Nicole Racine

• Ph.D., R.Psych.
• Professor (Assistant) at University of Ottawa

Introduction Promoting youth mental health and well-being is a global concern. Administering social-emotional learning programs in contexts that are familiar to youth have the potential to increase mental well-being by helping youth develop fundamental coping skills that may contribute to their resilience. Implementing social-emotional learning pro...

Les données préliminaires indiquent que la première année de la pandémie a été associée à une augmentation de la détresse mentale chez les enfants, les adolescents et leurs familles dans le monde entier. Il était généralement présumé que les enfants se remettraient une fois les perturbations initiales de la pandémie, comme les fermetures d’écoles,...

Background Few studies have explored the potential for family dynamics to hinder or promote help-seeking and disclosure behaviours among adolescents who self-harm or experience suicidality. We sought to examine whether family dynamics may influence self-harm-related disclosure to parents or other family members and online help-seeking. Methods We...

Importance Exposure to adverse childhood experiences (ACEs) before the age of 18 years is a major contributor to the global burden of disease and disability. Objective To meta-analyze data from samples with children 18 years or younger to estimate the average prevalence of ACEs, identify characteristics and contexts associated with higher or lower...

A healthy child–caregiver relationship is fundamental for positive early child development. Robust evidence indicates that these relationships yield positive impacts on children’s cognitive, social, and emotional growth. Evidence-based parenting programs are an effective way to improve parenting skills and strengthen the child–caregiver relationshi...

This cross-sectional study examines the prevalence and risk of mental disorders, substance use disorders, and suicidal behaviors among transgender and gender-diverse (TGD) and cisgender Canadians.

Background The COVID-19 pandemic is associated with increases in child mental health problems, but the persistence of these changes in the post-pandemic era remains uncertain. Additionally, it is unclear whether changes in mental health problems during the pandemic exceed the anticipated increases as children age. This study controls for the linear...

Support has been found for the intergenerational transmission of risk from maternal adverse childhood experiences (ACEs) to child outcomes. Less research has focused on longitudinal psychosocial pathways that account for this transmission. In the current study, path analysis examined mediating pathways (i.e., maternal adult attachment insecurity, r...

Objective Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or...

Out‐of‐school programs are an accessible option to bolster the mental well‐being of youth, who may be at risk of developing further emotional and behavioural concerns. Developing a more nuanced understanding of the tools and methods available to understand youth mental health needs, in the context of out‐of‐school programs is needed to provide rele...

Community agencies and practitioners around the globe seek opportunities to learn various assessment tools and interventions rooted in attachment theory. However, information regarding the feasibility of implementation and sustainability of these tools once participants have been trained to use them, is limited. This study investigated the perceive...

Public perceptions of energy choices will play a major role in the energy transition. Climate-related emotions, particularly concerns and worries, influence these perceptions, as they signal a heightened awareness of climate risks and greater personal salience of climate change. Here we conduct a series of meta-analyses to estimate whether climate...

Purpose: Sexual and gender diverse (SGD) youth have been particularly vulnerable to mental health difficulties and substance use during the COVID-19 pandemic. However, estimates have varied across studies pointing to the potential for moderator variables. This meta-analytic and narrative synthesis provides estimates of the prevalence of mental heal...

Screening for social determinants of health, including maternal depression, is a recommended pediatric practice. However, the magnitude of association between maternal and child screening tools remains to be determined. The current study evaluated the association between maternal postnatal depressive symptoms and child developmental milestones, as...

Background A positive child-caregiver relationship is one of the strongest determinants of child health and development, yet many caregivers report challenges in establishing a positive relationship with their child. For over 20 years, Make the Connection® (MTC), an evidence-based parenting program, has been delivered in-person by child-caring prof...

Background Children of substance-involved mothers are at especially high risk for exposure to adverse childhood experiences (ACEs) and poor mental health and development. Early interventions that support mothers, children, and the mother-child relationship have the greatest potential to reduce exposure to early adversity and the mental health probl...

This article details an approach to creating the system structures needed to actually manage a system that is trauma informed. Many people are interested in having trauma-informed systems but without proper infrastructure it may not be sustainable. This article discusses an approach to infrastructure development using Transformational Collaborative...

Exposure to abuse in childhood can have long-term implications for physical and mental health across the life course, including the perinatal period. However, bourgeoning research demonstrates that child abuse experiences are far from deterministic, with several factors contributing to resilience in the face of adversity. This chapter provides an o...

Exposure to adverse childhood experiences (ACEs), including maltreatment and family dysfunction, is a major contributor to the global burden of disease and disability. With a large body of international literature on ACEs having emerged over the past 25 years, it is timely to now synthetize the available evidence to estimate the global prevalence o...

Background: Adverse childhood experiences (ACEs) can be associated with negative health outcomes such as substance use. However, extant literature assessing this association is mixed. Objective: The present meta-analysis was conducted to obtain a pooled effect size for the association between ACEs and substance use (i.e., smoking, problematic al...

Longitudinal changes in maternal depressive and anxiety symptoms and predictors of symptom variation among a group of middle-to-upper income Canadian women (n = 2152) were examined prior to the pandemic (2017-2019) and at three pandemic timepoints (May-July 2020, March-April 2021, November-December 2021). Mean maternal depression and anxiety scores...

Background: Exposure to sexual content, such as online pornography or live sexual content, has been posited in the literature as a risk factor for problematic sexual behaviors (PSBs) in children and adolescents, and has been identified as an important avenue for research and intervention, particularly given the ubiquitous access to technology amon...

Importance: There is a growing body of high-quality cohort-based research that has examined changes in child and adolescent mental health during the COVID-19 pandemic vs before the pandemic. Some studies have found that child and adolescent depression and anxiety symptoms have increased, while others have found these symptoms to have remained stab...

This cohort study compared children’s recreational screen time with screen time before the COVID-19 pandemic and during 3 pandemic waves to examine whether changes in screen time were greater than those associated with age.

Screening for social determinants of health, including maternal depression, has become a common and recommended pediatric practice. However, the magnitude of association between maternal and child screening tools remains to be determined. The current study evaluated the association between maternal postnatal depressive symptoms and child developmen...

Youth engagement in research, which involves meaningfully collaborating with youth as full partners in the research process, has contributed to improved research collaborations, enhanced youth participation, and increased motivation for researchers to address scientific questions relevant to youth. Engaging youth as partners in the research process...

Background: There is a lack of consensus about the effect of the COVID-19 pandemic on the mental health of children and adolescents. We aimed to compare rates of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation during the pandemic with those before the pandemic. Methods: For this systematic review an...

Objective This study examined the prevalence of elevated maternal anxiety and/or depression symptoms up to eight years after childbirth and the association between role and relationship strains during parenting and mental health challenges from three to eight years after childbirth. Methods This study used data from the All Our Families longitudin...

Objectives: To explore the barriers and facilitators from the perspective of family physicians on the implementation of a pilot trauma-informed care (TIC) initiative to promote resilience, with particular emphasis on asking about adverse childhood experiences (ACEs), in a maternity care clinic.Methods: Using an exploratory qualitative design, in-de...

Objectives Adverse childhood experiences (ACEs) are associated with poor physical and mental health outcomes in pregnancy, prompting many care agencies to ask about ACEs as part of routine care. However, limited research has been conducted in the clinical setting to demonstrate associations between ACEs and maternal health (i.e., pregnancy complica...

Un tiers des enfants au Canada subissent une forme de maltraitance pendant leur enfance, expérience qui est associée à des problèmes de santé mentale, émotionnels et de comportement à l’âge adulte. Toutefois, la maltraitance est loin d’avoir un effet déterministe, car nombreux sont les enfants qui s’adaptent à l’adversité. Au cours des 30 dernières...

On comprend maintenant de plus en plus que la recherche translationnelle doit être co-créée en collaboration avec des partenaires communautaires et que les solutions aux problèmes sociaux nécessitent de sortir du silo universitaire. Cependant, moins de la moitié des programmes de psychologie au Canada offrent des cours d’évaluation communautaire, l...

Children exposed to child sexual abuse (CSA) vary considerably with regards to their presenting concerns and treatment needs. One factor creating heterogeneity amongst children experiencing CSA is their history of experiencing other victimizations (i.e., poly-victimized or not). However, little is known about risk factors for poly-victimization as...

Socio-demographic risks are associated with higher child screen time and higher screen time is associated with poor socioemotional and developmental health. Existing studies have not examined children’s screen time as a mechanism through which distal risks may be associated with child outcomes. In the current study, we examined whether two proximal...

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: (1) the prevalence of depression and anxiety in parents of young children (<age 5) during the COVID-19 pandemic, and (2) sociodemographic (e.g., parent age, being racially minoritized) a...

The COVID-19 pandemic has posed notable challenges to post-secondary students, causing concern for their psychological well-being. In the face of school closures, academic disruptions, and constraints on social gatherings, it is crucial to understand the extent to which mental health among post-secondary students has been impacted in order to infor...

Background: There has been an increase in use of trauma-informed care (TIC) approaches, which can include screening for maternal Adverse Childhood Experiences (ACEs) during prenatal care. However, there is a paucity of research showing that TIC approaches are associated with improvements in maternal or offspring health outcomes. Using retrospectiv...

In Reply We appreciate the response to our systematic review and meta-analysis in JAMA Pediatrics¹ suggesting that, in addition to a near doubling in clinically elevated depressive and anxiety symptoms in children and adolescents during the COVID-19 pandemic, there have been increases in other mental health concerns, including eating disorders (EDs...

There is now a growing understanding that translational research must be co-created in collaboration with community partners and that solutions to real-world social problems require stepping outside the academic silo. Fewer than half of psychology programs in Canada, however, offer courses in community-based research or evaluation, leaving a gap in...

Background Adverse childhood experiences (ACEs), including abuse, neglect, and/or household dysfunction, are associated with physical and mental health difficulties in pregnancy and the postpartum period. These associations have prompted the adoption of screening for ACEs in prenatal care settings; however, little is known about whether asking abou...

Background Mothers have experienced a near doubling of depression and anxiety symptoms pre- to during the COVID-19 pandemic. The identification of mechanisms that account for this increase can help inform specific targets for mental health recovery efforts. The current study examined whether women with higher levels of depression and anxiety sympto...

Objective: Survivors of childhood cancer experience late effects as a result of their cancer treatment. Evidence for the prevalence of pain as a late effect has been equivocal. This study aimed to describe the prevalence and patterns of pain and biospsychosocial variables that may be related to pain in this population. Method: Survivors of child...

The COVID-19 pandemic has prompted unprecedented disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase of anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care has been affected causing barriers to mental health care access. This study...

The underpinnings of child psychopathology are laid early in development and can be transmitted across generations. Following the review of prominent theories of intergenerational risk transmission, this chapter explores the mechanisms by which parent mental health, adversities, and social difficulties confer risk for early child psychopathology. W...

CONTEXT: A growing body of research has examined the role of maternal adverse childhood experiences (ACEs) on child behavior problems. OBJECTIVE: To summarize the literature examining the association between maternal ACEs and child behavior problems via a systematic review. DATA SOURCES: Electronic searches were conducted in Medline, PsycINFO, an...

Importance Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature. Objective To ascertain more precise estimates of the global prevalence of child and adolescent clinically...

Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financi...

Objectives: Our aim is to understand the effect of the COVID-19 pandemic on families who have been followed longitudinally in two cohorts studied in Alberta, Canada. We will examine household infections during the COVID-19 pandemic, financial impact, domestic violence, substance use, child school and daily life and relationships in the home. We wil...

Strategies used to restrict the spread of COVID-19, such as school closures and limited extracurricular activities, have resulted in shifts in children’s sedentary behaviors¹ and increases in screen time have largely been assumed. One limitation of the existing research is that it is either cross-sectional¹ or uses national norms as a comparison²....

Research on the effects of adversity has led to mounting interest in examining the differential impact of adversity as a function of its timing and type. The current study examines whether the effects of different types (i.e., physical, sexual, and emotional abuse) and timing (i.e., early, middle childhood, adolescence, or adulthood) of adversity o...

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: 1) the prevalence of depression and anxiety in parents of young children (< age 5) during the COVID-19 pandemic, and 2) sociodemographic (e.g., parent age, minority status) and methodolo...

Objective: There is a dearth of Canadian-based literature on children referred to treatment services following maltreatment exposure. In order to inform assessment, intervention, and program development to improve outcomes, insight into the demographics and mental health needs of this population is required. Methods: A retrospective file review...

The study rapidly reviewed and meta-analyzed the worldwide prevalence of depression and anxiety among pregnant women during the COVID-19 pandemic. A systematic search of the literature and meta-analyses were conducted from December 2019 – February 2021 with a total of 46 studies meeting inclusion criteria. Depression was assessed in 37 studies (N =...

Background: Acceptance of a vaccine against SARS-CoV-2 is critical to achieving high levels of immunization. The objectives of this study were to understand mothers' SARS-CoV-2 vaccine intentions to explore reasons for and against SARS-CoV-2 vaccination. Methods: Participants from the All Our Families pregnancy longitudinal cohort whose children...

Background Parents have faced substantial social and economic challenges during the COVID-19 pandemic. Preliminary cross-sectional research has demonstrated increases in mental health problems in mothers during the COVID-19 pandemic compared with pre-pandemic estimates. We aimed to study an existing longitudinal cohort of mothers to assess changes...

Background: Exposure to adverse childhood experiences (ACEs) is a risk factor for maternal substance use in pregnancy, however, mechanisms by which maternal ACEs may influence substance use in pregnancy have not been fully explored. The current study examines the association between maternal ACEs and substance use in pregnancy (i.e., alcohol, smoki...

Objective: The present study rapidly reviewed and meta-analyzed the worldwide prevalence of depression and anxiety among pregnant women during the COVID-19 pandemic. Methods: A systematic search of the literature and meta-analyses were conducted. Results: Fifteen studies with 11,091 participants met inclusion criteria. Depression was assessed in 11...

Background It has been proposed that adverse childhood experiences (ACEs) can put women at risk for mental illness in the pregnancy and postpartum periods. While some studies have found strong support for this proposition, others have found weak or no support. This study is a meta-analysis of the association between ACEs and maternal mental health...

The Atypical Maternal Behavior Instrument for Assessment and Classification—Brief (AMBIANCE‐Brief) was developed to provide a clinically useful and psychometrically sound assessment of disrupted parenting behavior for community practitioners. With prior evidence of this tool's reliability and validity in laboratory settings, this study aimed to det...

Substance use in pregnancy, including alcohol use, drug use, or smoking, is associated with poor health outcomes for both the mother and her unborn child. Building on previous research that has examined the cumulative impact of Adverse Childhood Experiences (ACEs) on maternal binge drinking and alcohol use in pregnancy, the current study sought to...

Background Acceptance of a COVID-19 vaccine is critical to achieving high levels of immunization. The objective of this study is to understand factors associated with COVID-19 vaccine intentions among parents and explore reasons underlying decision making. Methods Participants from a longitudinal cohort were invited to participate in a COVID-19 im...

Survivors of childhood cancer may be at risk of experiencing pain, and a systematic review would advance our understanding of pain in this population. The objective of this study was to describe: 1) the prevalence of pain in survivors of childhood cancer, 2) methods of pain measurement, 3) associations between pain and biopsychosocial factors, and...

Bien que les répercussions médicales de la COVID-19 soient notables, les conséquences interpersonnelles, financières et sociales de la pandémie auront probablement l’effet le plus important et le plus soutenu sur la santé psychologique des Canadiens. Depuis l’apparition de la pandémie, la maladie mentale a augmenté et la demande de ressources et de...

Self-regulation is the ability to manage emotions, modulate behaviors, and focus attention. This critical skill begins to develop in infancy, improves substantially in early childhood and continues through adolescence, and has been linked to long-term health and well-being. The objectives of this study were to determine risk factors and moderators...

Many children start but do not complete trauma treatment, and there is little knowledge of factors that predict treatment dropout in children who have endured maltreatment. The current study examines the risk and protective factors associated with premature treatment dropout within a sample of 118 children (aged 3–18) referred to a Child Advocacy C...

The ongoing COVID-19 pandemic has led to unprecedented disruptions and stress in the lives of children and families internationally. Heightened family stress and turmoil can increase risk for child maltreatment. As a result, child maltreatment experts are concerned that there will be an influx of children requiring trauma assessment and treatment d...

Emerging evidence suggests rates of posttraumatic stress and psychological stress in the general population are elevated due to COVID-19. However, a meta-analysis is needed to attain more precise prevalence estimates due to between study variability. Thus, we performed a rapid review and meta-analysis of posttraumatic stress and general psychologic...

Background: The negative effect of adverse childhood experiences (ACEs) on physical and mental health has led to calls for routine screening for ACEs in primary care settings. We aimed to examine the association between maternal ACEs and children's behaviour problems (externalizing and internalizing) at age 5 in the context of other known predicto...

Resulting from a community‐identified need for a well‐validated indicator of caregiving difficulties for use in practice settings, a brief form of the Atypical Maternal Behavior Instrument for Assessment and Classification System (AMBIANCE) was developed for use as a screening instrument. Prior to its dissemination, this study aimed to assess the f...

Background: Although the buffering effect of protective factors on children's outcomes following exposure to adverse childhood experiences has been well documented, research gaps remain as to whether this buffering effect differs based on the type of adversity experienced (i.e., maltreatment versus household dysfunction). Objective: To examine w...

Global debates among researchers, clinicians, policy makers, and parents on the benefits vs consequences of children’s screen time exposure are ubiquitous. Research suggests that excessive screen time is likely consequential for early child development and health.¹,2 Accordingly, the World Health Organization and various pediatric societies have is...

Background: Toxic stress resulting from childhood abuse can lead to poorer physical and mental health for pregnant women and their unborn children. To provide a clinical response to these experiences, momentum to incorporate questionnaires about childhood adversity, including abuse, into patient care is building. Limiting factors to this initiative...

Experiences of childhood adversity are common, with more than 50% of adults reporting having experienced at least 1 adversity as children and more than 6% exposed to 4 or more adverse childhood experiences (ACEs).¹ There is currently a controversial debate in the medical field as to whether the ACEs questionnaire, which asks about abuse, neglect, a...

Background: A strong association between the number of adverse childhood experiences (ACEs) and the risk of maternal depression has been demonstrated; however, this association has not been examined with regards to changes in depression across the perinatal period. The objectives of this longitudinal study were to: (1) determine whether ACEs predi...

Background: The unique psychosocial needs of parents and caregivers of young children with cancer are poorly understood. The aims of the present study were to examine health-related quality of life (hrqol), stress, and psychological distress in parents of young children (0-4 years) diagnosed with cancer; and the associations between parent psychos...

In Reply We appreciate the opportunity to engage in scholarly discussion surrounding our contribution to JAMA Pediatrics on screen time and children’s development.¹ Ophir et al state that “all between-person associations were not significant.” This is incorrect because the confidence interval for the between-person association does not include zero...

Background: Investigations have found mothers’ adverse childhood experiences (ACEs) confer an intergenerational risk to their children's outcomes. However, mechanisms underlying this transmission have only been partially explained by maternal mental health. Adult attachment insecurity has been shown to mediate the association of ACEs and mental hea...

Objective: The objective of the study was to identify distinct trajectories of delayed communicative development from 12 to 36 months and examine differences in risk factors and developmental outcomes for each trajectory. Methods: Participants were 2192 children drawn from a prospective longitudinal pregnancy cohort in a large Canadian city. Mat...

Background Self-regulation, defined as the ability to manage emotions, regulate behaviors, and focus attention, are developed early in childhood and provide the underpinnings for social, emotional, academic, and behavioural well-being in childhood. Early identification of factors associated with poor-self regulation can help inform interventions to...

Background: Stress and anxiety in pregnancy and the postpartum period are associated with poor long-term maternal and child health outcomes. Social support has been shown to mitigate the effects of maternal stress and anxiety; however, the directionality and longitudinal associations among these variables are poorly understood. Using a novel multi...

Importance: Excessive screen time is associated with delays in development; however, it is unclear if greater screen time predicts lower performance scores on developmental screening tests or if children with poor developmental performance receive added screen time as a way to modulate challenging behavior. Objective: To assess the directional a...

The aims of the current study were to examine the association between maternal adverse childhood experiences (ACEs) and antepartum health risks, and to investigate whether social support moderated this association. It was hypothesized that ACEs would be associated with antepartum health risks; however, social support in the prenatal period would bu...