This month's brainbuzz™ features new results from CAMH's longstanding Ontario Student Drug Use and Health Survey; research on how electroconvulsive therapy decreases the risk of suicide death; and information about the world’s first global summit on psychedelic medicine which will be co-hosted by CAMH later this month. Please reach out at any time if you have any questions or feedback.
Aristotle Voineskos VP Research, CAMH
Majority of Ontario students surveyed
report feeling depressed about the
future because of COVID 19
The COVID-19 pandemic has had a major impact on the mental health of Ontario students, with 59 per cent saying the pandemic has made them feel depressed about the future, and 39 per cent reporting it has made their mental health worse. About 18 per cent report they seriously contemplated suicide in the past year. This according to the latest Ontario Student Drug Use and Health Survey (OSDUHS) Report released today by the Centre for Addiction and Mental Health (CAMH).
The data were collected between March and June 2021 among 2,225 Ontario students in grades 7 to 12. The 2021 OSDUHS report contains some of
the most comprehensive provincial youth data available from during the pandemic, providing a snapshot of student mental health and substance use during a period of at-home learning.
"Ontario students were already reporting high levels of suicidal ideation, self-harm and psychological distress before COVID-19 emerged,” said Dr. Hayley Hamilton, Senior Scientist in CAMH's Institute for Mental Health Policy Research, and survey lead. “These data indicate that the added stresses of the pandemic—such as lockdowns and remote learning—have further negatively impacted the mental health of a large
proportion of students."
Overall, almost half of Ontario students (47 per cent) indicate moderate to severe levels of psychological distress, which refers to symptoms of anxiety and depression, in the past month. An added concern is the large number of students (42 per cent) with unmet mental health needs who say they wanted to seek help in the past year but did not know where to turn.
"The pandemic has acted as a double-edged sword, negatively impacting the mental health of students while exacerbating the gaps that already existed regarding equitable access to timely mental health supports," said Dr. Joanna Henderson, Director, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, and Executive Director, Youth Wellness Hubs Ontario. "Too many students are stuck on long wait lists, or are not getting the kind of help they need and deserve. We can’t wait until after the pandemic to address these issues. There is an urgent need to improve the system now, including continued investment from all levels of government.”
Remote learning
With Ontario schools switching to remote learning for months at a time over the course of the pandemic,
the survey asked for the first time about the impact of internet-based schooling on students’ mental health. One quarter of respondents (26 per cent) said they found remote learning “very difficult” or “extremely difficult.”
Climate change
The survey also asked students for the first time if concerns over climate change were affecting their mental health. Fifty per cent said that worries about climate change were making them feel depressed about the future.
“This is the time in life when people are often most optimistic, but these numbers reflect what I’m hearing from my young patients,” said CAMH youth
psychiatrist Dr. Amy Gajaria. “The growing worry about climate change, plus the pandemic layered on top, can foster a sense of general pessimism and depression about the future, especially for those young people who are already struggling with aspects of their daily life. These issues are very real to this cohort, and these worries about the future definitely impact their mental health in the present.”
Screen time, social media and gambling
Nearly one in three students (31 per cent) report spending five hours or more each day on social media sites. Just under one-quarter of students (24 per cent) play video games for five hours or more on a daily basis and one in five (20 per cent) meet the criteria for
a video gaming problem, including disruption to family and school life. Just under one-quarter of students (24 per cent) play video games for five hours or more on a daily basis and one in five (20 per cent) meet the criteria for a video gaming problem, including disruption to family and school life.
Just under one in seven students (15 per cent) report gambling with money online in the past year. This rate has more than tripled from 2019 when only four per cent of students said they gambled online.
Physical activity and body image
Only one in five students (21 per cent) are physically active on a daily basis
for at least 60 minutes, while more than four in five students (83 per cent) spend three hours or more every day on screens recreationally. Just under half of students (46 per cent) say they are constantly worried about their weight or body shape.
