Poster Introductions III--Antipsychotic Utilization in British Columbia from 1997 to 2006

This study examined the prevalent use of antipsychotic medication in British Columbia from 1997 to 2006 among individuals aged 20 and above. Utilization data were obtained from BC’s PharmaNet system – a provincially maintained database that contains prescription dispensation records and demographic information for individuals residing in BC. Using the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification, claim records for Antipsychotics, Atypical Antipsychotics, Butyrophenones, Phenotiazines, Thioxanthenes, and Miscellaneous Antipsychotics were identified in the PharmaNet dataset. Individuals who filled at least 1 antipsychotic prescription in a given year were counted as prevalent users. Results were examined across gender and several age groupings. Preliminary analyses of the results provide evidence for increasing prevalent use from 1997 to 2006. Similarly, initial results suggest prevalent use increases with age, with older age groups (75 and above) exhibiting dramatic jumps in utilization. Results will be discussed in light of the various indications for the use of antipsychotic medications and the various health concerns associated with its prolonged use, particularly among the elderly. Joseph H. Puyat is an MSc student in the School of Population and Public Health (SPPH), Faculty of Medicine, University of British Columbia. He was a project manager and researcher at the Center for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences, Simon Fraser University where he worked on various projects including the analysis of the BC provincial prescription database to examine the pharmacoepidemiology of psychotropic drugs, and, the development of supported self-management strategies for the treatment of mood disorders. Before joining CARMHA, he conducted studies on aggression and violence among students groups and wrote research reports examining social psychological processes shaping the Filipino youth\u27s self-concept

Assessing gaps and variations in depression care and the impact of physician incentives

Depression is increasingly becoming the leading cause of disability worldwide. While effective treatments like psychological or antidepressant therapies are available, concerns remain about under treatment and disparities in care as these can adversely affect mental health outcomes. Through a series of studies, this thesis estimated the magnitude of the gap and variations in depression care and the impact physician incentives had on treatment gaps. To perform all population-based analyses, this thesis used linked health administrative data from the Canadian province of British Columbia. An algorithm for identifying cohorts was developed to ensure that observation periods for detecting diagnosis and assessing use of mental health care were identical for all individuals. Administrative data were used to derive indicators that measure receipt of counseling/psychotherapy, receipt of antidepressants, adherence to antidepressant therapy, and physician continuity of care. Analytical approaches used in the study include calculating proportions to estimate treatment gaps, building generalized and mixed effects regression models to examine treatment variations and running interrupted time series analysis to investigate policy impacts. Results of the analyses suggest that four out of ten individuals with depression did not receive any depression care from the formal health system. Among the treated, only one in two received minimally adequate care, mostly through antidepressants. Minimally adequate treatment varied by sex, age, overall health status, place of residence, physician practice, and presence of specific comorbid physical conditions. Study results also indicate that physician incentives affected depression care patterns, although the overall impact was modest. Specifically, the downward trend in counseling/psychotherapy and the upward trend in antidepressant therapy initiation were disrupted. Likewise, the percentage of individuals who received minimally adequate counseling/psychotherapy increased gradually over time while the percentage of those who received minimally adequate antidepressant therapy decreased. Some gains were also achieved in measures of physician continuity of care. Overall, study results show that wide gaps in depression care persist despite recent efforts to improve mental health care. Expanding public coverage for psychological therapies and exploring reforms that require fundamental changes in mental health service delivery are needed to enhance treatment options and accessibility.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

A cross-sectional survey of activities to support mental wellness during the COVID-19 pandemic

Background: During the COVID-19 pandemic, public health restrictions such as social distancing, isolation and self-quarantine have been implemented for several months. Because of these restrictions, in-person contact with friends, family, and mental health supports had been limited, potentially impacting mental wellbeing. Objectives: In this study, we examined the impact of the pandemic on the mental health of adults and investigated the types of activities people engage in to manage and maintain their mental health. Methods: An online survey was circulated in Canada and had a total of 221 participants from September 24 to December 8, 2020. Results: The majority of participants were females (73.2%), between the ages of 18 and 34 (51.1%), and employed full-time (56.1%). Individuals who are unemployed and those with an annual income less than $25,000 had the highest scores in depression, anxiety and psychological distress. Around 19.4% of the sample scored above the cutpoint for depression, which is higher compared to a pre-pandemic population prevalence of 4.7%. Similarly, higher prevalence of anxiety and distress symptoms were observed: 16.3% of the sample had moderate anxiety symptoms compared to a pre-pandemic population prevalence of 11.6%; and 37.7% of the sample had moderate distress symptoms compared to a pre-pandemic population prevalence of 20%. Conclusions: Our findings suggest that the COVID-19 pandemic has negatively impacted the mental health of many adults and that individuals engage in a wide range of activities that may maintain and promote mental wellness during the pandemic, such as exercising, reading, and listening to music

Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study

Objective To evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.Design A cross-sectional analysis using data from Canadian Community Health Survey—Mental Health (2012).Setting The survey was administered across Canada’s 10 provinces using multistage cluster sampling.Participants The study sample consisted of individuals reporting depression, anxiety or bipolar disorder.Study variables and analysis The explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region.Results Among 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support.Conclusion Comorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care

Home-based and community-based activities that can improve mental wellness: a protocol for an umbrella review.

