Mental Health - CHEO Research Institute

Our Multidisciplinary Approach

Mental Health Research at CHEO integrates the three pillars of our mission of high quality clinical care, ground-breaking research, and the education of the next generation of clinical scholars. A number of active research groups exist in psychiatric emergency services, eating disorders, ADHD, pediatric-mental health interface, and knowledge mobilization and outcomes management. Among the research scholars are local, provincial, national, and international leaders of research in child and youth mental health. All of the research enterprises are fully embedded in clinical practice creating the opportunity for the mental health community to be the type of learning environment expected in one of Canada’s leading pediatric teaching hospitals.

Mental Health in the Emergency Department

While 15% of children and youth live with a mental illness, only 1 in 6 receives any substantial mental health services. Emergency Departments (ED) are increasingly becoming a primary source to obtain mental health services for children and youth. Some researchers propose that this increase is due to lack of inpatient and outpatient mental health services. The range of mental health emergency services provided and the subsequent direct and indirect follow-up care after discharge from the emergency department varies with limited understanding of the factors that influence clinical decision making. The long-term goal of this research is to develop evidence-based practice and clinical guidelines for the delivery of ED mental health services for children and youth.

Related News

Research Projects

Heavy social media use and psychological distress among adolescents: the moderating role of sex, age, and parental support
04/07/2023

The current study is a secondary data analysis of the 2019 Ontario Student Drug Use and Health Survey (OSDUHS) (46). This representative cross-sectional school-based survey included Ontarians in grades 7–12 from English and French public and Catholic schools (n = 14,142). Two hundred sixty-three schools from 47 public and Catholic school boards participated in this survey. Ethics approval was obtained from the Research Ethics Boards of the Center for Addiction and Mental Health (CAMH; 029/2016), York University (e2014-099), and 47 public and Catholic school boards’ research review committees. Participation in the survey required active parental written consent and student assent. The survey was completed anonymously during school time.
Associations Between Type and Timing of Physical Activity and Sedentary Behavior With Mental Health in Adolescents and Young Adults
23/06/2023

Leisure-time PA was found to have a favorable association with mental health, particularly in the evenings of weekdays and afternoons of weekend days. On the other hand, leisure SB was associated with poorer mental health in most of the time segments analyzed, and nonleisure SB in the evenings was also related to worse mental health. The type and timing of PA and SB behaviors play an important role in the relationship with mental health.
Loneliness during COVID-19 and its association with eating habits and 24-hour movement behaviours in a sample of Canadian adolescents
23/06/2023

Loneliness is a recognized public health concern and has exacerbated during the COVID-19 pandemic due to the lockdowns and decreased social interactions (Ernst et al., 2022). This may have resulted in emotional distress and disordered eating in adolescents; however, no studies have examined the association between loneliness and breakfast skipping. Skipping breakfast is an unhealthy behaviour pattern that can transition from adolescence to adulthood with detrimental impacts on health (Smith et al., 2010). Many adolescents skip breakfast despite the benefits of regular breakfast consumption.
A Primary Care Mental Health Pathway for Children and Youth: A Mental Health Services Quality Improvement Initiative in Ontario
07/06/2023
Longitudinal associations between different types of screen use and depression and anxiety symptoms in adolescents
28/04/2023

Higher screen time was longitudinally associated with higher anxiety and depression symptoms at one-year follow-up in adolescents. Time-change associations between screen usage and depressive and anxiety symptoms were observed. Also, associations differed based on sex and screen type, whereby greater increases in screen use predicted greater emotional distress. Findings from this prospective analysis suggest that screen time is an important determinant of anxiety and depressive symptoms among adolescents. Future studies are recommended to help inform programs promoting screen time reduction with a goal to enhance adolescents’ mental health.
Youth engagement in child maltreatment research: Gaps, barriers, and approaches
10/03/2023

Growing evidence suggests that putting the priorities of youth at the forefront of research enhances the quality, relevance, and impact across all stages of the research process.
Pediatric emergency department physicians’ perceptions of virtual mental health assessments for urgent needs
07/02/2023

While many physicians agreed that there is a potential benefit of the ED virtual care platform for urgent mental health assessments, time constraints and lack of confidence in providing satisfactory virtual mental health care with minimal mental health support limited its acceptability. These findings can inform the future implementation of mental health services using an innovative virtual ED platform.
Building Resilience and Attachment in Vulnerable Adolescents: A Pilot Trial of a Brief Group Intervention for Adolescents with Mild to Moderate Suicidal Ideation and their Caregivers
11/11/2022

