Renée El-Gabalawy

University of Manitoba | UMN · Department of Anesthesia and Perioperative Medicine

Introduction: Risk assessment for post-operative delirium (POD) is poorly developed. Improved metrics could greatly facilitate peri-operative care as costs associated with POD are staggering. In this preliminary study, we develop a novel stress-diathesis model based on comprehensive pre-operative psychiatric and neuropsychological testing, a blood...

Purpose This narrative review summarizes the current literature on postoperative traumatic stress, namely post-traumatic stress disorder (PTSD), including defining features, epidemiology, identification of patient and perioperative risk factors, assessment tools, intervention recommendations, and future directions. Principal findings Postoperative...

Background The Corona Virus Immune Disease-2019 (COVID-19) pandemic has broadly impacted the mental health of individuals worldwide, especially with restrictions including social distancing and quarantining. Persons with IBD are at increased risk of mental health disorders. The aim was to understand how the COVID-19 pandemic affected adults with a...

Aim To assess the association between maladaptive health behaviours and elevated mental health (MH) symptoms during the COVID-19 pandemic among persons with inflammatory bowel disease (IBD). Methods Participants of the population-based University of Manitoba IBD Research Registry (n = 2,942) were invited to participate in a survey in November 2020...

Objective: This study examined mental health symptoms, help-seeking, and coping differences between Canadian essential workers (EWs) versus non-EWs, as well as common COVID-related concerns and longitudinal predictors of mental health symptoms among EWs only. Design: An online, longitudinal survey (N = 1260; response rate (RR) = 78.5%) assessing...

Purpose: Distress, often manifesting as anxiety, is common in breast cancer patients and becomes particularly elevated before surgery. This study investigated perspectives of those undergoing breast cancer surgery concerning what enhances and reduces distress and anxiety across the perioperative period (i.e., from diagnostic evaluation to recovery...

Background: There is some evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium after non-cardiac surgery. There is limited evidence in this regard for cardiac surgery. A suppressed electroencephalogram pattern, occurring with deep anesthesia, is associated with increased incidence of postoperative...

Background: Sleep disturbance is associated with mental health symptomatology, but this impact is understudied during COVID-19. The aims of this study are to: 1) examine correlates of sleep disturbance, and 2) examine the longitudinal relationship between sleep disturbance and mental health symptoms 6 months later, during the pandemic. Methods:...

Introduction: We estimated the incidence and prevalence of benzodiazepine and Z-drug (separately and jointly as BZD) use in the inflammatory bowel disease (IBD) population compared with matched controls without IBD and examined the association of mood/anxiety disorders (M/ADs) with the use of BZD from 1997 to 2017. Methods: Using administrative...

Few studies have examined the longitudinal courses of anxiety disorders in military members. This study examined the prevalence and predictors of courses of any anxiety disorder in members and veterans of the Canadian Armed Forces, including no lifetime, remitted, new onset, and persistent/recurrent anxiety disorder. The 2018 Canadian Armed Forces...

Introduction Military sexual trauma (MST) is an ongoing problem. We used a 2002 population-based sample, followed up in 2018, to examine: (1) the prevalence of MST and non-MST in male and female currently serving members and veterans of the Canadian Armed Forces, and (2) demographic and military correlates of MST and non-MST. Methods Data came fro...

Background: Many outpatient chronic pain clinics administer extensive patient intake questionnaires to understand patients' pain and how it impacts their lives. At our institution's pain clinic, many patients include free text in these predominantly closed-ended questionnaires, but little is known about the content categories included in this free...

Objectives: Despite a higher prevalence of posttraumatic stress disorder (PTSD) and greater severity and chronicity of cardiovascular disease (CVD) in females than males, sex-differences in explanations for the PTSD-CVD relationship are lacking. This study examined sex-differences in the role of health risk factors in mediating the relationship bet...

Objective Preoperative distress is commonly experienced by surgical patients and is associated with adverse health-related outcomes. Research suggests preoperative distress may be elevated among cancer surgery patients relative to other surgical groups and there appears to be greater recognition of the adverse impacts of distress for these patients...

At present, there is a lack of information on patient and caregiver values, and perceived priorities and barriers, to guide successful post-discharge recovery. This was a single centre, multiple methods study that investigated patient, caregiver, and healthcare provider perceptions of the discharge process after cardiac surgery. Themes emerging fro...

