Did You Know?

Held annually in communities across Canada, Pink Shirt Day encourages people to take a stand against bullying and discrimination.

Also known as Anti-Bullying Day, the event asks participants to show their support by wearing pink to their schools and workplaces. This year’s official t-shirts feature the theme “Sprinkle Kindness” — a playful reminder that kindness grows when shared.

Pink Shirt Day organizers also promote kindness and inclusion through school outreach, offering a special 45-minute broadcast educators can sign up to receive. The broadcast is organized by WITS Foundation, a Canadian charity dedicated to creating safe environments for children and youth. Learn more on the Pink Shirt Day Canada website.

Events like Pink Shirt Day matter because the effects of bullying extend far beyond childhood. Being victimized early in life has been linked to anxiety, depression and suicidality, and studies show these mental health challenges can persist into middle age. To learn more about how bullying impacts child mental health, read Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.

Young people typically access opioids in one of three ways. Health practitioners may prescribe opioids, to address post-operative pain, for example. Some youth also take opioids that were prescribed to others, both with and without the others’ knowledge. As well, a small number of young people obtain opioids outside the health care system, including unregulated substances such as non-medical heroin or illegally manufactured fentanyl.

A survey of more than 1,000 American adolescents who had misused prescription opioids provides further insight regarding how these substances were obtained. The most common sources were friends or relatives. Similarly, an online survey of Canadians, including youth, found that 34% of those who had misused opioids obtained these substances from friends or relatives who had prescriptions.

For more information, see Vol. 18, No. 2 of the Children’s Mental Health Research Quarterly.

The Canadian Student Tobacco, Alcohol and Drug Survey has been providing data on past-year opioid misuse for students in Grades 7 to 12 since 2014. Its four surveys have shown that over time, heroin use has remained stable, with 0.5 to 0.8% of youth misusing this substance. Misuse of fentanyl and oxycodone also remained relatively stable, at around 1.0%. For other opioids — namely, morphine, codeine and/or Tylenol #3 (i.e., acetaminophen with codeine) — misuse rates were higher, ranging from 2.3 to 2.8%.

The BC Adolescent Health Survey also provides information on opioid misuse for students in Grades 7 to 12 in the province. Data from the 2023 survey, which included more than 38,000 youth, found that 1% reported ever using heroin, fentanyl or other opioids. The 2018 survey similarly found that 1% of youth reported ever using heroin (other opioids were not included in that survey).

For more information, see Vol. 18, No. 2 of the Children’s Mental Health Research Quarterly.

Findings from a systematic review by the Children’s Health Policy Centre highlight promising pathways for treating eating disorders among young people. For anorexia, Multifamily Therapy and Family Therapy led to 78% and 57% of participants, respectively, sustaining positive outcomes by six-month follow-up. Systemic Family Therapy coupled with treatment-as-usual (comprising individual care) also performed well — with 60% of participants sustaining positive outcomes by three-year follow-up. For bulimia, findings were somewhat more muted. Nevertheless, by one-year follow-up, Family-Based Treatment led to nearly 49% of participants sustaining positive outcomes, while Cognitive-Behavioural Therapy (CBT) led to nearly 39% sustaining improvements. While Canadian replication studies are needed, these findings suggest four implications for practice and policy:

• Include parents in the treatment when possible. The most successful treatments involved parents. For anorexia, these treatments included Multifamily Therapy, Family Therapy and Systemic Family Therapy. For bulimia, Family-Based Treatment also involved parents. Consequently, when treating an adolescent with either anorexia or bulimia, practitioners should engage parents whenever feasible.
• Consider CBT when family therapy is not an option. Some parents may not be able to participate in treatment with their children. But CBT for youth with bulimia can still lead to substantial benefits. As well, CBT is an effective treatment for adolescents with binge-eating disorder.
• Teach skills that can endure after treatment ends. Many of the aforementioned interventions led to positive outcomes months, or years, after treatment ended. Examples included Systemic Family Therapy, Multifamily Therapy and CBT, which taught skills young people could use on an ongoing basis. Skills-based interventions should therefore be a priority.
• Evaluate BC outcomes. Canadian replication studies are needed for programs that showed promise in other jurisdictions. So if programs are implemented in BC, they should be accompanied by outcome evaluation — to ensure that they also benefit other young Canadians.

For more information, see Vol. 18, No. 1 of the Children’s Mental Health Research Quarterly.

A randomized controlled trial found that cognitive-behavioural therapy (CBT) was an effective treatment for young people with binge-eating disorder. The treatment focused on helping youth develop consistent, moderate eating using self-monitoring and problem-solving, typically in eight sessions. Three months after treatment ended, 100% of youth who received CBT stopped engaging in binge eating, compared to 50% of those receiving regular care (which included any treatment services offered through their health maintenance organization, such as eating and weight-related services). This means that practitioners have viable treatment options for assisting youth with binge-eating disorder.

For more information, see Vol. 18, No. 1 of the Children’s Mental Health Research Quarterly.

Researchers set out to test the common belief that eating disorders primarily affect individuals from more advantaged socio-economic groups. They conducted a systematic review based on 62 studies, albeit with most not being limited to children and youth. The authors did not find a consistent relationship between socio-economic status and eating disorders. Rather, individuals with eating disorders came from a wide range of backgrounds. These authors therefore challenged the stereotype that eating disorders disproportionately affect those who are advantaged. This insight can help practitioners and policy-makers in ensuring that identification, assessment and treatment are inclusive of all young people.

For more information, see Vol. 18, No. 1 of the Children’s Mental Health Research Quarterly.

A systematic review of 14 studies from seven countries, including Canada, provides evidence that many young people with eating disorders experience lengthy waits for treatment. Among children aged 12 and younger, the average time from diagnosis to treatment was 9.8 months. For teens and adults combined, the comparable figure was 34.7 months. Both figures are far too high, particularly for young people.

Increased treatment needs during the pandemic have added to the challenges. A study of six Canadian pediatric hospitals found that treatment admissions for eating disorders rose sharply during the pandemic. Hospitalizations for new patients increased from 7.5 cases per month in the previous five years to 20.0 cases per month during the first pandemic wave. Similarly, a study measuring hospital use for eating disorders for all children and adolescents in Ontario found an increase immediately after the pandemic started, with levels remaining well above typical during the ensuing 10 months — including a 66% increased risk in emergency room visits for eating disorders and a 37% increased risk in being hospitalized for these conditions.

For more information, see Vol. 18, No. 1 of the Children’s Mental Health Research Quarterly.

A study that included all 1.3 million children born in Denmark from 1995 to 2016 provides unique data on when eating disorders typically emerge. The authors found that the peak age of onset for anorexia and bulimia was 15 years. They also found that the incidence of eating disorders for girls was more than six times the incidence for boys. Another survey, including more than 10,000 teens in a representative American sample, found slightly different results. These data showed younger ages of onset, namely, 12.3 years for anorexia, 12.4 for bulimia and 12.6 for binge-eating disorder. Despite these differing findings, both studies highlight the need for practitioners and policy-makers to ensure the availability of treatments for eating disorders among teens, including younger ones.

For more information, see Vol. 18, No. 1 of the Children’s Mental Health Research Quarterly.

A systematic review from the Children’s Health Policy Centre provides data on the proportion of young people aged 12 to 18 years who met diagnostic criteria for eating disorders — meaning that they had both symptoms and impairment. Prevalence was derived by combining findings from five rigorous original studies that assessed eating disorders in the population. All five included anorexia and bulimia while one included binge-eating disorder; however, none included avoidant/restrictive food intake disorder. The overall prevalence for eating disorders was 0.2%. This means that at any given time, approximately 700 youth in BC will meet diagnostic criteria for an eating disorder and therefore need treatment.

Still, this figure may underestimate the needs, given that it is derived from studies conducted before the COVID-19 pandemic. And evidence is emerging that eating disorder cases increased during the pandemic. For instance, a study of six Canadian pediatric hospitals found a sharp rise in cases among nine- to 18-year-olds early in the pandemic. Specifically, new diagnoses rose significantly, from 24.5 per month during the previous five years to 40.6 per month during the first wave of the COVID-19 pandemic (March through November 2020).

For more information, see Vol. 18, No. 1 of the Children’s Mental Health Research Quarterly.

A recent systematic review by the Children’s Health Policy Centre identified two programs that successfully prevented the onset of eating disorders for teen girls — one in a general population (Education Program) and one for those at risk (Body Project). These findings suggest the following recommendations for practice and policy.

• Invest in effective prevention programs. Both successful programs addressed an established risk factor for the development of eating disorders in teen girls — body dissatisfaction. As well, both taught skills for resisting social pressures to be thin. While replication studies are needed, these evaluations suggest that it is possible to prevent new cases of eating disorders and the suffering that accompanies them. Policy-makers in BC could support offering these successful examples, while evaluating the impact in local settings. Canadian studies evaluating new approaches and programs would also be helpful.
• Make use of virtual delivery’s added benefits. Virtual delivery allows programs to reach more young people in need, particularly in rural and remote communities. And the Body Project study suggests another potentially under-recognized benefit of virtual programs: recording the sessions allows young people to catch up on any missed content. This approach can not only improve program completion but also help young people integrate information on their own time.
• Sustain prevention efforts long term. Some programs included in the review showed that selected gains diminished over time. For example, Dissonance, a precursor program to Body Project, reduced dieting at one-year but not three-year follow-up, while the Body Project reduced self-reported eating disorder symptoms at six-month but not two-year follow-up. These findings suggest that some girls may benefit from booster sessions to ensure ongoing benefits.
• Address established risk and protective factors. The programs we reviewed focused on body dissatisfaction, a risk factor often first detected in adolescence. Yet, other factors can emerge earlier in childhood, including problematic eating patterns and high anxiety levels. Therefore, it may be possible to help more children by intervening in the early years. Intervening early should include offering effective anxiety prevention programs, such as those featured in our Effective Interventions report, to reduce this condition in and of itself and as a precursor to eating disorders. Practitioners can also bolster protective factors, including assisting with parent-teen relationships to improve closeness and relationship satisfaction.

Expanding efforts to prevent eating disorders is a crucial way to reduce the number of young people experiencing these conditions and the associated mental and physical stress and distress. Beyond helping young people achieve well-being and meet their potential, effective prevention efforts should also reduce later treatment costs by reducing the numbers in need. Given the benefits for individual children and families and for society, new prevention investments are therefore strongly warranted.

For more information, see Vol. 17, No. 4 of the Children’s Mental Health Research Quarterly.