INTRODUCTION: Mental disorders affect about 13% of the world's population. While evidence-based mental health treatments are available, a significant number of persons with mental illnesses are untreated or do not receive adequate mental healthcare due to various reasons, including costs, stigma and the desire to self-manage symptoms. In the past few years, there has been an increase in the body of evidence regarding leisure activities and mental wellness. However, there is currently no published overview of the state of the evidence on these activities and their potential preventive and therapeutic effects on mental health. METHODS AND ANALYSIS: Using Joanna Briggs Institute (JBI) review guidelines, an umbrella review will be undertaken to synthesise findings from systematic reviews and meta-analyses on the mental health benefits of home-based and community-based activities. MEDLINE, PsycInfo, Embase, CINAHL, Web of Science, Epistemonikos, Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews and Implementation Reports will be searched for potentially relevant systematic reviews and meta-analyses published from January 1991 to present. Title/abstract screening, full-text review, data extraction and assessment of methodological quality will each be performed independently by two reviewers. A third review author will be available to resolve discrepancies in any of the review tasks. To assess the quality of potentially eligible reviews, the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses will be used. Findings will be presented in table form and will be summarised by study population, type of home-based or community-based activity or intervention, and type of mental health outcomes. Overall assessment of the strength of existing evidence from eligible systematic reviews will be provided following the grading of recommendation, assessment, development and evaluation approach

Reliability of diaphragm voluntary activation measurements in healthy adults

Voluntary activation can be used to assess central fatigue of the diaphragm after tasks such as exercise or inspiratory muscle loading. Cervical magnetic stimulation (CMS) of the phrenic nerves elicits an involuntary contraction, or twitch of the diaphragm. This twitch is quantified based on a measure of transdiaphragmatic pressure (Pdi) and can be used to evaluate diaphragm contractile function and diaphragm voluntary activation (diaphragm-VA). The test-retest reliability of diaphragm-VA using CMS is currently unknown. Thirteen participants (4M:9F; 253 years) performed a series of interpolated twitch manoeuvres, which included a maximal inspiratory effort against a semi-occluded mouthpiece and two CMS-stimuli, one during the inspiratory manoeuvre and one after when the participant returned to functional residual capacity to quantify diaphragm-VA. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) measured between-day and within-session reliability of diaphragm-VA, respectively. Maximal diaphragm-VA values were 908% (SEM: 3.8%) and 917% (SEM: 3.8%) during visits 1 and 2 (p=0.781), respectively, and displayed ‘excellent’ between-day reliability (ICC:0.98; 95%CI:0.96-1.00; SEM: 1.5%). Our results suggest that assessing diaphragm-VA using CMS is reliable in young healthy adults. Measuring diaphragm-VA may provide additional insight into the consequences and mechanisms of diaphragm fatigue. Novelty bullets: • Magnetic stimulation of the phrenic nerves can reliably measure voluntary activation of the diaphragm • Diaphragm voluntary activation can be used to provide additional insight into fatigability of the diaphragm.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Pectoralis muscle area and its association with indices of disease severity in interstitial lung disease.

RATIONALE The pathophysiology of interstitial lung disease (ILD) impacts body composition, whereby ILD severity is linked to lower lean mass. OBJECTIVES To determine i) if pectoralis muscle area (PMA) is a surrogate for whole-body lean mass in ILD, ii) whether PMA is associated with ILD severity, and iii) if the longitudinal change in PMA is associated with pulmonary function and mortality in ILD. METHODS Patients with ILD (n = 164) were analyzed retrospectively. PMA was quantified from a chest computed tomography scan. Peripheral oxygen saturation (SpO2), 6-min walk distance (6MWD), and pulmonary function were obtained as part of routine clinical care. Dyspnea and quality of life were assessed using the UCSD Shortness of Breath Questionnaire and European Quality of Life 5 Dimensions questionnaire, respectively. RESULTS PMA was associated with whole-body lean mass (p  0.05). The annual negative PMA slope was associated with annual negative slopes in FVC, FEV1, and DLCO (all p < 0.05), but not FEV1/FVC (p = 0.46). Annual slope in PMA was associated with all-cause mortality (hazard ratio = -0.80, 95% CI:0.889-0.959; p < 0.001). CONCLUSION In patients with ILD, PMA is a suitable surrogate for whole-body lean mass. A lower PMA is associated with indices of ILD severity, which supports the notion that ILD progression may involve sarcopenia

Exercise responses and mental health symptoms in COVID-19 survivors with dyspnoea

Objectives Dyspnoea is a common persistent symptom post-coronavirus disease 2019 (COVID-19) illness. However, the mechanisms underlying dyspnoea in the post-COVID-19 syndrome remain unclear. The aim of our study was to examine dyspnoea quality and intensity, burden of mental health symptoms, and differences in exercise responses in people with and without persistent dyspnoea following COVID-19. Methods 49 participants with mild-to-critical COVID-19 were included in this cross-sectional study 4 months after acute illness. Between-group comparisons were made in those with and without persistent dyspnoea (defined as modified Medical Research Council dyspnoea score ≥1). Participants completed standardised dyspnoea and mental health symptom questionnaires, pulmonary function tests, and incremental cardiopulmonary exercise testing. Results Exertional dyspnoea intensity and unpleasantness were increased in the dyspnoea group. The dyspnoea group described dyspnoea qualities of suffocating and tightness at peak exercise (p<0.05). Ventilatory equivalent for carbon dioxide (VʹE/VʹCO2) nadir was higher (32±5 versus 28±3, p<0.001) and anaerobic threshold was lower (41±12 versus 49±11% predicted maximum oxygen uptake, p=0.04) in the dyspnoea group, indicating ventilatory inefficiency and deconditioning in this group. The dyspnoea group experienced greater symptoms of anxiety, depression and post-traumatic stress (all p<0.05). A subset of participants demonstrated gas-exchange and breathing pattern abnormalities suggestive of dysfunctional breathing. Conclusions People with persistent dyspnoea following COVID-19 experience a specific dyspnoea quality phenotype. Dyspnoea post-COVID-19 is related to abnormal pulmonary gas exchange and deconditioning and is linked to increased symptoms of anxiety, depression and post-traumatic stress