Browsing by Author "Dimitropoulos, Gina"

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    A Phenomenological Study on the Experience of Composing Rap Lyrics among ‘at-risk’ Youth
    (2017) Young, Amber; Nicholas, David; Benzies, Karen; Dimitropoulos, Gina
    Existing literature exploring the integration of Hip Hop in therapeutic contexts predominately focuses on utilizing the music in a receptive fashion, while a limited amount of literature has explored active techniques (i.e., lyric composition). Utilizing a qualitative phenomenological method, this study explored the experience of composing Hip Hop lyrics of young people who have been labelled ‘at risk’ (N=5). From the participant interviews emerged seven categories related to the experience of composing Hip Hop: (a) Hip Hop as a constant in one’s life, (b) Descriptions of the composing process, (c) Hip Hop song composition is therapeutic, (d) Hip Hop supports expression, (e) Remixing the story: Constructing and living the story we tell of ourselves, (f) Acts of resistance: ‘Each one, teach one’, and (g) Delivery of content: Messages within messages. The findings are discussed in relation to existing literature and implications are offered for the clinical social work context.
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    Adapting and adopting highly specialized pediatric eating disorder treatment to virtual care: a protocol for an implementation study in the COVID-19 context
    (2021-04-08) Couturier, Jennifer; Pellegrini, Danielle; Miller, Catherine; Agar, Paul; Webb, Cheryl; Anderson, Kristen; Barwick, Melanie; Dimitropoulos, Gina; Findlay, Sheri; Kimber, Melissa; McVey, Gail; Lock, James
    Abstract Background The COVID-19 pandemic has negatively impacted individuals with eating disorders; resulting in increased symptoms, as well as feelings of isolation and anxiety. To conform with social distancing requirements, outpatient eating disorder treatment in Canada is being delivered virtually, but a lack of direction surrounding this change creates challenges for practitioners, patients, and families. As a result, there is an urgent need to not only adapt evidence-based care, including family-based treatment (FBT), to virtual formats, but to study its implementation in eating disorder programs. We propose to study the initial adaptation and adoption of virtual family-based treatment (vFBT) with the ultimate goal of improving access to services for youth with eating disorders. Methods We will use a multi-site case study with a mixed method pre/post design to examine the impact of our implementation approach across four pediatric eating disorder programs. We will develop implementation teams at each site (consisting of therapists, medical practitioners, and program administrators), provide a remote training workshop on vFBT, and offer ongoing consultation during the initial implementation phase. Therapists will submit videorecordings of their first four vFBT sessions. We propose to study our implementation approach by examining (1) whether the key components of standard FBT are maintained in virtual delivery measured by therapist self-report, (2) fidelity to our vFBT model measured by expert fidelity rating of submitted videorecordings of the first four sessions of vFBT, (3) team and patient/family experiences with vFBT assessed with qualitative interviews, and (4) patient outcomes measured by weight and binge/purge frequency reported by therapists. Discussion To our knowledge, this is the first study to evaluate an implementation strategy for virtually delivered FBT for eating disorders. Challenges to date include confirming site participation and obtaining ethics approval at all locations. This research is imperative to inform the delivery of vFBT in the COVID-19 context. It also has implications for delivery in a post-pandemic era where virtual services may be preferable to patients and families living in remote locations, where access to specialized services is extremely limited. Trial registration ClinicalTrials.gov NCT04678843 , registered on December 21, 2020.
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    An exploratory study of challenges and successes in implementing adapted family-based treatment in a community setting
    (2018-12-03) Astrachan-Fletcher, Ellen; Accurso, Erin C; Rossman, Setareh; McClanahan, Susan F; Dimitropoulos, Gina; Le Grange, Daniel
    Abstract Although family-based treatment (FBT) is accepted as the first-line treatment for adolescent anorexia nervosa, studies show that it is infrequently used by clinicians in community settings. To elucidate some of the barriers to implementing this evidence-based treatment, mixed (quantitative and qualitative) methods were used in this exploratory study to examine therapist experiences with FBT. Twelve clinicians (N = 12) at a community treatment center retrospectively reported on their experiences with FBT training and supervision in FBT. A subset of clinicians (n = 7) additionally completed a structured interview about their experiences in using FBT. Results demonstrate that therapists endorsed certain common misconceptions about FBT prior to training, but that negative beliefs about FBT decreased after its implementation in their setting. These findings suggest that increased education about evidence-based treatments may diminish negative stereotypes about such treatments, which may ultimately increase their uptake in community settings. Sustainability of FBT is discussed in the context of how this community setting incorporated FBT principles into their ongoing clinical practice.