Background A growing body of research highlights the experiences of moral injury among healthcare professionals during the COVID-19 pandemic. Moral injury (i.e., participating in or witnessing acts that violate one's central moral values), is associated with a host of psychological sequelae and corresponding negative psychosocial impacts. There is...

Objective Use of benzodiazepines and Z-drugs (non-benzodiazepine sedative hypnotics) is controversial due to adverse health outcomes in the general population. However, little is known about their use in people with multiple sclerosis (MS). We estimated the incidence and prevalence of benzodiazepine and Z-drug use (jointly BZD) in the MS population...

Background Posttraumatic stress disorder (PTSD) and physical health conditions commonly co-occur and are both prevalent among military personnel. This study examined how courses of PTSD (no PTSD, remitted, new onset, persistent/recurrent) are associated with physical health conditions, among a population-based sample of Canadian military personnel....

Background Chronic pain is a prevalent and burdensome problem within the Canadian healthcare system, where the gold standard treatment occurs at multidisciplinary pain facilities. Patient intake questionnaires (PIQs) are standard practice for obtaining health information, with many patients including free-text (e.g., writing in margins of questionn...

Background: Medical care advancements have increased the survival rates of children with complex medical conditions (CMC). Parents/caregivers of these children experience a range of positive and negative emotional experiences as a result. This population experiences an increased risk of mental health concerns, versus the public; however, there is a...

Objective This study examined mental health profiles of pregnant and postpartum females, with and without perinatal complications, compared to non-perinatal females of childbearing age. Methods We analyzed nationally representative data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309; 51.9% female). A...

Objective Suicidality (ideation, plans, attempts) is elevated among those with chronic pain. However, population-based research is limited and studies primarily focus on mechanisms associated with increasing rather than decreasing risk. This study aimed to identify correlates associated with increased and decreased odds of suicidality among Canadia...

LAY SUMMARY Chronic pain is pain that has lasted three to six months or longer. Many people with back pain, migraines, arthritis, and gastrointestinal conditions such as irritable bowel syndrome have chronic pain. The experience of chronic pain may have various negative effects on individuals. Pain may prevent a person from doing everyday tasks suc...

Purpose: The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. Methods: Using a population-ba...

Objectives There is growing recognition of illness-induced post-traumatic stress disorder (PTSD), defined by illness being the index trauma that induces PTSD symptoms. This is the first study to examine 1) the lifetime prevalence of illness–induced PTSD among military personnel and veterans, and its 2) sociodemographic, military, trauma, and physic...

Dissociative symptoms and suicidality are transdiagnostic features of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The primary objective of this study was to examine associations between dissociation (i.e., depersonalization and derealization) and suicidality (i.e., self‐harm and suicide attempts) among individual...

We aimed to examine rates of breast and cervical cancer screening in women with immune-mediated inflammatory diseases (IMID), including inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) versus a matched cohort with IMID; and examine the association of psychiatric comorbidity with screening in these populations....

The CRN produces real-world pain research within the CPN. Patients referred to CRN sites: A) may be excellent research participants, and B) could ultimately benefit from advances of such research. A shared infrastructure could facilitate cost-effective multicenter research. This emerging network will provide synergies that combine: 1) skilled acade...

Objectives: This study examined the prevalence of suicidality and associations with pain characteristics (i.e., presence of usual pain/discomfort, pain intensity) among those with chronic pain conditions (i.e., arthritis, migraine, back pain). Methods: We analyzed data from the 2012 Canadian Community Health Survey-Mental Health supplement (N =...

The mental health impacts of the COVID-19 pandemic are gaining attention. While many are experiencing increased stress due to COVID-19, some perceive the pandemic as traumatic. This preliminary study identified respondents who endorsed a COVID-19-related trauma as their most stressful traumatic experience (i.e., index trauma). We analyzed data from...

Background: Individuals with immune-mediated inflammatory diseases, such as inflammatory bowel disease, multiple sclerosis and rheumatoid arthritis, are at increased risk for influenza and related complications. We examined and compared the uptake of influenza vaccination among people with and without these diseases, as well as the influence of ps...

Objective: The current study used the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS) to (1) examine the incidence and prevalence of mental disorders and (2) estimate the comorbidity of mental disorders over the follow-up period. Method: The CAFVMHS (2018) is a longitudinal study with two time points of assess...

Background Anxiety is common in patients with rheumatoid arthritis (RA) and associated with worse RA outcomes. This study assessed the feasibility and preliminary health impacts (mental and physical) of a non-therapist assisted, online mental health intervention targeting anxiety in this population. Methods Participants with confirmed RA and eleva...

