Literature Collection

BACKGROUND: Like many other nations, the rates of mental illness among children and youth have risen. Youth and emerging adults (YEA) between the ages of 16 and 25, in particular, have the highest rate of mental health disorders of any age group leading clinicians and researchers to ponder new and innovative ways to treat mental ill health (1-2). Youth centred practices (YCP) have emerged as possible new approaches in youth mental health care to better treat YEA living with mental illness, but also to empower this population to take control of their wellbeing. Despite the growing use of the term 'youth-centred,' there is little consensus on what this looks like in mental health care for youth. Using research coming out of MINDS of London-Middlesex, we explore how mental health professionals, including clinicians, researchers, administrative staff, and trainees, understand the term YCP and how they implement youth-centredness in practice. METHODS: Using a Youth Participatory Action Research framework as a guide, MINDS' researchers worked alongside YEA research assistants in all phases of research. Participants were selected from a pool of known practitioners and mental health programs utilizing YCP, as identified by YEA research assistants. Qualitative focus group and interviews, developed using an appreciative inquiry approach, were conducted with 13 mental health care professionals, staff, and trainees to ascertain how they understand and practice YCP. Researchers conducted a codebook thematic analysis of the data: five themes and fourteen subthemes were identified. RESULTS: Our analysis identified five main themes: (1) Acknowledging YCP's Role in Supporting YEA Mental Health; (2) Developing Authentic and Meaningful Relationships Between YEA and Care Providers; (3) Collaboration in Care: Engaging YEA as Active Agents in their Treatment; (4) Creation and Maintenance of Accessible Service to Facilitate YEA Engagement; and (5) Moving Beyond Tacit Knowledge to YCP as a Trainable Construct. Underlying each of these key components of YCP was a thread of recognition that systems of care for YEA must be responsive to the unique needs of those the system intends to serve. This process is seen as dynamic and fluid; often representative of societal change and growth, the specific needs of YEA will remain in flux and YCP approaches require continued reflexivity. CONCLUSIONS: When YCPs are used in mental health care, YEA and their lived experiences are respected by trusted adults on their care team. At the core, YCPs are collaborative. There is a shift from the dynamic of "practitioner as expert" to one that provides YEA a sense of agency and autonomy to make informed decisions regarding their care.

INTRODUCTION: While bipolar disorder is not uncommon in primary care, collaborative care models for bipolar depression treatment are underdeveloped. Our aim was to compare initial pharmacological treatment patterns for an episode of bipolar depression in different care models, namely primary care (PC), integrated behavioral health (IBH), and mood specialty clinic (SC). METHODS: A retrospective study of adults diagnosed with bipolar disorder who received outpatient care in 2020 was completed. Depressive episodes were captured based on DSM-5 criteria, ICD codes, or de novo emergent symptom burden (PHQ-9 ≥ 10). Pharmacological strategies were classified as 1) continuation of current regimen, 2) dose increase or 3) augmentation 4) switch to monotherapy or 5) a combination of more than two different strategies. Logistic regression was applied. RESULTS: A total of 217 encounters (PC = 32, IBH = 53, SC = 132) representing 186 unique patients were identified. PC was significantly more likely to continue the current regimen, while combination strategies were significantly more likely recommended in IBH and SC. Mood stabilizers were significantly more utilized in IBH and SC. There were no significant group differences in antidepressant use. LIMITATIONS: Retrospective study design at a single site. CONCLUSIONS: This study provides evidence of delays in depression care in bipolar disorder. This is the first study to compare treatment recommendations for bipolar depression in different clinical settings. Future studies are encouraged to better understand this gap and to guide future clinical practice, regardless of care model, emphasizing the potential benefits of decision support tools and collaborative care models tailored for bipolar depression.

OBJECTIVES: Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. METHODS: We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. RESULTS: The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.