5th Annual Integrative Psychiatry Conference | May 27, 2022
McGill Graduate Student Association of Psychiatry (GSAP)
Published online: May 27, 2022Qualitative Systematic Review about the Subjective Experience of Latinx Individuals Living with a Schizophrenia Spectrum Diagnosis
Corresponding Author: Anne-Sophie Leroux, email anne-sophie.leroux2@mail.mcgill.ca
Abstract
Background and Objectives: Subjective experience can be understood phenomenologically both as the experience of the self and as the experience of the self in the presence of others. More broadly, subjective experience can be considered the experience of the individual as shaped by different internal and external factors. It is important to study the subjective experience of individuals living with a schizophrenia spectrum diagnosis: it will enable us to learn about their illness experience and how they are living with their schizophrenia illness. In the case of cultural populations, such as Latinx communities, studying the subjective experience at the intersection of the schizophrenia spectrum will produce an understanding of how individuals identifying with this culture and living with this condition understand themselves and experience their condition specifically. The objectives of this research are to generate meaning about how Spanish-speaking Latinx individuals living on the schizophrenia spectrum experience their self. This understanding can produce knowledge about this population’s specific needs. Methods: A Qualitative Systematic Review (QSR) consists of a literature review systematically screening the corpus on the topic with a scientific methodology to attempt to collect all potential documents and grey literature available in a selection of databases. Results: This QSR is currently collecting and extracting data. Discussion: Data Analysis will use Thematic Synthesis (Thomas & Harden, 2008) to uncover the meaning of the subjective experience of Spanish-speaking Latinx individuals living with a schizophrenia spectrum diagnosis. Knowledge Translation: This QSR is important to many different types of knowledge users (researchers, patients, public health policy makers, etc.) because it will provide an understanding in an understudied area, from outside of Latin America. By focusing on the common ground within this heterogeneous population, it will hopefully identify the needs in terms of developing adequate and culturally adapted therapeutic and medical services that will take into account Latinx experiences
Promoting Help-Seeking for Mental Health Problems among Older Adults: Co-Design and Feasibility Testing of a Theory-Based, Behaviour-Change Intervention
2Kurongkurl Katitjin, Edith Cowan University, Perth, WA, Australia
Corresponding Author: Claire Adams, email cadams.elizabeth@gmail.com
Abstract
Background and objectives: Rates of engagement with mental health-related services among older adults are low, and initiatives to increase help-seeking in older populations are limited. This study aimed to develop and test an intervention designed to promote mental health help-seeking among older adults. Methods: Nine key stakeholders were recruited to inform the design and implementation of the intervention. Semi-structured interviews were conducted to investigate stakeholders’ views and recommendations. To test the feasibility and acceptability of the intervention, 241 adults ≥65 years were randomly assigned to receive the intervention or control materials. Results were analysed using descriptive statistics. Results: The final intervention consisted of a brochure with behaviour-change messages based on the Theory of Planned Behaviour. The intervention addressed help-seeking attitudes, subjective norms, perceived behavioural control, and barriers to help-seeking. Control participants received a brochure with common public health messages. 147 participants completed the pilot test (intervention group n = 68, control group n = 79, retention rate = 61%). Participants most frequently responded with agree/strongly agree to 10 feasibility and acceptability criteria, supporting the feasibility and acceptability of the intervention. Discussion: The intervention is a promising approach to promote mental health help-seeking among older adults. The intervention is intended for use in primary health care and health promotion, to encourage older adults to engage early with mental health-related services. Further research is needed to determine the effectiveness of the intervention in improving help-seeking behaviour. Fit with knowledge translation: The intervention was designed in consultation with knowledge users, including health care professionals, health care executives, representatives from community organisations, and consumers. The stakeholder group was involved in the development phase of this study, which helped to enhance the relevance of the intervention and enabled the identification of problems and solutions prior to implementation.
Effectiveness of Non-pharmacological and Non-surgical Interventions to Improve Health outcomes in Systemic Sclerosis: Living Systematic Review and Patient-engaged Knowledge Translation to Support Shared Decision-making
2Department of Psychiatry, McGill University, Montreal, QC, Canada
3Department of Psychology, McGill University, Montreal, QC, Canada
4Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
5Department of Medicine, McGill University, Montreal, QC, Canada
6Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
7Biomedical Ethics Unit, McGill University, Montreal, QC, Canada.
Corresponding Author: Brett D. Thombs, email brett.thombs@mcgill.ca
Abstract
Background: Systemic sclerosis (SSc; scleroderma) is a rare autoimmune rheumatic disease with a major negative impact on quality of life. Non-pharmacological/non-surgical interventions (e.g., psychological, educational, rehabilitation, physiotherapy, dentistry, diet/nutrition) may improve quality of life, but their effectiveness is not well understood. SSc patients often seek advice from health care providers about non-pharmacological/non-surgical interventions; however, SSc health care providers are not able to easily synthesize what is known or present it in a patient-friendly, easily comprehensible format. This poses a barrier to shared decision-making between patients and providers. Objectives: We aim to conduct a systematic review of evidence on non-pharmacological/non-surgical interventions. To ensure effective knowledge translation, the review will be (1) continually updated to integrate new evidence as it becomes available (i.e., “living”) and (2) accompanied by similarly living patient-oriented knowledge translation tools to support shared decision-making. Methods: Eligible studies will be randomized controlled trials (RCTs) of non-pharmacological/non-surgical interventions in SSc. All RCTs included in a previous systematic review, that searched for trials through March 2014, will be evaluated for inclusion. Additional trials will be sought from that date onwards using a similar search strategy via various databases. Two independent reviewers will determine study eligibility and will extract data using a pre-specified standardized form. Meta-analyses will be done for interventions where there are ≥2 eligible RCTs that report similar health outcomes. Knowledge Translation: The proposed project was selected as a priority by our patient partners, who will be involved in all stages of the project. As we update the living systematic review, we will engage in patient-oriented knowledge translation through a website that will be co-created with SSc patient partners, health care professional partners, researchers, and a web developer. Our novel living systematic review and patient-engaged knowledge translation methods to support shared decision-making will serve as a model for projects in other diseases.
Enhancing cognitive behavioural supervision: Trainee perspectives on supervision interventions
2McGill University, Montreal, QC, Canada
Corresponding Author: Jesse Renaud, email jesse.renaud@muhc.mcgill.ca
Abstract
Background: Clinical supervision is the main method by which mental health professionals acquire the competence to deliver safe and effective therapy (Rakovshik & McManus, 2013). Cognitive-behavioural therapy (CBT) is an effective treatment, whether delivered by experienced therapists or trainee therapists under supervision (Forand et al., 2011). While different models of supervision exist, cognitive-behavioural supervision (CBS) parallels CBT in structure and form. However, little is known about what CBS aspects are most appreciated by trainees. Methods: Participants were eight trainees completing a CBT rotation in a teaching hospital. Weekly individual supervision was provided by staff psychiatrists and psychologists. Following each supervision session, trainees completed a measure of supervision satisfaction, which included open-ended questions about what they found most helpful. Responses from 139 supervision sessions were coded using criteria from an observer-rated measure of CBS supervisor competence. Results: The CBS interventions that trainees identified as most helpful were: didactic teaching, planning for future therapy sessions, building case formulations, engaging in experiential exercises, and receiving evaluations on their work. Themes related to the supervisory alliance (e.g., collaboration, management of the supervision session) were identified as the most common areas for improvement. Discussion: Current results underscore the importance of integrating specific CBS interventions to promote trainee satisfaction and maximize learning during supervision sessions. Fit with knowledge translation: The knowledge gained from this research will provide valuable information for supervisors in the MUHC CBT unit, where the data was collected, to enhance their supervision practices and promote trainee satisfaction and learning. This research will be published in a peer-reviewed journal and disseminated at a clinical conference where CBT supervisors across Canada will learn about integrating these results into their practice.
A Cross-Sectional Study on Factors Associated with Sleep Disturbance in Systemic Sclerosis: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort Study
2Department of Psychiatry, McGill University, Montreal, QC, Canada
3Department of Clinical Psychology, Radboud University, Nijmegen, GE, Netherlands
4Centre for Prognosis Research, School of Medicine, Keele University, Staf, United Kingdom
5Ottawa Scleroderma Support Group, Ottawa, ON, Canada
6Scleroderma Foundation, Los Angeles, CA, United States
7Sclérodermie Québec, Montreal, QC, Canada
8Scleroderma Australia, Melton, Vic, Australia
9Scleroderma Victoria, Melton, Vic, Australia
10Scleroderma Society of Ontario and Scleroderma Canada, Hamilton, ON, Canada
11Nationale vereniging voor mensen met lupus: Dutch patient organization for systemic autoimmune diseases, Utrecht, UT, Netherlands
12Department of Medicine, McGill University, Montreal, QC, Canada
13Research Institute of the McGill University Health Centre, Montreal, QC, Canada
14Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
15Johns Hopkins University School of Medicine, Baltimore, MD, United States
16San Diego State University, San Diego, CA, United States
17Université Paris Descartes, Paris, IDF, France
18Department of Psychology, Western University, London, ON, Canada
19Lawson Research Institute, London, ON, Canada
20Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada
21Department of Psychology, McGill University, Montreal, QC, Canada
22Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
23Biomedical Ethics Unit, McGill University, Montreal, QC, Canada.
Corresponding Author: Marieke Alexandra Neyer, email mariekealexandran@gmail.com
Abstract
Previous studies have reported that the majority of people with systemic sclerosis (SSc; scleroderma) experience sleep disturbances that impair their daily functioning. No studies have compared SSc sleep disturbance scores to general population norms. Objectives were to (1) compare levels of patient-reported sleep disturbances in SSc to general population norms and (2) identify disease factors associated with sleep disturbance. This international cross-sectional study included participants from the Scleroderma Patient-centered Intervention Network Cohort (SPIN) who completed sleep disturbance measures (Patient-Reported Outcomes Information System-29 profile version 2.0) as part of baseline assessments. Sleep scores were compared to US general population norms (mean = 50, SD = 10). Associations of sleep disturbance with SSc-related variables were assessed using multiple linear regression. Among the 1499 SSc patients included, mean sleep disturbance scores were higher than in the US general population (mean difference = 2.1, 95% confidence interval [CI] 1.48 to 2.72). Higher sleep disturbance scores in SSc were independently associated with the presence of esophageal (1.17 points, 95% confidence interval [CI] 1.63 to 4.12) and intestinal gastrointestinal involvement (1.30 points, 95% CI 0.38 to 2.22), pain (3.19 points per standard deviation [SD], 95% CI 2.74 to 3.66), pruritus (1.08 points per SD, 95% CI 0.66 to 1.51), smoking (1.54 points, 95% CI 0.28 to 3.27) and higher BMI scores (0.87 points, 95% CI 0.44 to 1.24). Sleep disturbance scores among people with SSc were only minimally higher than in the US general population. Nonetheless, those with significant gastrointestinal involvement, pain, pruritus and who are smokers or overweight may be vulnerable to sleep disturbances that warrant attention. The study was conducted in collaboration with SSc patient advocates from international support organizations to explore issues of particular concern to the SSc community and to share the results of this study directly with those affected.
Towards Improving Language Accessibility in Standardized Measures: Validating the French Translation of the 6-item De Jong Gierveld Loneliness Scale
2Research Center, Douglas Mental Health University Institute, Montreal, QC, Canada
3Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
Corresponding Author: Michaela Bourque, email michaela.bourque@mail.mcgill.ca
Abstract
Background And Objectives: The 6-item De Jong Gierveld Loneliness Scale (DJGLS-6) has been validated in popular languages including, but not limited to, English, Spanish, and Chinese; however, some translations, though actively in use, have yet to be validated. Thus, this work seeks to examine the validity and reliability of the French translation of the DJGLS-6. Methods: 640 Francophone participants completed the DJGLS-6 at two timepoints, composing the sample for this study. Participant responses were analyzed for internal consistency using Cronbach’s alpha, interitem correlations, and item-total correlations at the full and subscale levels. Divergent validity between the DJGLS-6 and the Generalized Self Efficacy Scale was measured using Pearson’s product-moment correlation. Test-retest reliability was examined using a sub-sample of 481 participants, applying Pearson correlation and intraclass correlation coefficients to establish statistical significance. A confirmatory factor analysis (CFA) was applied to explore goodness-of-fit. Results: The psychometric properties of the scale were found to be acceptable at the total scale ( = .66, ITC = 0.40, IIC = .24), with moderate test-retest reliability (ICC= .65). However, results at the emotional loneliness subscale were sub-optimal ( = .49, ITC = 0.31, IIC = .24) when compared to the social loneliness subscale ( = .83, ITC = 0.69, IIC = .61). The CFA revealed a good fit according to SRMR (=0.02), CFI (=0.95), and RMSEA (90% CI 0.08-0.13). Discussion: The French translation of the DJGLS-6 is a reliable and valid measure; though findings should caution that the emotional loneliness subscale may not be comparably significant when analyzed independently. Overall, the French DJGLS-6 scale should be used with a confident awareness of these findings. Fit With Knowledge Translation: This work seeks to increase the overall accessibility of this scale by increasing knowledge users’ confidence in the application of a statistically valid and reliable measure to future research. Keywords: Loneliness, psychometrics, French, validation, DJGLS-6
Development of patient-reported outcome measures in early intervention services for psychosis in Chennai, India and Montreal, Canada
2Prevention and Early Intervention Program in Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, QC, Canada
3Schizophrenia Research Foundation, Chennai, India
Corresponding Author: Neha Nair , email neha.nair@mail.mcgill.ca
Abstract
Background and objectives: Patient-reported outcome measures (PROMs) can provide valuable information and promote shared decision-making between patients and clinicians. However, they are infrequently used in mental health services, particularly within psychosis. Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH) are two such single-item PROMs in which patients rate their health and mental health on a 5-point Likert scale from ‘poor’ to ‘excellent’. This study aims to examine the psychometrics of the SRH and SRMH in early intervention services for psychosis in Chennai, India (a low-and-middle income context) and Montreal, Canada (a high-income context), and in three languages (French, English and Tamil) to better establish the cross-cultural suitability of these measures. Methods: Test-retest reliability was examined using data obtained from 30 patients in Montreal and 29 patients in Chennai and established using the intra-class correlation coefficient (ICC2,1). Criterion validity was examined by using data from 87 patients in Montreal and 163 patients in Chennai and estimated by using Kendall’s tau-b correlation coefficient to compare SRH and SRMH ratings with clinician-rated outcome measures (CROMs) of depression, anxiety, positive and negative symptoms, and overall functioning. Results: SRH and SRMH had good to excellent test-retest reliability (ICC >0.63) at both sites and for English and Tamil versions. In Montreal, significant negative correlations were found between the two PROMs and symptom measures at Months 12 and 24, indicative of criterion validity. In Chennai, correlations with symptom measures were not always significant, indicating that PROMs and CROMs did not always converge. Discussion: Our findings show the promise of single-item PROMs that may be more feasibly integrated in real-world settings. Measuring recovery with PROMs may not only be patient-empowering but also essential in contexts like Chennai where clinician and patient perceptions about outcomes vary. Context and culture may influence PROMs significantly, an intersection that needs more attention. Knowledge Translation: In assessing the cross-cultural reliability and validity of patient-reported outcome measures, we can implement accessible PROMs into mental health services, prioritizing patient voices and giving clinicians more insight into patient experiences. By bridging the knowledge gap between patients and clinicians, we can allow service-users to take a more active role in their recovery.
Cross-Sectional Study on Factors Associated with Symptoms of Anxiety among People with Systemic Sclerosis: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort Study
2Department of Psychiatry, McGill University, Montreal, Quebec, Canada
3Department of Medicine, McGill University, Montreal, Quebec, Canada
4Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
5Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
6Department of Psychology, McGill University, Montreal, Quebec, Canada
7Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada.
Corresponding Author: Brett D. Thombs, PhD, email brett.thombs@mcgill.ca
Abstract
Background: Anxiety in people with systemic sclerosis (SSc) is common and may greatly impair one’s ability to carry out daily activities. Anxiety leads to a reduction in health-related quality of life of people with SSc, but the prevalence of anxiety and the factors associated with anxiety are often overlooked in research in this population. Objectives were to assess factors associated with symptoms of anxiety in a large multimodal SSc cohort. Methods: Participants in the Scleroderma Patient-centered Intervention Network Cohort who completed anxiety symptoms measures (Patient-Reported Outcomes Measurement Information System version 2) as part of baseline assessments were included. Associations between anxiety symptoms with sociodemographic variables, SS-related variables, and overlap syndromes were assessed with a complete case analysis using multiple linear regression. Continuous predictor variables were standardized. Preliminary findings: Among 1515 participants (mean age = 55.1 years old) 82.4% were white and 87.7% were female. Higher depressive symptom scores were independently associated with age (B = -.14, t(1510) = -5.04, 95% CI [-.19, -.08]), smoking status (B = .35, t(1510) = 3.72, 95% CI [.16 to .53]) and BMI (B = .06, t(1510) = 2.40, 95% CI [.01 to .11]) among sociodemographic and lifestyle variables; time since first non-Raynaud’s symptoms (B = -.05, t(1510) = -2.02, 95% CI [-.10, -.00]), GI involvement (B = .26, t(1510) = 3.35, 95% CI [.11, .41]), and severity of itch (B = .22, t(1510) = 8.75, 95% CI [.17, .27]) among SSc variables. Interpretation: Anxiety symptoms are common among people with SSc and interfere significantly with the ability to carry out daily activities for many. Research is needed to better understand patterns of anxiety and potential causes and to develop interventions to target anxiety symptoms sources and support coping.
Mental Health Symptom Changes by Sex or Gender in Early-COVID-19 Compared to Pre-pandemic: A Systematic Review and Meta-analysis
2Department of Psychiatry, McGill University, Montreal, QC, Canada
3Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
4Department of Psychology, McGill University, Montreal, QC, Canada
5Department of Biostatistics and Health Informatics, King's College London, London, UK
6Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
7Centre for Addiction and Mental Health, Toronto, ON, Canada
8Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
9Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
10School of Epidemiology and Public Health, University of Ottawa, ON, Canada
11Correctional Service of Canada, Ottawa, ON, Canada
12Department of Psychiatry, University of Toronto, Toronto, ON, Canada
13McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
14Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
15Department of Medicine, McGill University, Montreal, QC, Canada
16Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada
17Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
18Biomedical Ethics Unit, McGill University, Montreal, QC, Canada
Corresponding Author: Tiffany Dal Santo, email tiffany.dalsanto@mail.mcgill.ca
Abstract
Background and Objectives: Women and gender-diverse individuals have faced disproportionate socioeconomic burden during COVID-19. Reports of greater negative mental health changes compared to men, however, have been based on cross-sectional research. We compared mental health changes from pre-COVID-19 to COVID-19 by sex or gender. Methods: Nine databases were searched to August 30, 2021. Eligible studies reported mental health symptom changes by sex or gender. A restricted maximum-likelihood random-effects meta-analyses was conducted. Results: 12 studies (10 unique cohorts) were included, all of which reported dichotomized sex or gender data during early COVID-19. Continuous symptom change differences were not statistically significant for depression (standardized mean difference [SMD]= 0.12, 95% CI -0.09–0.33; 4 studies, 4,475 participants; I2=69.0%) and stress (SMD= -0.10, 95% CI -0.21–0.01; 4 studies, 1,533 participants; I2=0.0%), but anxiety (SMD= 0.15, 95% CI 0.07–0.22; 4 studies, 4,344 participants; I2=3.0%) and general mental health (SMD= 0.15, 95% CI 0.12–0.18; 3 studies, 15,692 participants; I2=0.0%) worsened more among females/women than males/men. There were no significant differences in changes in proportions above cut-offs: anxiety (difference= -0.05, 95% CI -0.20–0.11; 1 study, 217 participants), depression (difference= 0.12, 95% CI -0.03–0.28; 1 study, 217 participants), general mental health (difference= -0.03, 95% CI -0.09–0.04; 3 studies, 18,985 participants; I2=94.0%), stress (difference= 0.04, 95% CI -0.10–0.17; 1 study, 217 participants). Discussion: Outcomes did not differ or were worse by small amounts among women versus men during early COVID-19. These findings diverge from what has been reported in some cross-sectional studies and the media. Fit with Knowledge Translation: This study provides researchers, clinicians, policy makers, and the public with quality evidence on mental health related to sex and gender in COVID-19. Results serve as a starting point for other studies on mental health in vulnerable groups and for developing policies to address needs.
Preconception and prenatal stress predict broad autism phenotypes in young adults: Project Ice Storm
2Douglas Mental Health University Institute, Montreal, Canada
3Centre for Child Development and Mental Health, Lady Davis Institute-Jewish General Hospital, Montreal, Canada
4Department of Psychiatry, McGill University, Montreal, Canada
Corresponding Author: Suzanne King, email suzanne.king@mcgill.ca
Abstract
Background and Objectives: Many studies have investigated the association between prenatal maternal stress (PNMS) and autism spectrum disorder (ASD). The broad autism phenotype (BAP), sub-clinical levels of ASD, includes aloof personality, rigid personality and pragmatic language. It remains unclear whether PNMS explains variance in distinct BAP domains in young adult offspring, and whether this variance is moderated by timing of exposure to the stressor or offspring sex. Methods: We recruited women who were pregnant during or within 3 months of the 1998 Quebec Ice Storm crisis, and assessed three aspects of stress (objective hardship, subjective distress and cognitive appraisal). At age 18 years, the offspring completed a BAP self-report (N=33, 22F/11M). Hierarchical linear regressions were implemented to examine the effect of PNMS on BAP traits and the association between timing of exposure and BAP traits. Moderated regressions with bootstrapping were implemented to examine the moderation of timing or offspring sex on PNMS effects. Results: We found that the greater the mothers’ objective hardship, the more severe the young adults’ aloof personality. The greater the mothers’ objective hardship and the more negative the mothers’ cognitive appraisal, the more severe the young adults’ rigid personality. The greater the mothers’ subjective distress, the greater the young adults’ pragmatic language impairment. These associations were irrespective of timing of exposure to the ice storm or offspring sex. Discussion: Our study highlights different aspects of PNMS contributing to different autistic-like phenotypes extending to young adulthood.
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