e-Posters – Early Investigator

e-Posters will be available at all times during the conference. Delegates can view them on monitors stationed throughout the conference space or on their personal smart phone, laptop, tablet, or desktop.

e-Poster – Early Investigator
PE01 – A Qualitative Study of the Effectiveness of a Cascading Mentorship Model in Developing CanMEDS Competencies in Postgraduate Medical Education
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Mitesh Patel*, MD; Tina Guo, MD; Mushfika Chowdhury, HBSc; Rahna Rasouli, BSc

CanMEDS Roles:

  1. Health Advocate
  2. Scholar
  3. Collaborator

At the end of this session, participants will be able to: 1) Define a cascading mentorship model; 2) Identify how a cascading mentorship model furthers CanMEDS competencies in postgraduate medical education initiatives; and 3) Consider how to integrate a cascading mentorship model into other postgraduate medical education initiatives for residents across all disciplines.

The CanMEDS framework defines competencies that physicians require to meet patients’ needs, all of which can be cultivated through mentorship activities. The Advocacy Mentorship Initiative (AMI) at the University of Toronto uses a cascading mentorship model (CMM), whereby resident mentors (RMs) mentor undergraduate medical student mentors (MSMs), who in turn mentor youth raised in at-risk environments. Both RMs and MSMs are mentored by the AMI program lead, a staff psychiatrist.

Objective: This qualitative study aims to identify the merits of using a CMM to enhance competencies in RMs.

Methods: RMs involved in AMI from January 2017 to December 2020 were invited to participate in the study. Interviews were conducted to canvas participants about how AMI impacted them, and these were recorded, transcribed, and anonymized. Braun and Clarke’s approach to thematic analysis was used to identify mid-level “sub-themes” and high-level “themes.”

Results: Eleven RMs participated in the study. A major theme identified was how AMI enhanced the medical learner experience by augmenting the educational experience of MSMs, cementing RMs’ values and attitudes and cementing RMs’ knowledge and competencies. The second theme captured was the effective facets of a mentorship program in AMI, including the CMM, and collaborative and inclusive relationships between mentors and mentees.

Conclusion: RMs identified that the CMM of AMI cultivated CanMEDS competencies in medical learners, deepened medical learners’ understanding of social determinants of health, and offered a bidirectional approach to teaching and learning between MSMs and RMs. MSMs and RMs also learned from the staff psychiatrist.

References:

  1. Kafai Y, Griffin J, Burke Q, et al. A cascading mentoring pedagogy in a CS service learning course to broaden participation and perceptions. In: Proceedings of the 44th ACM technical symposium on computer science education – SIGCSE ’13. Denver (C): ACM Press; 2013.
  2. Patel M, Aitken D, Xue Y, et al. An evaluation of cascading mentorship as advocacy training in undergraduate medical education. BMC Med Educ 2021;21:65.

e-Poster – Early Investigator
PE02 – A Scoping Review on Barriers to Mental Health Care in Canada from the Perspectives of Health Care Providers
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Jeffrey Wang*, BSc; Andrew Olagunju, MD; Stanislav Pasyk, MD

CanMEDS Roles:

  1. Health Advocate
  2. Communicator
  3. Scholar

At the end of this session, participants will be able to: 1) Understand various barriers to adequate mental health care; 2) Highlight the importance of intrasystemic challenges to mental health care; and 3) Identify key areas for improvement and gain new ideas for streamlining service collaboration and efficiency.

Mental illness is among the leading causes of disability globally, yet the treatment gap is wide, even for developed countries. The perspectives of end users and mental health providers are critical to understanding barriers to adequate mental health care and developing scalable interventions that improve access and quality of services; however, the views of providers are relatively understudied, precipitating our review to gauge their perspectives on the barriers to mental health care in Canada.

Methods: We searched Medline or PubMed and PsychINFO for Canadian studies published from 2000–2021 with terms for mental health, barriers, and referrals. Included studies were evaluated with the National Institutes of Health Study Quality Assessment Tools and Critical Appraisal Skills Programme.

Results: A total of 631 papers were screened, and 20 studies, including 13 qualitative, 1 cross-sectional, 1 retrospective, and 5 mixed-methods were eligible. Through inductive content analysis, five themes of barriers emerged: 1) patient accessibility (19% of studies), 2) health systems availability and complexity (31%), 3) training and education (25%), 4) work conditions (21%), and 5) cultural sensitivity (4%). Among barriers discussed, common issues included lack of resources for both patients and providers, gaps in continuing education for primary care providers, and health system challenges, such as difficulty securing referrals, unclear intake criteria, and confusion due to contacts overload.