Positive trends
The 2021 OSDUHS report also indicates many positive trends in youth behaviour. Binge drinking is down significantly (8 per cent as compared to 15 per cent in 2019). E-cigarette use/vaping is also down significantly (15 percent as compared to 23 per cent prior to the pandemic). There is an increase in the number of students getting eight hours or more sleep on a school night (49 per cent up from 37 per cent). And while one quarter of students (24 per
cent) say their relationship with their parents or guardian has become a bit worse or a lot worse during the pandemic, more than one-third (35 per cent) say their relationship had become a bit or a lot better.
About OSDUHS
The Institute for Mental Health Policy Research at CAMH has conducted the Ontario Student Drug Use and Health Survey (OSDUHS) every two years since 1977. The OSDUHS is the longest-running ongoing school survey of adolescents in Canada, and one of the longest running
in the world. This report describes the 2021 results for physical indicators, mental health indicators, bullying, gambling and related problems, video gaming and related problems, and other risk behaviours among Ontario students. All data are based on self-reports derived from anonymous questionnaires completed online. The survey was administered by the Institute for Social Research (at York University) on CAMH’s behalf.
Electroconvulsive therapy reduces suicide
by 50 per cent in first year after hospitalization for depression
Electroconvulsive therapy (ECT) was associated with a 50 per cent reduction in risk for suicide among patients with depression in the year after their hospitalizations, according to a new CAMH- and ICES-led study of over 67,000 patients published in the journal Lancet Psychiatry.
It is the most convincing study to date that establishes a clear link between ECT and suicide prevention, and builds on a previous CAMH study using ICES patient data published in Lancet Psychiatry in July 2021 that established that ECT has a very safe medical side effect profile.
“ECT significantly reduced the risk of suicide death while also being a medically safe procedure,” said lead author Dr. Tyler Kaster, Medical Head of the Temerty Centre for Therapeutic Brain Intervention at CAMH. “These
findings suggest that ECT can prevent suicide in severe depression and potentially be a life-saving procedure.”
Researchers have been challenged with finding answers to the important question of how to measure the impact of ECT on suicide prevention, since to study this in a clinical trial would be next to impossible. Suicide is an extremely rare event, so tens of thousands of patients would need to be enrolled in such a trial. This study used ten years of Ontario patient hospitalization data housed at ICES, including the Ontario Mental Health Reporting System that provides an unprecedented level of detail regarding the social, demographic and clinical characteristics of patients hospitalized for mental health problems in Ontario. These datasets enabled the researchers to identify patients with depression who received ECT as well as
patients with very similar characteristics who did not receive ECT – and then look forward to compare the two groups on their risk for suicide in the year after hospitalization.
Among the 67,000 patients hospitalized for depression during the ten-year study period, just under 9 per cent received ECT while the other 91 per cent did not. According to the authors, the reasons patients do not receive ECT is fear about the procedure, lack of access to treatment, or ECT not being presented as an option by the clinical team.
“I think within our own healthcare system in Ontario, the rest of Canada and globally, this study should reinforce the importance of ensuring access to ECT for inpatients admitted with severe depression because it can save lives,” said study corresponding author Dr. Daniel Blumberger, Director of the Temerty Centre and Co-Chief of the General Adult Psychiatry and Health Systems Division at CAMH. “But during the pandemic, in part because of the backlog of cancelled surgeries, access to ECT has been reduced. One of the important messages of this study is that we need to ensure there is access to ECT
for all patients hospitalized with severe depression.”
Over the study period, patients who received ECT had 50 per cent fewer suicides in the year after their hospitalization than those who did not receive ECT and death from any cause in the first year after hospital release was reduced 25 per cent.
The authors state that the primary purpose of the study was to determine the benefits of ECT with respect to suicide, so that clinicians and patients could better understand the value of the treatment.
“Providers and patients express much uncertainty about whether to undertake a course of ECT treatment,” said Dr. Simone Vigod, study co-author, senior adjunct scientist at ICES and Head of the Department of Psychiatry at Women’s College Hospital in Toronto. “Some of this relates to misconceptions about what ECT is, and when it should be used. Some of it relates to ongoing uncertainty about the potential benefits and risks. We wanted to generate data that is useful for patients and providers in decision-making about ECT. Combined with the previous work on its medical safety, the current work showing that people with severe depression who receive ECT are at substantially lower risk for suicide over the year following discharge than similar people with severe depression who do not receive ECT should provide quite a bit of reassurance for patients and
providers. We hope physicians will take notice and consider this evidence with their patients that have severe depression.”
