Non-Competition Poster Abstracts

ABSTRACT #96
FILM THERAPY FOR ADOLESCENTS: A PILOT PROJECT
1
2
DR NADEEM AKHTAR , CYNTHIA ROBINSON , RILEY ROSE
3
AIMS AND HYPOTHESIS
This pilot project evaluated the impact of film-based group therapy on the Mental Health of
Adolescents. It was hypothesised that following the group, statistically significant improvements
on measures of Self Esteem, Illness Experience and Resilience (alongside qualitative support
from semi-structured interviews held in post-course focus groups) would be observable.
BACKGROUND
Viewing a Film can evoke strong emotions, reduce psychological defences and can give rise to
powerful insights. Literature describing and evaluating a method for meaningfully integrating the
use of film into group therapy is scarce. Traditional therapeutic groups can be intimidating for
adolescents, diagnosis specific and poorly attended.
To address this, a group, focusing on the themes integral to poor mental health (rather than
diagnosis), using film as a gateway for discussion was developed. To reduce apprehension,
divert from standard expectations of therapy, promote disclosure and socialisation, an
“immersive environment” was created (ie one with cinematic props, lighting and snacks).
METHODS
Two Courses were run from April-June and September-November, 2015. Participants aged 1418, with a Psychiatric diagnosis, were referred from Primary Care. Nine, weekly-sessions, (1 ½
hours each)
comprising socialization in the “immersive” environment, followed by
“Cinematherapy” aligned guided discussion were undertaken. The final session reviewed
previous sessions and participants were presented with Oscars as a memento. Scales were
completed before the first, and (prior to a focus group) following the last session.
RESULTS
Two tailed, paired t-tests on pooled data (n=13) demonstrated statistically significant
improvements between pre-and post measures on the State Self Esteem Scale (total score
,social self esteem, appearance self esteem- p<0.01; performance self esteem p<0.05) Mental
Health Inventory (p<0.01) and Child and Youth Resilience Measure (total score, p<0.05).
Qualitative analysis praised the immersive environment, peer support and social aspects of the
group.
CONCLUSIONS
The results support “Film Therapy” as a means for improving Illness Experience, Self Esteem,
Resilience ( and Peer Support/Socialisation) in an adolescent population. Continuation of the
pilot, with post-group follow up data, will be necessitated to further support these findings.
1 Nadeem Akhtar MA (Cantab), MBBS (Lond) MRCPsych (UK)
Assistant Professor, McMaster University Department of Psychiatry; Psychiatrist, Hamilton Family Health Team
2 Cynthia Robinson BSW, B.Ed, M.Ed,RSW
Child and Youth Groups Co-ordinator, Hamilton Family Health Team
3 Riley Rose (BSc)
Medical Student, Clinical Rotation, McMaster University
ABSTRACT #97
A randomized control trial of video games about early detection and intervention to test
efficacy on mental health literacy among homeless and street involved youth: A work in
progress
Archie S1, Ferrari M1, Hill-Finamore L2, Whittle A2, Clark D3.
Department of Psychiatry McMaster University; 2Good Shepherd Hamilton;3 Moonray Studios
1
This study examines the use of video game technology to help youth gain awareness of signs
and symptoms associated with hazardous substance use and serious mental illness. Harry’s
Journey, imparts the story of Harry - a youth and his diverse group of friends, as he considers
whether to seek help for his psychosis and marijuana use. Harry’s Journal is a checklist or
digital journal of symptoms experienced by the central character – it is a ‘digital ‘Trivial Pursuit’
that tests 12 symptoms associated with psychosis from Harry’s Journey. The PathwaysToCare
Map charts and integrates the mental health and addictions youth services located in Hamilton.
To outline information about the services, it relies on the interactivity of sound, images, and
voice-overs involving Harry and service providers. This project was funded in December 2015
by the Ontario Trillium Foundation.
Objectives
To evaluate the efficacy of the Back to Reality Series compared to a control game at improving
psychosis and substance use literacy, using the Early Psychosis Literacy Scale and the
Marijuana and Psychosis Quiz, among youth attending Good Shepherd programming
To explore their perceptions about substance use and among youth.
Hypotheses: Participants exposed to the Back to Reality Series (Experimental Group) will
demonstrate significant increases in mental health literacy and knowledge and about marijuana
and psychosis compared to those participants exposed to the control game (Control Group).
Methods: The study is designed to enroll a total of 200 eligible participants registered with the
Good Shepherd Hamilton programming, between the ages of 16 and 19 years of age. Good
Shepherd clients include street involved and shelter youth from racialized, Aboriginal,
LGBTTQIA, and newcomer backgrounds. All participants will receive usual care from the Good
Shepherd. This study involves a randomized single blind controlled trial of video games along
with a post-intervention individual interview. The results will be assessed using quantitative
questionnaires and qualitative interviews about mental health literacy. The interview will assess
the participants understanding of potential emotional and social manifestations of excessive
marijuana use during youth.
Implications: By playing the Back to Reality video games, this study will test whether youth
absorb knowledge about where and how to access community care through the interactivity of
the video games.
References: Fleming, T., Dixon, R., Frampton, C., & Merry, S. (2012). A pragmatic randomized
controlled trial of computerized CBT (SPARX) for symptoms of depression among adolescents
excluded from mainstream education. Behav Cogn Psychother, 40(5), 529-541. doi:
ABSTRACT #98
Evaluation of a yoga-based intervention for women with a history of trauma and
substance use
Debbie Bang2,3, Tashia Petker1,2, Christine Yanke3 & James MacKillop1,2
1
Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, West 5th
Campus, 2Department of Psychiatry and Behavioural Neurosciences, DeGroote School of
Medicine, McMaster University; 3Womankind Addiction Service, St. Joseph’s Healthcare
Hamilton, 431 Whitney Ave.
Background: Many people who seek treatment for substance use disorders (SUDs) have
experienced traumatic events and/or abuse. At St. Joseph’s Healthcare Hamilton’s Womankind
Addiction Service, rates of self-reported abuse and trauma among women admitted to the
Residential Treatment Program over the last five years are high (41% emotional; 31% physical;
25% sexual). Due to a common lack of community resources for trauma therapies, recent
research has focused on adapting non-pharmacological treatments for post-traumatic stress
disorder (PTSD) as complementary treatments for SUDs, such as yoga-based interventions.
Although the empirical evidence supporting yoga interventions is limited, the existing literature
reports significant effects of yoga on the reduction of both PTSD and SUD severity [1, 2], and on
reducing symptoms of mood and anxiety disorders [2].
Purpose: To perform an initial within-subjects program evaluation of the YogaFit Warrior
Program in the Residential Treatment Program at Womankind Addiction Service.
Methods: Participants were 45 adult women recruited from within the Residential Treatment
Program at Womankind Addiction Service. One-hour yoga sessions were provided twice weekly
as an addition to the existing treatment program, for the duration of 5 weeks. Participants
completed an assessment battery at the beginning and end of the 5-week session. Outcome
measures included indices of stress, anxiety, depression, substance use, cravings, mindfulness,
self-regulation, impulsivity, somatic complaints, and range of motion.
Results: Of the 45 women who participated, valid pre- and post-test data were available for 19
individuals. Statistically significant reductions were observed in measures of craving, stress, and
impulsivity. Additionally, statistically significant increases were observed in measures of
mindfulness and range of motion. Anecdotal reporting from participants and staff indicate that
the addition of yoga to treatment was enjoyable and well-tolerated.
Conclusion: Overall, the addition of semiweekly yoga sessions to the existing treatment
program provided meaningful mental and physical health benefits to clients. Findings indicate
that the impact of the YogaFit program on participants was positive on several outcome
measures. Limitations of this initial evaluation include a small sample size and lack of a
matched control group. Future evaluation studies of YogaFit will include a waitlist control group,
which will allow for evaluation of yoga-related benefits controlling for treatment-related effects.
References:
1.
Reddy S, Dick AM, Gerber MR, Mitchell K (2014) The effect of a yoga intervention on
alcohol and drug abuse risk in veteran and civilian women with posttraumatic stress
disorder. J Altern Complement Med 20:750–6.
2.
Da Silva TL, Ravindran LN, Ravindran A V. (2009) Yoga in the treatment of mood and
anxiety disorders: A review. Asian J Psychiatr 2:6–16.
ABSTRACT #99
A Quality Assurance Project to Obtain Feedback from Physicians Who Refer to the
Seniors Mental Health Outpatient and Outreach Program at St. Joseph’s Healthcare
Hamilton (Work in Progress)
Baxter J1, Mann J2, McAiney C2,3
1
Seniors Mental Health Service, St. Joseph’s Healthcare Hamilton, 2Bachelor of Health
Sciences Program, McMaster University, 3Department of Psychiatry and Behavioural
Neurosciences, McMaster University
Rationale: A growing number of seniors - as many as 40 percent - have identifiable mental
health problems (Kates et al., 2004). For this reason, there is an increased desirability for
improved collaboration between psychiatrists and primary care physicians in providing mental
health care to the elderly. The Seniors Mental Health Outpatient and Outreach Program at St.
Joseph’s Healthcare Hamilton provides care to seniors with mental health, addiction and
behavioural issues in Hamilton, Brant, Niagara, Halton, and Northwest Mississauga. Primary
care providers are key partners in the care provided, as they are responsible for implementing
the recommendations made by the team.
Purpose: In an effort to improve the service it provides, the Seniors Mental Health Outpatient
and Outreach Program is conducting a survey of family physicians who have referred one or
more of their patients to the program as part of a quality assurance initiative. The survey will
gather feedback on various aspects of the service, and solicit ideas for improving care as well
as the interactions between primary care providers and the teams.
Methodology: A list of primary care providers who referred one or more of their patients living in
the community during a one-year period was compiled. Of the 631 physicians identified, 400 will
be surveyed across the four regional teams in Southern Ontario - Halton (159), Niagara (92),
Hamilton (116) and Brant (33). Within each region, physicians are further categorized as having
referred one patient, two patients, or three or more patients to the program. The design of the
survey was informed by the literature on shared mental health care (Kates et al., 2004) and
optimal survey methodology (Flanigan et al., 2008). A cover letter and the one-page survey
consisting of eight Likert-scale items and one open-response question, will be faxed to each
physician’s office. A reminder fax, with an additional copy of the survey, will be sent to
physicians who have not responded two to three weeks after initial administration of the survey.