Conclusion: Health systems face a multifaceted set of challenges to improving access to mental health care that will require solutions from various stakeholders. Understanding these barriers is critical in focusing on initiatives to improve mental health care, both in Canada and in similar countries.

References:

  1. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013;382:1575–86.
  2. Kohn R, Saxena S, Levav I, et al The treatment gap in mental health care. Bull World Health Organ 2004;82:858–66.

e-Poster – Early Investigator
PE03 – Code Status Conversations in Psychiatry
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Andrew Lee*, MD; Elyse Platt, MD, MA, BAH

CanMEDS Roles:

  1. Health Advocate
  2. Scholar
  3. Professional

At the end of this session, participants will be able to: 1) Understand current national and hospital guidelines regarding code status conversations; 2) Review current literature regarding how to have code status conversations in psychiatry; and 3) Explore ethical considerations regarding code status conversations and suicidality.

Code status conversations, or goals of care conversations, are conversations clinicians have with their patients regarding what kinds of treatment or resuscitation measures the patient would like if their heart were to stop beating – this can include CPR, breathing assistance, and intubation or ventilation. According to many hospital guidelines, it is expected that the most responsible physician has a conversation with their patients about their goals of care after admission to hospital and reviews their preferences when there are changes to the patient’s medical condition. These recommendations are not specific to patients admitted to hospital for medical reasons but apply to patients admitted to psychiatry as well. Despite this lack of specificity, clinicians are not having goals-of-care conversations with their patients admitted under psychiatry nearly as often as patients admitted under medicine. We seek to understand reasons for this discrepancy. We hypothesize that factors of relative medical stability, capacity, and suicidality may contribute to the lack of code status conversations for psychiatry patients. We will explore some of the ethical and epistemic challenges of discussing end-of-life care with an acutely suicidal patient. We will look into the justifications for suicide prevention and examine how these come to bear on resuscitation efforts after suicide attempts. We will conclude that more research, education, and guidelines should be available to clinicians so they can engage in code status conversations with their psychiatric patients more effectively.

References:

  1. Warren MB, Lapid MI, McKean AJ, et al. Code status discussions in psychiatric and medical inpatients. J Clin Psychiatry 2015;76(1):49–53.
  2. McKean AJ, Lapid MI, Geske JR, et al. The importance of code status discussions in the psychiatric hospital: results of a single site survey of psychiatrists. Acad Psychiatry 2015;39:200–3.

e-Poster – Early Investigator
PE04 – Comparison of Extrapyramidal Symptoms Among Patients with Schizophrenia on Long-Acting Injectable Antipsychotics
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Tommy Han*, Bsc(H); Gabrielle Huneault, Bsc; Preet Gujral, Honours Bsc; Dana Ghanem, Bsc; Naista Zhand, MD
Supported by the Psychopharmacology Section

CanMEDS Role:

  1. Medical Expert

At the end of this session, participants will be able to: 1) Identify and evaluate which antipsychotic medication was associated with the most risk of extrapyramidal symptoms; 2) Describe the difference between extrapyramidal profiles of three classes of antipsychotic medications; and 3) List the extrapyramidal symptoms associated with taking anti-psychotic medications.

Extrapyramidal symptoms (EPSs) are adverse effects of antipsychotics and negatively impact patients’ social or motor functioning. Second-generation antipsychotics (SGAs), first-generation antipsychotics (FGAs), and partial D2 agonist antipsychotics are associated with EPS. Further, long-acting injectable formulations (LAIs) have been associated with a higher risk of EPS compared to oral counterparts. This study will assess EPSs in a clinical sample of schizophrenia patients who are taking LAIs and compare the severity of EPSs among the following three antipsychotic groups: 1) partial agonists, 2) SGAs, and 3) FGAs. Ninety-two patients were recruited. Using the Extrapyramidal Symptom Rating Scale (ESRS), severity of EPS was assessed among the three groups and information regarding factors associated with risk of EPS, including co-prescriptions, comorbidities, and demographics, were obtained from medical charts. Group differences in ESRS scores and subscores were analyzed with one-way ANOVAs. Among three groups of LAIs, there was no significant difference between total ESRS scores [F(2,89) = 0.892, p = 0.413] and ESRS subscores. Risperidone was associated with higher ESRS scores (p = 0.019) when compared to paliperidone, aripiperazole, and flupenthixol. Our results suggest doses above the maximum of paliperidone were commonly used (48.78%) and there was no significant difference in total ESRS scores between the low, average, or above-maximum doses of paliperidone [F(2,38) = 1.001, p = 0.37)]. Our results demonstrated a comparative risk of EPSs across all three antipsychotic classes. Risperidone was associated with more EPS compared to other medications. A higher threshold for the “maximum dose” of paliperidone could be considered and higher doses used with the same cautions as low-average doses.

