Wendy den Dunnen

Prescription Medication Misuse Among Adolescents With Severe Mental Health Problems in Ontario, Canada

The purpose of this study was to examine the prevalence of prescription medication misuse among adolescents with severe mental health problems in Ontario, Canada, and to explore some of the factors that influence the misuse of prescription medication. Data were obtained from the Resident Assessment Instrument for Mental Health. A total of 2,677 adolescents between the ages of 12 and 18 years who were admitted into adult mental health beds were analyzed. Logistic regression was used in estimating the likelihood of misusing prescription medication. Overall, 17% of adolescent inpatients misused prescription medication. In the multivariate model, the following were found to be associated with misuse: being female, having multiple psychiatric admissions, education, threat or danger to self, problem with addiction, history of emotional abuse, use of alcohol, past year use of opiates and cannabis, as well as symptoms of depression. Misuse of prescription medication was less likely to occur among adolescents with a diagnosis of schizophrenia and adolescents who were admitted as a result of posing a threat or danger to others. Implications of the findings are discussed with suggestions for future research.

The enduring effects of early-childhood adversities and troubled sleep among Canadian adults: a population-based study

OBJECTIVE Although many studies have consistently found that early-childhood adversities are important risk factors for physical and mental health problems later in adulthood, few have examined the association between early-childhood adversities and troubled sleep. The objective of this study was to examine the association between early-childhood adversities and troubled sleep among adult Canadians. METHODS Data for this paper (N = 19,349) were obtained from Statistics Canadas 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Logistic regression analysis was conducted to examine the association between early childhood adversities and troubled sleep, while accounting for various sociodemographic, socioeconomic, health, and mental health factors. RESULTS Of the 19,349 respondents examined, 2748 representing 14.2% had troubled sleep. Controlling for sociodemographic, socioeconomic, health, and mental health factors, it was observed that for each additional childhood adversity experienced, the odds of having troubled sleep increased by 10% (odds ratio = 1.10, p <0.001, 95% confidence interval = 1.07-1.13). In addition, psychological distress, older age, being female, being unmarried, being white, a lower annual income, chronic pain, poor perceived health, and mental health difficulties were associated with troubled sleep. CONCLUSION The results of this paper provide population-based evidence for childhood adversities as a major predictor of troubled sleep in adulthood. The long-standing effects of these adversities on sleep highlight the importance of early detection, such as consistent assessment of sleep habits for children, adolescents, and adults, who have experienced childhood adversities, in health and mental health settings.

Predicting Residential Treatment Outcomes for Emotionally and Behaviorally Disordered Youth: The Role of Pretreatment Factors

This study examined outcomes with 170 children and youth admitted to residential treatment with complex mental health problems. Overall, outcomes at 2 years post-treatment was predicted by children and youths behavioral pretreatment status reflected in lower internalizing and externalizing behavior at admission. These findings recognize a cluster of variables upon admission that are differentially predictive of specific outcomes. Higher school participation/achievement and an absence of witnessing interparental abuse predicted educational status. Family status was predicted at admission by higher family functioning, being younger in the family, and children and youth who had poor community behavior. The results are discussed as they relate to pretreatment screening and the need to evaluate service outcomes.

Childhood abuse and cannabis use among adolescents with mental health needs in Ontario, Canada

Objective: The purpose of this study was to examine the association between childhood abuse (emotional, physical and sexual abuse) and cannabis use among adolescents with mental health needs. Methods: Data on 3681 adolescent in-patients, 12–18 years old, were obtained from the Resident Assessment Instrument for Mental Health (RAI-MH). Using logistic regression, we estimated the odds of using cannabis by adolescents who experienced childhood abuse after controlling for age, gender, Aboriginal origin, problems with addiction, history of criminal justice involvement and symptoms of depression and mania. Results: There were 1844 adolescents, representing 50.1%, who reported using cannabis within the last 12 months. Controlling for demographic and patient characteristics, we found that cannabis use in the past year was strongly associated with childhood sexual and physical abuse. Compared to non-abused females, females who experienced sexual and physical abuse were more likely to have used cannabis. For males, the experience of physical abuse was marginally associated with cannabis use. Conclusion: The current data demonstrate the strong association between childhood sexual and physical abuse and cannabis use with a particularly strong association for females. Efforts aimed at treating cannabis use in adolescents who present with mental health needs should also consider their abuse histories.

The role of sense of community belonging on unmet health care needs in Ontario, Canada: findings from the 2012 Canadian community health survey

AimThis article examines the association between sense of community belonging and unmet health-care needs among individuals in Ontario, Canada, after adjusting for predisposing, enabling, and need factors associated with health-service use.Subjects and methodsThis study is based on data from Statistics Canada’s 2012 Canadian Community Health Survey. A sample of 21,257 individuals aged 12 and older was analyzed. Logistic regression was conducted to examine the association between sense of community belonging and unmet health-care needs.ResultsThe study found that one in ten individuals reported having unmet health-care needs. Sense of community belonging had a significant independent effect on unmet health-care needs. Respondents with a weak sense of community belonging were 1.27 times more likely to report having unmet health-care needs. Respondents who were younger, were females, had a higher education, or were without a regular doctor were more likely to have unmet health-care needs. Other factors associated with unmet health-care needs included poor physical health, poor mental health, difficulties in carrying out instrumental activities of daily living, and chronic conditions.ConclusionThe findings of this study emphasize the need to develop health-care policies and programs that appropriate and meet the needs of individuals with different health-related problems alongside the need to increase sense of community belonging.

Discharge of adolescents with mental health problems against medical advice: Findings from adult mental health inpatient facilities across Ontario, Canada

Little is known about discharge against medical advice (DAMA) among adolescents with mental health problems. The objective of this study was to examine the prevalence of DAMA and provide some insight into the factors that influence DAMA among adolescents with mental health problems using a large dataset from Ontario, Canada. Data on 1811 adolescents aged 14-18 years who were discharged from adult mental health beds between October 2005 and March 2010 were analyzed using logistic regression. Of the 1811 discharges in the sample, 78(4.3%) were against medical advice. In the multivariate model, older age, having limited insight or no insight into mental illness, provisional DSM-IV diagnoses of substance-related disorders, eating disorders, and personality disorders increased the odds of DAMA. Length of stay was negatively associated with DAMA. The findings of this study highlight the importance of completing comprehensive assessments at the time of admission to identify adolescents who are at risk of treatment refusal and provide timely intervention to prevent DAMA.

Examining the independent protective effect of subjective well-being on severe psychological distress among Canadian adults with a history of child maltreatment

The purpose of this study was to examine the independent protective effect of subjective well-being on severe psychological distress among adult Canadians with a history of child maltreatment. Data for this study were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). A sample of 8126 respondents aged 20-69 years old who experienced at least one child maltreatment event was analyzed using binary logistic regression with severe psychological distress as the outcome variable. Of the 8126 respondents with a history of child maltreatment, 3.9% experienced severe psychological distress within the past month. Results from the multivariate logistic regression revealed that emotional and psychological well-being each had a significant effect on severe psychological distress. For each unit increase in emotional well-being, the odds of a respondent having severe psychological distress were predicted to decrease by a factor of 28% and for each unit increase in psychological well-being, the odds of a respondent having severe psychological distress were predicted to decrease by a factor of 10%, net the effect of demographic, socioeconomic, and health factors. Other factors associated with psychological distress included: younger age, poor self-perceived physical health, and chronic condition. Having post-secondary education, having a higher income, and being non-White predicted lower odds of severe psychological distress. Although, child maltreatment is associated with stressful life events later in adulthood, subjective well-being could serve as a protective factor against severe psychological distress among adults who experienced maltreatment when they were children.

Prevalence and Correlates of Criminal Activity in Adolescents Treated in Adult Inpatient Mental Health Beds in Ontario, Canada

Using logistic regression, this study seeks to examine the prevalence and correlates of criminal involvement in the previous year among adolescents in inpatient psychiatric facilities across Ontario, Canada. A sample of 2,613 adolescents aged 12 to 18 years who were admitted to adult inpatient mental health beds were examined. Just over one quarter of adolescents engaged in criminal activity within the past year. Older age, male gender, previous psychiatric admissions, a history of child abuse, poor insight into mental illness, substance use, specific types of mental health disorders, and aggressive behavior were all significantly associated with the presence of prior criminal activity. The well-founded association between mental health problems, substance use, and criminal behavior highlights the need for effective screening in settings providing services in the areas of juvenile justice, mental health, and addictions. Clinician awareness in all three settings is recommended so that these factors associated with at-risk behavior can be identified and appropriate treatment and referrals can be provided at the earliest point of involvement with any of these service systems.

Police Charging Decisions in Child Maltreatment Investigations: Findings from the 2008 Ontario Incidence Study of Reported Child Abuse and Neglect

ABSTRACT The objective of this study was to use logistic regression and examine factors that influence charging decisions by the police during child maltreatment investigations. An estimated 4,808 substantiated child maltreatment investigations that involved police were obtained from the 2008 Ontario Incidence Study of Reported Child Abuse and Neglect. Of the 4,808 cases examined, police laid charges in about one-third of the cases. Controlling for all other factors, police were 1.6 times more likely to lay charges in physical abuse cases and 2.5 times more likely to lay charges in sexual abuse cases. Other factors associated with police charging decisions include: older victim, cases with multiple types of maltreatment, cases opened for ongoing services, and cases of the child living in a house known to have drugs or household hazards. The article discusses the results and their implications for child welfare policy and practice.