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Article ; Online: Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health.

Richards, Misty C / Benson, Nicole M / Kozloff, Nicole / Franklin, Michelle S

2023 Volume 75, Issue 3, Page(s) 291–293

Abstract: A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or ... ...

Abstract	A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity.
MeSH term(s)	Child ; Adolescent ; Humans ; Mental Health ; Pandemics ; Mental Health Services ; COVID-19 ; Child Psychiatry
Language	English
Publishing date	2023-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1220173-x
ISSN	1557-9700 ; 1075-2730
ISSN (online)	1557-9700
ISSN	1075-2730
DOI	10.1176/appi.ps.20220283
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Article ; Online: Engagement in Mental Health Services.

Sosnowski, Alexandra / Kozloff, Nicole / Dixon, Lisa B

Psychiatric services (Washington, D.C.)

2022 Volume 73, Issue 7, Page(s) 838–839

MeSH term(s)	Humans ; Mental Disorders/psychology ; Mental Disorders/therapy ; Mental Health Services
Language	English
Publishing date	2022-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	1220173-x
ISSN	1557-9700 ; 1075-2730
ISSN (online)	1557-9700
ISSN	1075-2730
DOI	10.1176/appi.ps.22073006
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Zs.A 416: Show issues

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Article ; Online: Sex differences in the prevalence and factors associated with anxiety disorders in Canada: A population-based study.

Yeretzian, Shant Torkom / Sahakyan, Yeva / Kozloff, Nicole / Abrahamyan, Lusine

Journal of psychiatric research

2023 Volume 164, Page(s) 125–132

Abstract: The prevalence of anxiety disorders continues to increase in Canada. The study aimed to evaluate sex differences in the prevalence of anxiety disorders, associated identity factors and social determinants, and their interactions among the Canadian ... ...

Abstract	The prevalence of anxiety disorders continues to increase in Canada. The study aimed to evaluate sex differences in the prevalence of anxiety disorders, associated identity factors and social determinants, and their interactions among the Canadian population. We used data from the 2017-2018 Canadian Community Health Survey (CCHS), a nationally representative survey. We evaluated associations between sex, other identity characteristics and social determinants, and anxiety disorders using multivariable logistic regression. To account for the complex sampling design, we applied sampling and bootstrap weights. The CCHS included 113,290 respondents, representative of 98% of the Canadian population over 12 years old. The prevalence of self-reported anxiety disorders was higher among females than males (11.6% vs 6.3%, p < 0.001). Adjusted regression analysis revealed higher odds of having mood disorders for those who were female, non-White, non-immigrant, homosexual or bisexual, unemployed, had lower income or food insecurity, had a disability and a weak sense of community belonging. Younger age was associated with higher odds of anxiety disorders among females (aOR: 1.50, 95%CI: 1.10-2.05) but not among males (aOR: 0.99, 95%CI: 0.64-1.56). An association between employment and higher income with lower odds of anxiety disorders, and bisexuality with higher odds of anxiety disorders, was stronger among males compared with females. Anxiety disorders are more prevalent among females than males in Canada. Age, employment, income, and sexual orientation have varying associations with anxiety disorders among the sexes. Strategies for improving mental health must recognize the complex links between sex and intersecting factors.
MeSH term(s)	Humans ; Female ; Male ; Child ; Sex Characteristics ; Prevalence ; Canada/epidemiology ; Anxiety Disorders/epidemiology ; Mood Disorders/epidemiology ; Mood Disorders/psychology
Language	English
Publishing date	2023-06-16
Publishing country	England
Document type	Journal Article
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2023.06.018
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Article ; Online: Evaluating sex-differences in the prevalence and associated factors of mood disorders in Canada.

Yeretzian, Shant Torkom / Sahakyan, Yeva / Kozloff, Nicole / Abrahamyan, Lusine

Journal of affective disorders

2023 Volume 333, Page(s) 72–78

Abstract: Background: We assessed the sex-differences in the prevalence and associated factors of mood disorders in Canada using a nationally representative survey, focusing on identity characteristics and socioeconomic factors.: Methods: A secondary analysis ... ...