References:

  1. Chouinard G, Ross-Chouinard A, Annable L, et al. The Extrapyramidal Symptoms Rating Scale. Can J Neurol Sci 1980;7:233–44.
  2. Park S-C, Choi MY, Choi J, et al. Comparative Efficacy and Safety of Long-acting Injectable and Oral Second-generation Antipsychotics for the Treatment of Schizophrenia: A Systematic Review and Meta-analysis. Clin Psychopharmacol Neurosci. 2018;16(4):361-375. doi:10.9758/cpn.2018.16.4.361.

e-Poster – Early Investigator
PE05 – Facilitating Psychotherapy Delivery in Primary Care Through App-Based Psychotherapy Skills Education
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Connie Li*, BSc(H); Noel Amaladoss, MD

CanMEDS Roles:

  1. Health Advocate
  2. Medical Expert
  3. Communicator

At the end of this session, participants will be able to: 1) Identify the increasing demand for psychotherapy delivery in primary care settings, including family medicine practice; 2) Provide examples of how to distill evidence-based psychotherapy interventions into tangible, discrete skills to encourage their implementation; and 3) Consider the role of technology in psychiatry education and in disseminating psychotherapy skills.

Over 50% of patients with psychiatric concerns seek treatment from their family physician, typically without additional specialist involvement. While evidence favours the combination of psychotherapy and pharmacology over monotherapy for a number of mood and anxiety disorders, including major depressive disorder, bipolar disorder, and panic disorder (1), psychotherapy training is not a formal component of family medicine residency programs in Canada. Through the development of a mobile application, we aim to promote accessible psychotherapy education.

Methods: The mobile application will comprise essential psychotherapy skills, identified through a needs-based assessment completed by family medicine residents. This assessment will aid in generating a body of core psychotherapy content, with specific consideration of multicultural perspectives. Content review will be conducted with psychiatrists. In collaboration with students of McMaster’s integrated biomedical engineering program, this content will be translated into an application interface. Accreditation for continuing medical education (CME) credits will be sought following the development of this mobile application-based education tool.

Objectives/Results: The objective of this study is to distill psychotherapy interventions into concrete step-by-step skills and leverage technology to deliver these skills to trainees. Ultimately, we aim to promote the incorporation of psychotherapy into primary practice. Subsequent to application development, we will assess family medicine residents’ self-perceived competency in delivering psychotherapy. Filling this gap in family medicine training will help make psychotherapy a mainstay of primary care.

References:

  1. Huhn M, Tardy M, Spineli LM, et al. Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses. JAMA Psychiatry 2014;71:706–15.
  2. Lin E, Goering P, Offord DR, et al. The use of mental health services in Ontario: epidemiologic findings. Can J Psychiatry 1996;41:572–7.

e-Poster – Early Investigator
PE06 – Impact of Co-Occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Lia Gentil*, PhD
Supported by the Community Psychiatry Section

CanMEDS Roles:

  1. Collaborator
  2. Professional
  3. Medical Expert

At the end of this session, participants will be able to: 1) Estimate the risk of frequency of emergency department use and hospitalization for mental health (MH) reasons; 2) Learn how mental disorders and chronic physical illness, versus mental disorders alone, impact emergency department use and hospitalization for MH reasons; and 3) Compare patients with mental disorders and patients with mental disorders plus chronic illness in emergency department use and hospitalization.

Patients with mental disorders (MDs) are at higher risk of experiencing a wide range of chronic physical illnesses (CPIs) that may result in more acute care. This study estimated the risk of frequency of emergency department (ED) use and hospitalization for mental health reasons among 1,999 patients with MDs alone, compared with 678 patients with MD plus CPI (MD-CPI).

Methods: Patients visiting one of six Quebec EDs for MH reasons and with a new onset MD in 2014–2015 (index visits) were included. Negative binomial models comparing these two groups estimated the risk of frequent ED use and hospitalization at 12-month follow up to ED index visits, controlling for key clinical, sociodemographic, and service use variables.

Results: Patients with MD-CPIs with more severe overall clinical conditions and receiving more intensive specialized MH care were at higher risk for frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner consultations protected against hospitalization. Patients aged 65 years and over had lower risk of ED use, whereas risk of hospitalization was higher for the group aged 45 to 64 years, versus patients aged 12 to 24 years; risk was higher for men than women.

Conclusion: Strategies that may be implemented to improve adequacy of care for patients with MD-CPIs or for those with MD only with more severe clinical profiles include assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care. Prevention and outreach strategies may be promoted, especially among men and older age groups.

References:

  1. Chiu YM, Vanasse A, Courteau J, et al. Persistent frequent emergency department users with chronic conditions: a population-based cohort study. PLoS One 2020;15(2):e0229022.
  2. Razzano LA, Cook JA, Yost C, et al. Factors associated with co-occurring medical conditions among adults with serious mental disorders. Schizophr Res 2015;161:458–64.

e-Poster – Early Investigator
PE07 – Interest in Rural Training Experiences in a Canadian Psychiatry Residency Training
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Jacquelyn Paquet*, MD, BScN, BSc; Vincent Agyapong, MD, PhD; Pamela Brett-MacLean, PhD; Katharine Hibbard, MD, MSc

CanMEDS Roles:

  1. Health Advocate
  2. Collaborator

At the end of this session, participants will be able to: 1) Identify the barriers to rural psychiatric training in Canada; 2) Identify strategies to incorporate rural training; and 3) Identify the current innovation to address unmet needs of rural communities.

With most mental health professionals concentrated in urban settings, people living in rural and remote areas face significant barriers to accessing mental health care. Recognizing that early training exposure is associated with practice in rural and remote locations, we sought to obtain baseline data regarding interest in expanded rural residency training opportunities.

Methods: In March 2021, all psychiatry residents at the University of Alberta (UofA) were invited to complete a 19-item survey that included both closed-ended (age, gender, year of study, rural experience, interest in rural training, etc.) and open-ended questions (challenges, etc.).

Results: Thirty-six residents completed the survey (response rate, 75%). Significant associations were identified between previous rural training experience and interest in rural psychiatry training and practice. Female residents and junior residents were significantly more interested in rural training experiences than their counterparts. Various concerns about rural training and ideas for enhancing rural psychiatry training were described.

Conclusions: These findings have provided the University of Alberta psychiatry residency program with directions for developing training opportunities, including early rural exposure, and introducing formal academic teaching focused on rural psychiatry. Further, senior core opportunities and electives are being explored to promote longitudinal and graduated exposure and responsibility. This effort is being undertaken to support our responsiveness and accountability to the rural and northern communities we are committed to serving.

References:

  1. Health Canada. Canada Health Act: Annual Report 2019–2020. Ottawa (ON): Government of Canada Publications; 2021 [cited 2022 Mar 19]. Available from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/canada-health-act-annual-report-2019-2020.html#c1.
  2. Hodges B, Rubin A, Cooke RG, et al. Factors predicting practice location and outreach consultation among University of Toronto psychiatry graduates. Can J Psychiatry 2006;51:218–25.

e-Poster – Early Investigator
PE08 – Motivations, Perceptions, and Effects of Cannabis Use in People with Mood and Anxiety Disorders
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Ankita Das*, MSc(c); Stefan Kloiber, MD, FRCPC

CanMEDS Role:

  1. Communicator

At the end of this session, participants will be able to: 1) Gain the ability to critically analyze and compare findings from the review with those from the mixed-methods study; 2) Gain the ability to effectively demonstrate the findings in a clear, concise manner; and 3) Take part in meaningful academic conversations.

Cannabis use is common in people with mood and anxiety disorders, the most prevalent mental health conditions in Canada and worldwide. In the era of cannabis legalization, medical cannabis programs, and a variety of available cannabis products in Canada, there is controversy and uncertainty about the potential risks and benefits of cannabis in such people.

Objective: We conducted a systematic review of the current scientific literature on perceptions, motivations, knowledge, and effects of cannabis use in people with mood and anxiety disorders and compared the results with data from a clinical study, using a mixed-methods approach, to assess perceptions and patterns of cannabis in this patient population.

Methods: Literature was searched in the PubMed database.

Results: A total of 72 articles met the inclusion criteria. Cannabis use appeared to provide symptom relief for mood disorders but seemed to exaggerate depressive symptoms over time. Most self-reported reasons for cannabis use were coping with negative affect and sleep problems. In contrast, those with social anxiety expected greater cognitive and behavioural impairment from cannabis use. Some veterans with post-traumatic stress disorder (PTSD) reported reasons related to the relief of side effects of psychotherapy medication to facilitate social competency and for direct confrontation of the source of trauma. Medical users reported failing to meet responsibilities because of use and problems with concentration or memory after use.

