Juveria Zaheer

• Centre for Addiction and Mental Health

Rationale: Recent studies have highlighted higher rates of suicidal ideation and behaviour and associated themes of gender role stress in Chinese women residing in North America. However, qualitative studies, which privilege their voices in the discourse of suicide prevention and provide insight into their experiences, are lacking. Objective: To...

Objective: To compare individuals with and without schizophrenia spectrum disorders (SSD) (schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified) who die by suicide. Method: This is a retrospective case control study which compared all individuals who died by suicide in Ontario, Canada with (cases) and without (c...

Objective: While mental illness is a risk factor for suicidal behaviour and many suicide decedents receive mental health care prior to death, there is a comparative lack of research that explores their experiences of mental illness and care. Suicide notes offer unique insight into these subjective experiences. Our study explores the following ques...

Mixed methods research (MMR) studies using health administrative data (HAD) coupled with qualitative methods can offer unique insight into the health inequities experienced by marginalized populations. However, little guidance exists on how and why to mix HAD and qualitative research. This methodology paper uses the real-life experiences of conduct...

Objective: The assessment and management of inpatient risk for violence in acute psychiatric care are challenges that introduce the potential for bias. This study aimed to examine inequities based on social determinants of health (SDoH) (e.g., race-ethnicity, gender, or mode of admission to acute care) that may lead to unfair assessment of psychia...

Background Group psychotherapy, an effective treatment for common postpartum mental disorders (e.g. depression, anxiety), has increasingly been delivered virtually since the pandemic. This study aims to understand experiential aspects of participating in videoconferencing-based group psychotherapy in the postpartum period. Methods Our urban academ...

Background Group psychotherapy is an effective treatment for postpartum depressive and anxiety symptoms, and interpersonal connection and support through the group process can aid recovery. Little is known about the implication of the delivery of interpersonally oriented group therapy in this population through videoconferencing. Objective To prag...

Collaborating with health system leaders and clinicians is essential for successful implementation of interventions, especially when using new information and communication technologies (ICTs). Recruiting clinicians in research poses challenges, such as time constraints. This poster shares lessons learned from a study conducted in a psychiatric eme...

Capacity to consent to treatment of substance use disorders at Ontario's Consent and Capacity Board: A review of past reported decisions Plain Language Summary Title An Ontario review of legal cases which have considered patients' ability to consent to substance use treatments

Background Emergency departments (ED) play a crucial role in suicide prevention, with evidenced-based safety planning interventions (SPI) playing an important role. Traditional safety plans, which are often paper based, come with challenges (i.e., not easily accessible, or easy to misplace). Digital safety planning tools offer an alternative mode o...

People with borderline personality disorder (BPD) are typically excluded from assertive community treatment (ACT) teams, the intensive model that typically serves people with serious psychotic and mood disorders. Nevertheless, many people with BPD are on ACT teams for clinical comorbidity or other reasons. Suitability and ability of ACT to provide...

BACKGROUND: Suicide is a major public health concern worldwide, including in Canada. The onset of major mental illnesses occurs during adolescence and young adulthood. Among this group, young Muslims in Canada may be particularly vulnerable due to unique stressors and emerging evidence indicating that Muslims in the U.S. report more suicide attempt...

Objective: In Canada and elsewhere, making treatment decisions for a person with serious mental illness (SMI) who was found incapable for treatment decisions via a substitute decision maker (SDM) is the norm. This practice is often called into question from a rights-based perspective. The literature on the views of affected individuals is limited....

Background: Women and gender-diverse people with early psychosis are at risk for suboptimal sexual health outcomes, yet little research has explored their sexual health experiences. Aims: This study explored sexual health experiences and related priorities among women and gender-diverse people with early psychosis, to identify opportunities for...

During the COVID-19 pandemic, researchers have questioned how the devastation of the pandemic might impact suicide rates. While initial evidence on suicide rates during the early stages of the pandemic is mixed, there are signs we should still remain vigilant. One way of conceptualizing the long-term effects of the pandemic is as a source of multip...

Importance: Reasons for elevated suicide risks among autistic people are unclear, with insufficient population-based research on sex-specific patterns to inform tailored prevention and intervention. Objectives: To examine sex-stratified rates of self-harm events and suicide death among autistic individuals compared with nonautistic individuals,...

BACKGROUND Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool, called the Hope app, to support suicide safety planning intervention. The app is...

Background Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is f...

Introduction Bipolar disorder (BD) is a source of marked disability, morbidity, and premature death. There is a paucity of research on personalized psychosocial interventions for BD, especially in lowresource settings. A previously published pilot randomized controlled trial (RCT) of a Culturally adapted PsychoEducation (CaPE) intervention for BD i...

