Donna E Stewart

University Health Network, Toronto, Ontario, Canada

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Publications (247)825.35 Total impact

  • Donna E Stewart
    Archives of Women s Mental Health 05/2015; DOI:10.1007/s00737-015-0539-7 · 1.96 Impact Factor
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    ABSTRACT: Using combined individual patient data from prospective studies, we explored sex differences in depression and prognosis post-myocardial infarction (MI) and determined whether disease indices could account for found differences. Individual patient data analysis of 10,175 MI patients who completed diagnostic interviews or depression questionnaires from 16 prospective studies from the MINDMAPS study was conducted. Multilevel logistic and Cox regression models were used to determine sex differences in prevalence of depression and sex-specific effects of depression on subsequent outcomes. Combined interview and questionnaire data from observational studies showed that 36% (635/1760) of women and 29% (1575/5526) of men reported elevated levels of depression (age-adjusted odds ratio = 0.68, 95% confidence interval [CI] = 0.60-0.77). The risk for all-cause mortality associated with depression was higher in men (hazard ratio = 1.38, 95% CI = 1.30-1.47) than in women (hazard ratio = 1.22, 95% CI = 1.14-1.31; sex by depression interaction: p < .001). Low left ventricular ejection fraction (LVEF) was associated with higher depression scores in men only (sex by LVEF interaction: B = 0.294, 95% CI = 0.090-0.498), which attenuated the sex difference in the association between depression and prognosis. The prevalence of depression post-MI was higher in women than in men, but the association between depression and cardiac prognosis was worse for men. LVEF was associated with depression in men only and accounted for the increased risk of all-cause mortality in depressed men versus women, suggesting that depression in men post-MI may, in part, reflect cardiovascular disease severity.
    Psychosomatic Medicine 04/2015; 77(4). DOI:10.1097/PSY.0000000000000174 · 4.09 Impact Factor
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    ABSTRACT: Postpartum depression (PPD) is the most common complication of childbearing with a 13% prevalence rate. Sleep disturbances are also common, particularly during early postpartum. In theory, l-tryptophan could improve sleep and reduce depressed mood in early postpartum; however, the first step in clinical development of tryptophan for use in postpartum is to measure the effect of oral l-tryptophan on its concentrations in breast milk, which is presently unknown. The aims were to investigate the effect of oral l-tryptophan and alpha-lactalbumin, a protein with high tryptophan concentration, on total and free tryptophan levels in breast milk and plasma, and to compare free tryptophan levels in breast milk with those in common infant formulas. Thirty healthy breastfeeding women were randomly allocated to receive 2g or 4g of l-tryptophan, or, 20g or 40g of alpha-lactalbumin or no supplement. Free tryptophan levels were also measured in 12 different infant formulas. Total tryptophan in breast milk was unaffected by oral administration of l-tryptophan or alpha-lactalbumin (repeated measures of ANOVA (rANOVA), group effect: p=0.93). Both l-tryptophan and alpha-lactalbumin were associated with greater free tryptophan levels in breast milk (rANOVA, group effect: p<0.001) (representing 2% of total tryptophan), but these concentrations were within the range of commonly used infant formulas. In contrast to most sleep inducing medications, l-tryptophan does not affect its total concentration in breast milk. These results support further investigation of dietary l-tryptophan and alpha-lactalbumin as part of a dietary supplementation approach to address sleep disturbances in postpartum and reduce risk of PPD. Copyright © 2015. Published by Elsevier B.V.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 03/2015; DOI:10.1016/j.euroneuro.2015.03.005 · 5.40 Impact Factor
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    ABSTRACT: A single-item measure of self-rated mental health (SRMH) is being used increasingly in health research and population health surveys. The item asks respondents to rate their mental health on a five-point scale from excellent to poor. This scoping study presents the first known review of the SRMH literature.
