Kelly K. Anderson

Objective: To estimate the prevalence of suicidal ideation among Canadians, identify psychiatric and sociodemographic correlates of past-12-month ideation and its association with community belonging, and compare the out-of-fold predictive performance of logistic regression and random forest models. Method: We analyzed the nationally representative 2022 Mental Health and Access to Care Survey (analytic n = 8,080; weighted population = 25,828,546). Survey-weighted logistic and multinomial regression used the master weight with 1,000 Fay-adjusted bootstrap replicate weights. Five-fold nested cross-validation compared a sociodemographic-plus-psychiatric logistic model, the same model with belonging added, and a random forest, using out-of-fold discrimination, average precision, Brier scores, and grouped permutation importance. Results: Past-12-month suicidal ideation was reported by 3.4% (95% CI, 2.9% to 3.9%) and lifetime-only ideation by 7.4% (95% confidence interval (CI), 6.7% to 8.2%). Independent correlates of past-12-month ideation were major depressive episode (MDE) (adjusted odds ratio (aOR) = 5.80; 95% CI, 3.61 to 9.33), very weak community belonging (aOR = 3.64; 95% CI, 1.88 to 7.04), generalized anxiety disorder (aOR = 2.65; 95% CI, 1.56 to 4.50), bipolar disorder (aOR = 2.43; 95% CI, 1.27 to 4.66), and separation/divorce (aOR = 2.25; 95% CI, 1.22 to 4.17). Adjusted probability rose from 2.0% at very strong to 6.0% at very weak belonging. No interaction was supported. Adding belonging did not improve discrimination (area under the curve (AUC), 0.823 vs. 0.823; difference = 0.000; 95% CI, −0.011 to 0.011); the random forest AUC was 0.843 (difference = 0.020; 95% CI, 0.004 to 0.038). Conclusions: Psychiatric morbidity, separation/divorce, younger age, and very weak community belonging were associated with past-12-month suicidal ideation. Community belonging was independently associated but did not improve cross-validated discrimination, whereas MDE was the most robust correlate.

Introduction: While early intervention services (EIS) have demonstrated short‐term benefits, the long‐term maintenance of these gains remains uncertain. Individuals with first‐episode psychosis exhibit significant variability in their course of recovery. Understanding the risk and protective factors that shape long‐term outcome trajectories is essential to predicting and promoting sustained recovery. Here, we present the protocol for an extended 10‐year follow‐up study of social, mental, cognitive, and physical health outcomes, supplemented through linkage with health administrative databases to offer a holistic perspective on long‐term outcome trajectories. Aim: The primary objective of the study is to model the heterogeneity of long‐term trajectories across multiple outcome dimensions over a 10‐year follow‐up period using data‐driven methods. Method: The Prevention and Early Intervention Program for Psychoses (PEPP‐Montreal) is a well‐established, high‐fidelity EIS program operating within a universal healthcare system and an epidemiologically defined catchment area in South‐West Montréal, Canada. Between 2003 and 2018, PEPP‐Montreal conducted a detailed two‐year longitudinal assessment of 689 individuals aged 14–35 with first‐episode affective or non‐affective psychosis. Discussion: This study will help distinguish clinically meaningful subgroups, characterize their profiles, and identify early predictors of long‐term outcomes while providing insight into the mechanisms of change within trajectories. In particular, the study will assess whether trajectories shaped during the critical period are sustained over the long term. To our knowledge, this represents the most comprehensive investigation of long‐term trajectories following EIS in North America and is expected to lay the groundwork for optimizing EIS and developing personalized interventions.

The COVID-19 pandemic negatively impacted mental health, particularly among middle-aged and older adults, who have emerged as especially vulnerable. This scoping review synthesizes findings from 44 population-based studies retrieved from six databases, aiming to map changes in mental health outcomes during the pandemic and identify associated factors. During the global spread and response phase of the pandemic (May 2020–December 2021), a notable rise in depressive symptoms, anxiety symptoms, stress, distress, loneliness, and poor well-being was documented, highlighting a decrease in overall mental health of middle-aged and older adults. Whereas some studies from the transition period toward the endemic phase of the pandemic (2022–2023), began reporting signs of stabilization or improvement, particularly in depressive symptoms, anxiety symptoms and stress. Factors influencing these negative mental health outcomes were multidimensional (demographic, socioeconomic, health-related, behavioral, and COVID-19-related factors). Female sex, old age, being married, unemployment, lower education status, higher income, poor physical health, limited physical activity, perceived threat of COVID-19, social isolation, and lack of support were mainly associated with worsening mental health changes during the pandemic among middle-aged and older adults. However, there is little research highlighting population-level factors (COVID-19 cases, deaths, vaccination status, etc.) associated with these changes. Also, the evidence remains limited regarding mental health changes during the transition to the endemic phase, possibly due to shifts in research priorities, but it is essential to continue monitoring mental health outcomes to track long-term changes and to prepare for future public health emergencies.

Advancing equity in brain health research requires systematic attention to diversity and representativeness across the full research enterprise, from priority-setting and study design to knowledge translation. This paper, part of a series developing a cultural-ecosocial framework for brain health research, examines the conceptual foundations, current gaps, and practical strategies for integrating diversity and representativeness in neuroscience and mental health research. We review key dimensions of diversity relevant to brain health, analyze ongoing failures of representativeness in neurobiological and clinical research, and discuss how these failures compound structural health inequities. Drawing on recent developments in the field—including recommendations for responsible use of race and ethnicity in neuroimaging, the emergence of community-based participatory neuroscience, new international calls for global collaboration on equity in brain science, and insights from psychiatric genomics and race-based data collection—we outline specific recommendations for researchers, funders, and institutions. We situate these within the broader cultural-ecosocial framework introduced in companion papers in this thematic issue, connecting diversity and representativeness to social determinants of brain health, intersectionality, and ethical obligations toward marginalized communities. An Appendix provides practical guidelines for considering diversity and representativeness in brain health research design, consistent with transcultural psychiatric principles

Background: Collaboration between early psychosis intervention (EPI) services and primary care is crucial for continuity of care for first‐episode psychosis. The aim of this study was to describe the perceptions of staff at EPI programs on barriers and opportunities for collaboration with primary care. Methods: We conducted a qualitative descriptive study using focus groups with staff at six EPI programs across Ontario, Canada (2 rural, 4 urban) with 2–9 participants per focus group (total n = 39). Focus group sessions were audio recorded and transcribed verbatim. We used thematic analyses to code the transcripts and identify emergent themes. Results: Participants highlighted three points in the EPI treatment process where collaboration with primary care is important: during the referral/intake process, shared care throughout treatment, and at discharge from the EPI program. We identified four themes relating to broader structural issues impacting collaboration with primary care through the treatment process: client access to primary care, family physician knowledge of early psychosis, siloed communication structures, and time constraints for both EPI staff and family physicians. Conclusions: Improving primary care access in young people, increasing family physician knowledge of psychosis and EPI services, and allowing dedicated time for communication for both family physicians and EPI clinicians may improve collaboration and patient care through the processes of intake, ongoing care, and discharge from EPI services.

While early intervention services (EIS) have demonstrated short-term benefits, the long-term maintenance of these gains remains largely unexplored. Despite overall better outcomes, individuals with first-episode psychosis exhibit significant variability in their course of recovery. Understanding the risk and protective factors that shape long-term outcome trajectories is essential to predicting and promoting sustained recovery. The Prevention and Early Intervention Program for Psychoses (PEPP-Montreal) is a well-established, high-fidelity EIS program operating within a universal healthcare system and an epidemiologically defined catchment area in South-West Montréal, Canada. Between 2003 and 2018, PEPP-Montreal conducted a detailed two-year longitudinal assessment of 689 individuals aged 14–35 with first-episode affective or non-affective psychosis. Here, we present the protocol for an extended 10-year follow-up study of social, mental, cognitive, and physical health outcomes, supplemented through linkage with health administrative databases to offer a holistic perspective on long-term outcome trajectories. The primary objective of the study is to model the heterogeneity of long-term trajectories across multiple outcome dimensions over the 10-year follow-up period using data-driven methods. This approach will help distinguish clinically meaningful subgroups, characterize their profiles, and identify early predictors of long-term outcomes while providing insight into the mechanisms of changes within trajectories. In particular, the study will assess whether trajectories shaped during the critical period are sustained over the long term. To our knowledge, this represents the most comprehensive investigation of long-term trajectories following EIS in North America and is expected to lay the groundwork for optimizing EIS and developing personalized interventions.

Background: The prevalence of poor sleep is increasing. Women and men have different sleep needs, and uniquely female life transitions, such as the perinatal period and menopause, are associated with further differences in sleep patterns. In Canada, sleep disparities across socioeconomic groups are profound, but sleep research rarely differentiates between women and men. Objectives: To examine the current evidence on the sleep quality and quantity of Canadian women using a life course perspective, drawing comparisons to men’s sleep where possible, and to identify correlates associated with poor sleep to help determine avenues for improving women’s sleep health. Design: Systematic review. Methods: A literature search was conducted in August 2024 to identify observational studies examining the relationship between sleep and potential correlates. Community-based studies set in Canada with exclusively female participants, or those in which results were stratified by sex, were included. Risk of bias was assessed using tools developed by the CLARITY group at McMaster University. Outcomes were summarized narratively. Results: Fifty-five studies (including 25,952,718 total participants) were included. Among children and adolescents, short sleep was associated with poorer biopsychosocial health, particularly among girls. Sleep was affected by the menstrual cycle, and sleep difficulties were more prevalent among adult women than men. The perinatal period was fraught with sleep disturbances that influenced key aspects of motherhood. Sleep dissatisfaction was prevalent among perimenopausal and older women. Conclusion: Canadian women have different sleep patterns than men, and their sleep is negatively affected in uniquely female life transitions. Poor sleep is influenced by, and impacts, women’s health and behaviors. Characterizing these differences is an important step toward improving sleep health, and thus overall well-being, for women. Future research would benefit from further exploration of the role of social determinants of health and sleep. Registration: PROSPERO CRD42024582007.