Introduction The Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and characteristics vary substantially among psychiatrists. However, how this compares across jurisdictions and implications for workf...

Objective: Individuals with psychosis are at elevated risk of adverse sexual and reproductive health (SRH) outcomes, and not receiving adequate SRH care. SRH is important for youth, yet little is known about SRH care access and experiences among those with early psychosis. This study explored SRH care experiences among women and nonbinary individu...

Objectives: Up to 20% of individuals who die by suicide have visited an emergency department (ED) within 4 weeks of their death. Limited guidance is available regarding the modification of clinical outcomes following a psychosocial intervention in the ED for pediatric and adult populations. Methods: A systematic review following the Preferred Re...

Borderline Personality Disorder (BPD) is a condition characterised by significant social and occupational impairment and high rates of suicide. In high income countries, mental health professionals carry negative attitudes towards patients with BPD, find it difficult to work with patients with BPD, and even avoid seeing these patients. Negative att...

Introduction Managing violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. Howe...

Objective: To examine the association between Muslim religious affiliation and suicide and self-harm presentations among first- and second-generation immigrant youth. Methods: We performed a population-based cohort study involving individuals aged 12 to 24 years, living in Ontario, who immigrated to Canada between 1 January 2003 and 31 May 2017...

Objective: Of those with postpartum psychiatric emergency department (ED) visits, a minority of receive hospital admission at their initial visit. Among those discharged, we aimed to determine subsequent risk of psychiatric admission, and understand how social determinants of health (SDOH) - individually and collectively - impact this risk. Metho...

Background A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on...

In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of t...

Background Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) i...

Objectives: A patient's death by suicide is a common experience for psychiatrists, ranging from 33% to 80%, however, research about the impact of patient suicide on psychiatrists is limited to a few survey studies. This study had three main objectives: (1) understanding the emotional and behavioural impact of a patient's suicide on psychiatrists,...

Background The Cognitive Behavioral Therapy Skills Intervention (or CBTSI) aims to build mental health literacy and knowledge, allowing youth to build resilience and improve mental health broadly. In Ontario, Canada, youth voice is scant and European studies have largely reported on youth factors supporting stigma reduction, help-seeking intentions...

Objective Suicide is a complex multifactorial process influenced by a variety of biological, psychological, and social stressors. Many older adults face a characteristic set of challenges that predispose them to suicidal ideation, suicide-related behavior, and death by suicide. This study explored the subjective experience of suicidality through th...

Background There is a surplus of information communication technology (ICT) based interventions for suicide prevention. However, little is known about which of these ICTs are implemented in clinical settings and their characteristics. This scoping review aimed to map and characterize evidence of ICTs for suicide prevention implemented in clinical s...

Gatekeeping refers to clinicians’ strict application of eligibility criteria to determine a trans patient's “fitness” to engage in medical transition, resulting in significant barriers to gender-affirming care. Gatekeeping often uses “mental readiness” as a prerequisite to medical transition, which contributes to patient distress and systemic discr...

Introduction Suicide is a complex multifactorial process that can result from a variety of biological, psychosocial and social stressors. The relative contributions of these stressors vary across the lifespan, as has been shown through epidemiological studies. Older adults face a unique set of challenges which may predispose them to suicidal ideati...

Background: In Ontario, Canada, there is variability in how students experiencing a mental health crisis are transferred from university health clinics to hospital for emergent psychiatric assessment, particularly regarding police involvement and physical restraint use. We sought to understand existing processes for these transfers, and barriers t...

Introduction: There has been a proliferation of initiatives targeted towards improving psychological wellbeing among medical learners. Yet, many learners do not seek assistance due to stigma against help seeking. Understanding the prevailing discourses on mental health stigma and its effects in the context of medical education will improve insight...

Background: There is concern regarding the psychological impact of the perinatal period on LGBTQ2S+ childbearing individuals. Objectives: To characterize and synthesize the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care, and care-seeking. Search strategy: We conducte...

Introduction: There is a surplus of information and communication technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to exis...

Objective To determine whether the release of the first season of the Netflix series ‘13 Reasons Why’ was associated with changes in emergency department presentations for self-harm. Methods Healthcare utilization databases were used to identify emergency department and outpatient presentations according to age and sex for residents of Ontario, Ca...

Filial piety involves the Confucian view that children always have a duty to be obedient and to provide care for their parents. Filial piety has been described as both a risk and a protective factor in depression and suicide. This qualitative study aimed to explore the role of filial piety in the suicidal behavior of Chinese women. Qualitative inte...

Objective: Transgender individuals experience significant oppression resulting in mental health disparities. Factors associated with their need for acute mental health care are unknown. This study compared characteristics of transgender individuals who presented for acute mental health care with population-based comparison samples. Methods: This...