    BMC Health Services Research 09/2014; 14(1):398. DOI:10.1186/1472-6963-14-398 · 1.66 Impact Factor
  • Brett D. Thombs, Donna E. Stewart
    Journal of Psychosomatic Research 09/2014; DOI:10.1016/j.jpsychores.2014.07.017 · 2.84 Impact Factor
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    ABSTRACT: The purpose of this study was to examine decision-making among women considering antidepressant medication use in pregnancy. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) among pregnant women considering antidepressant medication treatment (N = 40). Overall DCS and subscale scores were compared between women who were antidepressant users and non-users. Semi-structured interviews (N = 10) explored barriers and facilitators of decision-making. Twenty-one women (52 %) had moderate or high decisional conflict (DCS ≥ 25). Overall DCS scores did not differ between groups, but antidepressant use was associated with feeling more adequately informed (subscale mean 17.5, SD 17.9 vs. 42.1, SD 23.8, p = 0.001) and clear about values (subscale mean 16.7, SD 15.1 vs. 29.8, SD 24.0, p = 0.043). Barriers to decision-making were (1) difficulty weighing maternal versus infant health, (2) lack of high quality information, (3) negative external influences, and (4) emotional reactions to decision-making. Facilitators were (1) interpersonal supports, (2) accessible subspecialty care, and (3) severe depressive symptoms. Many pregnant women facing decisions regarding antidepressant medication use experience decisional conflict. Interventions that provide accurate information, assistance with weighing risks and benefits of treatment, management of problematic external influences, and emotional support may reduce decisional conflict and facilitate the decision-making process.
    Archives of Women s Mental Health 08/2014; DOI:10.1007/s00737-014-0448-1 · 1.96 Impact Factor
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    ABSTRACT: Postpartum depression (PPD) has a prevalence rate of 13% and a similarly high proportion of women report a subclinical state of one or more MDE symptoms. The aim was to investigate whether monoamine oxidase-A (MAO-A) VT, an index of MAO-A density, is increased in the prefrontal and anterior cingulate cortex (PFC and ACC), during PPD or when a PPD spectrum symptom, greater predisposition to crying, is present. MAO-A is an enzyme that increases in density after estrogen decline, and has several functions including creating oxidative stress, influencing apoptosis and monoamine metabolism. Fifty seven women were recruited including 15 first onset, antidepressant naive, PPD subjects, 12 postpartum healthy who cry due to sad mood, 15 asymptomatic postpartum healthy women and 15 healthy women not recently pregnant. Each underwent [(11)C]-harmine positron emission tomography (PET) scanning to measure MAO-A VT. Both PPD, and greater predisposition to crying were associated with greater MAO-A VT in the PFC and ACC (multivariate analysis of variance (MANOVA), group effect, F21,135 =1.856; p=0.019; mean combined region elevation 21% and 14% in PPD and crying groups, respectively, relative to postpartum asymptomatic). Greater MAO-A VT in the PFC and ACC represents a new biomarker in PPD, and the PPD symptom of predisposition to crying. Novel strategies for preventing PPD (and some PPD symptoms) may be possible by avoiding environmental conditions that elevate MAO-A level and enhancing conditions that normalize MAO-A level. These findings also argue for clinical trials in PPD with the newer, well-tolerated MAO-A inhibitor antidepressants.Neuropsychopharmacology accepted article preview online, 30 July 2014; doi:10.1038/npp.2014.190.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 07/2014; 40(2). DOI:10.1038/npp.2014.190 · 8.68 Impact Factor
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    ABSTRACT: Postpartum depression (PPD) is the most common complication of childbearing with a 13 % prevalence rate, and there is no widespread approach for prevention. There is an appealing theoretical rationale for oral tyrosine to help prevent PPD. However, the effect of oral tyrosine on its total and free concentrations in breast milk and plasma of breastfeeding mothers is not known. Twenty-four healthy breastfeeding women were randomly assigned to 0, 2, 5, or 10 g of oral tyrosine. Free and total tyrosine in breast milk and free tyrosine in plasma were measured. Free tyrosine was also measured in 12 different infant formulas. Total tyrosine in breast milk did not rise, but there was a slight tendency towards a reduction (up to -12 %; repeated measures ANOVA (RMANOVA): p = 0.074). Maternal plasma tyrosine rose (RMANOVA: p < 0.005). In breast milk, 98 % of tyrosine was in proteins or peptides and 2 % was free. Free tyrosine levels in breast milk rose in each group (RMANOVA: p < 0.005), but levels were within the range found in common infant formulas. The negligible effect of oral tyrosine on its concentration in breast milk supports further development of oral tyrosine as part of a prevention strategy for PPD.