Conclusion: The results emphasize the importance of targeting coping motives as an essential treatment for all people with mood disorders. Results from this review are highly relevant to policy, prevention strategies, and clinical practice.

References:

  1. Bonn-Miller MO, Babson KA, Vandrey R. Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug Alcohol Depend 2014;136:162–5.
  2. Glodosky, N. C., & Cuttler, C. (2020). Motives Matter: Cannabis use motives moderate the associations between stress and negative affect. Addict Behav, 102, 106188. doi:10.1016/j.addbeh.2019.106188 Glodosky, N. C., & Cuttler, C. (2020). Motives Matter: Cannabis use motives moderate the associations between stress and negative affect. Addict Behav, 102, 106188. doi:10.1016/j.addbeh.2019.106188 Glodosky NC, Cuttler C. Motives matter: cannabis use motives moderate the associations between stress and negative affect. Addict Behav 2020;102:106188.

e-Poster – Early Investigator
PE09 – Professional and Evidence-Informed Innovation Supporting Child and Adolescent Psychiatry Training in Equity, Diversity, and Inclusion Principles
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Nikhita Singhal*, MD; Jenny Chum, MD; Catherine Deschênes, MD; Ayan Dey, MD; Jude Sanon, BSc; Yezarni Wynn, MD; Arfeen Malick, MD; Raj Rasasingham, MD; Chetana Kulkarni, MD

CanMEDS Roles:

  1. Health Advocate
  2. Scholar
  3. Collaborator

At the end of this session, participants will be able to: 1) Develop an awareness of systemic social inequities in child and youth mental health care; 2) Appreciate the need for dedicated training in equity, diversity, and inclusion principles; and 3) Explore innovative, evidence-informed approaches to addressing learning gaps and consider opportunities for adapting educational offerings.

The current social climate has brought attention to historic and systemic inequities impacting child and youth mental health. Despite this, equity, diversity, and inclusion (EDI) principles have not been a major component of Canadian child and adolescent psychiatry (CAP) training. Recognition of this gap provides an educational opportunity to bridge the disconnect between clinical work and health/social inequities with the aim of improving clinical care. Our objective is thus to develop and evaluate a series of evidence-informed virtual educational modules focused on EDI themes relevant to CAP. This project will begin with an environmental scan or needs assessment of national CAP EDI curricula (including a sampling of program directors, past and present psychiatry residents, and people with lived experience in the mental health system). This process will also involve exploring perceived EDI learning needs, including facilitators, barriers, and motivation for change within the various programs. Following this, we will co-design and co-develop a series of online learning modules addressing CAP EDI educational gaps identified through the aforementioned needs assessment. We will then pilot test, evaluate, and iteratively fine-tune these modules using Kirkpatrick’s levels of training criteria. This will be followed by local and national dissemination, with the goal of promoting EDI teaching and learning among postgraduate trainees in CAP (and the potential to adapt these modules to make them more broadly applicable to training and continuing education for various interdisciplinary health care professionals).

References:

  1. Fante-CoIeman T, Jackson-Best F. Barriers and facilitators to accessing mental healthcare in Canada for black youth: a scoping review. Adolescent Res Rev 2020;5:115–36.
  2. Medlock M, Weissman A, Wong SS, et al. Racism as a unique social determinant of mental health: development of a didactic curriculum for psychiatry residents. MedEdPORTAL 2017;13:10618.

e-Poster – Early Investigator
PE10 – Psilocybin’s Mechanism of Action in the Treatment of Depression
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Harrison Lee*, MD; Vivian Tsang, MD; Brandon Chai; Michelle Lin

CanMEDS Roles:

  1. Scholar
  2. Medical Expert
  3. Collaborator

At the end of this session, participants will be able to: 1) Identify the major mechanisms of action psilocybin has on the body and how it relates to depression; 2) Recognize the benefits of having multiple types of imaging in determining the effects psilocybin has on the body; and 3) Describe psilocybin’s role as an antidepressant and explain the advantages and disadvantages of using it as a treatment option.

Emerging evidence suggests that psilocybin has therapeutic benefits for treating depression. However, there is little consensus over the mechanism in which psilocybin elicits antidepressant effects. This systematic review summarizes the existing evidence of the mechanism of action (MOA) with which psilocybin alleviates depressive symptoms.

Methods: Ovid, MEDLINE, EMBASE, psychINFO, and Web of Science were searched, using MeSH terms and free text keywords in September 2021. The search included human and animal studies available in English and necessitated the testing of psilocybin’s MOA. Only antidepressant effects were considered. Two independent researchers screened all stages of the review, with a third researcher resolving conflicts. PROSPERO registration number is 282710.

Results: The search identified 2,193 papers and 49 were selected for full-text review. Of the 14 included papers, the most common proposed MOAs were as follows: changes in serotonin or glutamate receptor activity; altered amygdala and prefrontal cortex blood flow; changes in functional connectivity or neurotransmission within the hippocampus or prefrontal cortex; increases in synaptogenesis in medial frontal cortex and hippocampus.

Discussion: There appears to be a consensus over the neuroreceptors, neurotransmitters, and key areas of the brain involved in synaptogenesis; however, the exact MOA for psilocybin remains contested. Psilocybin appears to decrease cerebral blood flow to the amygdala but evidence on changing functional connectivity is lacking. The lack of consensus suggests that psilocybin’s MOA is complex, involving several pathways. Further studies are needed to characterize the MOA to better understand its clinical antidepressive effects.

References:

  1. Muttoni A, Ardissino M, John C. Classic psychedelics for the treatment of depression and anxiety: a systematic review. J Affect Disord 2019;258:11–24.
  2. Kuypers K. The therapeutic potential of microdosing psychedelics in depression. Therapeutic advances in psychopharmacology 2020;10:2045125320950567.

e-Poster – Early Investigator
PE11 – Substance Use, Racial Discrimination, Resilience, and Religiosity in Black People in Canada
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Elisabeth Dromer*; Jude Mary Cenat; Emmanuelle Auguste; Wina Paul Darius; Rose Darly Dalexis; Cary Kogan; Mireille Guerrier
Supported by the Addiction Psychiatry Section

CanMEDS Roles:

  1. Health Advocate
  2. Communicator
  3. Leader

At the end of this session, participants will be able to: 1) Know the prevalence of substance use in Black people in Canada; 2) Understand risk factors for substance use in Black people in Canada; and 3) Understand protective factors for substance use in Black people in Canada.

Despite evidence that Black people are confronted with various types of racial discrimination that put them at risk for alcohol and substance use disorders, no study in Canada has assessed the prevalence and factors related to substance use in Black communities. The purpose of this study was to fill this knowledge gap.

Methods: Black people in Canada completed questionnaires assessing substance use (alcohol, cannabis, and other drugs), everyday racial discrimination, resilience, religious involvement, and sociodemographic information. Multivariable regression analyses were used to determine factors related to substance use among Black people.

Results: The findings showed that 12.3% (95% confidence interval [CI] 9.64 to 15.01) of the participants met the criteria for a substance use disorder (alcohol, cannabis, and other drugs) in the past 12 months. Men and participants aged 15 to 24 years experienced significantly higher prevalence of substance use disorders compared to women and participants aged 25 and older (24.1% vs. 7.60%; ?2 = 29.95, p < 0.001; 4.38% vs. 14.81%; ?2 = 10.50, p < 0.001, respectively). Everyday racial discrimination (ß = 0.37, p < 0.001) and place of birth (born in Canada, ß = 0.18, p < 0.001) positively predicted substance use disorder, whereas religiosity, resilience, and gender (being a female) were negative predictors (ß = –0.11, p < 0.005; ß = –0.21, p < 0.001; ß = –0.12, p = 0.002).

Conclusion: Racial discrimination is associated with substance use among Black people in Canada. The study findings inform potential prevention and intervention strategies by examining protective factors related to substance use (religiosity, resilience, and gender) among Black people.

References:

  1. Metzger IW, Salami T, Carter S, et al. African American emerging adults’ experiences with racial discrimination and drinking habits: the moderating roles of perceived stress. Cultur Divers Ethnic Minor Psychol 2018;24:489–97.
  2. Cénat JM, Hajizadeh S, Dalexis RD, et al. Prevalence and effects of daily and major experiences of racial discrimination and microaggressions among Black individuals in Canada. Forthcoming. J Interpers Violence 2021;Jun 13.

e-Poster – Early Investigator
PE12 – The Effects of Income Inequality and Abortion Policies on the Prevalence of Postpartum Depression in 40 Countries
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Pablo Martinez*, PhD; José Ignacio Nazif-Munoz, PhD; Christophe Huynh, PhD

CanMEDS Role:

  1. Scholar

At the end of this session, participants will be able to: 1) Consider structural social determinants when discussing variations in the prevalence of postpartum depression across countries; 2) Understand the interactions between income inequality and abortion policies on postpartum depression prevalence across countries; and 3) Judge how these social determinants should be considered when discussing strategies to lower the prevalence of postpartum depression.