Coercive practices, including chemical and physical restraints and seclusion, are commonly used in psychiatric emergency and inpatient settings. These events are traumatic for patients, used disproportionately across race and class, and can lead to significant mistrust of the mental health care system. Institutions and mental health care providers...

Background Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspective...

IntroductionThere is a surplus of Information and Communication Technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to existin...

Despite increasing attention on suicidality in autistic people, we know little about suicidal presentations when autistic individuals present to hospital emergency departments (ED). We conducted an exploratory retrospective chart review of suicidal thoughts and behaviours (STB) of autistic adults who presented to a psychiatric ED. The analysis incl...

Background Associations between childhood trauma, personality, and Major Depressive Disorder (MDD) have been well established in studies conducted in high-income countries. However, there are limited studies on these associations in low and middle-income countries (LMICs), where MDD is highly prevalent. We assessed the relationships between childho...

Aims Among low- and middle-income countries (LMICs), bipolar disorder is recognized as one of the leading causes of disease burden for adults and is associated with marked suicide risk. There are limited data on suicidal ideation in bipolar disorder from LMICs. This study presents cross-sectional data on the prevalence of suicidality and associated...

Background: Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk for developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to...

Group-based health interventions are an important component of health promotion and management. To provide continuity of care throughout the COVID-19 pandemic, our institution undertook a rapid pivot to delivering group-based health interventions via a videoconferencing service which was securely embedded into both the electronic medical record and...

UNSTRUCTURED Group-based health interventions are an important component of health promotion and management. To provide continuity of care throughout the COVID-19 pandemic, our institution undertook a rapid pivot to delivering group-based health interventions via a videoconferencing service which was securely embedded into both the electronic medic...

Smartphone technology has seen expanding interest across nearly all areas of medicine, including psychiatry. This paper discusses the burgeoning use of digital technologies for symptom monitoring in the field of first episode psychosis. Drawing on Foucauldian theory as well as intersectional feminist materialist and critical disabilities scholarshi...

The prevalence and risk factors of suicidal ideation in bipolar depression in low- and middle-income countries (LMICs) are poorly understood. This study is a secondary, cross-sectional analysis of a randomized controlled trial from Pakistan, a lower middle-income country. Participants included psychiatric outpatients aged 18 to 65 with a known diag...

There is emerging evidence of high mortality rates after the first diagnosis of psychotic disorder. The objective of this study was to estimate the standardized mortality ratio (SMR) in a population-based cohort of individuals with a first diagnosis of schizophrenia-spectrum psychotic disorder (SSD). The cohort included a population-based sample of...

Introduction: While nearly half of all new psychotic disorders are diagnosed in the emergency department (ED), most young people who present to the ED with psychosis do not receive timely follow-up with a psychiatrist, and even fewer with evidence-based early psychosis intervention (EPI) services. We aim to test an intervention delivered using sho...

Introduction This study presents demographic and clinical profiles of adults with intellectual and developmental disabilities seen at a psychiatric emergency department (ED). Predictors of admission were also identified. Methods A retrospective chart review conducted from Oct 2016 to Jan 2017. Results A total of 73 patients representing 105 visit...

Introduction: While early psychosis intervention (EPI) has proliferated in recent years amid evidence of its effectiveness, programmes often struggle to deliver consistent, recovery-based care. NAVIGATE is a manualised model of EPI with demonstrated effectiveness consisting of four components: individualised medication management, individual resil...

Background Suicide is a major cause of mortality for individuals with schizophrenia spectrum disorders (SSD). Understanding the risk factors for suicide at time of diagnosis can aid clinicians in identifying people at risk. Methods Records from linked administrative health databases in Ontario, Canada were used to identify individuals aged 16 thro...

Objective The objective of this commentary is to summarize the few findings from the scientific literature pertaining to humane mental health transfer practices in the province of Ontario as well as the broader Canadian and international context. These findings are juxtaposed with a policing policy scan concerning the Ontario and Canadian contexts....

A cross-national qualitative suicide study was conducted by Tsinghua University and the University of Toronto with two samples of Chinese women in Beijing and Toronto. The aim of this article is to reflect on lessons learned from this collaborative study. A literature review guided the analysis. A focus group was conducted with members of both rese...

Background Smartphone technology has seen expanding interest across nearly all areas of medicine, including psychiatry, where app-based technologies frequently function as proxies for digitized behavioural phenotypes (Firth and Torous 2015). In the area first episode psychosis especially, there has been a rising interest in the use of digital platf...

Background: Psychotherapy is recommended as a first-line treatment for the management of common psychiatric disorders. The objective of this study was to evaluate the availability of publicly funded psychotherapy provided by physicians in Ontario by describing primary care physicians (PCPs) and psychiatrists whose practices focus on psychotherapy...

BACKGROUND The perinatal period is a vulnerable time during which depression and anxiety commonly occur. Left untreated or under-treated, there may be significant adverse effects, therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped care approach involve psychoeducation, peer...

Background: The perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, p...

Background Although suicide-prevention campaigns have been implemented in numerous countries, Canada has yet to implement a strategy nationally. This is the first study to examine the cost utility of the implementation of a multidimensional suicide-prevention program that combines several interventions over a 50-year time horizon. Methods We used...

Alterations in self-experience are increasingly attended to as relevant and important aspects of schizophrenia, and psychosis more broadly, through a burgeoning self-disorders (SD) literature. At the same time, issues of self, subject, and subjectivity within schizophrenia-spectrum illnesses have also gained attention from researchers across the so...

Mental illnesses contribute to a large proportion of the disease burden in children and adolescents in low and middle-income countries (LMICs). There is limited research completed in LMICs about paediatric mental health, particularly related to youth. School is a place where many adolescents first seek mental health support. This study examined how...

Background Schizophrenia spectrum conditions have been linked to alterations in self-experience from some of their earliest descriptions. These alterations include disruptions in self-awareness, agency/volition, and distortions of personal identity more generally, and are thought to apply to both a “minimal” and “narrative” self. The notion of schi...

Objectives Emergency medicine residents may be transitioning to practice with minimal training on how to supervise and assess trainees. Our study sought to examine: 1) physician comfort with supervision and assessment, 2) what the current training gaps are within these competencies, and 3) what barriers or enablers might exist in implementing curri...

Objective:: To investigate the degree to which psychiatrists are accessible to new outpatients and the factors that predict whether psychiatrists will see new outpatients. Methods:: We used administrative health data on all practicing full-time psychiatrists in Ontario, Canada, over a 5-year period (2009-2010 to 2013-2014). We used a regression...

This qualitative study explored the experiences and patterns of recovery of Chinese- born women living in Canada with a history of suicidal behaviour. It explores a number of dimensions of recovery including clinical, existential, functional, physical, and social. The women described engaging in ‘‘survival’’ recovery in the short term and ‘‘thrivin...

Suicide is a complex and tragic outcome driven by biological, psychological, social and cultural factors. Women of Chinese descent and women who have immigrated to other countries have higher rates of suicidal ideation and behaviour, and immigration-related stress may contribute. To understand the experiences of immigration and their relationship w...

In this chapter, we draw on a critical analysis of 120 inpatient charts from a large psychiatric institution in Toronto, Ontario to examine the concept of ‘insight’ as it is operationalized by psychiatrists in chart documentation. We argue that psychiatrists use insight as a discursive means to delegitimize patient perspectives that diverge from th...

Introduction: Final year emergency medicine residents may be transitioning to practice with little to no training on how to effectively supervise and assess trainees. It remains unclear how comfortable final year residents and new-to-practice physicians are with these competencies. The goal of our study was to examine physician comfort with supervi...

Background Although commonly used in anxiety and insomnia, recent guidelines recommend caution when prescribing benzodiazepines in the elderly. Here we examined rates of benzodiazepine prescribing to older adults in Ontario, Canada from 1998 to 2013 and impact of legislation that made prescribing regulations more strict. Method Annual benzodiazepi...

Objective: To describe recent trends and patterns in methadone maintenance treatment (MMT) practice regionally and over time in the province of Ontario. Design: Population-based descriptive study using health administrative data between September 1, 2011, and December 31, 2014. Setting: Ontario. Participants: All active MMT-prescribing physi...

Objective We sought to examine the short-term and long-term impacts of psychiatric hospitalisations among patients of Chinese and South Asian origin. Design Retrospective population-based cohort study using linked health administrative data. Setting We examined all adult psychiatric inpatients discharged between 1 April 2006 and 31 March 2014 in...

While mental illness is a risk factor for suicidal behaviour and many suicide victims receive mental health care prior to death, there is a comparative lack of research that explores their narratives of care. Suicide notes offer unique insight into these subjective experiences. Our study explores the following questions: “How is mental health care...

Background: An issue throughout all areas of medicine, nonadherence to medications is particularly challenging in first-episode psychosis (FEP), where discontinuation of medications has been found to be one of the most reliable predictors of relapse after symptom remission (Haddad et al, 2014; Alvarez-Jimenez et al, 2012). And while medication fact...

p> OBJECTIVE: Despite the high prevalence of mental illnesses and addictions, treatment rates remain low. In April 2010, a regional mass media campaign was implemented to increase awareness of mental health services in central Toronto, Canada. We studied the impact of this campaign on rates of psychiatric emergency department (PED) visits among all...