    Archives of Women s Mental Health 07/2014; 17(6). DOI:10.1007/s00737-014-0441-8 · 1.96 Impact Factor
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    ABSTRACT: We analyzed the impact of a requirement introduced in December 2010 that all applicants to the Canadian Institutes of Health Research indicate whether their research designs accounted for sex or gender. We aimed to inform research policy by understanding the extent to which applicants across health research disciplines accounted for sex and gender. We conducted a descriptive statistical analysis to identify trends in application data from three research funding competitions (December 2010, June 2011, and December 2011) (N = 1459). We also conducted a qualitative thematic analysis of applicants' responses. Here we show that the proportion of applicants responding affirmatively to the questions on sex and gender increased over time (48% in December 2011, compared to 26% in December 2010). Biomedical researchers were least likely to report accounting for sex and gender. Analysis by discipline-specific peer review panel showed variation in the likelihood that a given panel will fund grants with a stated focus on sex or gender. These findings suggest that mandatory questions are one way of encouraging the uptake of sex and gender in health research, yet there remain persistent disparities across disciplines. These disparities represent opportunities for policy intervention by health research funders.
    PLoS ONE 06/2014; 9(6):e99900. DOI:10.1371/journal.pone.0099900 · 3.53 Impact Factor
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    ABSTRACT: IMPORTANCE Perimenopause is a period of high risk for mood disorders, and it has been proposed that perimenopause is also a window of risk for processes linked to later dementia. However, in human perimenopause, the neurobiological changes implicated in the genesis of mood disorders or dementia have not been identified. Monoamine oxidase A (MAO-A) is an important brain enzyme that creates oxidative stress, influences apoptosis, and metabolizes monoamines. After declines in estrogen level, MAO-A density may be elevated for a month or longer, and repeated declines in estrogen level occur with greater magnitude during perimenopause. OBJECTIVE To investigate whether MAO-A total distribution volume (VT), an index of MAO-A density, is elevated in women of perimenopausal age (41-51 years). DESIGN, SETTING, AND PARTICIPANTS In a cross-sectional study at a tertiary care psychiatric hospital, 58 women underwent carbon 11-labeled harmine positron emission tomography. These included 19 young women of reproductive age (mean [SD], 28.26 [5.05] years), 27 women of perimenopausal age (mean [SD] age, 45.21 [3.41] years; including 14 women with change in menstrual cycle length with a mean [SD] age of 45.50 [4.00] years and 13 women with no change in menstrual cycle length with a mean [SD] age of 44.92 [2.81] years), and 12 women in menopause (mean [SD] age, 56.25 [3.19] years). MAIN OUTCOMES AND MEASURES Values of MAO-A VT in the prefrontal cortex, anterior cingulate cortex, dorsal striatum, ventral striatum, thalamus, hippocampus, and midbrain. RESULTS On average, MAO-A VT in perimenopausal age was elevated by 34% compared with reproductive age and by 16% compared with menopause (multivariate analysis of variance, group effect, F16,94 = 3.03; P < .001). Within the perimenopausal age group, meeting Stages of Reproductive Aging Workshop criteria for perimenopause, which is mainly based on menstrual cycle length, was not associated with MAO-A VT (F8,18 = 0.548; P = .81) but tendency to cry was positively correlated with MAO-A VT in the prefrontal cortex (r = 0.54; P = .008). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first report of a change in a central biomarker during perimenopausal age that is also present during major depressive episodes and high-risk states for major depressive episodes. The functions of MAO-A influence oxidative stress and apoptosis, 2 processes implicated as excessive in both mood disorders and dementia. Hence, greater MAO-A VT during perimenopause may represent a new target for assessing novel interventions to prevent mood disorders and reduce longer-term risk of neurodegenerative disease.