Survey responses will be analyzed using medians, means and standard deviations.
Comparisons between physicians who are ‘low’ and ‘high’ referrals will be made.
Results: Data collection is currently ongoing.
References
Flanigan, T. S., McFarlane, E., & Cook, S. (2008, May). Conducting survey research among
physicians and other medical professionals: a review of current literature. In Proceedings
of the Survey Research Methods Section, American Statistical Association (pp. 4136-47).
Kates, N., Fugere, C., & Farrar, S. (2004). Family Physician Satisfaction with Mental Health
Services: Findings from a Community Survey. Bulletin, 36(2)
Yaffe, M. J., Primeau, F., McCusker, J., Cole, M. G., Belzile, E., Dendukuri, N., ... & Laplante, J.
(2005). Psychiatric outpatient consultation for seniors. Perspectives of family physicians,
consultants, and patients/family: A descriptive study. BMC Family Practice, 6(1), 1.
ABSTRACT #100
An Evaluation of the Quality of Systematic Reviews and Meta-analyses in Child and
Adolescent Mental Health
Kathryn Bennett, PhD1,2; Stephanie Duda, MSc1
1
Department of Clinical Epidemiology and Biostatistics, McMaster University
Department of Psychiatry and Behavioural Neurosciences, McMaster University
2
Abstract
Background: Systematic reviews and meta-analyses (SR/MA) about interventions for child and
adolescent mental disorders are increasingly available. When conducted using rigorous
methods they provide a gold standard information source that can inform healthcare decisions
and future research priorities. Since little attention has been given to documenting and
improving their rigor, we applied SR methods to evaluate the quality of SR/MA about child and
adolescent anxiety, depression and suicide interventions.
Objectives: (i) What proportion of eligible SR/MA meet minimum quality standards defined
using AMSTAR criteria? (ii) Did SR/MA quality improve after AMSTAR was introduced (2007)?
(iii) Does journal impact factor predict SR/MA quality?
Methods: Pre-specified inclusion criteria identified eligible SR/MA (2000-2012). Two trained
raters applied AMSTAR to document review quality. Minimum quality was defined as an
AMSTAR score ≥ 5/9 (SR) or ≥ 6/11 (MA).
Results: Of 85 eligible reviews, 49.4% achieved a minimum quality rating: [anxiety (n=20):
40%; depression (n=35): 60%; anxiety and depression (n=16): 37.5%; suicide (n=14): 50%].
Among all eligible reviews failure rates for three AMSTAR criteria associated with high risk of
bias were: funding source/conflict of interest (68.2%); assessment of study quality (67.1%);
consideration of study quality in conclusions (62.4%). A statistically significant difference in
AMSTAR scores was observed for reviews published prior to the introduction of AMSTAR
(2000-2008) compared to after (2009-2012). A statistically significant correlation (r=0.25)
between AMSTAR scores and journal impact factor was found.
Conclusions: Significant quality gaps exist in SR/MA about interventions for child and
adolescent anxiety, depression and suicide. The weaknesses identified can be remedied
through increased attention to international quality standards by authors and journal editors, and
intensified review author collaboration to reduce the burden associated with time/resource
intensive standards. Both strategies can increase the pool of rigorous reviews available to
support evidence-informed healthcare decision-making and inform future research priorities.
References:
1. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: A measurement tool to
assess the methodologic quality of systematic reviews. BMC Medical Research
Methodology 2007;7:10.
2. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and
meta-analyses: The PRISMA statement. Journal of Clinical Epidemiology 2009; 62:10061012.
ABSTRACT #101
“Making the Race Fair for Young Children at Risk”: A Targeted Prevention Approach to
Reducing Child Emotional and Behaviour Problems (Study Protocol/Work-In-Progress)
Bennett, Teresa1,2; Georgiades, Katholiki2;Gonzalez, Andrea2;Lipman, Ellen1,2; and the Family
Check-Up Multi-Investigator Team
1) McMaster Children’s Hospital, Ron Joyce Child Health Centre; 2) Offord Centre for Child
Studies, McMaster University
Background: One of the largest predictors of adult mental illness is childhood emotional and
behavioural problems (EBP). Early childhood EBP are common (e.g., prevalence of 14-26%),
pervasive (affecting children across diagnostic boundaries, e.g., neurodevelopmental disability,
trauma), and pernicious (3- to 6-fold increased risk of future mental illness and impairment)1.
Thus, trans-diagnostic preventive interventions that address early childhood EBP are most likely
to yield highest impact on burden of suffering of children, families and communities.
Objective: With support from a Multi-Investigator Research Initiative (MIRI) grant from Brain
Canada/RBC Foundation, we will evaluate the Family Check-Up (FCU) as a targeted prevention
and early intervention program within a Canadian setting. The FCU is a brief, evidence-based
intervention that is unique in its focus on multimodal assessment, tailored intervention, and
emphasis on family engagement within a motivational interviewing framework. It has
demonstrated robust effects across child and family outcomes in US studies2, however it has yet
to be evaluated within a Canadian context.
Methods: This study will entail two phases: Phase 1: We will partner with McMaster Children’s
Hospital to build the clinical and systems infrastructure required to deliver, sustain and ultimately
scale up the FCU. Phase 2: We will conduct a 1:1 randomized controlled trial (RCT) of 280
participating caregiver-child dyads to examine the effects of the FCU as a targeted prevention
intervention within the Canadian context, as delivered to caregivers and children aged 2-4 years
at high risk of persistent childhood EBP. The study protocol is outlined.
Discussion: This project outlines an ambitious plan to create a novel and sustainable
infrastructure for prevention and early intervention in child mental health services. The FCU is
particularly promising in its capacity for scale-up. The model applies to different developmental
periods and has demonstrated successful delivery across diverse cultural groups and delivery
settings in the U.S.. If effectiveness is demonstrated within a Canadian context, community
agencies may feasibly train front-line clinicians to increase Hamilton’s capacity to prevent earlyonset trajectories of EBP in our most vulnerable children.
References:
1.Egger, H. L., & Angold, A. (2006). Common emotional and behavioral disorders in preschool
children: presentation, nosology, and epidemiology. Journal of Child Psychology and
Psychiatry, 47(3‐4), 313-337.
2. Dishion, T. J., Brennan, L. M., Shaw, D. S., McEachern, A. D., Wilson, M. N., & Jo, B. (2014).
Prevention of problem behavior through annual family check-ups in early childhood: intervention
effects from home to early elementary school. Journal of abnormal child psychology, 42(3), 343354.
ABSTRACT #102
Acute systemic amphetamine and PCP disrupt behavioural inhibition and motivation in
the rodent 5-choice serial reaction time task
Jayant Bhandari1; Ritesh Daya1,2; Ashley Bernardo1,2; Roohie Sharma1,2; Sharnpreet
Kooner1; Aaron Edward1; Dr. Ram K. Mishra1
1
Department of Psychiatry & Behavioural Neurosciences, McMaster University
McMaster Integrative Neuroscience Discovery & Study, McMaster University
2
Rationale: Because cognitive symptoms in schizophrenia, such as impaired attention, remain
difficult to treat by antipsychotic medication, it is important to use appropriate pre-clinical models
for drug discovery research. One common approach to produce and measure attentional
impairments in animals is pharmacological manipulation, such as chronic amphetamine or subchronic phencyclidine (PCP) administration, and the 5-choice serial reaction time task (5CSRTT). However, the ability of acute treatment with these drugs to produce attentional
impairments in animals has not been fully investigated using this task.
Purpose: We used 5-CSRTT to test the ability of acute systemic amphetamine and PCP to
impair attentional, inhibitory, and/or motivational performance, as well as the ability of
antipsychotics and a novel allosteric modulator (PAOPA) of the dopamine D2 receptor to
ameliorate impairments.
Methodology: Male Sprague Dawley rats were trained on 5-CSRTT and distributed into four
treatment groups that did not differ in any measured parameters. Rats then performed under
baseline settings twice a week, followed by two days of testing using variable stimulus duration.
Rats were administered vehicle, amphetamine (0.5, 1 mg/kg) or PCP (2.5, 3.5, 5 mg/kg). To
examine the predictive validity of these acute models, olanzapine (3 mg/kg), clozapine (2, 10
mg/kg), lurasidone (1 mg/kg), haloperidol (0.05 mg/kg), or PAOPA (1 mg/kg) were administered
on test days for amelioration of 5-CSRTT disruptions.
Results: Acute amphetamine and PCP did not alter response accuracy; instead they increased
premature and compulsive responses, and omissions. Lurasidone and clozapine, but not
olanzapine, offered some but not complete amelioration; PAOPA provided even more modest
amelioration, and haloperidol did not alter performance.
Conclusion: Acute systemic amphetamine and PCP may be more appropriate for representing
impulsivity, compulsivity, and avolition in schizophrenia using 5-CSRTT, with partial amelioration
by some antipsychotic medication.
References:
1.
Robbins, T.W. The 5-choice serial reaction time task: behavioural pharmacology and
functional neurochemistry. Psychopharmacology (Berl) 163, 362-380 (2002).
2.
Chudasama, Y. & Robbins, T.W. Psychopharmacological approaches to modulating
attention in the five-choice serial reaction time task: implications for schizophrenia.
Psychopharmacology 174, 86-98 (2004).
ABSTRACT #103
The Adolescent Irritability Scale
Khrista Boylan, MD PhD1234, Valbona Semovski, MSc Student13, Eric Duku, PhD1234,
Leslie Born, PhD12, Meir Steiner, MD PhD12
1. McMaster University, Hamilton, Ontario; 2. Department of Psychiatry and Behavioural
Neurosciences, 3. Department of Clinical Epidemiology and Biostatistics, 4. Offord Centre for
Child Studies, Hamilton, Ontario
Keywords: irritability, adolescent, scale
Background: Irritability, a common presenting symptom in youth is a criterion for various DSM
psychiatric disorders (Gadow & Drabick, 2012). To date, there is one measure of irritability in
adolescents. This study modified the Born-Steiner Irritability Scale (BSIS) for use in
adolescents, named the Adolescent Irritability Scale (AIS), and assessed the scale’s preliminary
psychometric properties.
Objectives: The primary objectives of the study were to test (i) face validity of the AIS to
adolescents (ii) reliability and factor structure of the AIS and (iii) examine the external validity of
the scale by comparing correlations across informants, with self-report of irritability and with
symptoms of depression.
Methods: Research was conducted at a tertiary pediatric hospital outpatient psychiatry clinic in
Hamilton. Tools that were used in the assessments of irritability and psychopathology included:
Adolescent Irritability Scale (AIS): Self-Rating (SR) and Observer-Rating (OR), Beck Depression
Inventory II (BDI II), Multidimensional Anxiety Scale for Children (MASC), Behaviour Problem
Checklist (DSM-IV Disruptive Behaviour Disorder Checklist). All measures administered at Time
1 whereas the AIS was also completed 2 weeks later. Descriptive statistics were done in SPSS
and factor analysis in MPlus.
Results: 121 adolescents’ ages 12-18 years (mean age = 15.15 years, SD = 1.67) completed
the study. The AIS showed acceptable reliability (Cronbach’s α = .88). Median scale scores
were significantly correlated across time (r = 0.62, p= 0.05). The AIS was significantly correlated
with the observer rating (r = .74, p < .01) and with depressive symptoms as measured by the
BDI (r = 0.39, p = 0.01). Factor analysis was inconclusive, with item response analysis
suggesting greater evidence of a one-factor model.
Conclusion: The AIS can identify a reliable construct of irritability in youth. Irritability is
moderately correlated with depression, which may be a feature of the clinical nature of the
sample. It is unclear whether irritability is a unidimensional construct based on the AIS model.
Further assessment of the AIS in non-clinical samples is important.
References:
1. Gadow, K., & Drabick, D. (2012). Symptoms of autism and schizophrenia spectrum
disorders in clinically referred youth with oppositional defiant disorder. Research
in Developmental Disabilities, 1157-1168
ABSTRACT #104
The Perceived Impact of McMaster’s Fall Break on Student Stress
Nathan Cooper1, Heather Poole2, Michael Agnew2, Ayesha Khan3
1
Assistant Professor, Department of Psychiatry and Behavioural Sciences, McMaster
University; 2Postdoctoral Fellow, McMaster Institute for Innovation and Excellence in
Teaching and Learning; 3Assistant Professor, Department of Psychology, Neuroscience
& Behaviour, McMaster University
Rationale: Over the past decade, universities and colleges across Canada have
introduced a fall break into their term calendars with the goal of reducing student stress
and increasing student retention and success. In 2015, a full-week fall break was
introduced at McMaster University. Despite the increasing adoption of a fall break in
post-secondary institutions across Canada, there is no published research investigating
whether implementing a fall break successfully meets the goal of decreasing student
stress (Pilato, 2014).
Purpose: To understand the perceived effect of McMaster’s new full-week fall break on
undergraduate student stress levels and the student experience.
Methods: We have designed a mixed-methods, interdisciplinary, multi-institutional study
to investigate the effect of the fall break on student stress and experience through selfreports (surveys, focus groups) and physiological markers (salivary cortisol levels). This
poster will present select survey data. In the week after the October fall break and again
in January, all McMaster undergraduate students were emailed a link to an online
survey. The surveys asked them to provide demographic and lifestyle information and to
report how the fall break had impacted their academic experience and stress levels, and
also provided space for additional comments. All surveys were completed anonymously.
Results: 1140 students completed the January survey; of these, 80.4% felt that the fall
break had been a good thing for them. 761 students provided comments on the October
survey. These were categorized according to valence (positive/negative/neutral) and
area of impact of the fall break (academic/personal/other). The majority of comments
(64.2%) indicated positive perceptions of the fall break. However, comments that
focused on academic impacts were more equally divided between positive and negative
perceptions (260 comments and 220 comments, respectively). Analyses of students’
judgements regarding the impact of the fall break on academic performance and stress
are ongoing, but will be reported in the poster.
Conclusion: McMaster’s fall break has been introduced to benefit students, and student
self-reports indicate overall positive experience of the fall break. However, the impact on
academic performance and experience may be more complex, with a substantial portion
of respondents indicating that the fall break had a negative academic impact.
References:
Pilato, K. (2014). Exploring the impact of a fall break on student mental health outcomes:
Year 1 report. Unpublished manuscript submitted to Vice-Provost and Associate Vice
President (Student Services), Brock University. Retrieved from:
https://www.brocku.ca/webfm_send/33279
ABSTRACT #105
Finding Trustworthy Information on the Internet to Support Evidence-Informed Decisionmaking in Child and Youth Mental Health: A Pilot Study
Stephanie Duda, MSc1; Kathryn Bennett, PhD1,2
1
Department of Clinical Epidemiology and Biostatistics, McMaster University
Department of Psychiatry and Behavioural Neurosciences, McMaster University
2
Abstract
Background: Clinicians, health service managers, policy-makers, youth and families regularly
search the web for information to help them make decisions relevant to child and youth mental
health (CYMH) care. Numerous web-based evidence repositories are now available, but little is
known about their content adequacy or trustworthiness with respect to CYMH decision
guidance.
Objective: To evaluate the content adequacy and trustworthiness of: i) internationally
recognized ‘best-in-class’ evidence repositories; and ii) CYMH focused evidence repositories.
Methods: Pre-specified inclusion criteria identified ‘best-in-class’ general repositories and
CYMH specific repositories. Two reviewers evaluated each site as follows: i) purpose; ii) target
audience; iii) coverage of common CYMH problems; iv) content [original research papers (i.e.,
primary studies or systematic reviews) or synopses]; v) content quality appraised (yes/no); vi)
rigorous quality appraisal methods (tool/number of raters); vii) searchable database; and viii)
user updates/alert service.
Results: Five ‘best-in-class’ and 8 CYMH specific repositories were identified. All ‘best-in-class’
repositories provided clear statements of purpose and target audience, contained systematic
reviews, documented review quality using rigorous methods, included a searchable database
and gave users regular updates/alerts. However, coverage of CYMH was very low. CYMH
repositories scored poorly on all criteria except content coverage. All 8 contained evidence
synopses not original reports; only 3/8 evaluated research quality and the methods used were
weak.
Conclusions: We identified significant gaps in the 13 web-based evidence repositories
reviewed. Our findings call for the creation of a new CYMH specific repository developed using
rigorous methods with input from specific user groups. They also call for the quality of existing
sites to be documented and made widely available to potential users so that harm and wasted
resources associated with the use of poor quality research evidence can be avoided.
References:
1) Bastian H, Glasziou P, Chalmers I. (2010). Seventy-five trials and eleven systematic reviews
a day: How will we ever keep up? PLoS Med; 7(9): e1000326.
2) Risk A, Petersen C. (2002). Health information on the internet - Quality issues and
international initiatives. JAMA; 287(20):2713-2715.
ABSTRACT #106
The 2014 Ontario Child Health Study Symptom Scales:
A Checklist for Measuring Selected DSM Disorders
Laura Duncan, MA, HRM PhD student in CE&B, Kathy Georgiades, PhD1, Mark Ferro1, PhD,
Ryan Van Lieshout1, MD, PhD, Peter Szatmari, MD, University of Toronto, Kathy Bennett1, PhD,
Harriet MacMillan1, MD, Ellen Lipman1, MD, Magdalena Janus1, PhD, Anna Kata1, MA, MPH
student at University of Waterloo & Michael Boyle1, PhD.
1
Offord Centre for Child Studies and the Department of Psychiatry and Behavioural
Neurosciences, McMaster University
Objective: This paper describes the development and psychometric properties of the 2014
Ontario Child Health Study (2014 OCHS) Symptom Scales – a self-completed checklist for
measuring parent and youth-reported symptoms in the previous 6 months of, generalized
anxiety disorder (GAD), separation anxiety disorder (SAD), major depressive disorder (MDD),
attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct
disorder (CD), based on DSM-IV-TR criteria and an updated version of the 1983 Ontario Child
Health Study checklist (Boyle et al., 1987; Offord et al., 1987).
Methods: To construct the scales, twelve child psychologists and psychiatrists: (1) rated the
extent to which brief item descriptors corresponded to symptoms specified in DSM-IV-TR; and
2) rank ordered the same set of items in terms of how well they represented each disorder
overall. Levels of agreement among clinicians were used to select the final set of items.
Psychometric evaluation of the item properties and scales came from a measurement study of
283 parent-youth dyads aged 9 to 18 years (185 from the general population and 98 from child
mental-health outpatient clinics). Parent and youth independently completed the checklist on
two occasions 7-14 days apart. Analyses were conducted to examine item characteristics as
well as the reliability and convergent and discriminant validity of the scales.
Results: With the exception of parent-report SAD in the general population, confirmatory factor
analyses exhibited adequate item-fit to all scales. Item analysis of convergent and discriminant
validity were 96.9% (155/160) and 95.2% (609/640) successful, respectively. With the exception
of CD, internal consistency (Cronbach’s alpha) exceeded 0.73, and test-retest reliabilities
(Pearson’s r) were above 0.71. The scales discriminated between the general population and
clinic samples while cross-informant correlations and regression analysis of the scales
supported their convergent and discriminant validity.
Conclusion: Completed in less than 5 minutes, the 2014 OCHS Symptom Scales provide
reliable and valid dimensional measurement of six DSM disorders assessed by parents and
youth in the general population and in children’s mental health settings.
References
1) Boyle, M.H., Offord, D.R., Hofmann, H.F., Catlin, G.P., Byles, J.A., Cadman, D.T., Crawford,
J.W., Links, P.S., Rae-Grant, N.I. & Szatmari, P. (1987). Ontario Child Health Study: I.
Methodology. Archives of General Psychiatry, 44, 826-831.
2) Offord D.R., Boyle, M.H., Szatmari, P., Rae-Grant, N.I., Links, P.S., Cadman, D.T., Byles,
J.A., Crawford, J.W., Munroe Blum, H., Byrne, C., Thomas, H. & Woodward, C.A. (1987),
Ontario Child Health Study: II. Six-month prevalence of disorder and rates of service utilization.
Archives of General Psychiatry, 44, 832-836.
ABSTRACT #107
How Creative is Cut Adult Mammalian Brain?
Anne P. Foerster; Michael J. Holmes
Department of Psychiatry and Behavioural Neurosciences, McMaster University
Rationale: Long interpreted as tragically toxic and doomed because its cut axons do not
elongate like regenerating peripheral nerves but withdraw, adult mammalian brain gives
evidence for performing a true multi-system cooperative regeneration when its incision is
independently defined so this outcome is detectable1.
Purpose: Find its basis so experiments can be designed to help it, and also to capture detailed
images of its orderliness, in comparison with that of the intact side of the brain, to provide a
possibly useful visual metaphor for recovery from disaster.
Methods: With advanced digital microscopy and an Atlas we analyze the effects of vertical cuts
in series of horizontal sections of 153 brains of rats where a wire cutting device was lowered
and implanted1. Its ventral removal of the device from the fixed organ produces two channels
that mark the ends of the cut and appear as two holes in the sections. Comprehensive triple
staining (unpublished) of its architectural patterning shows the 3D effect of lesions.
Results: Massive new orderly patterns are formed by local reorientation of severed structures
formerly facing the cut which now surround it in a way that suggests re-connection of their
connectomes , e.g. the layering of hippocampus. It was inexplicable until the classic Neuron
Doctrine became amplified by the concepts that the brain operated as a cooperative
neurovascular network and that glia regulate its connectome’s structure and functioning2. Since
the new patterns are vascularized we suggest that the vasculature is spatially specified also.
Cut axon populations can elongate immediately post-lesion; we will examine their interfaces
with brain tissue for clues about their basis.
Conclusion: This collection, which also includes monkey (Macaca mulatta) results, is a
valuable resource.
References:
1. Foerster, A.P. Spontaneous regeneration of cut axons in adult rat brain. Journal of
Comparative Neurology, 1982; 210 (4): 335-56
2. Fields, R.D., Woo, D.H, Basser, P.J. Glial Regulation of the Neuronal Connectome
through Local and Long-Distant Communication. Neuron, 2015; 86(2): 374-86.
ABSTRACT #108
Examining Abstract and Concrete Thinking Styles in Social Anxiety Disorder
Dubravka Gavric1, 3, Ph.D., C.Psych.; Karen Rowa1, 3, Ph.D., C.Psych.; Randi McCabe1, 3, Ph.D.,
C.Psych.; Jenny Chum1, B.H.Sc. Student; Cathy Hoang1, B.Arts Sc. Student; and David A.
Moscovitch2, Ph.D., C.Psych.
1
Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton; 2Department of
Psychology and Centre for Mental Health Research, University of Waterloo; 3Department of
Psychiatry and Behavioural Neurosciences, McMaster University
Background: Repetitive negative thought (RNT) has been identified as a transdiagnostic factor
in anxiety and depression, with research suggesting that it is associated with the onset and
maintenance of symptoms (e.g., Watkins, 2008). Although researchers and clinicians have
traditionally focused primarily on the content of RNTs, recent evidence suggests that the way
people think about situations can impact their emotional reactions. A growing body of research
in the area of depressive rumination (one type of RNT) suggests that focusing on concrete
aspects of one’s experience results in improved mood relative to more abstract thinking styles
which focus on the meaning of past events (Watkins et al., 2011). Although a similar ruminative
thinking style is known to occur in social anxiety disorder (SAD) no prior studies have examined
whether concrete and abstract thinking styles can be identified in individuals with SAD.
Purpose: The current study had two primary aims: a) develop a reliable coding scheme for
evaluating abstract and concrete thinking styles, and b) evaluate whether abstract thinking
styles are characteristic of RNT in individuals with SAD relative to anxious and healthy controls.
Method: Individuals with a principal diagnosis of SAD (n=24), anxious controls (n=24) and
healthy controls (n=25) were recruited for the current study. Participants completed a speech
task in the lab and the next day were asked to report thoughts they had about the speech since
it occurred. Their responses were coded using coding guidelines from the Autobiographical
Interview (Levine et al., 2002) by two research assistants blind to the participants’ group status.
Results: Participants had a mean of 7.03 (SD=6.31) statements; no group differences on
number of statements were found, F(2,72)=1.75, p=.18. Adequate inter-rater reliability on the
coding scheme was obtained (Cohen’s Kappa of .60). The SAD group had greater frequency of
abstract statements relative to the healthy but not the anxious controls, F(2, 72) = 2.84, p=.065
(marginally significant). No group differences were found on frequency of concrete statements,
F(2, 72) = 1.94, p=.31.
Conclusions: These findings suggest that the coding scheme developed provides a useful tool
for operationalizing abstract and concrete thinking styles across anxiety disorders. Although
increased frequency of abstract thinking was not specific to SAD, these findings suggest that it
may play a role more generally in anxiety disorders.
Key References:
1. Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological
Bulletin, 134, 163-206. doi: 10.1037/0033-2909.134.2.163
2. Watkins, E.R., Mullan, E., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., Eastman, R., &
Scott, J. (2011). Rumination-focused cognitive-behavioural therapy for residual depression:
phase II randomised controlled trial. The British Journal of Psychiatry, 199, 317-322. doi:
10.1192/bjp.bp.110.090282
ABSTRACT #109
A tool to enhance the decision making process for consent to electroconvulsive therapy
in older adults with depression (planned study)
Gojmerac, C. and Saperson, K.
Seniors Mental Health Program, St. Joseph’s Healthcare, Department of Psychiatry &
Behavioural Neurosciences, McMaster University
Electroconvulsive therapy (ECT) is an effective treatment for depression in older adults, with a
remission rate of 90%. Older, depressed patients have been shown to have the decisional
capacity to consent to ECT treatment (Lapid, Rummans, Pankratz, & Appelbaum, 2004).
However, there is significant stigma and fear associated with ECT among the general public and
even some healthcare practitioners. This poses a significant challenge to the decision making
process of older adults who are presented with ECT as a treatment option for depression. Some
of this is due to misinformation, or perhaps misperception, about the true risks and benefits.
Therefore, there is a need for the development of clinical tools to assist depressed older adults
with making informed treatment decisions. Mullan and colleagues (2009) developed a decision
aid on medications for patients with diabetes. A series of cards was used to describe the
features of the various available medication options, such as weight change, daily routine
requirements, and side effects. Compared to usual care, patients presented with the decision
aid cards reported the tool to be helpful, had improved knowledge about treatment, and had
more involvement in making decisions. The purpose of the present planned pilot study is to
develop an ECT specific decision aid, modeled on the diabetes decision aid, and evaluate the
impact of using the decision aid with depressed older adults for whom ECT is recommended.
The planned methodology is to conduct a randomized trial whereby eligible participants, drawn
from inpatient and outpatient psychiatric units, are randomized to either a decision aid group or
a usual care group. All participants will complete the MacArthur Competence Assessment Tool
for Treatment (MacCAT-T) at baseline in order to assess decisional capacity to consent to ECT
treatment. Proposed outcome measures will include questionnaires to be completed by
participants immediately after their clinical encounter. A knowledge questionnaire will assess
participants’ knowledge about the risks and benefits associated with ECT. The Decisional
Conflict Scale will assess personal perceptions of uncertainty in making choices and feeling
informed or uninformed. An additional outcome measure will be reassessment of decisional
capacity after the clinical encounter using the MacCAT-T. Our hypotheses are that the use of
the ECT decision aid will increased participants’ knowledge of ECT and its associated risks and
benefits, reduce uncertainty in making choices surrounding ECT treatment, and possibly
enhance decisional capacity over and above baseline.
References:
Lapid, M., Rummans, T., Pankratz, S., & Appelbaum, P. (2004). Decisional capacity of
depressed elderly to consent to electroconvulsive therapy. Journal of Geriatric Psychiatry and
Neurology, 17(1), 42-46.
Mullan, R.J. et al. (2009). The diabetes mellitus medication choice decision aid: a randomized
trial. Archives of Internal Medicine, 169(17), 1560-1568.
ABSTRACT #110
Work In Progress
Group Cognitive Behavioural Therapy for Insomnia (G-CBTI): Preliminary Data Evaluating
Efficacy, Acceptability and Impact of Comorbidity on Outcome
Sheryl M. Green, PhD1,2; Gillian Alcolado,PhD,1, Arela Agako, BA3, Joseph Pellizzari, PhD1,2,
Juliana Li, MD1,2, Colleen Carney, PhD3, & Randi E. McCabe, PhD1,2
1
St. Joseph’s Healthcare Hamilton; 2McMaster University; 3Ryerson University
Insomnia is a serious sleep disorder. Pharmacotherapy is the most common treatment offered
(NIHSS, 2005). However, there is high risk of side effects and long-term dependence.
Cognitive-behavioural therapy for insomnia (CBTi), is a well-established
psychological
treatment (Edinger et al, 2007) producing improvements that compare favorably
to those achieved with
medication. Few studies have examined group CBT for insomnia (GCBTi) and no formal protocols have been published. Group treatment has the potential added
benefit of interpersonal learning and reduced waitlist times. We developed a 6-session protocol
and intend to run 6 groups (n = 6 participants per group; one group complete to date) as part of
a formal research project. Patients with primary or comorbid diagnosis of insomnia are being
recruited from the Sleep Medicine program within St. Joseph’s Healthcare. Thus far, participants
completing the progam experienced increased sleep efficiency, decreased insomnia symptoms
(some no longer meeting criteria), and decreased maladaptive beliefs about insomnia. All
participants reported G-CBTi as highly acceptable, stating they would choose group over
individual format if given the option. Both quantitative and qualitative analysis on treatment
outcome of n = 3 groups will be revealed and implications for the treatment of insomnia,
discussed.
Edinger et al.(2007). Sleep, 30, 203-212.
ABSTRACT #111
Patients’ & Nurses’ Perceptions about Hope & Hope Engendering Interventions
in Forensic & Acute Mental Health Services
Mary-Lou Martin RN MScN MEd, Clinical Nurse Specialist at SJHH,
Ruth Sahr RN BScN, Nurse Educator at SJHH, Gail Burns RN, MN, Manager at SJHH,
Janet Landeen RN MEd PhD, Associate Professor at McMaster University,
Helen Kirkpatrick RN MScN MEd PhD, Best Practice Spotlight Coordinator at SJHH
Purpose: This study will explore hope and hope engendering interventions as perceived by inpatients and nurses from Forensic Services and Acute Mental Health Services in the Mental
Health and Addiction Program (MHAP) at St. Joseph’s Healthcare Hamilton (SJHH).The main
research question is: 1) what are the patients’ and nurses’ perceptions about hope and hopeengendering interventions in Forensic Services and Acute Mental Health Services?
Rationale: Little is known about hope in forensic and mental health patients. It is vital to uncover
the process by which these patients maintain their hope and how nurses promote hope.
Determining the personal meaning of hope could be the key to planning care that foster hope for
others.
Methodology: A mixed method qualitative and quantitative approach will be used to explore
patients’ and nurses’ perceptions about hope and hope engendering interventions. Purposive
sampling will be used to recruit patient participants. The sample will include a total of 30 inpatients, specifically 15 in-patients from Forensic Services and 15 in-patients from Acute Mental
Health Services at SJHH. All nurses (RNs & RPNs) from Forensic Services and Acute Mental
Health Services at SJHH will be invited to participate in the quantitative arm of the study. As
this is a pilot, sample size is impossible to determine a priori. The study aims to recruit a
minimum of 30 nurses; specifically, ~15 nurses from Forensic Services and ~15 nurses from
Acute Mental Health Services at SJHH.
Patients will be asked to complete the Integrative Hope Scale (IHS) and participate in an audio
recorded interview with open-ended questions. Nurses will be asked to complete the HopeEngendering Nurse Intervention – Nurse Version (HENI) questionnaire. Both nurses and
patients will also be asked to complete a Short Demographic Questionnaire.
Transcription will be done by a paid transcriptionist. Quantitative data will be collected through
the use of REDCap. Qualitative data will be analyzed using thematic analysis on the data
obtained from the patient interviews by two of the researchers. Quantitative data will be
analyzed using descriptive statistics.
Impact/Relevance to the Field. It is hoped that the results of the study will add to the body of
knowledge about hope and hope engendering interventions for patients and nurses in forensic
and acute mental health settings. This research has the potential to influence practice,
education and policy.
Hirsch, J.K., Visser, P.L., Chang, E.C., & Jeglic, E. (2012). Race and ethnic differences in hope
and hopelessness as moderators of the association between depressive symptoms and
suicidal behavior. Journal of American College Health, 60(2), 115-125.
Hobbs, M. & Baker, M. (2012). Hope for recovery – how clinicians may facilitate this in their
work. Journal of Mental Health, 21(2), 145-154.
ABSTRACT #112
Regional EEG Alpha Power is linked to Self-reported Shyness in Adults with Autism
Spectrum Disorders (ASD)
Karen J. Mathewson, PhD, McMaster University; Richard Xu, Undergraduate, McMaster
University; Irene E. Drmic, PhD, York University; Michelle K. Jetha, PhD, Cape Breton
University; Susan E. Bryson, PhD, Dalhousie University; Joel O. Goldberg, PhD, York
University; & Louis A. Schmidt, PhD, McMaster University.
Purpose: Direct examinations of the brain’s electrocortical activity may assist in characterizing
core features of ASD, such as behavioral inhibition or reduced sociability. To test this
hypothesis, we assessed associations among patterns of resting electroencephalogram (EEG)
alpha activity (7.5 to 12.5 Hz) and self-reported shyness and sociability in typical adult controls
and high-functioning adults with ASD or schizophrenia.
Content: EEG alpha activity is the dominant frequency in the resting brain. Studies have linked
differences in resting frontal EEG alpha power to individual differences in social behaviour.1, 2
Accordingly, resting alpha power and its associations with particular social behaviours may
differ between clinical patients and other groups. We predicted that associations between
resting regional alpha power and shyness (and/or sociability) would differ among two clinical
groups and controls.
Methodology: Three minutes of resting eyes-open EEG activity were recorded via a 128channel Geodesic Sensor Net from 15 (12 male) high-functioning adults with ASD, 42 (29 male)
high-functioning adults with schizophrenia, and 81 (36 male) controls. EEG power was derived
for the alpha frequency band in left and right frontal brain regions, and left and right parietal
brain regions. Group differences in self-reported shyness and sociability were assessed in
separate univariate ANOVAs, controlling for age and sex. Next, shyness and sociability
measures were regressed on age, sex, medication status, regional alpha power, and the
appropriate group-by-alpha power interaction, in separate hierarchical regression analyses.
Where warranted, regression analyses were followed by simple correlations between alpha
power and shyness or sociability for each group.
s
Results: Regression analyses revealed that medication status (ps < .02) and the interaction of
group with left and right, frontal and parietal alpha power (all ps < .03) accounted for significant
variance in shyness. In adults with ASD (with medication status controlled), greater alpha power
in left frontal and right parietal regions was specifically linked to increased difficulty in
overcoming shyness in new situations, and greater inhibition in social situations, despite
shyness (but not sociability) being greater in both patient groups than controls.
Conclusions: Shyness and eyes-open alpha power may be greater in adults with clinical
conditions. Medication status may partly explain higher levels of shyness in clinical populations.
In the ASD population, hypo-arousal in frontal and parietal regions explained unique variance in
self-reported shyness, after accounting for variance attributable to medication status.
References:
1. Schmidt, L. A. (1999).Frontal brain electrical activity in shyness and sociability. Psychological
Science, 10(4), 316-320.
2. Sutton, Burnette, Mundy, Meyer, Vaughan, Sanders, & Yale (2005). Resting cortical brain
activity and social behavior in higher functioning children with autism. Journal of Child
Psychology and Psychiatry 46(2), 211–222.
ABSTRACT #113
Analysis of St. Joseph’s Seniors Mental Health Suicide Risk Assessment Documentation
Chart Self Audit Tool
Taylor Mehta1 and Julia Baxter 2,3, MHS
1Bachelor
of Health Sciences (Honours) Program, McMaster University; 2 Department of Psychiatry and Behavioural
Neurosciences, McMaster University; 3 Seniors Mental Health Service, St. Joseph’s Healthcare Hamilton
Background: Suicide among seniors is an increasing problem. In Canada, approximately 1.3
seniors commit suicide per day.1 With a projected increase in the senior population, the number
of deaths due to suicide will also increase. Accreditation Canada has required organization
practices (ROPs) regarding suicide prevention. One practice involves assessing clients for
suicide risk. An important aspect of suicide assessment is documentation. Documentation
allows for a record of the suicide assessment. It helps for communication among health care
providers, continuing assessment, developing appropriate interventions, evaluating a client’s
progress, as well as quality monitoring.2
Objective: To develop, implement, and analyze a self-administered suicide risk assessment
documentation chart audit tool for the St. Joseph’s Seniors Mental Health Outpatient and
Outreach Services.
Methodology: An audit tool was developed based on a literature search on suicide risk
assessment documentation. A 12-question tool was tested and then simplified with a focus on
the ROP that a suicide risk assessment is completed at initial assessment. The questions
included on the audit tool focused on five major themes: previous suicidal risk, current suicidal
risk, risk factors, protective factors, and level of risk. Additionally, questions relating to location
of documentation, sharing of documented information with referral source, case managers’
comfort with suicide risk assessment and documentation were added. The final tool had 8 main
documentation questions plus 2 comfort questions and one suggestion question. The audit tool
was given to the 24 case managers of the St. Joseph’s Seniors Mental Health Outpatient and
Outreach Services in Hamilton/Brant, Halton, and Niagara. Case managers self-selected one
case to review using the audit tool. The client of the chart selected needed to have an indication
of current or previous suicidal ideation, be currently seeing a case manager, and had seen a
geriatric psychiatrist at least oncet.
Results: Twenty-one audit tools were completed. Clear documentation of the themed areas
was found 60% of the time. In the case manager assessment previous suicidal behavior was
documented the most frequently and level of risk was documented the least frequently. In the
physician’s initial assessment, current suicidal thoughts, behavior and whether the client has a
suicide plan was documented most frequently and level of risk was documented least
frequently. Approximately 84% of the information documented was shared with the referral
source. All 21 tools were used in the comfort analysis. 81% (17/21) of case managers indicated
that they were very or extremely comfortable in completing a suicide risk assessment with a
client. 48% (10/21) reported they were very or extremely comfortable documenting a suicide
risk assessment. A range of ideas were shared to strengthen assessment and documentation.
References:
1. Statistics Canada. Canadian statistics: suicides, and suicide rate, by sex, by age group
[Internet]. 2005. Available from: http://www40.statcan.ca/l01/cst01/health01.htm
2. Perlman CM, Neufeld E, Martin L, Goy M, & Hirdes JP. Suicide Risk Assessment Inventory:
A Resource Guide for Canadian Health Care Organizations. Toronto, ON: Ontario Hospital
Association and Canadian Patient Safety Institute; 2011.
ABSTRACT #114
Decreased Brain-Derived Neurotrophic Factor in Cortex of
The McGill-R-Thy1-APP rat, a Model of Alzheimer’s Disease
Bernadeta Michalski1; M. Florencia Iulita2; A. Claudio Cuello2; Margaret Fahnestock1
1
Department of Psychiatry & Behavioural Neurosciences, McMaster University
Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
2
Rationale: Alzheimer’s disease (AD) is the most common form of dementia. The AD brain is
characterized by increased levels of amyloid-β (Aβ) deposited as plaques. Recently, soluble
assemblies of Aβ, rather than plaques, have been identified as toxic molecules contributing to
neurodegeneration. Furthermore, evidence suggests that intra-neuronal Aβ may be highly toxic.
Brain-derived neurotrophic factor (BDNF), which is vital for learning and memory, is decreased
in the cortex of subjects with AD (Peng et al., 2005) and in several mouse models of AD. This
reduction of BDNF correlates with the degree of cognitive deficit. McGill-R-Thy1-APP rats, a rat
model of AD, over-express the human APP751 transgene with the Swedish and Indiana
mutations. At 3 months, hemizygous and homozygous transgenic rats exhibit high levels of
intra-neural and extracellular soluble Aβ which is accompanied by cognitive impairment (Iulita et
al., 2014). Aβ pathology, in the form of plaques, appears around 6-8 months of age only in the
brains of homozygous rats.
Purpose: To determine whether BDNF expression is altered in cortex of the McGill-R-Thy1APP rat model of Alzheimer’s disease.
Methods: Using real-time qRT-PCR, we measured BDNF mRNA expression in the cortex of
wild type, hemizygous and homozygous McGill-R-Thy1-APP rats at 3 months and at 13-15
months of age.
Results: We found that BDNF mRNA expression was significantly reduced in the cortices of
hemizygous rats at 3 months and 13-15 months compared to non-transgenic animals.
