Year: 2021

FOCUS on Adolescents: A mixed-methods study to optimize COVID-19 recovery and renewal efforts among adolescents in Canada and France

This award is co-funded by Health Research BC, through CIHR’s Operating Grant: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada. 

 

The COVID-19 pandemic and its corresponding health, social, and economic implications present potential lasting consequences for inequalities and vulnerabilities to manifest across later phases of the life course — a trend that may have significant impacts for adolescents aged 15-19. For example, school closures and other public health measures (e.g. isolation) have had significant effects on adolescent health — an age group whose need for social engagement and connection are essential for development. However, little is known about how social, economic, and cultural changes related to COVID-19 will affect adolescents’ health and social well-being over time.

 

To fill this knowledge gap, Dr. Rod Knight (principal investigator, assistant professor, UBC Department of Medicine) and Dr. Marie Jauffret-Roustide (co-principal investigator, research scientist, INSERM, University of Paris) are launching an international research study to extend their CIHR-funded France-Canada Observatory on COVID-19, Youth Health, and Social-wellbeing (FOCUS) – a research program launched in June 2020 to evaluate the impact of COVID-19 on youth aged 19-29 living in Canada and France – to include adolescents aged 15-19.

 

The FOCUS on Adolescents project will work alongside a group of adolescents from Canada and France to adapt the FOCUS Study’s program of research to include adolescents in a series of annual interviews and bi-annual national online surveys. At the end of the study, a participatory summit will be held in each country with youth and key stakeholders working with adolescents (e.g. clinicians, community members, policy makers) to identify interventions that best address the social and health needs of adolescents.

 

This research project will provide policy makers and clinicians with high-quality, real-time evidence to inform COVID-19 public health responses to improve health outcomes and reduce health inequities among adolescents.

End of Award Update – July 2024

 

Results

Our main objective was to involve adolescents aged 15-18 in our FOCUS research infrastructure, including the development and implementation of an online survey in Canada and France. To achieve this objective, we successfully engaged via in-person and virtual meetings with community organizations providing health and social support services to adolescents in both countries. These partnerships allowed us to adapt our online questionnaire and promotion strategies to reach and recruit a large group of adolescents in both countries: more than 300 adolescents took part of our survey in both countries. Involving adolescents in our research represents a key opportunity to investigate the differences between adolescents and young adults in terms of mental health and substance use, and therefore provide specific recommendations about the impact of the COVID-19 pandemic in each group.

 

Impact

During this research project, we implemented an international consortium of researchers from various disciplines, including Canadian and French researchers, which was a critical step to identify context-specific factors (e.g., differences in perceptions of mental health needs and vaccination) influencing research outcomes and developing further international, comparative research projects. We have presented research findings and other ongoing data analyses related to the FOCUS Study at international conferences and to our community partners as part of our knowledge mobilization activities.

 

Potential Influence

Our research activities allowed us to engage in constructive discussions with health providers and peer workers from community organizations regarding the influence of determinants of health on youth health and social wellbeing. For example, specific data analyses have been planned to inform community organizations about the health needs and concerns of adolescents and young adults in the current post-pandemic context.

 

Next Steps

Throughout the remainder of the FOCUS Study, we will continue to engage with community organizations and youth representatives to collaborate on the preparation of scientific articles. In order to accelerate the availability of our research findings, we will also develop a set of scholarly and policy-oriented deliverables, including those designed for key decisionmakers (e.g., government officials), as well as brief summaries of evidence, which we will promote through media engagement (e.g., media interviews, posts on social media platforms). For example, the preliminary findings of the 2023 FOCUS survey have been summarized in a community report that will be shared and presented to youth community organizations in France and Canada.

 

 

Useful Links

Impact of social determinants of mental health on child and parent risk, resilience and support access in the COVID-19 era: A nested mixed-methods study of short and long-term outcomes

This award is co-funded by Health Research BC, through CIHR’s Operating Grant: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada. 

 

Project co-leads include Evelyn Stewart MD and Hasina Samji PhD, who brought together their extensive collaborative networks. Dr. Stewart is a UBC professor, child and adolescent psychiatrist and Director of Research for Child and Adolescent Psychiatry, BCCH. Dr. Samji is an epidemiologist, SFU assistant professor and senior scientist at BCCDC.

 

Between November 2020 and July 2021, the group collected baseline data for the Personal Impacts of COVID-19 Survey (PICS), a Canadian study identifying vulnerability factors to poor mental health related to preexisting medical and living conditions, sex/gender minorities and poverty. Based on our PICS baseline findings, which includes 3,351 Canadians, rates of several COVID-era mental illnesses were several-fold higher than expected; and one quarter of parents reported needing but not receiving mental health support.

 

Our mixed-methods study will build upon PICS findings by re-contacting participants to better understand their pandemic-era mental health service access, future preferences and the role of social risk and resilience factors. It will also identify those with persisting, resolving and newly emerging mental illness during the COVID-19 recovery phase. In this way, our study will provide a current, comprehensive perspective on families’ experience of the COVID-19 pandemic and how services providers, community organizations and policymakers can best serve child and parent populations at highest risk for ongoing mental health impacts.

End of Award Update – July 2024

 

Results

Only 35% of participants reported accessing mental health supports for their youth throughout the pandemic. 20% reported needing but not receiving support. Most participants attributed their mental health needs to pandemic-related reasons. Those with unmet needs reported mostly needing a publicly funded psychiatrist/psychologist, or a private counsellor/psychologist. Participants also reported needing more mental health support from schools and community mental health teams. For many youths, informal coping strategies were very important, such as relying on friends for emotional support or engaging in hobbies and extracurriculars. These coping strategies were the most impacted by the pandemic and left many youths without both formal supports and informal coping strategies. Overall, these results highlight the amount of Canadian youths who needed but did not receive mental health services.

 

Impact

Participants will hopefully receive indirect benefits from this project in the form of improved provincial support services and policies regarding youth mental health and well-being during the COVID-19 pandemic recovery. Results from this project have informed the creation of a provincial report that is aimed at providing recommendations and action items for provincial service providers and policymakers who are in positions to make informed decisions and act on the outcomes reported in this project.

Additionally, we have been able to provide families and youths an opportunity to share their experiences and feel heard during a time that was very challenging and isolating. Several of our participants expressed positive therapeutic effects of participating in qualitative research and feeling connected and able to contribute to better outcomes in the future.

 

Potential Influence

The results and recommendations from this study have been shared widely with provincial healthcare providers, health institutions, patients, provincial decision-makers, and community organizations through posters, presentations, social media, infographics, and a provincial report. We hope that through wide dissemination to these different groups, the results of this project can contribute to the greater discussions on how to support BC resident’s mental health during the pandemic recovery phase. Our recommendations have already been incorporated into the ‘Improving Youth Mental Health and Well-Being During the COVID-19 Recovery Phase in BC Report’ that was organized and compiled through the combined efforts of the BC Children’s Hospital, The University of British Columbia, and Simon Fraser University. The purpose of this report was to identify strategies to support youth mental health and well-being during the pandemic recovery period. Findings from this project were presented at deliberative dialogue events to attendees that included partners from the education, health, community, and nonprofit sectors, alongside youth and families. These findings contributed to the report’s objective by examining the mental health impacts of the COVID-19 pandemic on youth, identifying which groups of youth have been disproportionately impacted, and what modifiable factors and coping strategies have helped to buffer the effects of the pandemic. This report presented recommendations and key action steps to hopefully guide youth mental health partners in the province to focus on recovering from the societal and mental health impacts of the pandemic.

 

Next Steps

We currently have two manuscripts in submission that we will continue to pursue for publication. This project has already provided opportunities for research trainees and will continue to provide opportunities for future trainees to conduct projects, particularly those examining how best to mitigate risk factors and support vulnerable identities that were most impacted during the pandemic.

Notably, we continue to collect longitudinal data through periodic survey follow-ups, which allows us to continue to track the long-term outcomes of COVID-19 on Canadian wellbeing and mental health and will support future analyses and manuscripts.

Evaluating a virtual care platform (REACHOUT) that delivers peer-led mental health support to adults with type 1 diabetes in rural and remote communities in British Columbia

Mental health is often overlooked in diabetes care. In fact, BC’s provincial health plan does not cover psychological services for patients with chronic illness. Studies have found that, of psychological stressors, diabetes distress (DD) is the most closely associated with poor blood sugar control and worse health consequences. DD refers to the unique and often hidden emotional burdens, and relentless frustrations and worries that patients experience when trying to manage this condition. In 2027, almost 35,000 British Columbians diagnosed with type 1 diabetes (T1D) will report clinically significant levels of DD. Unfortunately, T1D adults living in rural and remote regions will have the least access to mental health services. I seek to address three major gaps in BC’s diabetes care: the availability, affordability, and accessibility of mental health support for T1D patients living in settings with limited resources. In collaboration with T1D patients, clinical psychologists, digital health specialists, and biomedical engineers, I will use digital health strategies to “drive” a peer-led mental health support intervention (REACHOUT) to adults with T1D living in geographically isolated communities.

Improving clinical practice guidelines for antenatal corticosteroids: Incorporating a decision support tool to impact clinical counselling

Antenatal corticosteroids are a medication given to women who are at risk of an early delivery to reduce the chance of breathing problems for their baby after birth. Current guidelines recommend giving antenatal corticosteroids to pregnant women who might have their baby before 34 weeks of pregnancy. This medication may also help those at risk of an early delivery at 34-36 weeks of pregnancy but the balance between the benefits and harms of this treatment is less clear at these ages. Guidelines for giving this medication at 34-36 weeks of pregnancy are also unclear, making it difficult for doctors and patients to decide whether to use it. We will find out if including a decision support tool in clinical guidelines will improve how doctors discuss antenatal corticosteroids with patients at 34-36 weeks of pregnancy. We will ask patients whether they had better discussions with their doctor about this treatment after their doctor had access to the decision support tool within the clinical guideline, and we will ask doctors how this decision support tool impacted their counselling. This project could improve communication between doctors and patients, especially when it is unclear whether a treatment’s benefits outweigh its harms.

Exploring the experiences of racialized learners to understand and dismantle racist structures in our healthcare system

Racism is experienced by learners, professionals, and patients in our healthcare system and contributes to well-documented health inequities. However, patient care and health outcomes are improved through a diverse physician workforce. Medical schools have attempted to support diversity through the admissions process, including increased racial diversity in their programs. Yet we know little about the experiences of racialized learners once admitted. This study will explore the impact of existing policies, processes and practices on learners’ sense of agency, attending to their perspectives on how their experiences of racism impact patient care.
This study focuses on racialized learners’ experiences in their clinical education over time through the use of diaries and interviews. Engaging with learners across four medical schools, we will attend to the impact of important differences in their identities such as race, gender, and sexual orientation.
Through this study, we will identify concrete ways in which our healthcare (and clinical education) systems perpetuate racism. From this, I will work with clinicians, educators and policy makers to enact systems changes that will ultimately reduce health inequities.

Economic evaluation of the use of expanded criteria donor kidneys pre-emptively to improve the critical organ shortage

Kidney transplantation can be life saving for people with end-stage kidney disease at a lower cost than the only other alternative which is dialysis treatments. Unfortunately, there are not enough kidneys available for transplant. This means that until we can improve the kidney supply, patients will continue to have to wait on a waiting list and may die in the process.

Kidneys from older donors have been successfully used for transplant, but at a higher risk. This higher risk discourages some patients and physicians from accepting these kidneys for transplant. This results in kidneys being discarded that could otherwise have saved lives.

However, these kidneys will have better outcomes if they are given to patients before they ever need to start dialysis, instead of our current practice which is to wait until someone is at the top of the waitlist after years of dialysis. This research project will use economic models to study how allocating kidneys from older donors to some patients before they ever need dialysis might impact the overall kidney supply and patient outcomes. This research will help inform future health care policy which may improve organ supply for patients waiting for a life-saving transplant.

