Coping with Stressors by Drawing on Social Supports: The Experiences of Adolescent Syrian Refugees in Canada

This study explores how teenage Syrian refugees use their social networks to cope with stressors. Through interviews with nine youth aged 16 to 18 living in Ontario, Canada, stressors related to pre- and post-migration emerged. Family, peers, school staff, and organizations were identified as social networks, each having unique reasons why they were selected. Coping was categorized as individualistic or collectivistic. Teenage Syrian refugees draw upon social resources to navigate situations they are faced with, and cultural values influence the stress and coping process. Findings have implications for mental health care providers and policy-makers focused on migrant resettlement.Cette étude explore la manière dont les adolescents réfugiés syriens utilisent leurs réseaux sociaux afin de faire face aux facteurs de stress. À partir d’entrevues menées auprès de neuf jeunes âgés de 16 à 18 ans en Ontario, Canada, des facteurs de stress et post-migratoires ont émergé. La famille, les pairs, le personnel scolaire et les organisations ont été identifiés comme des réseaux sociaux, chacun ayant des raisons uniques pour lesquelles ils ont été sélectionnés. L’adaptation a été catégorisée comme individualiste ou collectiviste. Les adolescents réfugiés syriens s’appuient sur des ressources sociales pour traverser les situations auxquelles ils font face, et les valeurs culturelles ont une influence sur le stress et le processus d’adaptation. Les résultats ont des implications pour les prestataires de soins en santé mentale et les décideurs qui se penchent sur la réinstallation des migrants

The ethics and safety of medical student global health electives

Abstract Objectives: To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them. Methods: Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas's transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced. Results: We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spending a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macrolevel themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety. Conclusions: Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations

Mental health of transitional aged youth in Nicaragua: Perceptions and experiences of educators

Mental illnesses contribute to a large proportion of the disease burden in children and adolescents in low and middle-income countries (LMICs). There is limited research completed in LMICs about paediatric mental health, particularly related to youth. School is a place where many adolescents first seek mental health support. This study examined how educators in Nicaragua view youth mental health and how mental health can be supported in LMIC schools. Focus groups were completed with teachers serving youth from a variety of socioeconomic settings within León, Nicaragua. The study was completed from an Interpretivist theoretical paradigm and coding of qualitative data was completed consistent with Constructivist Grounded Theory. Educators described their roles in as detecting mental health problems and liasing with other supports; they noted barriers as cross-sector integration and social challenges. Educators felt that youth would be better served by improving integration of care, addressing structural factors, and providing more teacher supports. A model for addressing youth mental health in LMICs could include a stepped-care approach with schools providing preventative programming as well as developing within school referral strategies for youth with higher needs. There may be a role for the use of community health promoters

sj-docx-1-cpa-10.1177_07067437241233936 - Supplemental material for Racial/Ethnic Disparities in Psychiatric Traits and Diagnoses within a Community-based Sample of Children and Youth

Supplemental material, sj-docx-1-cpa-10.1177_07067437241233936 for Racial/Ethnic Disparities in Psychiatric Traits and Diagnoses within a Community-based Sample of Children and Youth by Andrew Dissanayake, Annie Dupuis, Christie L. Burton, Noam Soreni, Paul Peters, Amy Gajaria, Paul D. Arnold, Russell Schachar and Jennifer Crosbie in The Canadian Journal of Psychiatry</p

An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial

Abstract Introduction Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information ‘Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. Methods and analysis We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13–18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale—Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. Ethics and dissemination Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated