Effects of Treatment Setting on Outcomes of Flexibly-Dosed Intensive Cognitive Behavioral Therapy for Pediatric OCD : A Randomized Controlled Pilot Trial

Funding Information: The study authors would like to acknowledge the planning support of Drs. Eric Storch and Katherine Martinez, the recruitment and administrative support of the Provincial OCD Program Team at BC Children's Hospital, and the participation of all families. Funding. This study was supported by postdoctoral awards to RS from the Michael Smith Foundation for Health Research (#17821) and the BC Children's Hospital Research Institute. Both awards provided salary support for RS as well as research funds to support study implementation (e.g., staff salaries, participant reimbursement, etc.). A private donation to the Provincial OCD Program via the BC Children's Hospital Foundation also supported some research costs. Funding Information: This study was supported by postdoctoral awards to RS from the Michael Smith Foundation for Health Research (#17821) and the BC Children’s Hospital Research Institute. Both awards provided salary support for RS as well as research funds to support study implementation (e.g., staff salaries, participant reimbursement, etc.). A private donation to the Provincial OCD Program via the BC Children’s Hospital Foundation also supported some research costs. Publisher Copyright: © Copyright © 2021 Selles, Naqqash, Best, Franco-Yamin, Qiu, Ferreira, Deng, Hannesdottir, Oberth, Belschner, Negreiros, Farrell and Stewart.Introduction: Optimizing individual outcomes of cognitive-behavioral therapy (CBT) remains a priority. Methods: Youth were randomized to receive intensive CBT at a hospital clinic (n = 14) or within their home (n = 12). Youth completed 3 × 3 h sessions (Phase I) and up to four additional 3-h sessions as desired/needed (Phase II). An independent evaluator assessed youth after Phase I, Phase II (when applicable), and at 1- and 6-months post-treatment. A range of OCD-related (e.g., severity, impairment) and secondary (e.g., quality of life, comorbid symptoms) outcomes were assessed. Results: Families' satisfaction with the treatment program was high. Of study completers (n = 22), five youth (23%) utilized no Phase II sessions and 9 (41%) utilized all four (Median Phase II sessions: 2.5). Large improvements in OCD-related outcomes and small-to-moderate benefits across secondary domains were observed. Statistically-significant differences in primary outcomes were not observed between settings; however, minor benefits for home-based treatment were observed (e.g., maintenance of gains, youth comfort with treatment). Discussion: Intensive CBT is an efficacious treatment for pediatric OCD. Families opted for differing doses based on their needs. Home-based treatment, while not substantially superior to hospital care, may offer some value, particularly when desired/relevant. Clinical Trial Registration: www.ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03672565, identifier: NCT03672565.Peer reviewe

Age-specific determinants of psychiatric outcomes after the first COVID-19 wave : baseline findings from a Canadian online cohort study

Background: Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups. Methods: The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive–compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19–29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one. Results: Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups. Interpretation: Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts.Medicine, Faculty ofOther UBCNon UBCPediatrics, Department ofPsychiatry, Department ofReviewedFacultyResearcherPostdoctoralGraduateUndergraduat