Abstract	Background: We assessed the sex-differences in the prevalence and associated factors of mood disorders in Canada using a nationally representative survey, focusing on identity characteristics and socioeconomic factors. Methods: A secondary analysis of the 2017-2018 Canadian Community Health Survey (CCHS) - Annual Component was conducted using Gender-Based Analysis Plus, which is an analytical process for incorporating various intersecting identity factors into research, programs, and policies. The presence of mood disorders was assessed through self-reporting. Factors associated with mood disorders were evaluated using multivariable logistic regression analysis after the application of sampling and bootstrap weights. Results: The CCHS was completed by 113,290 Canadians, representative of 98 % of the population over the age of 12. Self-reported mood disorders were more prevalent among females than males (11.0 % vs 6.4 %, p < 0.001). Adjusted regression analysis revealed higher odds of reporting mood disorders for those who were female, unemployed, non-immigrant, non-White, smokers, homosexual or bisexual, had lower income, suffered from food insecurity, had a disability and weak sense of community belonging. Employment and higher income were more protective against mood disorders among males than females, and the association of older age with mood disorders was stronger in males than in females. Limitations: Mood disorders were assessed through self-reporting, and certain population groups were excluded from the survey. Conclusions: Females in Canada are affected by mood disorders at higher rates than males and certain factors have differential associations with mood disorders among the sexes. Strategies targeting mental disorders must be tailored towards the needs of specific groups.
MeSH term(s)	Male ; Humans ; Female ; Mood Disorders/epidemiology ; Prevalence ; Canada/epidemiology ; Socioeconomic Factors ; Surveys and Questionnaires ; Health Surveys
Language	English
Publishing date	2023-04-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	135449-8
ISSN	1573-2517 ; 0165-0327
ISSN (online)	1573-2517
ISSN	0165-0327
DOI	10.1016/j.jad.2023.04.027
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Zs.A 1485: Show issues

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Article ; Online: Mobile "mHealth" Interventions in Mental Health Care.

Polillo, Alexia / Kozloff, Nicole / Dixon, Lisa B

Psychiatric services (Washington, D.C.)

2021 Volume 72, Issue 11, Page(s) 1363–1364

MeSH term(s)	Humans ; Mental Health ; Mobile Applications ; Telemedicine
Language	English
Publishing date	2021-11-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1220173-x
ISSN	1557-9700 ; 1075-2730
ISSN (online)	1557-9700
ISSN	1075-2730
DOI	10.1176/appi.ps.721103
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Zs.A 416: Show issues

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Article ; Online: An SMS text messaging intervention to improve clinical engagement in early psychosis: A pilot randomized-controlled trial.

D'Arcey, Jessica N / Zhao, Haoyu / Wang, Wei / Voineskos, Aristotle N / Kozloff, Nicole / Kidd, Sean A / Foussias, George

Schizophrenia research

2024 Volume 264, Page(s) 416–423

Abstract: Disengagement of youth with psychosis from Early Psychosis Intervention (EPI) services continues to be a significant barrier to recovery, with approximately one-third prematurely discontinuing treatment despite the ongoing need. The current pilot trial ... ...

Abstract	Disengagement of youth with psychosis from Early Psychosis Intervention (EPI) services continues to be a significant barrier to recovery, with approximately one-third prematurely discontinuing treatment despite the ongoing need. The current pilot trial sought to evaluate the preliminary efficacy and feasibility of a weekly short message service (SMS) intervention to improve engagement in EPI services. This was a longitudinal single-blinded randomized control trial in which participants were assigned to receive either an active or sham SMS intervention over nine months. Sixty-one participants with early psychosis between the ages of 16 and 29 were enrolled, randomized, and received at least part of the intervention. Primary outcomes consisted of participant clinic attendance rates over the course of the intervention and clinician-rated engagement. Secondary measures included patient-rated therapeutic rapport, attitude toward medication, psychopathology, cognition, functioning, and intervention feedback from participants. Compared to the sham group, participants receiving the active intervention did not show improved appointment attendance rates; however, did exhibit some improvements in aspects of engagement, including improved clinician-rated availability, attitude toward medication, positive symptoms, avolition-apathy and social functioning. Thus, contrary to our hypotheses, digitally augmented care did not result in enhanced engagement in EPI services, as measured by clinic attendance, although with some indication that it may contribute to improved attitude toward medication and, potentially, medication adherence. Weekly SMS text messaging appeared to result in a pattern of engagement whereby individuals who were improving clinically attended appointments less often, possibly due to inadvertent use of the intervention to check in with clinicians. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04379349).
MeSH term(s)	Adolescent ; Humans ; Young Adult ; Adult ; Text Messaging ; Cell Phone ; Pilot Projects ; Medication Adherence ; Psychotic Disorders/drug therapy
Language	English
Publishing date	2024-01-18
Publishing country	Netherlands
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	639422-x
ISSN	1573-2509 ; 0920-9964
ISSN (online)	1573-2509
ISSN	0920-9964
DOI	10.1016/j.schres.2024.01.012
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Zs.A 2351: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults.

