Medicine and Health Sciences Commons^™

Social Connectedness, Adolescent Mental Health And Well-Being At The Later Stages Of The Covid-19 Pandemic: A Mixed Methods Exploration, Sarah Abdunnabi

Electronic Thesis and Dissertation Repository

COVID-19 posed novel challenges by limiting in-person interactions and shifting interactions online. Effects of online and offline social connectedness on adolescent mental health and well-being, and the moderating role of the social determinants of health (SDoH) were explored. Canadian adolescents (n=1,586; M_age=15.3, range 13 to 18 years; surveyed summer 2022) reported their social connectedness, psychological distress, and mental well-being. An ordinal logistic regression was performed to examine the association between social connectedness (online and offline) and dual-factor mental health. Responses to two open-ended survey questions were analyzed. Social disconnection was associated with higher odds of being in a …

Understanding The Information Needs Of Clients And Caregivers Regarding Early Psychosis: A Conventional Content Analysis, Tanvin K. Juneja

Electronic Thesis and Dissertation Repository

A first episode of psychosis is defined by the first presentation of psychotic symptoms that have gone untreated, characterized by a loss of contact with reality and significant declines in functioning. Low psychosis literacy among clients and caregivers can result in a delay in receiving treatment. This study sought to understand the information needs of clients and caregivers regarding early psychosis. Using a conventional content analysis, we conducted a secondary analysis of 64 transcripts from clients, caregivers, family physicians, and early psychosis intervention clinicians. Clients and caregivers often described having difficulties recognizing symptoms of early psychosis until they became overt …

Disordered Eating Behaviours In Adolescents With And Without A Formal Ed Diagnosis: Comparing Individual And Contextual Factors, Eve G. Chapnik

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This study explored various psychosocial factors associated with disordered eating in adolescents accessing mental health services across Ontario, Canada. Data were collected using the interRAI Child and Youth Mental Health (ChYMH) assessment tool and participants were categorized into three groups: individuals with diagnosed eating disorders (ED, n=207), disordered eating without a formal ED diagnosis (sub-ED, n=888), and other treatment-seeking youth (non-ED, n=3285). The ED and sub-ED groups did not differ in many ways, presenting with a similarly greater prevalence of mental health issues, and dysfunctional family and peer relationships, in comparison to non-ED youth. However, the ED …

Antidepressants Versus Placebo For Generalized Anxiety Disorder: A Systematic Review And Meta-Analysis, Katarina Kopcalic

Electronic Thesis and Dissertation Repository

Objectives: To assess the efficacy and acceptability of antidepressants compared to placebo among adults with a primary diagnosis of generalized anxiety disorder (GAD). Methods: Five electronic databases and 2 trial registries were searched to identify studies for inclusion. The risk of bias version 1 tool was used to assess the risk of bias. A random-effects meta-analysis was conducted using RevMan web. Results were presented using forest plots. Results: 38 studies (12,570 participants) were included. Very low-quality evidence showed a benefit for antidepressants over placebo in the rate of treatment response (RR, 1.39: 95% CI: 1.27, 1.52) and no differences in …

Exploring The Experience Of Disclosing In The Workplace, Jillian Auger

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An alarming rate of workplace violence/harassment is observed each year, with negative outcomes that affect the organization (i.e., financial loss) and those directly involved (i.e., job loss, financial strain, fear of being blamed, being labeled a ‘troublemaker’). The literature indicates that, for many victim-survivors, there is little hope for positive outcomes following a disclosure of workplace violence/harassment. In fact, some studies show that negative reactions to disclosure can compound and intensify the impact of violence/harassment on psychological functioning. However, minimal research has been devoted to the experiences of victim-survivors regarding the outcomes of a disclosure. Utilizing virtual semi-structured interviews, the …

Establishing The Minimum Clinically Important Difference (Mcid) Of The Quality Of Life In Childhood Epilepsy Questionnaire (Qolce-55), Mariela Leda

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The Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) is a validated, parent-reported measure of health-related quality of life (HRQOL) in children with epilepsy (CWE). The QOLCE-55 currently has no minimum clinically important difference (MCID), which is the minimum amount of change required to be considered meaningful to patients. The primary objective of this study was to estimate the MCID for the QOLCE-55 using the Making Mindfulness Matter© in Children with Epilepsy trial data. Parent-child dyads (n=66) completed the QOLCE-55 at baseline (week 0) and follow-up (week 9). MCID values for the QOLCE-55 were calculated using two types of methods: …

Regulatory Implications Of Inadequately Designed Pimavanserin Drug Trials Published With Risk Of Bias On Expedited Regulatory Approval Processes, Benson Law

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The objective of this retrospective critical appraisal study was to determine if the trials submitted to the Food and Drug Administration for the expedited approval of pimavanserin was of sufficient methodological quality to ascertain its safety and efficacy. After the general metrics of the trials were assessed, the Risk of Bias 2 tool and the PRagmatic Explanatory Continuum Indicator Summary tool were employed to evaluate the risk of bias and the design suitability of the trials. This study suggests that the decision to approve pimavanserin for the treatment of Parkinson’s Disease Psychosis failed to meet the threshold of evidence normally …

How We Debrief: An Interpretive Description Of Social Service Community Workers' Experiences, Andrea C. Krywucky

Electronic Thesis and Dissertation Repository

The aim of this research was to understand current practices of debriefing being used or not used in community social service organizations and the presumed frameworks or evidence justifying these practices in London, Ontario. The geographical area under concern has seen an increasing poverty gap, lack of affordable housing, toxic drug crisis, with mental health issues being exasperated by the pandemic. Social service agencies are overwhelmed with caseloads, creating an increase in need of care for frontline workers, as they are the first point of contact for many. This research utilized an interpretive description methodology to explore workers’ experiences and …

Data-Driven Neuroanatomical Subtypes In Various Stages Of Schizophrenia: Linking Cortical Thickness, Glutamate, And Language Functioning, Liangbing Liang

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The considerable variation in the spatial distribution of cortical thickness changes has been used to parse heterogeneity in schizophrenia. We aimed to recover a ‘cortical impoverishment’ subgroup with widespread cortical thinning. We applied hierarchical cluster analysis to cortical thickness data of three datasets in different stages of psychosis and studied the cognitive, functional, neurochemical, language and symptom profiles of the observed subgroups. Our consensus-based clustering procedure consistently produced a subgroup characterized by significantly lower cortical thickness. This ‘cortical impoverishment’ subgroup was associated with a higher symptom burden in a clinically stable sample and higher glutamate levels with language impairments in …

Predictors And Outcomes Of Patient Stigma Perception Appraisal: Developing And Testing Of A Dynamic Stigma Model Of Mental Illness, Sebastian Kwadwo Gyamfi

Electronic Thesis and Dissertation Repository

Background

The psychosocial perspectives of stigma have been explored over the years. However, research that encompasses the study of stigma as a socio-cultural, religious, and moral phenomenon is lacking. This study aimed to develop and test a Dynamic Stigma Model of Mental illness (DYSMO) among a cohort of Outpatients receiving care in Ghana.

Methods

The study examined hypothesized relationships within a newly developed stigma model using structural equation modeling techniques. A non-probabilistic convenience sampling technique was used to recruit 330 participants at the Out-Patient Department of two psychiatric hospitals in Southern Ghana.

Results

Confirmatory factor analysis produced a final model …

The Impact Of Initial Age Of Methamphetamine Use On Social Integration, Emily E. Guarasci

Electronic Thesis and Dissertation Repository

Background: Prevalence of methamphetamine use is rising in North America. Peers and social relationships are known to influence substance use patterns, but fewer studies have examined the role of early initiation on later social integration. We aimed to understand the relationship between age of first use and social integration.

Methods: Bivariate analyses were performed to assess the relationship between age of first use and social integration before performing a sex-based analysis. Multivariable linear regressions were used to help to understand this relationship.

Results: There was no significant association between age of first use and social integration scores for the sample. …

Role Of The Default-Mode Network During Narrative Integration In Major Depressive Disorder, Darren Ri-Sheng Liang

Electronic Thesis and Dissertation Repository

How brain activity is synchronized across individuals during narrative comprehension has previously been characterized by functional magnetic resonance imaging (fMRI) in healthy and patient populations. To our knowledge, there has been limited investigation as to how it is affected by major depressive disorder (MDD). We addressed this issue with fMRI through examination of inter-subject synchronization in the default mode network (DMN), brain structures which have previously been implicated in MDD pathology. Twenty-two patients with MDD and 20 matched control participants listened to Intact versus Scrambled versions of an auditory narrative; these experimental conditions differed in the degree of temporal integration …

Using Youth Voice To Inform Programs And Services Promoting Newcomers' Healthy Development, Alexandra C.G. Smith

Electronic Thesis and Dissertation Repository

Effective programs to support the healthy development and well-being of youth who have immigrated to Canada are needed. This integrated-article dissertation accentuated the perspectives of refugee and immigrant youth to identify considerations for programming and strategies to promote their healthy development. The first paper (Chapter Two) utilized focus groups to explore newcomer youths’ experiences relocating to a new country and advice for other youth who have recently arrived in Canada. We identified five overarching themes across groups through thematic analysis: (1) moving to a new county is hard, (2) maintain a healthy mindset, (3) take an active role in the …

Sex Differences In The Clinical Presentation Of Early Psychosis In A Primary Care Setting, Brooke Carter

Electronic Thesis and Dissertation Repository

Psychotic disorders can be variable in clinical presentation, and there may be differences by sex. The objective of this thesis was to explore sex differences in the clinical presentation of early psychosis in the context of primary care. Our systematic review and meta-analysis found that men experienced more negative symptoms and had a higher prevalence of substance use issues, whereas women experienced more depressive symptoms and had higher functioning. Our electronic medical record analysis from primary care found that positive symptoms and substance use were less prevalent in the medical records of women. We also found that visits by women …

Evaluating The Impact Of A Safe Exercise Training Workshop On Knowledge And Self-Efficacy To Manage Dysfunctional Exercise Among Eating Disorders Clinicians At Alsana Eating Disorders Center, Danika A. Quesnel

Electronic Thesis and Dissertation Repository

Engaging in dysfunctional exercise (DEX) is detrimental to eating disorders (EDs) prognosis, although common amongst clients. Though nutritionally supported exercise can improve ED treatment outcomes, without negatively impacting weight restoration, clinicians remain hesitant to address DEX, perhaps due to a lack of information and training. The current study examined the effects of a Safe Exercise at Every Stage (SEES) training on clinician knowledge and self-efficacy in managing DEX in ED treatment. Eating disorders clinicians completed measures before (n = 96) and after (n = 44) SEES training to assess their knowledge and self-efficacy around treating DEX, with a …

Emerging Adult Perspectives On Marijuana Usage And Social Isolation During Covid-19, Avery Kiana Wong

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Individuals struggling with emotional distress are twice as likely to use marijuana routinely. Young adults, ages 18 to 24, continue to be at increased risk for accidents, injuries, and poor cognitive functioning when using cannabis regularly, compared to those 24 and older. In addition, studies have shown that increased social isolation further increases the risk of marijuana use in young adults. Previous literature also demonstrated that marijuana is currently being used as a method of treatment for emotional distress. Much of the research conducted to date has focused on the collection of checklist data that has looked at the presence …

Troubling Service User Involvement In Health Professional Education: Toward Epistemic Justice, Stephanie Leblanc-Omstead

Electronic Thesis and Dissertation Repository

It has become increasingly popular in health professional education to solicit the contributions and involvement of people who have firsthand or ‘lived’ experiences of using mental health services – a practice hereafter referred to as service user involvement (SUI). SUI is founded on the premise that service users ought to be involved in the development and evaluation of services and systems they experience, which includes the education of future health professionals. Despite the momentum this practice has gained in a range of international contexts, SUI is often conceptualized, organized, and implemented uncritically, and with tremendous inconsistency across health professional education …

Exploring The Role(S) Of Trait Emotional Intelligence & Personality In Help-Seeking Behaviour Among Undergraduate Students, Nikola Cuvalo

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Trait emotional intelligence (EI) and the Big Five personality factors represent promising constructs in the individual differences literature that have been investigated in relation to help-seeking behaviour. This quantitative work explores the relationship between individual differences in trait EI, personality, and attitudes toward – as well as future intentions to engage in – help-seeking behaviour among undergraduate students at Western University. Stepwise regression modelling was used to determine which dimensions of personality and trait EI best predicted help-seeking outcomes and whether attitudes toward help-seeking predicted intentions to seek help from university-provided mental health sources. Resultsindicated that several individual facets of …

An Epidemic Amidst A Pandemic: A Critical Policy Analysis Of Supervised Consumption Sites, Vanisa Ezukuse

Electronic Thesis and Dissertation Repository

This study's primary purpose is to critically appraise current federal and provincial policies regarding supervised consumption sites (SCS), noting intended and unintended consequences; and how these policies could impact SCS users. This study's secondary goal is to compare current policies related to SCS in Alberta, British Columbia, Ontario, and Quebec to provide critical insight and suggestions for ongoing policy development. Carol Bacchi’s (2009) “What is the Problem Represented to Be?” framework was applied to the Canadian policy document with a focus on SCS. Four themes are proposed: Public Health versus Criminality, Presumptions versus Assumptions, Policy Unaccountability, and Policy Duality. It …

The Functional And Structural Consequences Of Aberrant Microglial Activity In Major Depressive Disorder, Jasmine D. Cakmak

Electronic Thesis and Dissertation Repository

Major depressive disorder (MDD) is a highly debilitating neuropsychiatric illness which has been linked with increases in both peripheral and central inflammation, as well as with changes in connectivity. Although countless studies have investigated these two topics, the relationship between neuroinflammation and functional/structural connectivity has not been explored. Using [¹⁸F]FEPPA PET imaging, we measured translocator protein-related (TSPO) microglial activity in the subgenual anterior cingulate cortex (sgACC) and insula and confirmed significantly increased [¹⁸F]FEPPA uptake in depressed patients (N=12) compared to healthy controls (N=23). Using a seed-based ROI analysis of fMRI data, we found that patients show …

Incidence Of Cancer And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders, Jared C. Wootten

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Evidence on cancer incidence in people with psychotic disorders, compared to the general population, is equivocal, although those with psychotic disorders so have more advanced stage of cancer at the time of diagnosis. The objective of this thesis was to compare cancer incidence and stage at diagnosis for people with psychotic disorders, relative to the general population. Our systematic review did not observe a significant difference in overall cancer incidence among people diagnosed with psychotic disorders (RR = 1.08, 95% CI: 1.00 to 1.16), however people with psychotic disorders were more likely to be present with advanced stage cancer at …

Why Do People Engage In Eating Disorder Behaviours?, Abbigail Kinnear

Electronic Thesis and Dissertation Repository

Eating disorders (EDs) are serious mental illnesses often with poor prognosis. Personalizing evidence-based treatments based on an individual’s reasons for engaging in ED behaviours – or the functions of EDs – may improve treatment outcomes; however, no validated measures assessing these functions exist. The goal of this study was to complete the initial steps in developing a measure of ED functions. Individuals who engage in ED behaviours (n = 16) and clinicians who treat EDs (n = 14) were interviewed, and a thematic analysis was conducted to determine key functions of EDs. Four main functions of EDs were …

Exploring The Burden Experiences Of Care Partners For People With Parkinson's Disease Living In Southwestern Ontario, Lisa A. Moszczynski

Electronic Thesis and Dissertation Repository

This thesis quantitatively explored the burden experiences of care partners of people with Parkinson’s Disease in Southwestern Ontario. Thirty-five complete responses (27 females, 8 males) and three partial responses to an online survey were obtained. The survey included a demographic section (41 items), two measures of burden and a quality of life measure. Care partner data were stratified based on Zarit Burden Inventory scores for analysis. Of the Little to No Burden (n=4), Mild Burden (n=15), Moderate Burden (n=8), and Severe Burden (n=4) groups, weekly hours spent on care duties and years in the care partner role were similar. The …

Childhood-Onset Epilepsy And Long-Term Child And Maternal Well-Being, Klajdi Puka

Electronic Thesis and Dissertation Repository

The long-term prognosis of pediatric epilepsy is favorable with respect to seizures, whereby 66% to 80% of children attain seizure control. However, psychiatric and psychosocial problems among children with epilepsy (CWE) and their parents are common, and little is known about their long-term outcomes. The objectives of this dissertation were to: 1) validate a parent-reported measure of young adult’s health-related quality of life (HRQOL), to allow for a consistent informant to report on CWE’s HRQOL from childhood into young adulthood; 2) delineate the long-term course of CWE’s HRQOL and identify the clinical, parent, and family characteristics associated with the trajectory …

Barriers To Safety Planning And Best Practices For Supporting Survivors Of Domestic Violence In Rural, Remote, And Northern Regions, Sara Kohtala

Electronic Thesis and Dissertation Repository

Domestic violence (DV) or intimate partner violence (IPV) is defined as physical, emotional, psychological, or sexual harm in an intimate relationship. In extreme cases, it may culminate in domestic homicide which is defined as the killing of an intimate partner, their children or their family members. Intimate partner violence and domestic homicide is prevalent worldwide. Over ninety-nine thousand reports of DV were made to police in Canada in 2018. According to the Canadian Domestic Homicide Prevention Initiative for Vulnerable Populations, some victims may face greater barriers in receiving assistance on a timely basis such as immigrants and refugees, Indigenous people, …

Long-Term Patterns Of Acute Mental Health Service Use After A First Episode Of Psychosis: Examining Ongoing Psychiatric Care Beyond The Critical Period, Eugene Law

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The long-term patterns of acute mental health service use after treatment in an early psychosis intervention (EPI) program are not well known. The objective of this thesis was to investigate the long-term patterns of acute mental health service use. We used health administrative data to examine the patterns and risk factors associated with acute mental health service use over the of 5- to 10-year period post-EPI admission. Between years 5 to 10 post-EPI admission, approximately one quarter of people contacted acute mental health services. Factors associated with acute mental health service use during this period included younger age at admission, …

"It's Certainly Someone's Job": The Roles Of Health Care Providers In Homelessness Prevention, Kayla May

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Comprehensive strategies to end all homelessness must include prevention-focused approaches in addition to the provision of emergency services and responsive housing programs. This qualitative descriptive study examines nurse practitioners’ and physicians’ perceptions of their roles in homelessness prevention and their current involvement in prevention-oriented activities. Data from interviews with health care providers was analyzed using a blended inductive and deductive approach, guided by a Framework for Homelessness Prevention and findings from a document analysis. The results highlighted health care providers’ conceptualizations of poverty, housing instability, and associated risk factors and found that providers consider information about patients’ social and economic …

Exploring The Mental Health Experiences Of African, Caribbean, And Black Youth In London, Ontario, Lily Yosieph

Electronic Thesis and Dissertation Repository

This qualitative study explores the mental health experiences of African, Caribbean, and Black (ACB) youth in London, Ontario, investigating how the factors of race, gender, culture, and place have shaped their perceptions and experiences of mental health. The data collection and analysis were conducted using a phenomenological approach and a critical lens informed by feminist, intersectionality, and critical race theories. These data illuminate the ways in which these young people’s attitudes toward mental health and help-seeking strategies are impacted by broader social constructs and community expectations, which they navigate and often resist in their everyday lives. Their insights can provide …

The Experiences Of Iraqi Refugees In Canada: A Life History Study Of War And Resilience In The Aftermath Of Migration, Nada Nessan

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This thesis reports on a life history narrative on the experiences of Iraqi refugees who resettled in Canada after living through war. The aim of this study is to help change the narrow perspectives on the mental health of war affected populations to a broader perception shaped by cultural and social aspects and to inform the development of meaningful and cultural relevant programs and policies with a particular attention to the concept of resilience.

The first part of the study presents the chronological narratives, or profiles. of eight participants. The second part of the study is a thematic discussion of …

Trends And Factors Associated With Suicide Deaths In Older Adults, Eada Novilla-Surette

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Suicide in older adults is a significant overlooked problem worldwide; particularly in Canada where a national suicide prevention strategy has not yet been established. This population-level study utilized and analyzed linked administrative health care databases (from 2011-2015) that were available at ICES (provincial health care administrative data steward), to build a better understanding of suicide (rate; trends; risks/preventive factors) in older adults living in Ontario, Canada. The findings suggest that suicide remains a persistent cause of death in older adults (with an average annual suicide rate of 0.1 per 1000 people over 5 years; the risks include being male, living …