Study results demonstrate that the BRAVA intervention has the potential to reduce SI among adolescents who present to hospital services in crisis. Further studies are required to establish BRAVA's efficacy in a randomized controlled trial.
A stochastic optimization approach for staff scheduling decisions at inpatient units
26/10/2022

In this paper, we propose an optimization scheme in order to schedule the operations of the orthopedic surgery division at Habib Bourguiba University Hospital. This type of planning could be performed for a general problem of scheduling “n” operations in “m” operating rooms and “b” recovery beds with the conditions that: m ⩽ b, longer operation takes longer recovery time and no wait as much as possible between the operating room and the recovery room.
Sociodemographic and mental health characteristics associated with changes in movement behaviours due to the COVID-19 pandemic in adolescents
02/10/2022

Ongoing efforts continue to be made to understand the potential impacts of COVID-19-related preventative public health measures. This large cross-sectional study is among the first to describe the sociodemographic and mental health characteristics of Canadian adolescents in relation to perceived changes in movement behaviours during the months immediately following introduction of lockdown measures. The survey capturing responses of students across Ontario, Quebec, and British Columbia (Canada) found that a perceived increase in screen time as a result of the pandemic was highly prevalent, with social media increase among females compared to males having the largest effect size among gender-based comparisons of movement behaviour changes.
Physician Perspectives on the Implementation of a Trauma Informed Care Initiative in the Maternity Care Setting
18/08/2022

Building on previous research, physicians were concerned about the time required to engage in conversations about trauma with patients (Flanagan et al., 2018; Purkey et al., 2018). Interestingly, while time management was a concern, physicians also acknowledged that not every case required additional time. Specifically, some physicians identified that some patients may require more time to discuss concerns while others did not feel the need to have detailed discussions about their past experiences
Cyberbullying involvement, parental support, and cannabis use among adolescents
13/08/2022

Our results showed that cyberbullying involvement in any role (i.e., cyberbullying victim only, cyberbullying perpetrator only, or cyberbullying perpetrator-victim) was associated with greater odds of cannabis use after adjusting for important covariates. Results further indicated that higher parental support was associated with lower odds of cannabis use in a dose-response fashion. Higher parental support was also associated with a lower risk of cyberbullying involvement.
Appearance satisfaction mediates the relationship between recreational screen time and depressive symptoms in adolescents
18/07/2022

Our results indicate that appearance satisfaction medi-ated the direct effect of recreational screen time on depressive symptoms, recreational screen time was sig-nificantly related to lower appearance satisfaction, which was significantly predictive of more severe depres-sive symptoms. As such, findings warrant randomized controlled trials designed to determine whether modu-lating screen time may be an efficacious strategy to reduce appearance dissatisfaction and depressive symp-toms during adolescence.
The Canadian 24-hour movement guidelines and self-rated physical and mental health among adolescents
01/04/2022

The objective of this study was to examine the associations of meeting combinations of these recommendations with self-rated physical and mental health.
Parenting during the COVID-19 pandemic: The sociodemographic and mental health factors associated with maternal caregiver strain
03/01/2022

Introduction: The COVID-19 pandemic has introduced new stressors for parents (“caregivers”) that may affect their own and their child’s mental health (MH). We explored self-reported levels of caregiver strain (parents’ perceived ability to meet parenting demands), and the MH and sociodemographic factors of caregivers to identify predictors of strain that can be used to guide MH service delivery for families.
When the Bough Breaks: A systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic
28/12/2021
Examining the Bidirectional Association Between Body Esteem and Body Mass Index During Adolescence
01/11/2021

The decreasing trajectory of body esteem over time suggests the need for prevention efforts to improve body esteem throughout adolescence.
Motivational Interviewing and the Use of Psychological Services Among Youth With Chronic
01/10/2021

All specialized pediatricians have a role to play in ensuring that at-risk youth with CMCs receive the psychiatric support they need.
Building Resilience and Attachment in Vulnerable Adolescents (BRAVA): a brief group intervention for adolescents with mild-to-moderate suicidal ideation and their caregivers
08/09/2021

Further studies are required to establish BRAVA’s efficacy in a randomized controlled trial.
Longitudinal association between movement behaviours and depressive symptoms among adolescents using compositional data analysis.
02/09/2021

Isotemporal substitution estimates indicated that decreasing screen time by 60 minutes/day and replacing that time with 60 minutes of additional sleep is associated with the largest change in depressive symptoms across all subgroups.
Associations between screen time and cognitive development in preschoolers
26/08/2021

Higher total screen time was unfavourably associated with working memory in preschoolers, while adherence to global and national screen time recommendations appeared to be a protective factor. Therefore, these findings provide further evidence for the importance of pediatricians and other health professionals discussing screen time recommendations with families, given these individuals are seen as a credible source for parents (32). Screen time was unrelated to expressive vocabulary in our sample.
Moving Towards Racial Equity in the Child and Youth Mental Health Sector in Ontario, Canada
30/07/2021

As we highlight these domains, we urge researchers, policy makers, and child and youth mental health service providers to work together to advance racial equity in meaningful ways.
Psychological and Demographic Determinants of Substance Use and Mental Health During the COVID-19 Pandemic
25/06/2021

These characteristics should be considered when developing prevention and treatment programs for adults with problematic alcohol use and comorbid anxiety and depression.
Coping in adolescents: A mediator between stress and disordered eating
16/06/2021

Overall, the findings from this study are among the first to demonstrate significant mediation relationships between stress (both negative life events and perceived stress) and ED symptomatology for emotion-oriented coping in both male and female adolescents. These findings suggest that using emotion-oriented coping in response to real or perceived stress increases the risk for ED symptomatology across all adolescents. These findings suggest that intervention or prevention efforts aimed at teaching adolescents how to tackle or cope with a problem by aiming to address the stressor itself (i.e. task-oriented coping) versus trying to escape the emotion that accompanies it may have a protective effect against emerging ED symptomatology, and likely full-blown eating disorders in the face of stress during a vulnerable developmental period.
Implementation and evaluation of a curriculum on the assessment and treatment of disruptive behaviour disorders
03/04/2021

Pre–post-evaluation of the curriculum showed improved knowledge in participants.
Psychiatric disorders in emerging adults with diabetes transitioning to adult care: a retrospective cohort study
12/02/2021

Prolonged gaps in care during transfer to adult care are common and may be associated with increased psychiatric disorder risk. Developmental factors associated with adolescence and emerging adulthood may further amplify this risk.
Psychological Correlates of Sedentary Screen Time Behaviour Among Children and Adolescents: a Narrative Review
09/12/2020

Practitioners, parents, policy makers and researchers should collectively identify and evaluate strategies to reduce screen time, or to use screens more adaptively, as a means of promoting better mental health among children and adolescents.
Development of a Clinical Pathway for the Assessment and Management of Suicidality on a Pediatric Psychiatric Unit
24/09/2020

This framework, developed with the aim to standardize care for psychiatrically admitted suicidal children and adolescents, may serve as a flexible template for use in similar settings and could be adapted according to local realities and resources.
Head to toe practice: Implementation and outcomes of a suicide screener in pediatric hospital inpatient units
19/08/2020

The hope is that this new practice will reduce emergency hospital visits for mental health crises and facilitate early access to mental health services.
Evaluating the psychometric properties of the parent-rated Strengths and Difficulties Questionnaire in a nationally representative sample of Canadian children and adolescents aged 6 to 17 years
19/08/2020

The original five-factor, parent-rated SDQ demonstrates evidence of factorial validity and reliability as a population measure of mental health difficulties among Canadian children and adolescents.
What’s the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal
25/07/2020

Unfortunately, misperceptions of harm remain which can compromise clinical care, research, and public health surveillance efforts. Our objective was to evaluate the empirical evidence on whether and how asking about suicide related behaviors (SRB), such as suicidal ideation and suicide attempts, and non-suicidal self-injury (NSSI) results in harmful outcomes.
Medications for sleep disturbance in children and adolescents with depression: a survey of Canadian child and adolescent psychiatrists
01/03/2020

Melatonin and certain off-label psychotropic drugs are perceived as being more effective and appropriate to address sleep disturbances in children and adolescents with depression.
Exploring Acceptance and Commitment Therapy for parents of preterm infants
01/02/2020

One promising intervention that has not been explored in the NICU is Acceptance and Commitment Therapy (ACT), a behavioural therapy that has had positive mental health-related outcomes in similar parental populations.
Health outcomes associated with emergency department visits by adolescents for self-harm: a propensity-matched cohort study
06/11/2019

Adolescents with emergency department visits for self-harm have higher rates of mortality, suicide and recurrent self-harm, as well as higher health care costs, than matched controls.
The effect of high-intensity interval training on inhibitory control in adolescents hospitalized for a mental illness.
01/10/2019