    JAMA Psychiatry 06/2014; 71(8). DOI:10.1001/jamapsychiatry.2014.250 · 12.01 Impact Factor
  • Brett D. Thombs, Donna E. Stewart
    Journal of Psychosomatic Research 06/2014; 76(6). DOI:10.1016/j.jpsychores.2014.03.102 · 2.84 Impact Factor
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    ABSTRACT: Background Postpartum depression (PPD) is the most common complication of childbearing with a 13% prevalence. Vulnerability to depressed mood has an important role in the onset of major depressive episodes (MDE), but has not been investigated in postpartum. The aim is to assess whether day-5 postpartum blues and severity of dysfunctional attitudes predicts vulnerability to depressed mood. Methods About 45 healthy women were recruited: group 1 (n=12) was day-5 postpartum during the typical peak of postpartum blues. Group 2 (n=11) was within 18 months postpartum and reported a vulnerability to cry (and had elevated dysfunctional attitudes but no MDE). Group 3 (n=11) was within 18 months postpartum and no vulnerability to cry. Group 4 (n=11) was not recently postpartum. Vulnerability to depressed mood was measured by the change in the visual analog scale from the sad mood induction procedure (MIP). Results Univariate analysis of covariance demonstrated that day-5 postpartum blues and level of dysfunctional attitudes were highly predictive of change in sad mood (postpartum blues: F(1,41)=12.9, p<0.005, dysfunctional attitudes scale score: F(1,41)=11.49, p<0.005). Limitations Although the effects were robust, sample sizes were 11–12 within each group. Conclusion Two factors (day-5 postpartum and severity of dysfunctional attitudes) predicted vulnerability to sad mood. Since the severity of postpartum blues predicts PPD, MIP on day-5 postpartum represents a quantitative measure that can be applied to screen novel, early interventions for preventing PPD. Interventions to prevent PPD through increasing resilience against mood induction should target postpartum women with greater severity of dysfunctional attitudes.
    Journal of Affective Disorders 06/2014; 161:16–20. DOI:10.1016/j.jad.2014.02.047 · 3.71 Impact Factor
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    ABSTRACT: Objective Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or the postpartum period. Methods Searches included the CINAHL, EMBASE, ISI, MEDLINE, and PsycINFO databases through April 1, 2013; manual journal searches; reference list reviews; citation tracking of included articles; and trial registry reviews. RCTs in any language that compared depression outcomes between women during pregnancy or postpartum randomized to undergo depression screening versus women not screened were eligible. Results There were 9,242 unique titles/abstracts and 15 full-text articles reviewed. Only 1 RCT of screening postpartum was included, but none during pregnancy. The eligible postpartum study evaluated screening in mothers in Hong Kong with 2-month-old babies (N = 462) and reported a standardized mean difference for symptoms of depression at 6 months postpartum of 0.34 (95% confidence interval = 0.15 to 0.52, P < 0.001). Standardized mean difference per 44 additional women treated in the intervention trial arm compared to the non-screening arm was approximately 1.8. Risk of bias was high, however, because the status of outcome measures was changed post-hoc and because the reported effect size per woman treated was 6–7 times the effect sizes reported in comparable depression care interventions. Conclusion There is currently no evidence from any well-designed and conducted RCT that screening for depression would benefit women in pregnancy or postpartum. Existing guidelines that recommend depression screening during pregnancy or postpartum should be re-considered.
    Journal of Psychosomatic Research 06/2014; 76(6). DOI:10.1016/j.jpsychores.2014.01.006 · 2.84 Impact Factor
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    ABSTRACT: People who have experienced intimate partner violence (IPV) or child maltreatment (CM) are at risk of having lower resilience and adverse psychological outcomes. In keeping with the social and environmental factors that support resilience, there is a need to take a public health approach to its investigation and to identify existing initiatives in particular settings and populations that can guide its deliberate promotion.
    Journal of Public Health 05/2014; 37(1). DOI:10.1093/pubmed/fdu030 · 2.30 Impact Factor
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    ABSTRACT: Elevated levels of irritability have been reported across a range of psychiatric and medical conditions. However, research on the causes, consequences, and treatments of irritability has been hindered by limitations in existing measurement tools. This study aimed to develop a brief, reliable, and valid self-report measure of irritability that is suitable for use among both men and women and that displays minimal overlap with related constructs. First, 63 candidate items were generated, including items from two recent irritability scales. Second, 1,116 participants (877 university students and 229 chronic pain outpatients) completed a survey containing the irritability item pool and standardized measures of related constructs. Item response theory was used to develop a five-item scale (the Brief Irritability Test) with a strong internal structure. All five items displayed minimal conceptual overlap with related constructs (e.g., depression, anger), and test scores displayed negligible gender bias. The Brief Irritability Test shows promise in helping to advance the burgeoning field of irritability research.
    Assessment 05/2014; DOI:10.1177/1073191114533814 · 3.29 Impact Factor
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    ABSTRACT: Though intimate partner violence (IPV) is predominately understood as a women's health issue most often emerging within heterosexual relationships, there is increasing recognition of the existence of male victims of IPV. In this qualitative study we explored connections between masculinities and IPV among gay men. The findings show how recognising IPV was based on an array of participant experiences, including the emotional, physical and sexual abuse inflicted by their partner, which in turn led to three processes. Normalising and concealing violence referred to the participants' complicity in accepting violence as part of their relationship and their reluctance to disclose that they were victims of IPV. Realising a way out included the participants' understandings that the triggers for, and patterns of, IPV would best be quelled by leaving the relationship. Nurturing recovery detailed the strategies employed by participants to mend and sustain their wellbeing in the aftermath of leaving an abusive relationship. In terms of masculinities and men's health research, the findings reveal the limits of idealising hegemonic masculinities and gender relations as heterosexual, while highlighting a plurality of gay masculinities and the need for IPV support services that bridge the divide between male and female as well as between homosexual and heterosexual.
    Sociology of Health & Illness 05/2014; DOI:10.1111/1467-9566.12099 · 1.88 Impact Factor
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    ABSTRACT: This study aimed to identify aspects of the caregiving situation contributing to family caregivers' psychological well-being. Longitudinal cohort study with structured quantitative interviews 1, 3, 6, and 12 months post stroke. A subset of participants also completed surveys 18 and 24 months post stroke. Participants included individuals hospitalized for their first stroke and their family caregivers. Psychological well-being was assessed by the Positive Affect Scale. A total of 399 stroke survivor, caregiver dyads completed the 1-year follow-up and 80 dyads completed the second year of follow-up. Using mixed effects modeling for longitudinal data, caregivers reported more psychological well-being when they provided more assistance to stroke survivors who had fewer symptoms of depression, better cognitive functioning, and who had more severe strokes. In addition, caregivers who maintained participation in valued activities had more mastery, gained personally providing care, were in better physical health, were older, and were from Quebec reported more psychological well-being. Caregivers followed for a second year post stroke reported better psychological well-being when caring for stroke survivors with fewer symptoms of depression and more severe strokes and when the caregivers had a greater sense of mastery and gained more personally providing care. Our findings contribute to the caregiver intervention development literature by identifying aspects of the caregiving situation that are associated with positive outcomes. Incorporating specific aspects, for example, strategies to enhance caregiver mastery into programs and services offered to caregivers may enhance their positive experiences with providing care and ultimately enhance the sustainability of the caregiving situation.
    Stroke 03/2014; 45(4). DOI:10.1161/STROKEAHA.113.004309 · 6.02 Impact Factor
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    ABSTRACT: Not much is known about factors that contribute to resilience among women facing intimate partner violence (IPV), particularly from countries where patriarchy predominates. This qualitative study aimed to gather the perspectives of Indian women self-identified as resilient in the face of IPV and tried to understand the strategies and resources that helped them to maintain or regain resilience. Data were collected from 16 consenting women who reported IPV and whose husbands were being treated for alcohol problems at a psychiatric centre in Bangalore, India. A semi-structured guided interview format that aimed at understanding factors that enabled them to feel resilient despite IPV in their challenging circumstances was used to gather narratives from the participants. Six themes were identified using QSR NVivo software. They were as follows: the support of women, men and family; personal attributes; dignity and work; being strong for the children; and faith in God. Among these women, supportive social networks, personal attributes and aspirations were major clusters contributing to resilience. Attention to these factors may provide an important, strengths-based perspective for interventions to enhance women's resilience when facing IPV.
