Christopher M. Perlman’s research while affiliated with University of Waterloo and other places

The objectives of this study were to characterize 24-month trajectories of psychopathology, validate psychopathology groups, and identify youth, parent, family, and neighbourhood characteristics associated with each identified trajectory in a sample of youth with chronic physical illness (CPI). Data come from a longitudinal study of 263 youth aged 2–16 years diagnosed with CPI and their parents. Participants were recruited from outpatient clinics at a pediatric hospital in Canada and assessed at recruitment (baseline), 6, 12, and 24 months. Parents reported on youth psychopathology using the Emotional Behavioural Scales. Latent class growth analysis was used to identify trajectories of psychopathology. Baseline predictors of trajectory group membership were investigated using multinomial logistic regression. Three distinct psychopathology trajectories best fit the data; the model had a BIC of -3579.70 and average posterior probabilities of 0.97. The trajectories were classified as, low-stable (LS: n = 156, 58%), moderate-decreasing (MD: n = 85, 34%), and high-decreasing (HD: n = 21, 8%). Youth who were older [HD: OR = 1.33 (1.05, 1.69)], had higher disability scores [HD: OR = 1.31 (1.19, 1.45) and MD: OR = 1.14 (1.08, 1.21)], had parents with greater psychological distress scores [HD: OR = 1.11 (1.05, 1.18) and MD: OR = 1.04 (1.01, 1.07)], and came from households with higher incomes [HD: OR = 4.67 (1.06, 20.67)] were associated with higher psychopathology trajectories compared to LS. Parent-reported youth psychopathology was generally low over 24 months, though over one-third had symptoms that reflected borderline clinical psychopathology. Predictors for group membership could help identify at-risk youth with CPI early for psychopathology.

Purpose To estimate six-month prevalence of child mental health service contacts and quantify associations between child health status and mental health service contacts, including number of types of contacts. Methods Data come from 6,242 children aged 4–17 years in the Ontario Child Health Study. A list of chronic conditions developed by Statistics Canada measured physical illness. The Emotional Behavioural Scales assessed mental illness. Child health status was categorized as healthy, physical illness only, mental illness only, and multimorbid (≥ 1 physical and ≥ 1 mental illness). Mental health service contact was aggregated to general medicine, urgent medicine, specialized mental health, school-based, alternative, and any contact (≥ 1 of the aforementioned contacts). Regression models quantified associations between health status and type of mental health contact, including number of types of contacts. Results Weighted prevalence estimates showed 261,739 (21.4%) children had mental health-related service contact, with school-based services being the most common contact amongst all children, regardless of health status. Children with multimorbidity had higher odds for every mental health contact than healthy controls (OR range: 4.00-6.70). A dose-response was observed, such that the number of contacts increased from physical illness only (OR = 1.49, CI: 1.10–1.99) to mental illness only (OR = 3.39, CI: 2.59–4.44) to multimorbidity (OR = 4.13, CI: 2.78–6.15). Conclusion Over one-fifth of children had mental health-related service contact and contacts were highest among children with multimorbidity. Types of mental health contacts for children with multimorbidity are diverse, with further research needed to elucidate the barriers and facilitators of mental health use.

This study investigated whether child psychopathology trajectories mediate the association between parent psychological distress/family functioning and mental health service use (MHSU) among children with a chronic physical illness (CPI). Data come from a longitudinal study of 263 children and youth aged 2–16 years diagnosed with a CPI and their parents assessed at baseline, six, 12, and 24 months. Parent psychological distress was measured by creating a composite score from the Centre for Epidemiological Studies Depression scale and Generalized Anxiety Disorder-7 scale, and family functioning was measured using the McMaster Family Assessment Device. Previous work identified three trajectories of psychopathology among children: low-stable, moderate-stable, and high-decreasing. Path analysis was used to estimate potential mediating effects. A significant indirect effect of parent psychological distress on healthcare professional contact through child psychopathology was found ($\:\beta\:=$ 0.001(0.001), p = 0.021). The indirect effect of family functioning was not significant ($\:\beta\:=$ − 0.001(0.001), p = 0.155). Addressing parent mental health may reduce child psychopathology and potentially decrease MHSU in children with CPI. Understanding these pathways is needed to develop family-centred interventions that support mental health in children with CPI and their parents.

Psychological trauma is a prevalent mental health concern, with most individuals experiencing at least one traumatic event in their lifetime. Early leaves from inpatient settings are a pertinent challenge among persons who have experienced trauma and may reflect unmet care needs. This study examined patterns of early leaves among persons with trauma from inpatient care in Ontario, Canada. All records for individuals who have experienced trauma with an index admission of over 72 h between January 1, 2015 and December 31, 2019 were included (N = 11,043). Logistic regression using generalized equation estimation was used to assess the association between demographic and clinical characteristics, substance use, social relationships, staff dynamics, and control interventions with the outcome of early leaves. In the final model, alcohol (OR: 1.83, 95% CI: 1.27–2.64), other substances (OR: 2.15, 95% CI: 1.34–3.46), and poly substance use (OR: 2.46, 95% CI: 1.82–3.31) all increased the odds of early leaves after considering possible facility effects, and after adjusting for other demographic and clinical factors. Being older, employed, and having mood disorders reduced odds of early leaves. Early leaves are important within treatment planning, particularly in relation to addressing complex traumas. While challenges related to substance use may be driving some of the early leaves, there may also be challenges to providing complex care within acute mental health settings. Further exploration of policies and practices to prevent early leaves are necessary, including the potential need for longer-term specialized treatment programs.