The DISCO study: Rethinking STI prevention

Syphilis, chlamydia and gonorrhea are three of the most common sexually transmitted infections (STI). Over the last decade, these STIs have seen a resurgence in many parts of Canada, with most infections seen in major urban centres. These infections have primarily affected gay, bisexual, and other men who have sex with men (gbMSM). Recently, a small pilot study found that doxycycline — an inexpensive, well-tolerated antibiotic — given daily may prevent new STIs in gbMSM. Another study looked at the use of doxycycline given after a sexual encounter for prevention of STIs, and the results of this study showed protection against STIs as well. Based on these promising data, along with the concerning increases in STIs seen in Canada, the current study will examine the use of doxycycline as either a daily prevention therapy (preexposure prophylaxis, or PrEP) or an ‘after sex’ prevention tool (postexposure prophylaxis, or PEP) for STIs in gbMSM. While examining for efficacy as its primary goal, this study will also do an examination of some of the potential challenges and concerns associated with the use of a daily antibiotic: drug resistance, tolerability and side effects, and how acceptable this drug is for people to take regularly.

Perioperative stroke screening and outcomes in high-risk surgical patients

Up to two percent of patients will experience a stroke during or after surgery and these patients have a high chance of disability and death. Currently, we don’t understand clearly how to prevent, detect, and treat stroke after surgery. Although risk factors have been identified including older age and cardiac surgery, high risk surgical patients are not usually identified and strokes can be missed, leading to fewer treatment options and more complications. My previous pilot study showed that anesthesia and surgery can limit the accuracy of standard screening tools for stroke. We urgently needed a screening tool and protocol specifically for surgical patients. We also don’t understand well how patients recover after perioperative stroke, such as which patients survive, and whether they can stay in their homes. Building on our prior research, this multiphase study aims to: (1) Understanding which patients do poorly after perioperative stroke and whether those factors can be changed; (2) Compare mortality and other complications after stroke between those who had recent surgery and those who did not; and (3) Identify a useful perioperative stroke screening tool to quickly and accurately detect stroke after surgery.

Does timing matter? A trial of intermittent fasting in haematological malignancies

Does when we eat make a difference to our health? We know that food choices can impact cancer risk but what if the timing plays a role as well? Evidence shows that fasting may slow cancer growth through a process called autophagy. Through an interdisciplinary research team, I am currently running a small trial testing the effects of intermittent fasting (IF) in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) at BCC-Victoria who are not on anti-cancer treatment. Specifically, I am asking whether IF regimens, differing in fasting timing and duration, stimulates autophagy, improves quality of life, impacts gut microbiome, and/or results in clinical benefit (i.e. reduced lymphocyte count). I am also following participants’ safety, ability to follow the fast, and fasting preferences. While early results look promising, I propose growing this study into a larger trial with three phases to clarify the effects of IF on cancer and the microbiome. Understanding these effects may help discover simple diet recommendations for patients with cancer that cause a response in cancer cells or slow cancer progression, are safe and reduce treatment side effects when used alongside current, standard treatments.

Neuropsychological functioning in treatment resistant schizophrenia

Schizophrenia is a severe and disabling psychiatric illness involving primary symptoms of psychosis (hallucinations, delusions, disordered thinking and behavior). Unfortunately, as many as 30% of patients respond poorly to standard antipsychotic medications and are considered to have treatment resistant schizophrenia (TRS). Neuropsychological impairment is an important clinical feature of schizophrenia, as cognitive deficits predict poor treatment response, daily functioning, and disability. However, very little is known about cognitive functioning in the clinically complex subset of patients with TRS. The aims of this project are therefore to investigate the severity, pattern, and variation in cognitive functioning among individuals with TRS, and to determine whether cognitive difficulties predict treatment response and functioning. This will be achieved by analyzing clinical and neuropsychological data that has been collected on TRS patients who have been treated within the BC Psychosis Program since 2012. Findings using this unique dataset will have a direct impact on shaping assessment and treatment strategies, improving prognosis and ability to predict functioning, and improving clinical decision-making and planning.