Objective Childhood maltreatment is associated with pain catastrophizing. Both childhood maltreatment and pain catastrophizing are prevalent in certain immune-mediated inflammatory disease (IMID) populations. However, it is unknown whether childhood maltreatment contributes to the high rates of pain catastrophizing in IMID cohorts. We assessed the...

Objectives: Posttraumatic stress disorder (PTSD) is associated with various physical health conditions. However, it is unclear whether the relationship between PTSD and physical health conditions differs according to age. This study aims to examine the associations between PTSD and physical health conditions across four adult age categories. Method...

Objective This study examined baseline risk and protective predictors and interim correlates of the persistence/recurrence, remission, and onset of posttraumatic stress disorder (PTSD) in a 16-year prospective, nationally representative sample of Canadian Forces members and veterans. Methods The 2018 Canadian Armed Forces Members and Veterans Ment...

Objectives The coronavirus 2019 (COVID-19) pandemic has resulted in profound global impact, with older adults at greater risk of serious physical health outcomes. It is essential to also understand generational differences in psychosocial impacts to identify appropriate prevention and intervention targets. Across generational groups, this study exa...

Introduction A history of childhood maltreatment is associated with increased risk of perinatal complications, with research primarily focused on childhood sexual abuse. Limited research has examined the relationship between different types of childhood maltreatment on perinatal complications, particularly in population-based samples. Methods This...

The profession of clinical psychology employs scientific methods to enhance the understanding, identification, prevention, and treatment of mental health conditions and problems. One common methodological approach used in this respect is epidemiology. This chapter will provide an overview of the importance of epidemiology in clinical psychology, hi...

Background Inflammatory bowel disease (IBD) is associated with an increase in psychiatric comorbidity (PC) compared with the general population. We aimed to determine the impact of PC on health care utilization in persons with IBD. Methods We applied a validated administrative definition of IBD to identify all Manitobans with IBD from April 1, 200...

Objective Knowledge is limited regarding the longitudinal course and predictors of mental health problems, suicide, and physical health outcomes among military and veterans. Statistics Canada, in collaboration with researchers at the University of Manitoba and an international team, conducted the Canadian Armed Forces Members and Veterans Mental He...

Background: Mechanical ventilation to alter and improve respiratory gases is a fundamental feature of critical care and intraoperative anesthesia management. The range of inspired O2 and expired CO2 during patient management can significantly deviate from values in the healthy awake state. It has long been appreciated that hyperoxia can have delet...

Background Difficulties accessing surgical care (e.g., related to wait times, cancellations, cost, receiving a diagnosis) are understudied in Canada. Using population-based data, we studied difficulty accessing non-emergency surgical care, including (1) the incidence and annual changes in incidence, (2) types of difficulties, and (3) associated fac...

Background Little is known about the effects of changes in the presence or absence of psychiatric disorders on health care utilization in multiple sclerosis (MS). Objective To evaluate the association between “active” mood and anxiety disorders (MAD) and health care utilization in MS. Methods Using administrative data from Manitoba, Canada, we id...

Purpose: Worldwide, patients experience difficulties accessing elective surgical care. This study examined the perceived health, social, and functional impacts of elective surgical cancellations and postponements in Canada. Methods: We analyzed a subset of aggregate data from the Canadian Community Health Survey (CCHS) annual components from 200...

This chapter summarizes the current literature on post-traumatic stress disorder (PTSD) and chronic pain among military personnel in Canada, the United States, and the United Kingdom, including an overview of clinical features, prevalence, correlates, comorbidity, assessment, and intervention. PTSD and chronic pain are both prevalent among military...

Background: The COVID-19 pandemic has resulted in profound global impact with high rates of morbidity and mortality. It is essential to understand the psychosocial impacts of the pandemic to identify appropriate prevention and intervention targets. Across generational groups, this study examined: (1) rates of precautions and adaptive and maladaptiv...

Objectives Psychiatric comorbidity is frequent in rheumatoid arthritis (RA) and complicates treatment. We describe the impact of psychiatric comorbidity on health care use (utilization) in RA. Methods We accessed administrative health data (1984‐2016) and identified a prevalent cohort with diagnosed RA. RA cases (N=12984) were matched on age, sex...

Objective: To estimate incidence of newly diagnosed mental disorders among ICU patients. Design: Retrospective-matched cohort study using a population-based administrative database. Setting: Manitoba, Canada. Participants: A total of 49,439 ICU patients admitted between 2000 and 2012 were compared with two control groups (hospitalized: n = 1...

