Browsing by Author "Arnold, Paul D."

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    A protocol for the formative evaluation of the implementation of patient-reported outcome measures in child and adolescent mental health services as part of a learning health system
    (2024-07-15) McCabe, Erin; Dyson, Michele; McNeil, Deborah; Hindmarch, Whitney; Ortega, Iliana; Arnold, Paul D.; Dimitropoulos, Gina; Clements, Ryan; Santana, Maria J.; Zwicker, Jennifer D.
    Abstract Background Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care. Methods This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre’s services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals’ experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre’s operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres’ population. Discussion The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings.
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    Effects of Candidate Genes and Polygenic Risk on the Development of Depression in Youth Experiencing Peer Victimization
    (2024-10-16) Kim, Min Jae; Arnold, Paul D.; Bousman, Chad A.; Long, Quan
    Background: Peer victimization is a common form of childhood adversity, where children who have experienced victimization have an increased susceptibility to various psychiatric disorders including depression. However, environmental influences have varying degrees of effect between individuals, and therefore our study focused on how genetic predisposition in conjunction with environmental factors interacts to confer risk for depression. Gene by environment (G x E) interaction studies with a focus on candidate genes and polygenic risk scores (PRS-depression) have been conducted in the past for depression, but with inconsistent findings. Testing both candidate genes and PRS, and their interaction with environmental factors, may be a promising approach for understanding the complex aetiology of depression. Methods: Longitudinal data from the McMaster Teen Study have been obtained, where students initially assessed from age 10 (Grade 5) were followed to age 26 (n=875). A computer-based self-reported questionnaire was used to obtain participants’ peer victimization experience and depressive symptoms from age 10 to 26, along with their genotype data. Dopamine transporter gene (DAT1/SLC6A3), monoamine oxidase A gene (MAOA), and the serotonin transporter gene (SLC6A4) were selected for candidate gene analysis. Depression-PRS was calculated using the genome-wide metaanalysis of depression by Howard et al. (2019). Results: Peer victimization was significantly associated with depressive symptoms in adolescence (p < 0.05). Candidate gene polymorphisms and depression-PRS were not significantly associated with depressive symptoms (p > 0.05). Furthermore, there were no significant candidate gene by peer victimization and PRS-depression by peer victimization interactions associated with depressive symptoms. Conclusion: Through our study, findings suggest that exposure to peer victimization experience was independently associated with an increased risk of depressive symptoms in adolescence. Both candidate genetic variants and polygenic risk scores did not have a significant main effect on depression risk. Lastly, neither candidate gene risk nor polygenic risk of study participants were significantly associated with depression following peer victimization experiences. Future studies will greatly enhance our knowledge on how genetic risk plays a potential role in explaining individual differences in the development of depression following adverse environmental exposures, including peer victimization. Keywords: Peer victimization, depression, candidate gene, polygenic risk score, gene by environment interaction, adolescence
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    The genetic architecture of youth anxiety: a study protocol
    (2024-02-23) McAusland, Laina; Burton, Christie L.; Bagnell, Alexa; Boylan, Khrista; Hatchard, Taylor; Lingley-Pottie, Patricia; Al Maruf, Abdullah; McGrath, Patrick; Newton, Amanda S.; Rowa, Karen; Schachar, Russell J.; Shaheen, S-M; Stewart, Sam; Arnold, Paul D.; Crosbie, Jennifer; Mattheisen, Manuel; Soreni, Noam; Stewart, S. E.; Meier, Sandra
    Abstract Background Anxiety disorders are the most common psychiatric problems among Canadian youth and typically have an onset in childhood or adolescence. They are characterized by high rates of relapse and chronicity, often resulting in substantial impairment across the lifespan. Genetic factors play an important role in the vulnerability toward anxiety disorders. However, genetic contribution to anxiety in youth is not well understood and can change across developmental stages. Large-scale genetic studies of youth are needed with detailed assessments of symptoms of anxiety disorders and their major comorbidities to inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. Methods The Genetic Architecture of Youth Anxiety (GAYA) study is a Pan-Canadian effort of clinical and genetic experts with specific recruitment sites in Calgary, Halifax, Hamilton, Toronto, and Vancouver. Youth aged 10–19 (n = 13,000) will be recruited from both clinical and community settings and will provide saliva samples, complete online questionnaires on demographics, symptoms of mental health concerns, and behavioural inhibition, and complete neurocognitive tasks. A subset of youth will be offered access to a self-managed Internet-based cognitive behavioral therapy resource. Analyses will focus on the identification of novel genetic risk loci for anxiety disorders in youth and assess how much of the genetic risk for anxiety disorders is unique or shared across the life span. Discussion Results will substantially inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. Given that the GAYA study will be the biggest genomic study of anxiety disorders in youth in Canada, this project will further foster collaborations nationally and across the world.