Background Inpatient psychiatry is a critical service in a community-based care system for persons with serious mental illness (SMI). Currently, there are few generally accepted or widely used outcomes to assess the effectiveness of inpatient treatment. Method Following a Donabedian Model of Health Care Quality, we utilized eight scales from the RAI Mental Health assessment to derive a clinician-scored outcome measure consisting of 4 domains (Psychosis, Depression, Impairment, and Aggression). We combined subscales measuring these domains into a Composite Measure. We used this measure to assess the entire population (N=719) of our large specialized mental health hospital at the beginning (T1) and end (T2) of three months in the hospital (or admission to discharge in shorter stays). We evaluated the content validity of the measure by comparing items and scales with a list of putative contributors to hospital admission (symptoms and complications). To evaluate concurrent validity, we compared mean scores among hospital units with varying lengths of stay and clinical complexity (acute versus chronic versus complex chronic). We used ROC analysis to evaluate the CIIMHS’s ability to predict discharge from the hospital. To evaluate construct validity, we examined the measure’s responsiveness to changes among patients after treatment in the hospital. Results We found strong evidence for all four kinds of validity. Conclusions The composite measure represents a valid measure of inpatient mental health status and will serve as a valuable measure of the quality of care for inpatient psychiatry.

Introduction This study explores the attitudes of psychologists towards psychedelics and psychedelic‐assisted therapy (PAT) following the world‐first regulatory changes in 2023 in Australia which permitted psilocybin and 3,4‐methylenedioxy‐methamphetamine (MDMA) to be used in clinical services. Methods A purposive sample of 20 Australian psychologists was recruited using snowball sampling. Semi‐structured interviews were conducted which explored participants' attitudes, knowledge and concerns about PAT. Data were coded and analysed to identify and develop theme categories. Results Most psychologists exhibited positive attitudes towards psychedelics and their therapeutic potential, viewing them as promising for addressing chronic mental health conditions like depression. However, there was a notable concern regarding the limited evidence on efficacy and potential adverse experiences, as well as the complexity of the individualised treatment protocol. Despite enthusiasm, many psychologists had limited detailed knowledge about the interventions themselves. The need for comprehensive education and training programs, including exposure to psychedelic experiences and credible higher education institutions, was emphasised to ensure competence in administering PAT. Discussion and Conclusions Psychologists displayed notably positive attitudes towards PAT, likely reflecting both shifting perceptions of psychedelics and self‐selection bias within the sample. Despite this optimism, concerns were raised about psychiatric risks and the necessity for comprehensive and reputable training and supervision. The cohort showed openness to both novel treatments and innovative training methods, underscoring the importance of enhancing educational frameworks to ensure effective implementation of PAT.

Objective This epidemiological study estimated the lifetime prevalence of chronic physical illness (i.e., an illness that lasted or was expected to last ≥6 months) and 6-month prevalence of mental disorder and multimorbidity (i.e., ≥1 physical illness and ≥1 mental disorder) in youth. Associations between physical illness and mental disorder were quantified, including the number of illnesses. Secondary objectives examined factors associated with mental disorder, after controlling for physical illness. Methods Data come from 10,303 youth aged 4–17 years in the 2014 Ontario Child Health Study (OCHS). Physical illness was measured using a list of chronic conditions developed by Statistics Canada. Mental disorders were measured using the OCHS Emotional Behavioural Scales. The Health Utility Index Mark III assessed overall functional health. Results Weighted prevalence estimates showed 550,090 (27.8%) youth had physical illness, 291,986 (14.8%) had mental disorder, and 108,435 (5.4%) had multimorbidity. Physical illness was not associated with mental disorder. However, youth with 2 physical illnesses, as compared to no physical illnesses, had increased odds of having any mental (OR = 1.75 [1.08, 2.85]), mood (OR = 2.50 [1.39, 4.48]) and anxiety disorders (OR = 2.40 [1.33, 4.31]). Mean functional health scores demonstrated a dose–response association across health status categories, with the highest scores among healthy youth and the lowest scores among multimorbid youth (all p < .05). Conclusion Chronic physical illness and mental disorders are prevalent in youth. Youths with 2 physical illnesses have a higher likelihood of mental disorders. Higher functional health scores protected against all mental disorders. Mental health interventions for youth should promote strong overall functional health.

Context The COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust. Methods We conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively). Findings We present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations. Conclusions This global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes.