undergraduate students.

This study examined data from the 2017 Aboriginal Peoples Survey to consider predictors of land-based activity engagement. We hypothesized that higher self-reported mental and physical health scores, an increased sense of cultural belonging, living in a rural community, and no prior individual or family history of residential school attendance would predict a higher frequency of land-based activity engagement among First Nations individuals living off-reserve. Results from linear regression analyses suggested that an increased sense of cultural belonging, being male, and living in a rural community with a population of less than 1000 people were significant predictors of the frequency of land-based activity engagement. With these preliminary findings, further research can explore how physical and mental health outcomes influence the frequency of land-based activity engagement, in addition to how community-specific indicators may promote higher frequency of these activities, particularly among First Nations individuals living off-reserve.

Electronic health interventions involve health services delivered using the Internet and related communication technologies. These services can be particularly relevant for Indigenous populations who often have differential access to health-care services compared to general populations, especially within rural and remote areas. As the popularity of electronic health interventions grows, there is an increased need for evidence-based recommendations for the effective use of these technologies. The current study is a systematic review of peer-reviewed and available grey literature with the aim of understanding outcomes of electronic health interventions for mental health concerns among Indigenous people. Studies used electronic health technologies for substance use treatment or prevention, suicide prevention, parenting supports, goal setting and behaviour change and consultation services. Various technological platforms were used across interventions, with both novel and adapted intervention development. Most studies provided qualitative results, with fewer studies focusing on quantitative outcomes. Some preliminary results from the engagement of Indigenous individuals with electronic health services has been demonstrated, but further research is needed to confirm these results. Identified barriers and facilitators are identified from the reviewed literature. Recommendations for future development of electronic health interventions for Indigenous youth are provided.

We examined the explanatory roles of social determinants of health (SDOH) for First Nations people using a four-domain model of health and wellness based on the Medicine Wheel (i.e., physical, mental, emotional, and spiritual health), including colonial-linked stressors (i.e., historical trauma, childhood adversities, racial discrimination) and cultural resilience factors (i.e., cultural strengths, traditional healing practices, social support). Data were collected in partnership with a First Nation in Ontario, Canada in 2013 through a community survey (n = 194). For each outcome (physical, mental, emotional, and spiritual health), a modified Poisson regression model estimated prevalence ratios for the SDOH, adjusting for age, sex, education, and marital status. Negative associations were found for historical trauma with physical, mental, emotional, and spiritual health; for childhood adversities with mental health; and for racial discrimination with physical, mental, and emotional health. Positive associations were found for cultural strengths with physical, mental, and emotional health and for social support with physical, mental, emotional, and spiritual health. We observed negative associations between use of traditional healing practices and mental and emotional health. Our findings suggest that these SDOH may play important roles in relation to wellness through associations with the domains of health modelled by the Medicine Wheel.

Objective Exposure to adverse childhood experiences (ACEs) is linked to disruptions in typical neurodevelopment of brain structures and functioning, including changes in executive functions. Although the relationships among ACEs, executive functions, and psychopathology are well documented in pediatric samples, a systematic review is needed to examine these relationships in adulthood. Method A systematic review examining the link between ACEs and executive functions among adult clinical and nonclinical samples was conducted across 33 scientific and grey literature databases. Among reviewed studies, 17 sources met review criteria, with 11 involving clinical samples and six involving nonclinical samples. Results Among clinical samples, evidence suggested that ACEs increased risk for executive function difficulties among those diagnosed with bipolar disorder, schizophrenia, post-traumatic stress disorder, and those experiencing a first episode of psychosis, however not within those diagnosed with major depressive disorder. Among nonclinical samples, executive function difficulties associated with ACEs were found among those in early and middle adulthood. Not all retrieved sources showed consistent findings, and two studies described better executive function outcomes among those who experienced childhood sexual abuse and emotional abuse. Conclusions Executive function difficulties associated with ACEs appear to persist into adulthood, though inconsistently. Future research may further explore distinct differences among specific ACEs and executive function difficulties to further inform ongoing prevention and treatment efforts.

Objective The aim of the Maternal Infant Support Worker (MiSW) pilot program was to implement a virtual training program for lay maternal-infant health providers in remote First Nations communities in Northwestern Ontario, Canada. Methods The MiSW pilot program was administered jointly by a community college and a university and consisted of a 20-week virtual course followed by a 9-month mentored work placement in the community. Results The MiSW pilot program was delivered successfully; 11 of 13 participants received a certificate from a community college. MiSWs provided culturally and linguistically appropriate care to women, infants, and families in their respective communities. MiSWs provided doula support in their communities-a first for our region since the policy of forced evacuation for birth was implemented. MiSWs developed a community of practice for ongoing education, as well as to support each other in their work. Conclusion The MiSW pilot program demonstrated that it is possible to provide a virtual training program and then provide continued virtual mentorship as the participants work in their First Nations communities. By prioritizing Indigenous voices above those of the research team, we were able to gain the trust of the MiSWs and maintain engagement with communities.

Health concerns in Indigenous people are often greater in comparison to those in non-Indigenous populations, including increased rates of chronic diseases and mental health concerns. Adverse childhood experiences (ACEs) may be an explanatory variable for such heightened rates of mental and physical health difficulties for Indigenous populations as these communities have experienced a lack of adequate health care due to remoteness, historical traumas, cultural insensitivity, racism, and perpetuating systemic discrimination. To date, relatively few studies have examined ACEs within an Indigenous population and their relevance to both physical and mental health outcomes. The present study explored existing ACE literature relevant to Indigenous populations and mental or physical health outcomes by retrieving and organizing available ACE literature. A systematic review was conducted using 14 electronic databases of peer-reviewed literature and 18 grey literature databases. Twenty-one publications investigating general health outcomes and prevalence of ACEs met eligibility criteria. ACEs were reported to be higher in Indigenous populations when compared to non-Indigenous population. Higher ACE scores for Indigenous participants were associated with increased rates of suicidality and psychological distress. Protective factors to reduce the impact of ACEs were cultural identity and connectedness, education, social support, and psychological resilience. Future research may further explore the relationship between ACE scores and protective factors, varying prevalence within specific sub-populations, and consistent reporting of outcomes across studies. Ongoing research has the potential to clarify existing dose–response relationships between early traumatic experiences and current health disparities experienced within some Indigenous communities.

Background: Prior to legalization in October 2018, marijuana was the most commonly used illicit drug in Canada, with 60-73% of undergraduate students reporting use over their lifetime. Research con...

This systematic review assessed the current evidence base of substance use prevention programs for Indigenous adolescents in the USA, Canada, Australia and New Zealand. The authors investigated (a) the outcomes, type, setting and context of prevention programs; (b) the common components of beneficial prevention programs; and (c) the methodological quality of evaluations of included prevention programs. The authors searched eight peer-reviewed and 20 grey literature databases for studies published between 1 January 1990 and 31 August 2017. Data extracted included type of program (culturally adapted, culture-based or unadapted), the setting (school, community, family or multi-setting), delivery (computerised or traditional), context (Indigenous-specific or multi-cultural environment) and common components of the programs. Program evaluation methodologies were critically appraised against standardised criteria. This review identified 26 eligible studies. Substance use prevention programs for Indigenous youth led to reductions in substance use frequency and intention to use; improvements in substance-related knowledge, attitudes and resistance strategies; and delay in substance use initiation. Key elements of beneficial programs included substance use education, skills development, cultural knowledge enhancement and community involvement in program development. Five programs were rated as methodologically strong, seven were moderate and fourteen were weak. Prevention programs have the potential to reduce substance use among Indigenous adolescents, especially when they are developed in partnership with Indigenous people. However, more rigorously conducted evaluation trials are required to strengthen the evidence base.

Examining treatment outcomes of nonresidential and residential treatment programs may suggest best practices for Indigenous communities delivering treatment services. A systematic review of peer-reviewed and gray literatures comparing treatment outcomes for Indigenous populations was completed. Three studies compared treatment outcomes and reported varying results. Reported outcomes were retention and relapse rates, cultural knowledge, and participant treatment duration. Most retrieved studies described residential treatment outcomes, but it was unclear whether this modality is the best option for Indigenous people seeking treatment. Further research describing treatment modalities, across a continuum of care, situated within culturally developed treatment frameworks is required.

Cross-informant agreement between parent–youth dyads has been the focus of extensive research, but youth from diverse cultures have received less attention. Cross-information agreement between Indigenous and non-Indigenous parent–youth dyads were compared. A total of 152 parent–youth dyads, consisting of 29.6% Indigenous and 70.4% non-Indigenous, were contrasted on level of agreement using the Child Behavior Checklist and Youth Self-Report forms of the Achenbach System of Empirically Based Assessment. The overall level of agreement for the full sample (r = .41) was comparable to the extent literature. As predicted, externalizing difficulties were rated with significantly higher levels of agreement than internalizing difficulties (externalizing r = .51; internalizing r = .32). While age did not significantly moderate the levels of agreement, gender did show an effect with female youth reporting higher levels of problems than males. The most notable finding was the cultural effect on levels of agreement. The rate of cross-informant agreement for the Indigenous parent–youth dyads was significantly higher than the low to moderate agreement found for non-Indigenous pairs. Moreover, the level of cross-informant agreement between the externalizing and internalizing problem scales was similar for the Indigenous dyads (r = .59; r = .62, respectively), but was significantly different for the non-Indigenous dyads (r = .50; r = .19, respectively). This study highlights possible cultural differences in cross-informant agreement between Indigenous and non-Indigenous youth and their parents

This commentary focuses on how some Indigenous communities in the United States (U.S.) and Canada are addressing the opioid epidemic within the context of the COVID-19 pandemic, from the perspective of the co-authors as researchers, clinicians, and pharmacists working within or among Indigenous communities in three eastern Canadian provinces and two western U.S. states. The pandemic has likely exacerbated opioid use problems among Indigenous communities, especially for individuals with acute distress or comorbid mental illness, or who are in need of withdrawal management or residential services. In response to the pandemic, we discuss first how greater prescription flexibility has facilitated and even increased access to medications for opioid use disorder. Second, we describe how Indigenous-serving clinics have expanded telemedicine services, albeit not without some challenges. Third, we note challenges with restricted participation in traditional Indigenous healing practices that can be helpful for addiction recovery. Fourth, we mention providers' worries about the pandemic's impact on their patients' mental health and safety. We argue that certain treatment transformations may be helpful even after the pandemic is over, through enhancing access to community-grounded treatment, decreasing stigma, and promoting patient self-efficacy., Highlights • COVID-19 pandemic has challenged opioid use treatment for Indigenous peoples. • Treatment has been aided through expanded telemedicine and prescription flexibility. • These adjustments may expand future treatment access to Indigenous communities.

There is a high prevalence of Indigenous youth experiencing either precarious housing or homelessness in northwestern Ontario. Given that Indigenous pathways to homelessness can differ from non-Indigenous youth, interventions that address homelessness must also adapt to meet diverse needs. The Housing Outreach Program Collaborative (HOP-C) is a tertiary prevention intervention designed to provide congruent housing and peer and mental health supports for youth experiencing homelessness in Toronto, Ontario. Less is known regarding its adaptability to adequately serve Indigenous youth in northwestern Ontario. This study assessed the preliminary effectiveness and feasibility of an adaptation of the HOP-C North program for transitional aged Indigenous youth exiting homelessness in Thunder Bay, Ontario. Participants completed premeasures (n = 15) and postmeasures (n = 8) as well as qualitative interviews regarding their experiences in the program. Qualitative interviews were also conducted with staff (n = 14) engaged in implementing the program. After completing the HOP-C North program, participants reported improvements in a number of outcomes, including increased educational enrollment, attainment of employment, reduced hospitalizations, and increased engagement in clinical mental health services. Specific program aspects that participants found helpful included increased program flexibility, accessibility, emphasis on relationships, relevance of programming, fostering participant autonomy, and an adaptive approach to program implementation. These findings suggest that the HOP-C North model, when adapted, is a helpful program for Indigenous youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background Conducting culturally-relevant research with Indigenous populations requires a balance of approaches that benefit Indigenous communities, while perceiving and mitigating the potential risk of harm when engaging in research-related activities. Reducing the burden of research is especially useful for research with Indigenous populations as ongoing systemic marginalization and discrimination through historical colonial practices may result in a higher likelihood of experiencing harm from research activities. One way to ensure that stakeholder experiences with the research processes are not burdensome, and to understand how study implementation practices are perceived across research teams, supporting organizations, and individual participants is to build this into the study method. Objective The current study describes stakeholder experiences within a broader research study, entitled the First Nations ACE Study, which examined early childhood experiences and health outcomes for Indigenous people seeking treatment for substance use. Participants and setting Five treatment centre staff participated in ongoing consultations with the research team and described their experiences within a Community-Based Participatory Research (CBPR) study. Method A document review of client satisfaction questionnaires of seventy-five participants provided quantitative feedback on experiences in addition to qualitative interviews with staff. Results Overall, experiences of both treatment centre staff and clients were generally positive. Additional results described the importance of continuous stakeholder participation, and ongoing study adaptations to remain aligned with CBPR approaches as pressure for expediency and convenience have the potential to encroach upon CBPR values. The study method was described to mitigate participant and staff burden, as well as risk of participant harm. Conclusions Directions for future research are discussed, including discussion of modifications that will be made to future iterations of the presented research study.

The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact. The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada. The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic.

Background Patients who present to emergency departments after intentional self-harm are at an increased risk of dying by suicide. This applies particularly to men, who represent nearly two-thirds of those who die by suicide in Ontario. One way of potentially addressing this gap is to offer a course of blended problem-solving therapy, comprised of a brief course of evidence-based psychotherapy for individuals at risk for suicide, facilitated by the use of a patient-facing smartphone application and a clinician-facing “dashboard.” This approach has the potential to combine the benefits of face-to-face therapy and technology to create a novel intervention. Methods This is a cohort study nested within a larger pragmatic multicentre pre- and post-design cluster randomised trial. Suicidal ideation assessed by the Beck Scale for Suicide Ideation is the primary outcome variable. Secondary outcome measures include depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder 7-item scale), post-traumatic stress disorder (Primary Care PTSD Screen), health-related quality of life (EuroQol 5-dimension 5-level questionnaire), meaning in life (Experienced Meaning in Life Scale), perceived social supports (Multidimensional Scale of Perceived Social Support), alcohol use (Alcohol Use Disorders Identification Test), drug use (Drug Abuse Screening Test Short Form 10), problem-solving skills (Social Problem-Solving Inventory–Revised Short Form), and self-reported healthcare costs, as well as health service use measured using Ontario administrative health data. A process evaluation will also be conducted following study completion. Discussion The cohort study will test whether better adherence to the intervention results in better outcomes. The value of the cohort study design is that we can examine in more detail certain subgroups or other variables that are not available in the larger cluster randomised trial. This trial will aim to improve standards by informing best practice in management of men who self-harm and present to hospitals in Ontario. Trial registration ClinicalTrials.gov, NCT03473535. Registered on March 22, 2018.

Background Due to the high prevalence of mental disorders among people with opioid use disorder, the objective of this study was to determine the association between concurrent mental disorders, mortality, morbidity, and continuous treatment retention for patients in opioid agonist treatment in Ontario, Canada. Methods We conducted a retrospective cohort study of patients enrolled in opioid agonist treatment between January 1, 2011, and December 31, 2015. Patients were stratified into two groups: those diagnosed with concurrent mental disorders and opioid use disorder and those with opioid use disorder only, using data from the Ontario Health Insurance Plan Database, Ontario Drug Benefit Plan Database. The primary outcome studied was all-cause mortality using data from the Registered Persons Database. Emergency department visits from the National Ambulatory Care Database, hospitalizations Discharge Abstract Database, and continuous retention in treatment, defined as 1 year of uninterrupted opioid agonist treatment using data from the Ontario Drug Benefit Plan Database were measured as secondary outcomes. Encrypted patient identifiers were used to link information across databases. Results We identified 55,924 individuals enrolled in opioid agonist treatment, and 87% had a concurrent mental disorder diagnosis during this period. We observed that having a mental disorder was associated with an increased likelihood of all-cause mortality (odds ratio (OR) 1.4; 95% confidence interval (CI) 1.2–1.5). For patients diagnosed with mental disorders, the estimated rate of ED visits per year was 2.25 times higher and estimated rate of hospitalization per year was 1.67 times higher than for patients with no mental disorders. However, there was no association between having a diagnosis of a mental disorder and 1-year treatment retention in OAT-adjusted hazard ratio (HR) = 1.0; 95% CI 0.9 to 1.1. Conclusion Our findings highlight the consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada.

Little is known regarding the specific types of service models and collaborations that are necessary to support diverse populations of youth in transition out of homelessness. Transitional supports addressing the complex needs of this population are needed to stabilize the array of housing arrangements that youth access. This study was a pilot randomized controlled trial of one such critical time intervention, called the Housing Outreach Program-Collaboration (HOP-C). HOP-C is a multicomponent, multidisciplinary intervention that provides 6 months of mental health and peer support, along with transitional case management to youth who have transitioned into some form of stable housing out of homelessness. In this trial, 65 youth were randomized to receive HOP-C plus treatment as usual or transitional case management plus treatment as usual. Outcome assessments were completed by 30 treatment and 28 control participants. The findings suggest that this intervention is feasible with mental health, employment or education, and housing metrics favoring HOP-C with odds ratios ranging from 2.28 to 3.18 and better subjective housing stability. Other indicators showed less change. HOP-C appears feasible and should be tested in a fully powered trial, providing the intervention for a duration longer than 6 months. Overall, these data suggest the potential benefit in fostering city-level, multidisciplinary teams sourced from several organizations to support youth transitioning out of homelessness. Pragmatic trial method considerations for this population are also addressed as are the ethical considerations pertinent to engaging highly marginalized youth in clinical trials. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective The objective of this study was to evaluate the relationship between concurrent physician-based mental health services, all-cause mortality, and acute health service use for individuals enrolled in Opioid Agonist Treatment in Ontario, Canada. Methods A cohort study of patients enrolled in opioid agonist treatment in Ontario was conducted between January 1, 2011, and December 31, 2015, in Ontario with an inverse probability of treatment weights using the propensity score to estimate the effect of physician-based mental health services. Treatment groups were created based on opioid agonist treatment patients’ utilization of physician-based mental health services. Propensity score weighted odds ratios were calculated to assess the relationship between the treatment groups and the outcomes of interest. The outcomes included all-cause mortality using data from the Registered Persons Database, Emergency Department visits from the National Ambulatory Care Database, and hospitalizations using data from the Discharge Abstract Database. Encrypted patient identifiers were used to link across databases. Results A total of 48,679 individuals in OAT with mental disorders. Opioid agonist treatment alone was associated with reduced odds of all-cause mortality (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3–0.4). Patients who received mental health services from a psychiatrist and primary care physician while engaged in OAT, the estimated rate of ED visits per year was higher (OR = 1.3, 95% CI 1.2–1.4) and the rate of hospitalizations (OR = 0.5, 95% CI 0.4–0.6) than in the control group. Conclusion Our findings support the view that opioid agonist treatment and concurrent mental health services can improve clinical outcomes for complex patients, and is associated with enhanced use of acute care services.

Health solutions for Aboriginal children should be guided by their community and grounded in evidence. This manuscript presents a prospective cohort study protocol, designed by a community-university collaborative research team. The study’s goal is to determine whether community-based screening and triage lead to earlier identification of children’s emotional health needs, and to improved emotional health 1 year later, compared to the standard referral process. We are recruiting a community-based sample and a clinical sample of children (ages 8 to 18 years) within one Canadian First Nation. All participants will complete the Aboriginal Children’s Health and Well-being Measure (ACHWM)© and a brief triage assessment with a local mental health worker. All participants will be followed for 1 year. Children with newly identified health concerns will be immediately connected to local services, generating a new opportunity to improve health. The development of the research design and its execution were impacted by several events (e.g., disparate worldviews, loss of access to schools). This manuscript describes lessons learned that are important to guide future community-based research with First Nations people. The optimal research design in an Aboriginal context is one that responds directly to local decision makers’ needs and respectfully integrates Aboriginal ways of knowing with Western scientific principles. Such an approach is critical because it will generate meaningful results that will be rapidly adopted, thus reducing the knowledge-to-action gap.

Single-session therapy is being implemented in a number of mental health settings to increase the accessibility and efficiency of services, despite limited evidence supporting its utility. This stu...

Health researchers are increasingly encouraged to use large, community-level data sets to examine factors that promote or diminish health, including social determinants. First Nations people in Canada experience disparity in a range of social determinants of health that result in relatively low community well-being scores, when compared to non-First Nations people. However, First Nations people also possess unique protective factors that enhance well-being, such as traditional language usage. Large data sets offer First Nations a new avenue for advocating for supports and services to decrease health inequity while developing culture-based evidence. However, care must be taken to ensure that these data are interpreted appropriately. In this paper, we respectfully offer a cautionary note on the importance of understanding culture and context when conducting First Nations health research with large data sets. We have framed this caution through a narrative presentation of a simple and concrete example. We then outline some approaches to research that can ensure appropriate development of research questions and interpretation of research findings.

Objective Over 50 years of research implicates perfectionism in suicide. Yet the role of perfectionism in suicide needs clarification due to notable between-study inconsistencies in findings, underpowered studies, and uncertainty about whether perfectionism confers risk for suicide. We addressed this by meta-analyzing perfectionism's relationship with suicide ideation and attempts. We also tested whether self-oriented, other-oriented, and socially prescribed perfectionism predicted increased suicide ideation, beyond baseline ideation. Method Our literature search yielded 45 studies (N = 11,747) composed of undergraduates, medical students, community adults, and psychiatric patients. Results Meta-analysis using random effects models revealed perfectionistic concerns (socially prescribed perfectionism, concern over mistakes, doubts about actions, discrepancy, perfectionistic attitudes), perfectionistic strivings (self-oriented perfectionism, personal standards), parental criticism, and parental expectations displayed small-to-moderate positive associations with suicide ideation. Socially prescribed perfectionism also predicted longitudinal increases in suicide ideation. Additionally, perfectionistic concerns, parental criticism, and parental expectations displayed small, positive associations with suicide attempts. Conclusions Results lend credence to theoretical accounts suggesting self-generated and socially based pressures to be perfect are part of the premorbid personality of people prone to suicide ideation and attempts. Perfectionistic strivings' association with suicide ideation also draws into question the notion that such strivings are healthy, adaptive, or advisable.

Protective behavioural strategies represent a harm reduction approach that individual gamblers can implement to reduce harm associated with gambling. This review evaluated the empirical evidence to date on the effectiveness of protective behavioural strategies in gambling. The strategies reviewed encompass four broad categories: self-exclusion (a requested ban from a gambling venue), time limit setting, monetary limit setting, and cashless, card-based gambling programs. There were also five strategies that did not fall into one of these categories. The amount of evidence available was limited for the majority of strategies; the evidence for self-exclusion was the most promising, but results were inconsistent across studies. The quality of the evidence was also low, and there were numerous limitations that affect the generalizability of results and the inferences that can be made. For these reasons, few evidence-based recommendations for clinicians could be made at this time. Finally, this review provides rationale and recommendations for additional research in protective behavioural strategies in the gambling context.

Background: Gambling venues and industry regulators utilise a variety of strategies to reduce potential consumer harm from gambling. These strategies originate at the level of governmental and indu...

Objective The objective was to characterize the relationship between geography, concurrent psychiatric services, all-cause mortality, and acute health care use for individuals enrolled in Opioid Agonist Treatment, in Ontario, Canada. Methods We conducted a propensity score matching study of patients enrolled in Opioid Agonist Treatment in Ontario for the first time between January 1, 2011, and December 31, 2015. We first compared outcomes between patients who were actively engaged and patients who were not actively engaged in Opioid Agonist Treatment. We created treatment and a control groups on the basis of an individual’s access to psychiatric care within an episode of Opioid Agonist Treatment. Relative risk and number needed to treat were calculated to determine the correlation between psychiatric care and health outcomes among patients enrolled in Opioid Agonist Treatment at two time points within an episode of care and for two geographic regions in Ontario (north and south). Results During the first year of Opioid Agonist Treatment, concurrent psychiatric care was associated with a reduction in all-cause mortality in southern Ontario (RR 0.80, 95% CI, 0.73–0.87), a reduction in emergency department visits in both northern and southern Ontario (north: RR = 0.76, 95% CI, 0.72–0.81; south: RR = 0.87, 95% CI, 0.86–0.88), and a reduction in hospitalizations (north: RR = 0.88, 95% CI. 0.82–0.94, south: RR = 0.92, 95% CI, 0.91–0.93). Conclusion Our findings have significant clinical and political implications for health system planning highlighting the need for integrated mental health and addiction services for individuals with Opioid Use Disorder. Electronic supplementary material The online version of this article (10.1186/s13011-019-0213-6) contains supplementary material, which is available to authorized users.

Moving towards reconciliation within Indigenous research requires the careful examination of existing practices at all stages of the research process. Engagement in and dissemination of reflexive processes may increase the relevance of research results for Indigenous communities and partners. This article describes and contextualizes the results obtained from this qualitative research study examining parenting needs and child reunification in these communities. The initial results were deemed relevant by the partnering community but research stakeholders reported that they did not reflect all community values. Based on the advice of the Research Advisory Group, the research team decided to further analyze the results to address these shortcomings. The reanalysis process focused on improving the perceived meaningfulness and relevance to communities. Exploration of how these results were re-situated in an Indigenous framework of wellbeing is discussed. Researcher reflections about the project processes and considerations for future research are explored.

Research indicates that mindfulness is linked to higher-order neurocognitive control processes, and the associated executive functions and self-regulation capacities needed in daily life. The current study examines the roles of executive function and self-regulation in the link between dispositional mindfulness and well-being using a multi-method, two-phase longitudinal design. Two multiple mediator models were tested in a sample of 77 undergraduate students. Self-regulation independently mediated the relationship between mindfulness and positive affect; however, both executive function and self-regulation independently mediated the relationship between mindfulness and negative affect. The mindfulness facets of acting with awareness and non-judgment were most strongly related to executive function and well-being outcomes, while describing and acting with awareness were most strongly related to self-regulation. Performance-based neurocognitive control was related to self-regulation and positive affect, and a test of inhibition/shifting was related to executive function in daily life. Thus, students who are more dispositionally mindful than their peers tend to be non-judgmental and act with awareness, rather than on automatic pilot, which may engage executive functions and self-regulation.

There is a need for Indigenous-centered research to appraise culture's role in wellness. Researchers described the development and validity of the Native Wellness Assessment (NWATM). The NWA has culture-as-intervention at its apex. Wellness, culture, and cultural intervention practices (CIPs) are explored from an Indigenous perspective. Indigenous clients completed matching self-report and observer versions of the NWA at three time points during addictions treatment. Statistically and psychometrically, the NWA content and structure performed well, demonstrating that culture is an effective and fair intervention for Indigenous peoples with addictions. The NWA can inform Indigenous health and community-based programs and policy.