Shelley Roberts was one patient with treatment-resistant depression who chose ECT. As a young mother she was worried about the potential memory loss associated with ECT, but in the end felt that she had to do it.
“I didn’t want to lose any memories of my son growing up, but I was afraid that if I didn’t do anything he wouldn’t have a mother anymore,” said Roberts. “I wouldn’t be alive today if not for ECT.”
In Canada, over 1 in 9 adults (3.2 million Canadians or 11.3 per cent) will experience major depression in their lifetime, at which time they will most likely
be prescribed antidepressants and/or psychotherapy. However, about a third of these individuals will fail to respond to these first-line treatments, and then will be diagnosed with treatment-resistant depression. There are a number of interventions for this condition including medication combinations, new drugs like ketamine and a neurostimulation treatment called repetitive transcranial magnetic stimulation (rTMS). However, when these treatments don’t lead to improvement or when a depression becomes very severe leading to hospitalization, ECT is often considered as the next step, as it is highly effective at rapidly reducing symptoms of depression and suicidal thinking. Learn more about ECT.
CAMH’s Temerty Centre for Therapeutic Brain Intervention is one of the world’s leading centres in brain stimulation treatment, research and training. Through clinical research projects, the Temerty Centre is driving treatment advances using repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and ECT.
From Research to Reality: Global Summit on Psychedelic-Assisted Therapies and Medicine
Bringing together policymakers, researchers and clinicians from around the world to discuss the state of research on psychedelic therapies and its translation to policy and practice.
It will focus on high-quality scholarship that reflects diverse ways of knowing, including panels on pathways to the regulation of psychedelic substances and on the intersection of science and spirituality, among other topics.
Featured speakers include:
David Nutt, PhD — Edmond J. Safra Chair in Neuropsychopharmacology and deputy head of the Centre for Psychedelic Research at the Imperial College London, Editor of the Journal of Psychopharmacology, and president of the European Brain Council
Anja
Loizaga-Velder, PhD — Director of Research and Psychotherapy at the Nierika Institute for Intercultural Medicine in Mexico
Matthew W. Johnson, PhD — Professor and Associate Director for the Center for Psychedelics & Consciousness Research at Johns Hopkins University
Monnica Williams, PhD — Associate Professor in the School of Psychology at the University of Ottawa, Canada Research Chair in Mental Health Disparities, and Director of the Laboratory for Culture and Mental Health Disparities
Joe Tafur, MD — Integrative Family Physician at the Ocotillo Center for Integrative Medicine in Phoenix, Arizona, curandero, speaker and author of Fellowship of the
River exploring role of spiritual healing in modern healthcare
The evening of Saturday, May 28 will feature a special in-person and virtual public event entitled Psychedelic-Assisted Therapy - Facts & Fictionfeaturing some of the world’s top researchers and advocates in the field of psychedelic-assisted therapies and medicine. Accessible to anyone curious about psychedelics for the treatment of mental health and addictions, this exciting panel discussion will cover the latest research in the field, opportunities in the psychedelics industry, Indigenous and cultural
perspectives and much more.
A recently published CAMH-led study in the Addiction Journal, investigated how alcohol use, an important risk factor for suicide, may be contributing to the accelerated rate of increase in the suicide mortality rate among women in the US, compared to men. https://twitter.com/CAMHResearch/status/1522291142825496576?cxt=HHwWgMCyzdPuoaAqAAAA
Congratulations to Dr. Aristotle Voineskos who was awarded the 2022 A.E. Bennett Award for Clinical/Translational Research at the recent Society of Biological Psychiatry Annual Meeting. The award recognizes superb international research in biological psychiatry by young investigators. https://twitter.com/CAMHResearch/status/1522671240833638401?cxt=HHwWgoC9uaLbzqEqAAAA
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