Criterion E2 (“reckless or self-destructive behavior”) was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/...

Background Trauma exposure is associated with adverse health-related correlates, including physical comorbidities, and is highly prevalent among public safety personnel (PSP). The current study (1) examined the association between context of index trauma exposure (part of job vs. other) and physical conditions and (2) established the prevalence of...

Objective: We investigated facets of posttraumatic growth (PTG) theory, including the nature of the index event, the relationship between suffering and PTG, and prosocial correlates of PTG. Methods: Undergraduate students (N = 253) completed measures of PTG and trauma-related, psychopathology/affect, and prosocial correlates. Results: Differences e...

Aims Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics a...

Objectives Chronic pain and generalized anxiety disorder (GAD) are co-occurring, and both conditions are independently associated with substance misuse. However, limited research has examined the impact of comorbid GAD and chronic pain on substance misuse. The aim of this article was to examine the associations between comorbid GAD and chronic pain...

We conducted a systematic review and a fixed-effects meta-analysis to determine whether incident adverse psychiatric events (APE) including depression, anxiety, psychosis, or suicide were associated with biologic therapy in IBD. Six randomized controlled trials and a cohort study met criteria, reporting an incidence of APE in 4,882 patients. The ri...

Objective: To evaluate the association between trauma exposure type, number and type of DSM-5 posttraumatic stress disorder (PTSD) symptoms, and binge eating symptoms. Methods: Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III: 2012-2013), which surveyed a nationally representative sample...

This study examined the association between post-traumatic growth (PTG), post-traumatic stress disorder (PTSD), and trauma-related factors in cardiac outpatients. Participants recruited from four cardiology clinics between November 2014 and July 2015 (N = 52, 69.2% men, Mage = 65 years) completed self-assessments of PTG and PTSD along with demograp...

In three studies, we examined how racial/ethnic majority (i.e., White) and non-Indigenous minority participants in Canada responded to reparations for Indigenous peoples in Canada. Our goal was to understand whether and why there may be intraminority solidarity in this context. In Study 1, with a large, national survey (N = 1,947), we examined the...

Background: Cannabis can be prescribed for posttraumatic stress disorder (PTSD) and chronic pain, and comorbid cannabis use disorder (CUD) can occur in both conditions. Research demonstrates that PTSD and chronic pain commonly co-occur. Methods: Data were acquired from the National Epidemiologic Survey on Alcohol and Related Conditions-III (N =...

Background: There is some evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium after non-cardiac surgery. There is limited evidence in this regard for cardiac surgery. A suppressed electroencephalogram pattern, occurring with deep anesthesia, is associated with increased incidence of postoperative...

Background: Generalized anxiety disorder (GAD) and chronic pain conditions commonly co-occur, and are both independently associated with suicidality; however, little is known about the impact of chronic pain on suicidality among individuals with GAD. The aim of this study was to examine the associations between comorbid GAD and chronic pain condit...

Posttraumatic stress disorder (PTSD) is commonly comorbid with a range of physical health conditions. The aim of this study was to examine the association between index trauma and PTSD symptom clusters with physical health conditions, among individuals with PTSD in a population-based sample. Data were analyzed from the 2012-2013 National Epidemiolo...

Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were s...

Objective To test the validity and reliability of screening instruments for depression and anxiety in rheumatoid arthritis (RA). Methods Participants with RA completed the Patient Health Questionnaire (PHQ‐2, PHQ‐9), Patient Reported Outcomes Measurement Information System Depression Short Form‐8a (PROMIS Depression) and Anxiety Short Form‐8a (PRO...

Objective: Trauma and post-traumatic stress disorder (PTSD) have been associated with a variety of physical conditions; however, their relationship with cancer is unclear. Methods: Using the cross-sectional 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309), we examined the association between trau...

Respiratory end-tidal (ET) gas control is fundamental to anaesthetic management. The range of ET O2 and CO2 during the conduct of anaesthesia can significantly deviate from values in the awake state. Recent work shows ET CO2 influences the incidence of perioperative neurocognitive disorder (POND). We examine the effects of controlled alterations in...

Background Inflammatory bowel disease (IBD) is associated with a high prevalence of comorbid depressive and anxiety disorders. A significant proportion of IBD patients with comorbid psychiatric disorders remain undiagnosed and untreated, but factors associated with diagnosis are unknown. We evaluated the prevalence of undiagnosed depression and anx...