Traumatic events spark other mental health challenges

A study of 2,000 Welsh and English youth at age 18, showed that young people who had faced trauma were at much higher risk of specific mental disorders. These included:

  • substance use disorder (other than alcohol or cannabis) — 3.5 times higher odds
  • conduct disorder — 2.3 times higher odds
  • cannabis use disorder — 2.3 times higher odds
  • generalized anxiety disorder — 2.2 times higher odds
  • depression — 2.2 times higher odds
  • attention-deficit/hyperactivity disorder — 1.9 times higher odds
  • alcohol use disorder — 1.5 times higher odds.
  • self-harm —3.5 times higher odds.
  • attempting suicide — 5 times higher odds
  • committing a violent offense — 1.5 times higher odds.

In a similar study with US youth, all traumatic exposures assessed were associated with up to double the risk for developing a substance use disorder. As well, exposure to interpersonal violence more than doubled the risk for girls developing conduct disorder. For more information, see Vol. 15, No. 1   of the Children’s Mental Health Research Quarterly.

Traumatic events affect a third or more of young people

Experiencing a significant injury. Witnessing the death of a loved one. Being sexually assaulted. These are just a few of the serious traumas children may experience, which are also commonly referred to as adverse childhood experiences. To support children who have experienced such extreme adversities, it is important to understand the prevalence of the problem. We identified two studies providing prevalence data, based on large, representative samples of young people. The first involved interviews with 2,000 Welsh and English youth at age 18. Some 31% reported experiencing at least one trauma during their lifetime.

The most frequent trauma was learning details about a traumatic event affecting someone close to them, without directly witnessing it (27.9%). Being assaulted or threatened with assault, including maltreatment by adults, was also common (21.5%). As well, many youth described experiencing significant accidents or illnesses (19.0%).

The second study involved interviews with nearly 6,500 American youth aged 13 to 17 years. In this study, 61.8% reported being exposed to at least one potentially traumatic event during their lifetime. Experiencing the unexpected death of a loved one was the most frequent trauma (28.2%), followed by experiencing disasters (14.8%) and witnessing death or injury (11.7%). Adding to this burden, 14.1% of youth reported experiencing two traumatic events, and 18.6% reported being exposed to three or more. For more information, see Vol. 15, No. 1 of the Children’s Mental Health Research Quarterly.

BC gov’t standing committee welcomes message about children’s mental health

Senior members of the Children’s Health Policy Centre (CHPC) team addressed the BC provincial government Select Standing Committee on Children and Youth on Dec. 5/22. This talk was given in collaboration with Jennifer Charlesworth, the BC Representative for Children and Youth.

The topic? How to reduce the number of children needing to come into government care while improving mental health outcomes for those who do.

Christine Schwartz, Simon Fraser University Adjunct Professor, and Charlotte Waddell, CHPC director, were the spokespeople. They shared key findings, including that parents who are at-risk for maltreating their children can be kept out of the government care system with effective interventions, such as the Nurse-Family Partnership program.

“BC policymakers need to be acknowledged for the substantial investments they’ve already made in keeping children with their parents by offering the Nurse-Family Partnership,” said Schwartz. “The program has proven success in supporting children and families.”

Schwartz also spoke about the mental health burdens experienced by children in care. She noted, “As a practicing psychologist, I’ve seen the connection between the trauma children in government care have experienced and the mental health burdens they still carry.”

Still, CHPC team stressed how children who end up in care can have their health needs met with well-proven prevention and treatment interventions such as cognitive-behavioural therapy for anxiety, depression and posttraumatic stress disorder.

How to treat young people with psychosis

Psychosis can cause great distress concerning symptoms and substantial costs for young people and their families and communities — including the costs of lost human potential when healthy development is interrupted. Research shows that interventions can mitigate the distress and symptoms, particularly if young people receive these early in the disorder’s course. The Children’s Health Policy Centre suggests three recommendations to guide the treatment of psychosis:

  1. Ensure careful assessment and diagnosis. Some causes of psychosis, such as substance use, are reversible. Some causes, such as seizures or infections, are also treatable. So, a first step is always to find out what is causing the presenting problem. Diagnosis can then guide treatment planning, for example, considering whether longer-term antipsychotic medications are needed, as with schizophrenia. After the diagnosis has been established, ongoing monitoring is also crucial to assess a youth’s symptoms, functioning and response to treatment, including any adverse effects.
  2. Use antipsychotic medications carefully. Antipsychotics are a mainstay in treating psychosis in young people — both short and long term. Aripiprazole and olanzapine stood out in this review, with two RCTs for each medication showing benefits in young people. Yet adverse events were common and severe, so both choice of medication and dosing need to be carefully monitored to ensure that benefits outweigh harms. Guidelines from the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children address monitoring for six antipsychotic medications, including aripiprazole and olanzapine. These guidelines need to be closely followed for any youth who is prescribed antipsychotics.
  3. Offer psychosocial interventions as well. All youth with psychosis should be offered early psychosis intervention (EPI) programs, as they lead to reduced hospitalizations and psychotic symptoms. EPI programs typically included a range of psychosocial interventions, such as cognitive behavioural therapy, social skills training and family interventions. As well, some youth will have challenges that antipsychotics do not address and these psychosocial interventions will likely benefit them, as well.

For more information, see Vol. 14, No. 4 https://childhealthpolicy.ca/wp-content/uploads/2020/11/RQ-14-20-Fall.pdf  of the Children’s Mental Health Research Quarterly.

Learning to prevent adverse childhood experiences

Nicole Catherine, Associate Director of the Children’s Health Policy Centre, and Canada Research Chair Tier 2 in Child Health Equity and Policy, gave a virtual presentation to a group of Fraser Health authority Community Health Specialists on Adverse Childhood Experiences on Dec. 1.

Titled Health and wellbeing: It starts with children, the presentation focused on findings from the BC Healthy Connections Project and a project underway with the Elizabeth Fry Society, Voices of EFry Mothers. Both projects involve learning from research data—provided by children and mothers in British Columbia—on how to prevent early childhood adversities.

“By preventing adverse childhood experiences, we can help ensure that all children have the best start in life and can reach their full potential,” Catherine said. The purpose of the talk was to establish further research collaborations between the Centre and Fraser Health on new early childhood research initiatives.

Her 20-minute talk was followed by a lively question-and-answer session and an invitation to collaborate on new initiatives to better support underserved children and mothers.

Can psychosocial interventions help with psychosis?

Psychosocial interventions for psychosis may be helpful when used along with antipsychotic medications. For example, the programs Cognitive Remediation Therapy and Computer-Assisted Cognitive Remediation both improved selected cognitive skills, and the Think Program reduced emergency room visits for mental health concerns. But additional studies are still needed to expand treatment options. For example, a form of cognitive-behavioural therapy (CBT) shows promise with first-episode psychosis, according to a recent pilot study in youth aged 14 to 18 years. This form of CBT involved setting individual goals and helping young people achieve them. Although too few youth were recruited to definitively assess the impact, initial findings suggested that CBT may reduce psychotic symptoms. Further evaluation of CBT is therefore warranted. Expanding the psychosocial treatment options for youth with psychosis is particularly important given the severe side effects of antipsychotic medications. For more information, see Vol. 14, No. 4  of the Children’s Mental Health Research Quarterly.

CHPC team member named co-investigator on digital child mental health initiative

Associate Director of the Children’s Health Policy Centre, Nicole Catherine — who has recently been named Canada Research Chair Tier 2 in Child Health Equity and Policy — is a co-investigator for a new mental health initiative know as DIVERT.

The Digital, Inclusive, Virtual, and Equitable Research Training is a trans-disciplinary mental health online training platform dedicated to improving child mental health research and practice in Canada. DIVERT aims to improve inclusion and increase accessibility for underserved children and families.

The national team is funded primarily by a multi-million-dollar investment from the Canadian Institutes of Health Research and enabled by a multi-million-dollar investment in digital infrastructure and expertise from IBM Canada.

DIVERT aims to harness the knowledge of a diverse range of educators so they can all learn together through online connections, national mentorship groups based on lived experiences, research collaborations (with children, families, industries, Non-Governmental Organizations and health care organizations), annual in-person meetings, and the future evolution of a certificate program. Anyone can join DIVERT Mental Health. Doctoral students, post-doctoral trainees and early career researchers conducting research on digital child mental health are encouraged to apply.

Building on her research expertise, Catherine will be mentoring three trainees and providing lectures on child health equity and policy and on efforts to better support underserved children and families.

Medication studies for psychosis raise concerns

The Children’s Health Policy Centre found two studies for medications for psychosis — aripiprazole and olanzapine — each suggesting benefits, with aripiprazole leading to greater remission rates. Yet both medications also led to adverse events that require close monitoring. Our review of medications has two concerning implications that should be addressed in future research. First, neither of these medication studies was conducted at arm’s length from the drug manufacturers. Future studies need to be conducted independently, particularly given the safety profiles of antipsychotics. Second, we did not find any evidence from randomized controlled trials meeting our criteria for risperidone (brand name Risperidal), which is commonly prescribed for young people. Other researchers have raised concerns about the poor quality of trials on risperidone (and other antipsychotics). It is therefore important that new trials be conducted to expand the evidence on effective medications for treating young people who have psychosis. For more information, see Vol. 14, No. 4  of the Children’s Mental Health Research Quarterly

CHPC team member named co-investigator on digital child mental health initiative

Associate Director of the Children’s Health Policy Centre, Nicole Catherine — who has recently been named Canada Research Chair Tier 2 in Child Health Equity and Policy — is a co-investigator for a new mental health initiative know as DIVERT.

The Digital, Inclusive, Virtual, and Equitable Research Training is a transdisciplinary mental health online training platform dedicated to improving child mental health research and practice in Canada. DIVERT aims to improve inclusion and increase accessibility for underserved children and families.

The national team is funded primarily by a multi-million-dollar investment from the Canadian Institutes of Health Research and enabled by a multi-million-dollar investment in digital infrastructure and expertise from IBM Canada.

DIVERT aims to harness the knowledge of a diverse range of educators so they can all learn together through online connections, national mentorship groups based on lived experiences, research collaborations (with children, families, industries, Non-Governmental Organizations and health care organizations), annual in-person meetings, and the future evolution of a certificate program. Anyone can join DIVERT Mental Health. Doctoral students, post-doctoral trainees and early career researchers conducting research on digital child mental health are encouraged to apply.

Building on her research expertise, Catherine will be mentoring three trainees and providing lectures on child health equity and policy and on efforts to better support underserved children and families.

Child heath policy researcher earns major award

Nicole Catherine has been officially been named Canada Research Chair (CRC) Tier 2 in Child Health Equity and Policy. And, with this announcement, she has also become the new Associate Director of the Children’s Health Policy Centre.

The announcement of her CRC appointment, which was made yesterday in Ottawa, is highly significant and a tremendous honour. The CRC program provides universities with the opportunity to recruit world-class scholars who are emerging global leaders in their field.

Catherine joined the CHPC team in 2012 when she was named Scientific Director, and later Co-Principal Investigator, for the BC Healthy Connections Project. She became the Mowafaghian University Research Associate in 2013 and was appointed Assistant Professor in the Faculty of Health Sciences at SFU in 2022.

Catherine’s research to date has focused on three areas:

  • Ensuring better inclusion of children who are experiencing disadvantage — in both research and policy-making
  • Promoting health and wellbeing in early childhood through public health programming
  • Informing the development and evaluation of interventions that address avoidable early childhood adversities and health inequities.

“I continue to be inspired by the children and young mothers who generously contribute to this research,” Catherine said in reflecting on her award.

CHPC director Charlotte Waddell, had an enthusiastic response to the announcement. “I find Nicole’s commitment to scholarship and to children to be exemplary,” she said. “And she could not be a more creative and supportive person to work with. We are thrilled with this news.”

A story on Catherine can also be found on the website of SFU’s Faculty of Heath Sciences.