Polillo, Alexia / Foussias, George / Wang, Wei / Voineskos, Aristotle N / Veras, Jacqueline / Davis-Faroque, Nicole / Wong, Albert H C / Kozloff, Nicole

JAMA network open

2023 Volume 6, Issue 9, Page(s) e2333526

Abstract: Importance: Broad efforts to improve access to early psychosis intervention (EPI) services may not address health disparities in pathways to care and initial engagement in treatment.: Objective: To understand factors associated with referral from ... ...

Abstract	Importance: Broad efforts to improve access to early psychosis intervention (EPI) services may not address health disparities in pathways to care and initial engagement in treatment. Objective: To understand factors associated with referral from acute hospital-based settings and initial engagement in EPI services. Design, setting, and participants: This retrospective cohort study used electronic medical record data from all patients aged 16 to 29 years who were referred to a large EPI program between January 2018 and December 2019. Statistical analysis was performed from March 2022 to February 2023. Exposures: Patients self-reported demographic information in a structured questionnaire. The main outcome for the first research question (referral source) was an exposure for the second research question (initial attendance). Main outcomes and measures: Rate of EPI referral from acute pathways compared with other referral sources, and rate of attendance at the consultation appointment. Results: The final study population included 999 unique patient referrals. At referral, patients were a mean (SD) age of 22.5 (3.5) years; 654 (65.5%) identified as male, 323 (32.3%) female, and 22 (2.2%) transgender, 2-spirit, nonbinary, do not know, or prefer not to answer; 199 (19.9%) identified as Asian, 176 (17.6%) Black, 384 (38.4%) White, and 167 (16.7%) other racial or ethnic groups, do not know, or prefer not to answer. Participants more likely to be referred to EPI services from inpatient units included those who were older (relative risk ratio [RRR], 1.10; 95% CI, 1.05-1.15) and those who identified as Black (RRR, 2.11; 95% CI, 1.38-3.22) or belonging to other minoritized racial or ethnic groups (RRR, 1.79; 95% CI, 1.14-2.79) compared with White participants. Older patients (RRR, 1.16; 95% CI, 1.11-1.22) and those who identified as Black (RRR, 1.67; 95% CI, 1.04-2.70) or belonging to other minoritized racial or ethnic groups (RRR, 2.11; 95% CI, 1.33-3.36) were more likely to be referred from the emergency department (ED) compared with White participants, whereas participants who identified as female (RRR, 0.51 95% CI, 0.34-.74) had a lower risk of ED referral compared with male participants. Being older (odds ratio [OR], 0.95; 95% CI, 0.90-1.00) and referred from the ED (OR, 0.40; 95% CI, 0.27-0.58) were associated with decreased odds of attendance at the consultation appointment. Conclusions and relevance: In this cohort study of patients referred to EPI services, disparities existed in referral pathways and initial engagement in services. Improving entry into EPI services may help facilitate a key step on the path to recovery among youths and young adults with psychosis.
MeSH term(s)	Humans ; Adolescent ; Female ; Male ; Young Adult ; Critical Pathways ; Cohort Studies ; Retrospective Studies ; Early Intervention, Educational ; Psychotic Disorders/epidemiology ; Psychotic Disorders/therapy
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.33526
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Article ; Online: Sex Differences in Suicide Trends Among Adolescents Aged 10 to 14 Years in Canada.

Mitchell, Rachel H B / Kozloff, Nicole / Sanches, Marcos / Goldstein, Benjamin I / Amini, Jasmine / Bridge, Jeffrey A / Sinyor, Mark

Canadian journal of psychiatry. Revue canadienne de psychiatrie

2023 Volume 68, Issue 7, Page(s) 547–549

MeSH term(s)	Humans ; Male ; Adolescent ; Female ; Sex Characteristics ; Suicide ; Sex Factors ; Canada/epidemiology
Language	English
Publishing date	2023-05-02
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	304227-3
ISSN	1497-0015 ; 0008-4824 ; 0706-7437
ISSN (online)	1497-0015
ISSN	0008-4824 ; 0706-7437
DOI	10.1177/07067437231173370
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Article ; Online: The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship.

Reid, Nadine / Buchman, Daniel / Brown, Rebecca / Pedersen, Cheryl / Kozloff, Nicole / Stergiopoulos, Vicky

Administration and policy in mental health

2022 Volume 49, Issue 6, Page(s) 1060–1071

Abstract: Purpose: Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to ... ...

Abstract	Purpose: Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to explore stakeholder perspectives on the acceptability of using financial incentives to promote service engagement among homeless adults with mental illness. Methods: As part of a larger mixed-methods pragmatic trial of a community-based brief case management program in Toronto, Canada, twenty-two trial participants were purposefully recruited to participate in semi-structured qualitative interviews, and five service providers and seven key informants were purposefully recruited to participate in a focus group and interviews, respectively. Topics included perspectives of acceptability and lived experiences of using financial incentives to support engagement, health and well-being. Data collection occurred between April 2019 and December 2020. Data was audio-recorded and transcribed. Coding and interpretation of data was informed by grounded theory and inductive thematic analysis. Results: Stakeholders held diverse views on the acceptability of financial incentives to promote service engagement in this population. Main themes across groups included moralizing recipient motivation; tensions in how best to define and respect autonomy; and consideration of potential unintended consequences for both individuals and the service system. Significant group differences within some themes emerged. Conclusion: Results highlight ongoing debates over using financial incentives to facilitate service engagement among adults experiencing homelessness and mental illness. Differences in stakeholder perspectives suggest the need for person-centredness in health and research settings, and balancing theoretical risks and long-term goals with likely potential for immediate benefits.
MeSH term(s)	Adult ; Humans ; Authorship ; Ill-Housed Persons ; Mental Disorders/therapy ; Motivation ; Qualitative Research
Language	English
Publishing date	2022-09-08
Publishing country	United States
Document type	Journal Article ; Pragmatic Clinical Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1025319-1
ISSN	1573-3289 ; 0894-587X
ISSN (online)	1573-3289
ISSN	0894-587X
DOI	10.1007/s10488-022-01217-y
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Article ; Online: Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives.

Reid, Nadine / Brown, Rebecca / Pedersen, Cheryl / Kozloff, Nicole / Sosnowski, Alexandra / Stergiopoulos, Vicky

Health expectations : an international journal of public participation in health care and health policy

2022 Volume 25, Issue 3, Page(s) 984–993

Abstract: Introduction: Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but ... ...

Abstract	Introduction: Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to support service engagement among adults experiencing homelessness and mental illness. Methods: This qualitative study is part of a larger mixed-methods pragmatic trial of financial incentives (Coordinated Access to Care for the Homeless-Financial Incentives [CATCH-FI]) within a community-based brief case management programme (CATCH) in Toronto, Ontario. Twenty-two CATCH-FI participants were purposefully recruited to participate in in-depth, semi-structured interviews; five CATCH service providers participated in a focus group and seven key informants in individual interviews. Data collection occurred between April 2019 and December 2020. All interviews and the focus group were audio-recorded and transcribed. Topic guides prompted participant perspectives on and experiences of using financial incentives to support engagement, health and well-being. Grounded theory and inductive thematic analysis guided coding and interpretation of transcripts. Triangulation and member-checking enhanced the analytical rigour and validity of findings. Results: CATCH service providers, key informants and subgroup of CATCH-FI participants perceived financial incentives to directly facilitate service engagement. The majority of CATCH-FI participants however highlighted that intrinsic motivation and service quality may be relatively more important facilitators of engagement. Most study participants across stakeholder groups perceived that financial incentives have direct positive influences on health and well-being in enabling access to basic needs and simple pleasures. Conclusions: Our data suggest that for some adults experiencing homelessness and mental illness, financial incentives can directly support service engagement. In addition, financial incentives may positively impact health and well-being by easing financial stress and enabling deeper attention to individual health needs. Further research on the effectiveness and acceptability of financial incentives is needed to improve understanding and uptake of a promising intervention to support health and health service use outcomes in an underserved population. Patient or public contribution: Study participants provided input into the study research questions, study design, interview guides and interpretation of findings.
MeSH term(s)	Adult ; Focus Groups ; Homeless Persons ; Humans ; Mental Disorders/epidemiology ; Mental Disorders/therapy ; Motivation ; Qualitative Research
Language	English
Publishing date	2022-02-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2119434-8
ISSN	1369-7625 ; 1369-6513
ISSN (online)	1369-7625
ISSN	1369-6513
DOI	10.1111/hex.13442
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