Although postpartum depression (PPD) has been associated with income inequality and abortion policies, the interaction between these social determinants and PPD remains unknown. This study explored the interaction between income inequality and abortion policies on PPD.

National estimates of PPD prevalence, based on the Edinburgh Postnatal Depression Scale, World Bank data on income inequality, and abortion policies per the Center for Reproductive Rights, were considered for 40 low-, middle-, and high-income countries. Abortion policies were coded as restrictive (to save the woman’s life) and non-restrictive (e.g., to preserve health, based on broad socioeconomic grounds, or on request). A meta-regression framework was used. In countries with non-restrictive abortion policies, 10-point increases in income inequality correlated with higher PPD prevalence (β = 0.07, 95% confidence interval [CI] 0.04 to 0.09). In countries with low-income inequality, restrictive abortion policies correlated with increased PPD prevalence, compared to non-restrictive abortion policies (β = 0.27, 95% CI 0.06 to 0.47). For every 10-point increase in income inequality, the effects of abortion policies on PPD prevalence decreased (β for interaction term = –0.06, 95% CI –0.11 to –0.01). The model accounted for 63.98% of the variance in PPD prevalence. Results were robust to sensitivity analyses.

Income inequality and abortion policies should be jointly considered when discussing structural social determinants of PPD across countries. Reductions in income inequality for countries with non-restrictive abortion policies and the liberalization of abortion policies for countries with low-income inequality should be the way forward to better perinatal mental health.

References:

  1. Martínez P, Nazif-Munoz JI, Rojas G, et al. Structural gender inequalities and symptoms of postpartum depression in 40 countries. J Affect Disord 2022;297:381–5.
  2. Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry 2018;8:24E8.

e-Poster – Early Investigator
PE13 – The Hypothesis of Metabolic Jet Lag in Bipolar Disorder: A Pilot Feasibility Study Exploring the Association Between Eating Rhythm Disruption and Illness Trajectories
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Elena Koning*, MSc; Fabiano A. Gomes, MD, PhD; Alexander Bambokian; Jacob Vorstman; Rafael Freire; Rodrigo B. Mansur, MD, PhD; Jennifer Fabe, RD, MSc; Roumen Milev, MD, FRCPC; Elisa Brietzke, MD, PhD

CanMEDS Role:

  1. Scholar

At the end of this session, participants will be able to: 1) Understand the role of biological rhythms dysfunction in bipolar disorder (BD); 2) Explore different ways to evaluate eating rhythm disruption in BD; and 3) Understand the applications of chrononutrition to psychiatry.

Changes in energy metabolism and expenditure are commonly observed in bipolar disorder (BD) and have been linked to a worsened clinical course. (1) Metabolic jet lag (MJL) is a state of shift in circadian patterns of energy homeostasis, expressed through behavioural changes, including irregularities in sleep and appetite. (2) The objective of this study is to determine the feasibility of an investigation assessing the association between MJL, evaluated through disruption in eating rhythms, and markers of illness severity in 10 men and women with DSM-5–defined BD type 1. Severity of illness trajectory parameters will be age of onset; illness duration; number of manic, hypomanic, and depressive episodes; number of admissions; history of suicide attempts; and functional status. A personalized “feedogram” will be elaborated using the app InnerAnalytics, which uses artificial intelligence to create a nutrition history of all foods and liquids ingested by people, based on pictures that subjects will take of their meals over 14 days. Additionally, the app BEHAPP will be used to quantify diurnal rhythms, movement, and social patterns through passive monitoring. Clinical evaluation of eating rhythm disruption will be conducted with the Biological Rhythm Interview for Assessment in Neuropsychiatry (BRIAN). This study will be the first to integrate the field of chrononutrition in the study of BD and the first to use the concept of MJL in psychiatry. This study will expand our knowledge of circadian dysfunction in mood disorders and contribute to the development of innovative, affordable, and safe nutritional approaches, such as time-restricted feeding.

References:

  1. McIntyre RS, Berk M, Brietzke E, et al. Bipolar disorders. Lancet 2020;396:1841–56.
  2. Asterholm IW, Scherer PE. Metabolic jet lag when the fat clock is out of sync. Nat Med 2012;18:1738–40.

e-Poster – Early Investigator
PE14 – The Impact of Economic Recessions on Mental Health: A Qualitative Scoping Review
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Olivia Guerra*, MD, BA(H); Vincent Agyapong, MSc, CCST, FRCPsych; Nnamdi Nkire, CINP, DCP, DHSM, MB

CanMEDS Roles:

  1. Health Advocate
  2. Scholar
  3. Leader

At the end of this session, participants will be able to: 1) Build an awareness of current qualitative research on the perceived connections between economic recessions and poor mental health in Organization for Economic Co-operation and Development (OECD) nations; 2) Learn what risk factors place people at higher risk of negative health outcomes during an economic recession; and 3) Discuss clinical and policy-level strategies to prevent and manage population mental health during recessionary periods.

In follow up to our 2021 review on the impact of economic recessions on mental health, this scoping review summarizes qualitative research, to develop a descriptive understanding of the key factors that transmute the socioeconomic stressors of a recession into poorer mental health. 

Methods: Six databases were searched for keywords, since 2020, yielding 313 results added to 22 qualitative records identified in the previous study from 2008 to 2020, for a total of 335 search results.  After inclusion and exclusion criteria were applied, 13 articles were included. Articles included were peer-reviewed, qualitative studies in OECD countries published from 2008 to 2021 and available online in English.

Results: Participants felt that financial hardship and unemployment during recessions increased stress, led to feelings of shame, loss of structure, and identity; and led to perceived lack of control, which increased interpersonal conflict, social isolation, maladaptive coping, depression, self-harm, and suicidal behaviour. Participants struggled with accessing health and social services and suggested reforms to improve navigation and efficiency of services and reduce perceived harms of austerity measures.

Conclusion: Providers should screen for mental distress and familiarize themselves with health and social resources in their community to help patients navigate these complex systems. Policy makers should be aware of the potential protective nature of unemployment safeguards and consider other low-cost measures to bolster mental health supports and informal social networks. Research in this area was limited. Further research would be beneficial, given the impact of the ongoing COVID-19 recession.

References:

  1. Guerra O, Eboreime E. The impact of economic recessions on depression, anxiety and trauma‐related disorders and illness outcomes–a scoping review. Behav Sci 2021;11:119.
  2. Antunes A, Frasquilho D, Zózimo JR, et al. Solutions to tackle the mental health consequences of the economic recession: a qualitative study integrating primary health care users and professionals’ perspectives. Health Policy 2019;123:1267–74.

e-Poster – Early Investigator
PE15 – Training in Telepsychiatry: Results from a National Study
Thursday, Oct. 27 – Saturday, Oct. 29
08:00 – 18:00
Meeting Room: e-Poster
Angelique Myles*, MSc, MD; Sarah Noble, MD; Jing Zhao, MD, PhD

CanMEDS Roles:

  1. Communicator
  2. Collaborator
  3. Professional

At the end of this session, participants will be able to: 1) Examine telepsychiatry exposure in residency programs across Canada; 2) Identify barriers to implementing telepsychiatry in future practice; and 3) Recognize the interest in adapting telepsychiatry into clinical practice.

Objective: This study examined Canadian psychiatry residents’ interest, exposure, and future plans to use telepsychiatry. In addition, respondents indicated barriers to implementing telepsychiatry.

Method: A 19-item electronic survey using Likert scales, yes/no, and multiple choice was generated with Google Forms. The survey was distributed to 17 psychiatry residency and fellowship programs in Canada.

Results: Of the approximately 500 eligible psychiatry residents who were contacted at the time this study took place, 165 (33%) returned completed questionnaires. Eighty-nine percent of respondents agreed that telepsychiatry is an important aspect of residency and 70% stated it should be a required part of residency. Of the 147 respondents who had clinical exposure to telepsychiatry, most indicated that their experience increased their interest. Almost one-half the respondents who had clinical experience with telepsychiatry reported that it was not equal to face-to-face patient encounters. Respondents indicated barriers, which included system barriers, such as fee codes and compensation, as well as access to technology and Internet connection. Patient barriers included socioeconomic challenges, lack of experience with technology, having intellectual disabilities, or requiring play-based therapy.

Conclusions: The COVID-19 pandemic has rapidly shifted telehealth to the forefront and, in doing so, an increasing number of Canadians are receiving virtual health care. Psychiatry residents across the country have indicated that, although they are exposed to telepsychiatry during their residency training, there continues to be gaps, highlighting the need for graduate medical education requirements for telepsychiatry during training.

References:

  1. Glover J, Williams E, Hazlett L, et al. Connecting to the future: telepsychiatry in postgraduate medical education. Telemed J E Health 2013;19:474–9.
  2. Serhal E, Crawford A, Cheng J, et al. Implementation and utilization of telepsychiatry in Ontario: a population-based study. Can J Psychiatry 2017;62:716–25.