Shannon L. Stewart

The objectives of this study were to examine the prevalence of non-suicidal self-injury (NSSI) among adolescents with mental health needs and specific factors associated with NSSI among adolescents aged 14 to 18 years who received mental health services in adult mental health facilities in Ontario, Canada. Data on 2,013 adolescents were obtained from the Ontario Mental Health Reporting System using the Resident Assessment Instrument—Mental Health (RAI-MH) and were analyzed using logistic regression. Approximately, 20.2% (407 adolescents) of the sample engaged in NSSI within the last 12 months. Results from multivariate logistic regression indicate that females were 2.19 times more likely to engage in NSSI than males. Intentional misuse of prescription medication emerged as the most important factor associated with NSSI. Other factors found to be associated with NSSI included multiple psychiatric admissions, sexual abuse, use of alcohol, mood disorders (e.g., depression), adjustment disorders, personality disorders and symptoms of depression. The article discusses the implications of the findings, with suggestions for future research.

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 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.

Background: The purpose of this study was to examine demographic, background, and psychopathology variables that predict length of stay and readmission among youth with mental health needs. Method: We analyzed data on 2445 youth who were admitted into adult psychiatric beds in Ontario, Canada. Multiple regression was used to examine length of stay, whereas logistic regression was used to examine the predictors of readmission. Results: Youth were likely to stay longer in hospital if they were older, were boys, had a diagnosis of schizophrenia, mood disorders, eating disorders, personality disorders, and intellectual disability. Education, discharged against medical advice, and a diagnosis of adjustment disorders were all associated with shorter length of stay. Age, living in a group home or assisted care, a diagnosis of schizophrenia, mood disorders, and intellectual disability predicted readmission. Conclusion: Strategies to improve current psychiatric services (e.g. how to reduce psychiatric hospital readmissions) are discussed.

This study seeks to identify some of the explanatory factors associated with the use of intrusive measures among children with mental health and developmental disabilities in psychiatric facilities. Intrusive intervention data were collected using an organizational database that was developed internally at a tertiary care facility. The sample was composed of 338 children/youth aged between 6 and 18 years (mean = 12.33, standard deviation = 2.70) admitted within a 2‐year period. Logistic regression was used to examine the relationship between chemical restraint, physical restraint and secure isolation, and programme type after controlling for demographic and other relevant client characteristics. The study found that the number of chemical restraints and secure isolations was higher for clients with developmental disabilities than for clients with mental health, whereas the number of physical restraints was lower for clients with developmental disabilities than clients with mental health issues. Demographic variables also predicted specific types of intrusive measures. The results of this study outline the differential factors associated with specific types of intrusive measures to control aggressive and self‐harm behaviours. The paper also outlines cultural change initiatives, organizational interventions, and policy implications for best practice services for children/youth in psychiatric facilities to further reduce intrusive measures.

The present study aims to identify patterns for use of medication given pro re nata (PRN or “on an as needed [preordered] basis”) or statim (STAT [a new order] or “at once, immediately”) and their efficacy in controlling aggressive behavior in the mental health (MH) services environment. PRN and STAT medication data were combined and referred to as PRN throughout this article, as the data were not collected in a manner required to differentiate between PRN and STAT medication administration. Analyzed data were extracted from the clinical records of a sample of children and youth admitted for the first time to a tertiary MH center. MH Program patients (characterized by at least one Axis I psychiatric diagnosis [Axis I group]) were compared to Dual Diagnosis Program patients (characterized by an Axis I diagnosis in addition to an Axis II diagnosis of mental retardation [Axis II group]). Age, gender, Program (Axis I or II group), and the length of stay for treatment produced significant differences in the use of PRNs between the two groups. Further, the study investigated the precipitating factors leading to use of PRNs, in conjunction with the level of supervision and the de-escalation techniques used to avoid the use of PRNs. Axis I patients were more likely to endanger others, whereas Axis II patients were more likely to endanger themselves. Both groups of patients demonstrated a need for an increased level of supervision prior to the crisis. Olanzapine, chlorpromazine, and lorazepam were effective in calming patients and preventing further aggressive outbursts.