    International Journal of Social Psychiatry 12/2013; 60(7). DOI:10.1177/0020764013513440 · 1.15 Impact Factor
  • Anita J Gagnon, Donna E Stewart
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    ABSTRACT: Exposure to violence associated with pregnancy (VAP) is an underrecognized public health and social problem that has an enormous impact on the physical and mental health of women and their children. Our recent study of 1,127 new mothers living in two urban areas of Canada found refugees and asylum-seekers to be more likely to have experienced VAP than immigrant or Canadian-born women. Interestingly, some migrants who had experienced VAP had low rates of postpartum depression risk on the Edinburgh Postpartum Depression Scale, suggesting that resilience may play an important role in maintaining their mental health. Hence, we sought to explore processes which enhance migrants' resilience to VAP. We conducted in-depth interviews with ten women who had been identified as experiencing VAP and having low risk of postpartum depression and performed thematic analyses. International migrant women found internal psychological and coping resources, external social supports, and systemic factors including government policies to be vital to their resilience. Participants perceived differences in resilience by gender and immigration status. International migrant women used a range of processes to maintain and enhance their resilience after VAP, and these may be helpful to less resilient women who are vulnerable to postpartum depression.
    Archives of Women s Mental Health 11/2013; 17(4). DOI:10.1007/s00737-013-0392-5 · 1.96 Impact Factor
  • Alice Han, Donna E Stewart
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    ABSTRACT: Very high rates of intimate partner violence during pregnancy (IPV-P) are reported in Latin America and the Caribbean (LAC) but data on prevalence and obstetric-related outcomes are limited. To conduct a literature review on risk factors, prevalence, and adverse obstetric-related outcomes of IPV-P in LAC. Systematic review of studies in MEDLINE (1946-2012) and LILACS (1982-2012), and hand searching of reference lists of included studies. Search terms were variations of partner abuse and pregnancy in LAC. Studies were excluded if they did not include IPV-P prevalence or if the perpetrator was not an intimate partner. Study quality was assessed via US Preventive Services Task Force criteria. In the 31 studies included, prevalence rates ranged from 3% to 44%. IPV-P was significantly associated with unintended pregnancies and adverse maternal (depression, pregnancy-related symptom distress, inadequate prenatal care, vaginal bleeding, spontaneous abortion, gestational weight gain, high maternal cortisol, hypertension, pre-eclampsia, STIs) and infant (prematurity, low birth weight, neonatal complications, stillbirth) outcomes (grade II-2 and 3 evidence). IPV-P is highly prevalent in LAC, with poor obstetric-related outcomes. Clinicians must identify women experiencing IPV-P and institute appropriate interventions and referrals to avoid its deleterious consequences.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 10/2013; 124(1). DOI:10.1016/j.ijgo.2013.06.037 · 1.56 Impact Factor

Publication Stats

5k Citations
825.35 Total Impact Points


  • 2000–2014
    • University Health Network
      Toronto, Ontario, Canada
  • 1989–2014
    • University of Toronto
      • • Department of Psychiatry
      • • Department of Anesthesia
      • • Department of Family and Community Medicine
      • • Saint Michael's Hospital
      Toronto, Ontario, Canada
  • 2008–2013
    • McGill University
      • • Department of Obstetrics and Gynecology
      • • Department of Educational and Counselling Psychology (ECP)
      • • Department of Psychiatry
      Montréal, Quebec, Canada
    • Ryerson University
      • School of Nutrition
      Toronto, Ontario, Canada
  • 2005–2012
    • York University
      • School of Kinesiology and Health Sciences
      Toronto, Ontario, Canada
  • 2011
    • Mount Allison University
      • Department of Psychology
      Sackville, New Brunswick, Canada
  • 2007
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 1990–2007
    • St. Michael's Hospital
      Toronto, Ontario, Canada
  • 2006
    • University of Rochester
      Rochester, New York, United States
    • Virginia Commonwealth University
      • Department of Psychiatry
      Richmond, VA, United States
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 1994
    • St. Joseph's Healthcare Hamilton
      Hamilton, Ontario, Canada