Literature Collection

OBJECTIVES: Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. METHODS: A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. RESULTS: As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. CONCLUSIONS: By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.

The increasing use of antidepressants, escalating rates of unintended pregnancy, and disproportionately high rate of maternal suicide in the United States, as compared with other high-income countries, all highlight the urgent need for more clarity on available treatment options for perinatal depression. Misrepresentative data obtained from animal experiments and observational human studies, many of which do not account for underlying mental illness as a confounder, largely overestimate the teratogenicity of antidepressants. These outdated data-coupled with a lack of clear guidance from leading agencies-have created a healthcare scenario rife with decisional conflict. As general practitioners frequently serve as patients' first point of contact within the US healthcare system, primary care is central to preconception and mental health management. This article educates primary care providers on the risks of untreated perinatal depression and the realities of antidepressant teratogenicity. Doubling as a narrative review, the article also synthesizes available evidence to provide a risk-based guide for treatment with antidepressants that emphasizes a shared decision-making approach.

Opioid abuse and dependence continues to rise in both the general population and pregnancy, with opioid overdose deaths having quadrupled in the last 15 years. Illicit drug use in last 30 days of pregnancy was over 4% with almost 0.6% documented maternal opiate use at time of birth. The management of the opioid-tolerant, buprenorphine-dependent or methadone-dependent patient in the peripartum period is reviewed. Options for treatment of opioid dependence, acute pain management, and perioperative multimodal analgesia are discussed. The effects of maternal management on neonatal abstinence syndrome are also reviewed.