Homozygous rats at both ages exhibited a strong trend towards reduced expression of BDNF
mRNA. Examination of BDNF protein levels by Western blot in cortex of wild type, hemizygous
and homozygous McGill-R-Thy1-APP rats at 3 months and 13-15 months of age is in progress.
Conclusions: These data support our previous findings that soluble Aβ, not plaques, leads to
down-regulation of BDNF in the brain and suggest that soluble, intra-neuronal Aβ may
contribute to this down-regulation.
References
Peng, S., Wuu, J., Mufson, E.J., Fahnestock, M. Precursor form of brain-derived neurotrophic
factor and mature brain-derived neurotrophic factor are decreased in the pre-clinical
stages of Alzheimer's disease. Journal of Neurochemistry, 2005; 93: 1412-1421
Iulita, M.F., Allard, S., Richter, L., Munter, L.M., Ducatenzeiler, A., Weise, C., Do Carmo, S.,
Klein, W.L., Multhaup, G., Cuello, A.C. Intracellular Aβ pathology and early cognitive
impairments in a transgenic rat overexpressing human amyloid precursor protein: a
multidimensional study. Acta Neuropathologica Communications, 2014; 2: 61
ABSTRACT #115
KORU at McMaster: A Feasibility Study of a 4-week Structured Program of Stressmanagement, Meditation and Mindfulness for Post-secondary Students
1
Catharine Munn, M.Sc, M.D., F.R.C.P(C), Asst. Clinical Professor 1,2,3, James MacKillop,
Ph.D1,2., Allan Fein, M.Sc.1, Nicole Carter, M.S.W. 1,2, Kathleen Mockler, R.S.W.1, Jillian
Halladay, BScN, R.N., M.Sc. Student, Graduate Studies in Health Research Methodology1
2
Arrive and Thrive Team, McMaster University, Student Wellness Centre, McMaster University,
3
Department of Psychiatry and Behavioural Neurosciences
Rationale: The majority of university students report high levels of stress, feeling overwhelmed
by anxiety, or feeling very sad during the academic year (ACHA, 2013). Many post-secondary
health and counseling centres in North America, including the McMaster Student Wellness
Centre, have seen increasing numbers of students presenting to mental health services,
resulting in prolonged wait times. This highlights the need for evidence-based, appealing,
accessible, brief, and cost-effective interventions aimed at improving student mental health and
wellbeing, such as mindfulness meditation. Traditional meditation teaching and learning
methods often require significant time and may not be practical or appealing to the student
population. KORU is a brief mindfulness, meditation, and mind-body skills program designed for
the emerging adult population at Duke University. There is one previous randomized controlled
trial of KORU to date, which demonstrated improvements in anxiety, depression, and sleep
symptoms (Greeson, et al., 2014).
Purpose: We are conducting a pre- and post-intervention evaluation of KORU in the McMaster
student population, measuring the effects of the program on student mental health and wellbeing
outcomes. We will identify improvements to the program recruitment and delivery methods and
determine the feasibility of a future clinical trial.
Methods: Participants are being recruited through convenience sampling by self-referral or
referrals from McMaster Student Wellness Centre physicians and counsellors. All consenting
participants will engage in 1.5 hours of guided KORU practice for 4 weeks, and a suggested 10
minutes of independent practice per day. Students will complete pre- and post-intervention
surveys and two follow-up surveys at 1 month and 3 months. The survey will primarily measure
stress using the Perceived Stress Scale. Secondary outcomes of distress, psychological
wellbeing, sleep, substance use, other mental health symptoms, and cognitive and affective
mindfulness will also be measured.
Results: Currently, the study is in the data-collection phase and 30 students have completed
KORU at this time.
Conclusion: We will present preliminary results and comment on the challenges and the
feasibility of proceeding to a randomized controlled trial to determine the impact of a 4–week
KORU intervention on post-secondary student mental health and well-being.
American College Health Association (ACHA). (2013). National College Health Assessment:
Spring reference group data report (Canadian). Retrieved from: http://www.achancha.org/docs/ACHA-NCHAII_CANADIAN_ReferenceGroup_ExecutiveSummary_Spring2013.pdf
Greeson, J. M., et al. (2014). A randomized controlled trial of Koru: a mindfulness program for
college students and other emerging adults. Journal of American College Health, 62(4):
222-233. doi:10.1080/07448481.2014.887571.
ABSTRACT #116
Reporting of standard research ethics procedures in general psychiatry peer-reviewed
empirical publications
Pallaveshi L1,2, Subramanian P.1,3 Rudnick A.4,5
1
2
2
3
Department of Psychiatry, Western University; Parkwood Institute Mental Health Bldg.; Department of
4
Psychiatry London Health Science Center; Department of Psychiatry and Behavioral Neurosciences,
5
McMaster University; St. Joseph Healthcare Hamilton, ON.
Rationale: Standard research ethics procedures such as obtaining informed consent and ethics
review and approval by an Institutional Review Board (IRB) are often underreported in empirical
research (Schroter et al. 2006). This is particularly concerning in relation to some of the most
vulnerable populations studied, such as children, seniors, and individuals with serious mental
illness, for whom informed consent sometimes has to be provided by substitute decision makers
(Rotenberg & Rudnick 2011).
Purpose: To examine the important but under-studied reporting of standard research ethics
procedures in general psychiatry journals and what predicts it.
Methods: We examined all primary empirical human research articles published from 2000 to
2012 (inclusive) in four general psychiatry journals: American Journal of Psychiatry, Archives of
General Psychiatry (recently renamed JAMA Psychiatry), British Journal of Psychiatry, and
Canadian Journal of Psychiatry. These articles were reviewed for the reporting of standard
research ethics procedures: informed consent or its waiver, ethics review/approval, and
assessment of capacity of participants to consent to (or decline) research participation. Chisquare analysis and Logistic Regression were used to test for significant variance and
predictors of reporting of these research ethics procedures by journal, year of publication,
number of authors, country of affiliation of the first author, and study design and evaluation
methods.
Results: Of 5,894 articles reviewed, 71.3% of the studies reported informed consent, 56.6%
reported ethics approval, 8.2% reported assessment of capacity to consent to (or decline)
research participation, and 2.7% reported a waiver of informed consent. Number of authors (p <
0.001), journal (p < 0.001), and study design (p < 0.001), were significant predictors for
reporting informed consent and ethics approval. Country of affiliation of first author (p < 0.001)
was a significant predictor of reporting informed consent and the year of publication (p < 0.001)
was a significant predictor of reporting ethics approval.
Conclusion: There was under-reporting of research ethics procedures in these journals, with
variance and predictors of it. Maximizing and monitoring such reporting is needed in psychiatry.
References
1.) Schroter S, Plownam R, Hutchings A, Gonzalez A. Reporting ethics committee approval
and patient consent by study design in five general medical journals. J Med Ethics,
2006; 32(12): 718-723.
2.) Rotenberg MA, Rudnick A. Reporting of ethics procedures in psychiatric rehabilitation
peer-reviewed empirical research publications in the last decade. Am J Psychiatr.
Rehab, 2011; 14: 97-108.
ABSTRACT #117
Using ACT-Based Interventions in the University Classroom
Heather Poole1, Sarah Kupferschmidt2, Wanda Smith3
1
Postdoctoral Fellow, McMaster Institute for Innovation & Excellence in Teaching & Learning;
2
Professor, McMaster University, Mohawk College; 3Assistant Professor, Department of
Psychiatry & Behavioural Neurosciences, McMaster University
Rationale: Levels of stress and anxiety in Canadian undergraduate students have increased in
recent years (Booth, Sharma, & Leader, 2015). Universities are struggling to meet students’
needs through a range of academic accommodations. Considering this, and the fact that
students are quite unlikely to seek professional help (Coles, Coleman, & Schubert, 2015),
students need strategies to help them manage stress and anxiety. Much research has focused
on managing stress via Mindfulness Based Stress Reduction (Kabat-Zinn, 1990). A newer
intervention that incorporates mindfulness is Acceptance and Commitment Therapy (ACT). ACT
combines acceptance and mindfulness strategies with commitment and behaviour change
strategies that focus on a person’s values, and has been shown to help individuals and groups
manage stress and anxiety (Hayes, Luoma, Bond, Masuda, & Lillis, 2006).
Purpose: To examine the effects of implementing two different schedules (condensed or
distributed) of ACT in a university classroom setting. Impacts on measures of stress, test
anxiety, psychological flexibility, mindfulness, and academic performance were assessed.
Methods: 61 university students were enrolled in two different sections of the same course. We
compared the effects of two schedules of ACT: one class received the training over
10 sessions (distributed training) and the other class had the exercises compressed into two
sessions at the end of the term (condensed training). Students completed all activities as a
group in class. They were assessed on various stress and ACT-relevant measures on the first
and last days of class. Academic performance was evaluated through course quizzes and
exams. Effects of the two training schedules over the course of the semester were evaluated
using mixed-design ANOVAs.
Results: Over the semester, test anxiety decreased, F(1,51)=4.33, p<.05, and scores on the
Observing subscale of the Five-Facet Mindfulness Questionnaire increased, F(1,56)=6.71,
p<.05. There was no effect of training schedule on either of these measures (ps>.75). Scores on
the Perceived Stress Scale indicated a significant interaction between time (pre-post) and
training schedule (distributed-condensed), F(1,55)=4.27, p<.05; post hoc tests revealed that
stress increased in students receiving condensed ACT training, t(31)=2.20, p<.05, but not in
those receiving distributed training, t(24)=-0.71, p>.40. Students made fewer requests for
academic accommodations than in previous years (low overall frequency prevents formal
statistical analysis), and student feedback on the ACT activities was overwhelmingly positive. Conclusion: These results support in-class ACT exercises as a promising method for reducing
student stress and indicate a moderate impact of the schedule of delivery.
References:
Booth, R. W., Sharma, D., & Leader, T. I. (2015). The age of anxiety? It depends where you
look: Changes in STAI trait anxiety. Social Psychiatry and Psychiatric Epidemiology, epublication ahead of print. DOI: 10.1007/s00127-015-1096-0
Coles, M. E., Coleman, S. L., & Schubert, J. (2015). College students' recommendations for
dealing with anxiety disorders. International Journal of Mental Health Promotion, 17, 68-77.
Hayes, S., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and
commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy,
44, 1-25.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your mind to face stress, pain
and illness. New York: Dell.
ABSTRACT #118
Kindergarten children with special health needs and functional impairments before and
after the introduction of full-day learning in Ontario, Canada
Caroline Reid-Westoby, PhD & Magdalena Janus, PhD
Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences,
McMaster University
Abstract
Rationale: Healthy development is a right for every child. A health disorder early in life can
have a tremendous impact on the developmental trajectory of a child. Sub-optimal health in
early childhood is a consistent risk factor for poor academic and behavioural outcomes, though
disorders accompanied by functional limitations have a greater impact on middle-school
outcomes than those without. Among otherwise healthy children, approximately one in five
kindergartners lack the developmental skills to take optimal advantage of school-based
education. Among those with an identified special health needs at that age, this proportion rises
to almost 80%.
Purpose: In the Canadian province of Ontario, full-day kindergarten (FDK) was recently
introduced on a universal basis. This universal program is meant to increase learning
opportunities for all children, not specifically for those with special needs. The aims of our
research were to investigate whether the introduction of FDK was associated with a change in
1) the prevalence of children with special needs, 2) the frequency of teacher-observed
functional impairments, and 3) developmental outcomes for children with those special needs
and impairments.
Methods: We used data from the Early Development Instrument (EDI; Janus & Offord, 2007) to
compare the prevalence rates and frequencies, as well as EDI scores for children in 437
schools before and after the introduction of FDK in Ontario, Canada. Considering the universal
goals of the program, we did not expect a difference in prevalence, but we anticipated that
increased exposure to learning would increase the teachers’ opportunity to observe functional
impairments with greater frequency and to enhance the children’s learning which might bring
better developmental outcomes.
Results: Results indicated that the prevalence of children with a diagnosed special health need
was similar before and after the implementation of FDK (4.4% versus 4.8%, respectively),
however, the prevalence of children with at least one functional impairment increased from
13.2% to 17.8%. Children with a diagnosed special need or observed functional impairment who
attended FDK had higher scores on the language and cognitive skills and communication and
general knowledge EDI domains than those who did not.
Conclusion: Our findings support the expectation that FDK increases the opportunity for
teachers to identify issues affecting children’s learning, and that it enhances the learning
experience of children with special health needs at least in language, cognitive, and
communication areas. This indicates that the full-day learning may be having a positive impact
on children who need it the most.
References
Janus, M. & Offord, D. (2007). Development and psychometric properties of the Early
Development Instrument (EDI): A measure of children’s school readiness. Canadian
Journal of Behavioural Science, 39(1), 1-22.
ABSTRACT #119
Examining the Importance of Holistic Healthcare Services for
Youth Admitted to a Mental Health Inpatient Unit
Carolyn Roy, M.A.1; Paz Fortier, M.Sc.2; Angela McHolm, Ph.D.1,3,4;Anne Niec, MD4,5
1
2
Department of Psychology, University of Guelph; Department of Psychology, Neuroscience &
3
Behaviour, McMaster University; Department of Psychiatry & Behavioural Neurosciences, McMaster
4
5
University; McMaster Children’s Hospital; Department of Pediatrics, McMaster University
Background: Physical and mental health concerns share many etiological pathways. However,
little is known about the effectiveness of holistic, or integrative healthcare. Even less is known
about the importance of such holistic care in children and adolescents. Late childhood and
adolescence is a developmental period associated with increased susceptibility to many mental
health concerns, including depression, anxiety, substance abuse, and psychosis. Furthermore,
many children and adolescence who experience mental health concerns often have comorbid
physical health concerns. Additional research examining the utility and effectiveness of holistic
healthcare may help improve both mental and physical healthcare for children, adolescents and
individuals of other age groups more broadly.
The Present Study: This study aims to provide descriptive information about the physical
health needs of mental health inpatients undergoing treatment. The Child and Youth Mental
Health Inpatient Unit at McMaster University Medical Centre requires all mental health inpatients
to undergo a physical assessment after admission to the unit. This study compiled descriptive
data from these assessments to identify the extent, and nature, of acute medical needs among
the population served. This is in turn may inform decision-making regarding the utility of a
more holistic approach to health care among mental health populations.
Method: Data for this study is based on 114 physical assessments of inpatients in the Child and
Youth Mental Health Inpatient Unit at McMaster University Medical Centre in 2014. Patients
(64% female) ranged in age from 8 to 17 years, with an average age of 14.91 years. The
physicians’ notes from the assessments were reviewed and data was extracted on the following
variables: age, gender, existing psychiatric diagnoses; current presenting health problems;
medical diagnoses made during the assessment; further medical assessments, investigations,
and consultations recommended; and any medical treatment given or recommended. Patients
presented with a range of psychiatric diagnoses/issues, including depression (62%), anxiety
(41%), eating disorders (29%), substance abuse (21%), psychosis (17%), self-harm (33%), and
suicidality (i.e., ideation and/or attempt; 47%). A proportion of cases reported a positive history
of exposure to child maltreatment (i.e., physical abuse: 12%; sexual abuse: 9%; neglect: 6%).
Preliminary analyses also suggest that a notable proportion of patients presented with medical
complaints including: headache (44%), abdominal pain (33%), bowel issues (28%), dizziness
(26%), chest pain (20%), and palpitations (18%). In response, a variety of further medical
investigations were arranged for these patients. Further analyses will be conducted to explore
potential relationships between psychiatric presentations and medical complaints in order to
explore the effectiveness and utility of including a physical health assessment as part of
standardized care in a mental healthcare setting.
References
Guerrero, A. (2003). General medical considerations in child and adolescent patients who
present with psychiatric symptoms. Child Adolesc Psychiatric Clinic N Am, 2003; 12:
613-628.
ABSTRACT #120
Utility of Practice Assignments in Remediating Symptoms of Post-Traumatic Stress
Disorder through Cognitive Processing Therapy (A study in progress)
Sarah Royal1, Karim Mithani2, Victoria Stead3, & Lisa A. Burckell1
1
Borderline Personality Disorder Service, St. Joseph’s Healthcare Hamilton, 2BHSc. Student,
Faculty of Health Sciences, McMaster University, 3MSc. Candidate, Department of Psychology,
Neuroscience & Behaviour, McMaster University
Rationale: Cognitive processing therapy (CPT) is an empirically verified intervention for posttraumatic stress disorder (PTSD) (Resick & Schnicke, 1992). An integral component of CPT
involves weekly completion of homework assignments, meant to help patients practice and
apply the lessons learned in individual and group therapy sessions (Kazantzis, Deane & Ronan,
2006). The utility of homework assignments has not been evaluated in patients with comorbid
borderline personality disorder (BPD) and PTSD, particularly when CPT is being administered
concurrently with dialectical behaviour therapy (DBT), the standard treatment for BPD.
Purpose: The present study aims to assess the effectiveness of homework completion in
reducing PTSD symptoms. We examined whether more frequent homework completion, as well
as greater perceived helpfulness of practice assignments, precipitated enhanced outcomes
overall. The results of this study may have significant implications for therapeutic guidelines.
Methods: Eligible participants (N= 24) were administered a Practice Assignment Review (PAR)
at weekly therapy sessions, for a total of 12 weeks. The questionnaires prompted patients to
reflect upon completion of homework since the last therapy session, as well as to rank the
perceived helpfulness of these assignments on an ordinal scale of 1–5. A PTSD Checklist (PCL5) questionnaire was also concurrently administered at these sessions. Self-reported
evaluations of time spent on homework, as well as perceived usefulness of the assignments,
were compared to longitudinal changes in scores on the PCL-5. A median split analysis of selfreported frequency and helpfulness was conducted to compare the treatment outcomes
(change in PCL scores from weeks 1-12) of high and low frequency/helpfulness groups.
Results: Despite an overall statistically significant decrease in PTSD symptoms due to
treatment, a repeated measures ANOVA revealed no significant difference in reduction of PCL
scores between high and low frequency practicing participants (F(1, 22) = 1.23, p>0.05). Linear
regression analysis exhibited no significant correlation between frequency of homework
completion and remediation of PTSD symptoms (R2 = 0.19). Similarly, there was no significant
relationship revealed between perceived helpfulness of practice assignments and treatment
outcomes (F(1,22) = 2.336, p>0.05; R2 = 0.22).
Conclusion: Frequency and perceived utility of independent practice does not appear to aid in
overall reduction of PTSD symptoms, suggesting that group and individual therapy sessions are
more imperative for clients’ overall treatment outcomes. Nevertheless, verification of these
results using a greater sample size, as well as more precise estimates of completion frequency
and perceived helpfulness, is required prior to drawing any clinical recommendations.
References
1. Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault
victims. Journal of consulting and clinical psychology, 60(5), 748.
2. Kazantzis, N., Deane, F., & Ronan, K. (2006). Homework Assignments in Cognitive and
Behavioral Therapy: A Meta-Analysis. Clinical Psychology: Science And Practice, 7(2),
189-202.
ABSTRACT #121
Sub-Clinical Anemia and Depressive Symptoms During the Perinatal Period: A Silent
Risk Factor for Mood Disruption in Pregnancy?
Meir Steiner MD Ph.D., Calan Savoy B.A., Gabriella Mattina B.Sc., Lauren Wright M.Sc.,
William Simpson B.Sc.,
Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON
Department of Psychiatry and Behavioural Neurosciences, McMaster University;
McMaster Integrated Neuroscience Discovery and Study Program, McMaster University,
Hamilton, ON
Rationale: Approximately 23% of Canadian women are diagnosed with anemia during
pregnancy (Stevens et al., 2013), while prevalence of Major Depressive Disorder is also
dramatically elevated in the antepartum period (Howard et al., 2014). Because maternal mood
has important implications for the future health of both mother and child, aggressive treatment of
both clinical and sub-clinical anemia may prove to me an effective first-line approach for treating
depressive symptoms.
Purpose: In this preliminary investigation, we evaluate the relationship between depression
symptoms and measures of anemia included in the complete blood count in a physically healthy
population of women.
Methods: 38 women during their third trimester of pregnancy were recruited from the Women’s
Health Concerns Clinic, St. Joseph’s healthcare Hamilton. They completed the CIDI-Venus
semi-structured diagnostic interview, the Edinburgh Postnatal Depression Scale (EPDS), and
received a complete blood count (CBC). Linear regression models were used to assess
variance in CBC measures accounted for by EPDS scores.
Results: After adjusting for age and weeks gestation, there was a relationship between EPDS
scores and hemoglobin (β=-.34, 95%CI= -.33- -.01), hematocrit (β=-.45, 95%CI= -31.13- -2.39),
mean corpuscular volume (β=-.45, 95%CI= -.75- -.14,), mean corpuscular hemoglobin (β= -.48.
95%CI=-1.90- -.41)and mean corpuscular hemoglobin concentration (β= -.42, 95%CI=-.57- .09). There was a positive association between EPDS and red blood cell distribution width (β=
.42, 95%CI=.60-6.39).
Conclusions: Self-report perinatal depression scores are associated with reduced CBC
measures consistent with clinical and sub-clinical anemia. These findings suggest that treatment
of anemia during pregnancy may reduce depressive symptoms with concomitant positive
outcomes for both mother and child.
References
Howard, L. M., Molyneaux, E., Dennis, C.-L., Rochat, T., Stein, A., & Milgrom, J. (2014). Nonpsychotic mental disorders in the perinatal period. Lancet, 384(9956), 1775–88.
Stevens, G. A., Finucane, M. M., De-Regil, L. M., Paciorek, C. J., Flaxman, S. R., Branca, F.,
Ezzati, M. (2013). Global, regional, and national trends in haemoglobin concentration and
prevalence of total and severe anaemia in children and pregnant and non-pregnant women
for 1995-2011: a systematic analysis of population-representative data. The Lancet. Global
Health
ABSTRACT #122
Teacher Reported Prevalence of Special Needs, Functional Impairments and Health
Disorder Diagnoses in Kindergarten Children: Preliminary Data from the Canadian
Children’s Health in Context Study (CCHICS)
Sarah E. Taylor1, Caroline Reid-Westoby1, Magdalena Janus1
1
Early Development Instrument, Offord Centre for Child Studies
Rationale: Each year, many children with sub-optimal health enter Canadian schools. They
could be categorized as having special educational needs (i.e. chronic medical, physical or
mentally disabling condition), functional impairments (i.e. a problem influencing the child’s ability
to work in a regular classroom), and/or a medical diagnosis (a mental or physical illness) and as
a result, they will often lack the skills necessary to succeed at school [1]. Up until now, there has
been no consistent way of assessing the prevalence of these conditions at a population level.
Purpose: The recently-funded Canadian Children’s Health in Context Study (CCHICS) aims to
address this gap using population level data from the Early Development Instrument (EDI) to
determine the prevalence of special needs, functional impairments and medical diagnoses
amongst kindergarten age children in Canada.
Methods: The EDI is a population-based measure of children’s developmental health at school
entry and is completed for each child by their kindergarten teacher during the second half of the
school year [2]. Data can then be aggregated to neighbourhood and community levels. The new
Canada-wide database contains information on 881,926 children from 10 provinces and 2
territories. Frequencies of the special needs, functional impairments and diagnoses were
examined to determine a population estimate of prevalence rates.
Results: These data revealed that 3.6% (n=29680) of Canadian children entering kindergarten
are identified as having a special need, 14.9% (n=75958) have a functional impairment and
7.3% (n=20988) have a medical diagnosis. There are also 0.7% (n=2110) of children identified
by their teacher as having all three challenges.
Conclusions: The identified children face unequal odds for succeeding at school, therefore, it is
important to explore the conditions under which they can flourish and achieve optimal
developmental outcomes. The CCHICS will link EDI data to Canadian Census and Taxfiler data
at a neighbourhood level in order to investigate possible socio-economic determinants
associated with rates of special needs, functional impairments, and diagnoses. These can then
be examined at local levels for more details to inform community and policy-level decisions for
future interventions aimed at improving equity at school entry for all children.
References:
1. Janus, M., Hughes, D., & Duku, E. (2010). Patterns of school readiness among selected
subgroups of Canadian children: Children with special needs and children with
diverse language backgrounds. The Canadian Council on Learning.
2. Janus, M., & Offord, D. R. (2007). Development and psychometric properties of the Early
Development Instrument (EDI): A measure of children's school readiness.
Canadian Journal of Behavioural Science, 39(1), 1-22. doi: 10.1037/cjbs2007001
ABSTRACT #123
Delay Discounting and Addictive Behaviour: A Meta-Analysis of Continuous Relationships
Lana Vedelago, BA1, Michael Amlung, PhD1, John Acker, MS2, Iris Balodis, PhD1, James
MacKillop, PhD1,3
1
Peter Boris Centre for Addictions Research, Department of Psychiatry and Behavioural
Neurosciences, McMaster University and St. Joseph’s Healthcare Hamilton; 2Center for Integrated
Healthcare, Syracuse VA Medical Center, 3Homewood Research Institute, Homewood Health
Centre.
Background: Behavioural economics is increasingly being applied to understand maladaptive
decision making in individuals with addictive disorders (Bickel et al., 2014). Delayed reward
discounting (DRD) is a behavioural economic construct which refers to the devaluation of rewards
based on their delay in time (Bickel et al., 2014). A meta-analysis by MacKillop et al (2011)
demonstrated that DRD rates in individuals with addictive disorders are significantly greater than
those in control groups. However, continuous associations between DRD and measures of
addiction severity and quantity/frequency (QF) of use remained unexplored.
Purpose: To examine continuous associations between DRD and addictive behaviours and to
examine the influence of potential moderators on these associations.
Methods: Studies identified via searches of PubMed, MEDLINE, and PsycInfo databases were
required to meet the following inclusion criteria: (i) published, peer-reviewed investigation in a
human sample; (ii) inclusion of a monetary DRD task; (iii) inclusion of a continuous measure of
addictive behavior; and (iv) inclusion of a correlation coefficient measuring the relationship between
DRD and addictive behavior. Primary analyses aimed to examine the aggregate effect sizes of the
association between DRD and addictive behaviour and to assess for the influence of three
moderators on this relationship: type of addictive behavior (alcohol, tobacco, cocaine, etc.), variable
type (QF vs severity), and DRD measure (questionnaire vs. task). Additionally, parameters of
publication bias were assessed.
Results: Sixty-four unique studies were included, yielding 138 effect sizes. The aggregated effect
size across studies was of small magnitude and highly statistically-significant (d = 0.29, p < 10-14).
Moderator analyses indicated significantly larger aggregated effect sizes for measures of severity
compared to QF (d = 0.32 vs. 0.14, respectively; Q = 6.49, p < 0.05) and non-significant differences
between type of addictive behaviour (Q = 4.91, p = 0.30) or DRD assessment type (Q = 0.01, p =
0.90). Indices of publication bias indicated modest impact of unpublished findings.
Conclusion: These findings align with the meta-analysis by MacKillop et al. (2011) and further
support the robust relation between DRD and addictive behaviour. Moderator analyses indicate that
steep DRD is more strongly associated with measures of addictive severity vs. quantity/frequency.
The results also support the use of a standardized questionnaire-based measure for efficient
assessment of DRD.
References
1.) Bickel, W.K., Johnson, M.W., Koffarnus, M.N., MacKillop, J., & Murphy, J.G. (2014). The
behavioral economics of substance use disorders: reinforcement pathologies and their
repair. Annual Review of Clinical Psychology, 10, 641-77.
2.) MacKillop, J., Amlung, M.T., Few, L.R., Ray, L.A., Sweet, L.H., & Munafò, M.R. (2011).
Delayed reward discounting and addictive behavior: a meta-analysis. Psychopharmacology,
216, 305-21.
ABSTRACT #124
Socioeconomic Status and Early Childhood Development: A Comparison of Canadian
Socioeconomic Indices and Their Relationships with the Early Development Instrument
Simon Webb1; Magdalena Janus1; Eric Duku1; Rob Raos1; Marni Brownell2; Barry Forer3;
Martin Guhn3; Nazeem Muhajarine4
1
Offord Centre for Child Studies, McMaster University; 2Manitoba Centre for Health Policy,
University of Manitoba; 3Human Early Learning Partnership, University of British Columbia;
4
Department of Community Health and Epidemiology, University of Saskatchewan;
Rationale: Evidence shows that neighbourhood socioeconomic characteristics, typically
measured using socioeconomic status (SES) indices, can play a role in of Canadians’ mental
and physical health. Less is known about the extent to which these indices are relevant to child
development. Awareness of these relationships can inform area-based health intervention
strategies by allowing policymakers to focus on areas with the greatest risks.
Purpose: This study examines the relationship between four frequently used Canadian indices
of SES and early child development. Through this analysis, we identify contextual
socioeconomic risk characteristics associated with specific developmental outcomes.
Methods: We replicate four established Canadian SES indices: the Canadian Deprivation
Index, the Socioeconomic Factor Index, the Canadian Marginalization Index and the Early
Childhood Mapping Project Index, using Canadian 2006 Census data aggregated to customdefined neighbourhoods. Their relationships to early childhood development are investigated by
linking the indices to developmental health data from the Early Development Instrument (EDI,
Janus & Offord 2007).
Results: Components of indices that measure social deprivation (divorce rates, percentage of
lone parents, etc.) have larger effects on the Physical Health and Well-being and Emotional
Maturity domains of the EDI, while measures of material deprivation (income, unemployment,
etc.) have larger effects on the Language and Cognitive Development domain. Two of the
replicated indices also included ‘cultural’ components (percentage of recent immigrants,
population born outside Canada, etc.) which had a large effect on the Communications Skills
and General Knowledge domain of the EDI. The Early Childhood Mapping Project index
explained the most variation in the EDI data, while the Canadian Deprivation and
Socioeconomic Factor indices had the advantage of simplicity and interpretability.
Conclusions: Results identified social, economic, and cultural dimensions of neighbourhood
SES are relevant to child development. This provides evidence to support the use of
multidimensional SES, since the various dimensions of SES affect early development in
different ways. These inferences can inform area-based intervention strategies by exposing
neighbourhood risk factors for specific aspects of early childhood development.
References:
Janus, M., & Offord, D. R. (2007). Development and psychometric properties of the Early
Development Instrument (EDI): A measure of children's school readiness. Canadian Journal of
Behavioural Science/Revue Canadienne des Sciences du Comportement, 39(1), 1-22.