The impact of pre-therapy HIIT to enhance focus and reduce impulsive thoughts and behaviours may improve adolescent patients’ response to mental health treatment.
Evaluation of eMentalHealth.ca, a Canadian Mental Health Website Portal: Mixed Methods Assessment
01/09/2019

Web analytic results showed that from January 1 to December 31, 2017, there were 651,107 users, with 1.97 million page views.
Health trajectories of children with severe obesity attending a weight management program
12/07/2019

Findings highlight the need to examine both mental and physical health outcomes beyond 1 year.
Changing Rates of Self-Harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-Sectional Study
01/06/2019

Rates of adolescents with self-harm and mental health ED visits have increased since 2009, with greater increases among females. Research is required on the determinants of adolescents’ self-harm and mental health ED visits and how they can be addressed in that setting.
Effects of weight teasing and gender on body esteem in youth: A longitudinal analysis from the REAL study
01/06/2019

Results suggest the weight teasing sources’ gender may differentially impact the victims’ body esteem, and highlights the need to consider these factors in weight teasing prevention strategies.
Obesity class versus the Edmonton Obesity Staging System for Pediatrics to define health risk in childhood obesity: results from the CANPWR cross-sectional study
02/04/2019

As BMI class increased, a concomitant increased disease burden in mechanical and social milieu issues was observed, whereas metabolic and mental health risks were high across BMI classes.
Embodied motherhood: Exploring body image in pregnant and parenting youth
01/02/2019

Future research exploring prepregnancy depression, eating disorder, body esteem, and depression in pregnant youth are needed.
Could long-term administration of melatonin to prepubertal children affect timing of puberty? A clinician’s perspective
31/01/2019

We conclude that to investigate an association between melatonin and pubertal timing, it will be important to conduct long-term randomized controlled trials of latency age children and also examine the cellular and systems-level interactions between melatonin and kisspeptin, a recently identified neuropeptide with a locus of action at the gonadotropin releasing hormone neurons that is important in contributing to the timing of puberty onset.
Evaluating Mental Health Service use During and After Emergency Department Visits in a Multisite Cohort of Canadian Children and Youth
21/01/2019

Children and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.
Self-Inflicted Injury-Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP-SI): a new surveillance tool for detecting self-inflicted injury events in emergency departments
11/10/2018

To assess the performance of the Canadian Hospitals Injury Reporting and Prevention Program’s newly developed self-harm surveillance tool (CHIRPP-SI) designed to improve emergency department (ED) hospital surveillance of youth self-inflicted injury (SI).
The mental health of adolescents and pre-adolescents living with inherited arrhythmia syndromes: A systematic review of the literature
01/05/2018
Sexual health of adolescent patients admitted to a psychiatric unit
01/04/2018

As many adolescents, particular those struggling with mental illness, do not attend preventative health visits, screening for pregnancy risk and other reproductive health needs is recommended at every adolescent encounter and in all settings.
Finding Ways Forward: Social Justice for Counsellors in the Evolution of a Collaborative Practice and Study Group
01/01/2018

The chapter is a demonstration of how an ethic of social justice plays out among counselors in a collective process of co-creating a study group uniquely suited to the needs of its members.
Brain on Fire: Incentive Salience, Hedonic Hot Spots, Dopamine, Obesity, and Other Hunger Games
21/08/2017

The surgical and pharmacological treatments of obesity are discussed, and evidence is presented for the selective use of DA-class drugs in obesity treatment.
Treat Me But Don’t Judge Me: A Qualitative Examination of Health Care Experiences of Pregnant and Parenting Youth
03/04/2017

To engage this high-risk population in health care, practitioners are encouraged to consider their own biases when servicing this population and work toward fostering positive, nonjudgmental interactions, and supportive environments.
Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program
30/08/2016

Repeat visits account for a large portion of all MH presentations to the PED. Furthermore, several patient characteristics are significant predictors of repeat PED use and of repeating use sooner and more frequently.
A Pilot Study of Citalopram Treatment in Preventing Relapse of Depressive Episode after Acute Treatment
01/02/2016

Subjects with depression who responded to open label treatment with citalopram in 12-week acute phase were randomized to continued treatment with citalopram or placebo for 24 weeks.
Effects of aerobic training, resistance training, or both on psychological health in adolescents with obesity: The HEARTY randomized controlled trial
31/08/2015

Resistance training, alone or in combination with aerobic training, may provide psychological benefits in adolescents with overweight or obesity, and therefore could be an alternative to aerobic training for some individuals in the biological and psychological management of adolescent obesity.