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    Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study
    (2023-10-18) Bhattarai, Asmita; Dimitropoulos, Gina; Bulloch, Andrew G.; Tough, Suzanne C.; Patten, Scott B.
    Abstract Background The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors. Methods The study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994–2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035). Results During the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM. Conclusion The findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.
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    Can the adverse childhood experiences (ACEs) checklist be utilized to predict emergency department visits among children and adolescents?
    (2021-09-25) Bhattarai, Asmita; Dimitropoulos, Gina; Marriott, Brian; Paget, Jaime; Bulloch, Andrew G. M.; Tough, Suzanne C.; Patten, Scott B.
    Abstract Background Extensive literature has shown an association of Adverse Childhood Experiences (ACEs) with adverse health outcomes; however, its ability to predict events or stratify risks is less known. Individuals with mental illness and ACE exposure have been shown to visit emergency departments (ED) more often than those in the general population. This study thus examined the ability of the ACEs checklist to predict ED visits within the subsequent year among children and adolescents presenting to mental health clinics with pre-existing mental health issues. Methods The study analyzed linked data (n = 6100) from two databases provided by Alberta Health Services (AHS). The Regional Access and Intake System (RAIS 2016–2018) database provided data on the predictors (ACE items, age, sex, residence, mental health program type, and primary diagnosis) regarding children and adolescents (aged 0–17 years) accessing addiction and mental health services within Calgary Zone, and the National Ambulatory Care Reporting System (NACRS 2016–2019) database provided data on ED visits. A 25% random sample of the data was reserved for validation purposes. Two Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression models, each employing a different method to tune the shrinkage parameter lambda (namely cross-validated and adaptive) and performing 10-fold cross-validation for a set of 100 lambdas in each model were examined. Results The adaptive LASSO model had a slightly better fit in the validation dataset than the cross-validated model; however, it still demonstrated poor discrimination (AUC 0.60, sensitivity 37.8%, PPV 49.6%) and poor calibration (over-triaged in low-risk and under-triaged in high-risk subgroups). The model’s poor performance was evident from an out-of-sample deviance ratio of − 0.044. Conclusion The ACEs checklist did not perform well in predicting ED visits among children and adolescents with existing mental health concerns. The diverse causes of ED visits may have hindered accurate predictions, requiring more advanced statistical procedures. Future studies exploring other machine learning approaches and including a more extensive set of childhood adversities and other important predictors may produce better predictions. Furthermore, despite highly significant associations being observed, ACEs may not be deterministic in predicting health-related events at the individual level, such as general ED use.
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    Canadian practice guidelines for the treatment of children and adolescents with eating disorders
    (2020-02-01) Couturier, Jennifer; Isserlin, Leanna; Norris, Mark; Spettigue, Wendy; Brouwers, Melissa; Kimber, Melissa; McVey, Gail; Webb, Cheryl; Findlay, Sheri; Bhatnagar, Neera; Snelgrove, Natasha; Ritsma, Amanda; Preskow, Wendy; Miller, Catherine; Coelho, Jennifer; Boachie, Ahmed; Steinegger, Cathleen; Loewen, Rachel; Loewen, Techiya; Waite, Elizabeth; Ford, Catherine; Bourret, Kerry; Gusella, Joanne; Geller, Josie; LaFrance, Adele; LeClerc, Anick; Scarborough, Jennifer; Grewal, Seena; Jericho, Monique; Dimitropoulos, Gina; Pilon, David
    Abstract Objectives Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. Methods Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. Results Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. Conclusions Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
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    Coming into Focus: Parents’ Experiences of Discovering their Child has Anorexia Nervosa
    (2019-06-05) Williams, Emily Pauline; Russell-Mayhew, Shelly K.; Dimitropoulos, Gina; Moules, Nancy J.‏
    After witnessing from both up close and afar how different families can respond to learning that their child is sick, and most likely has an eating disorder, I became deeply curious about the nuances in these parents’ reactions. I wondered about why some parents take fast action in helping their children, while others seem complacent or hesitant to recognize or admit that anything troublesome is happening. These curiosities propelled me into this research, where I sought to better understand how parents discover that their child has anorexia nervosa. My aim for this philosophical hermeneutic inquiry was to speak to parents who had discovered that their child was or had been experiencing anorexia nervosa. I interviewed 12 parents, making up nine families with a child with anorexia nervosa and asked about their discovery experiences. Findings from interviews and analysis revealed that discovering one’s child has/had anorexia nervosa was incredibly complex. Parents’ experiences illustrated that they were fractured by the discovery and by the illness, questioning their competencies and actions as parents. It was evident that the discovery was a continuous, ambiguous process, and at times information was both revealed and concealed from parents. Finally, interviews exposed the unspeakable nature of anorexia nervosa, and ways parents coped with the devastating impacts that anorexia nervosa had on their child, their family, and themselves. I conclude with implications for both research and clinical practice, where I make a case for greater supports being made available for parents during these chaotic and ambiguous times. Every parent that I interviewed shared that they felt left in the dark, without basic information regarding their child’s current status and possible prognosis. Parents felt unsure of how their lives had and were about to change, understandably, feeling enormous pressures and confusion as to how to support and care for their child with anorexia nervosa. While the child with anorexia nervosa is the fundamental focus, parents are worthy and in fact desperate for special attention as well.
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    Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review
    (2017-09-22) Kimber, Melissa; McTavish, Jill R; Couturier, Jennifer; Boven, Alison; Gill, Sana; Dimitropoulos, Gina; MacMillan, Harriet L
    Abstract Background Child maltreatment and eating disorders are significant public health problems. Yet, to date, research has focused on the role of child physical and sexual abuse in eating-related pathology. This is despite the fact that globally, exposure to emotional abuse, emotional neglect and intimate partner violence are the three of the most common forms of child maltreatment. The objective of the present study is to systematically identify and critically review the literature examining the association between child emotional abuse (EA), emotional neglect (EN), and exposure to intimate partner violence (IPV) and adult eating-disordered behavior and eating disorders. Methods A systematic search was conducted of five electronic databases: Medline, Embase, PsycINFO, CINAHL, and ERIC up to October 2015 to identify original research studies that investigated the association between EA, EN and children’s exposure to IPV, with adult eating disorders or eating-disordered behavior using a quantitative research design. Database searches were complemented with forward and backward citation chaining. Studies were critically appraised using the Quality in Prognosis Studies (QUIPS) tool. Results A total of 5556 publications were screened for this review resulting in twenty-three articles included in the present synthesis. These studies focused predominantly on EA and EN, with a minority examining the role of child exposure to IPV in adult eating-related pathology. Prevalence of EA and EN ranged from 21.0% to 66.0%, respectively. No prevalence information was provided in relation to child exposure to IPV. Samples included predominantly White women. The methodological quality of the available literature is generally low. Currently, the available literature precludes the possibility of determining the extent to which EA, EN or child exposure to IPV have independent explanatory influence in adult eating-related pathology above what has been identified for physical and sexual abuse. Conclusions While a large proportion of adults with eating disorders or eating-disordered behavior report EA, EN, or child exposure to IPV , there is a paucity of high-quality evidence about these relationships.
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    Correction: A qualitative evaluation of team and family perceptions of family-based treatment delivered by videoconferencing (FBT-V) for adolescent Anorexia Nervosa during the COVID-19 pandemic
    (2022-12-08) Couturier, Jennifer; Pellegrini, Danielle; Grennan, Laura; Nicula, Maria; Miller, Catherine; Agar, Paul; Webb, Cheryl; Anderson, Kristen; Barwick, Melanie; Dimitropoulos, Gina; Findlay, Sheri; Kimber, Melissa; McVey, Gail; Paularinne, Rob; Nelson, Aylee; DeGagne, Karen; Bourret, Kerry; Restall, Shelley; Rosner, Jodi; Hewitt-McVicker, Kim; Pereira, Jessica; McLeod, Martha; Shipley, Caitlin; Miller, Sherri; Boachie, Ahmed; Engelberg, Marla; Martin, Samantha; Holmes-Haronitis, Jennifer; Lock, James
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    Developing a provincial patient support network for children and families affected by Tourette syndrome and/or obsessive–compulsive disorder: results of a stakeholder consultation
    (2021-06-16) Fletcher, Julian; Dimitropoulos, Gina; Martino, Davide; Wilcox, Gabrielle; MacMaster, Frank; Arnold, Paul; Pringsheim, Tamara
    Abstract Background Tourette syndrome and OCD are disorders that frequently occur in children and cause a high level of disability. In Alberta there is a huge delivery gap in providing healthcare services for children with TS and OCD. A stakeholder consultation was performed to ascertain how service delivery could be improved across the province and to inform the development of a provincial information and support organization, the Tourette OCD Alberta Network. Methods A mixed-methods study was employed: 10 parents were recruited for interview and 140 parents responded to a survey. Results Qualitative data showed there was often an absence of a clear pathway to access healthcare for people with TS and OCD. The negative impact of not receiving treatment, information, and resources in a timely and prompt manner was also revealed. Good clinical practice existed across the province but too often it was hindered by a shortage of knowledge about TS and OCD. In schools, learning for students with TS and OCD was also impaired by educators’ lack of knowledge and preparedness in relation to the disorders. Conclusions This study identified ways that challenges with healthcare access, school learning, and seeking information can be overcome. Skills-based training webinars, educational outreach in schools, and peer support were recognized as actions for improving healthcare outcomes for people with TS and OCD. The aim of the Tourette OCD Alberta Network is to provide services and support that directly address the healthcare service delivery shortfalls shown in this study.
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    Development of the Strengths, Skills, and Goals Matrix: a tool for facilitating strengths-based adolescent and young adult engagement in research
    (2023-10-04) Allemang, Brooke; Patton, Megan; Greer, Katelyn; Pintson, Karina; Farias, Marcela; Schofield, Keighley; Samuel, Susan; Patten, Scott B.; Sitter, Kathleen C.; Dimitropoulos, Gina
    Abstract Background The involvement of adolescents and young adults (AYAs) with lived experience of health and mental health conditions as partners in research is increasing given the prominence of participatory approaches to research, including patient-oriented research (POR). Much of the relevant research is conducted by graduate students. While guiding AYA engagement frameworks and models exist, the processes of partnering with AYAs in patient-oriented graduate-level research projects have not been well established. Co-developed tools and practices are required to support strengths-based, developmentally appropriate AYA-graduate student partnerships. Objectives The objectives of this commentary are: (1) to share the processes of partnership between a graduate student and five Young Adult Research Partners (YARP), (2) to describe the co-design and implementation of the Strengths, Skills, and Goals Matrix (SSGM), a tool for facilitating strengths-based AYA engagement in research, and (3) to outline considerations for applying this tool across a variety of research contexts with patient partners. Main body Within the YARP-graduate student partnership, the SSGM offered extensive benefits, including tangible skill development, peer mentorship, and rapport building among all members. This tool offers strategies for strengths-based engagement practices which emphasize AYAs’ preferences and goals throughout POR projects. Practical recommendations and considerations for applying the SSGM within graduate-level research and beyond are described, including the importance of connecting AYAs’ current (and desired) skills to specific tasks within the research project and resulting outputs. Conclusions The SSGM has possible relevance in a variety of settings given its broadly applicable structure. Future research could explore the adaptation, application, and evaluation of the SSGM across research contexts to determine its feasibility and ease of implementation. Patient or public contribution This article was conceived of and co-authored by five young adult research partners. The YARP co-designed the SSGM presented in this article, the figures, and substantially contributed to the preparation of the article.
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    Examining the experiences of pediatric mental health care providers during the early stage of the COVID-19 pandemic
    (2023-05-04) Bright, Katherine; Cullen, Emma; Conlon, Olivia; Zulla, Rosslynn T.; Nicholas, David B.; Dimitropoulos, Gina
    Abstract Background The COVID-19 pandemic fundamentally impacted the way that mental health services were provided. In order to prevent the spread of infection, many new public health precautions, including mandated use of masks, quarantine and isolation, and closures of many in-person activities, were implemented. Public health mandates made it necessary for mental health services to immediately shift their mode of delivery, creating increased confusion and stress for mental health providers. The objective of this study is to understand the impact of pandemics on the clinical and personal lives of mental health providers working with children during the early months of the COVID-19 pandemic, March -June 2020. Methods Mental health providers (n = 98) were recruited using purposive sampling from a public health service in Canada. Using qualitative methods, semi-structured focus groups were conducted to understand the experiences of mental health service providers during the beginning of the COVID-19 pandemic. Results Data from the focus groups were analysed and three main themes emerged: (1) shift to virtual delivery and working from home; (2) concerns about working in person; (3) exhaustion and stress from working through the pandemic. Discussion This study gave voice to mental health providers as they provided continuity of care throughout the uncertain early months of the pandemic. The results provide insight into the impact times of crisis have on mental health providers, as well as provide practical considerations for the future in terms of supervision and feedback mechanisms to validate experiences.
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    Examining the impact of missing data in an undergraduate mental health survey
    (2023-08-04) Hews-Girard, Julia; Patten, Scott; Dimitropoulos, Gina; Szeto, Andrew; Thannhauser, Jennifer; Duffy, Anne; Rivera, Daniel; King, Nathan
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    Examining the Relationship Between Obsessive-Compulsive Symptoms, Genetic Risk and Cortical Thickness in Youth
    (2019-09-04) Corrigan, Kimberly; Arnold, Paul Daniel; MacMaster, Frank P.; Harris, Ashley D.; Dimitropoulos, Gina
    Obsessive-compulsive disorder (OCD) is a disabling neuropsychiatric disorder that affects approximately 1-3% of the population worldwide. One-third to one-half of individuals with OCD have symptom onset before 15 years of age. The heterogeneous clinical expression of OCD has rendered inconsistent findings from structural imaging studies with small sample sizes. Large scale structural imaging studies are needed to better understand the complicated neurobiology of OCD in child and adolescent population. To assess brain structure, magnetic resonance imaging (MRI) was used. FreeSurfer (Version 6.0) recon-all pathway was used to determine cortical thickness. The cingulate cortex, orbitofrontal cortex and insular cortex were selected as regions of interest. A candidate gene analysis of PTPRD SNP rs7856850 was performed using Illumina Multi-Ethnic Global microarray. Obsessive-compulsive symptom severity was determined using the Child Behaviour Checklist Obsessive-Compulsive Scale (CBCL-OCS). A significant relationship was found between the current CBCL-OCS score and the right posterior cingulate. Increase in symptom severity on the current CBCL-OCS predicted an increase in cortical thickness of the right posterior cingulate. Rs7856850 genotype did not significantly modify the relationship between symptom severity and right posterior cingulate thickness. This a unique large scale pediatric imaging study investigating the association between obsessive-compulsive symptoms and cortical thickness with an additional exploration of a PTPRD SNP variant. The results support the concept that the posterior cingulate is involved in the pathophysiology of OCD. The candidate gene analysis was inconclusive but hopefully, this study will encourage more research in the neurobiology of youth OCD.
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    Exploring Perceptions, Experiences, Acceptability and Validity of Mental Health Screening and Diagnosis among Undergraduate Students: A mixed methods study
    (2023-08-04) Hews-Girard, Julia; Patten, Scott; Dimitropoulos, Gina; Szeto, Andrew; Thannhauser, Jennifer
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    Exploring protective factors for pregnancy-related anxiety in Tanzanian women
    (2017) Wall, Vanessa; Premji, Shahirose; Letourneau, Nicole; McCaffrey, Graham; Dimitropoulos, Gina
    Pregnancy-related anxiety is highly correlated with pre-term birth which can be fatal in low-and-middle-income countries. Modifiable protective factors for pregnancy-related anxiety need to be identified to prevent this condition. This study aimed to identify factors associated with low or no pregnancy-related anxiety among women attending two antenatal clinics in districts of Mwanza, Tanzania. A cross-sectional secondary data analysis was completed using data from a longitudinal study that examined biomarkers of stress, anxiety, depression, and birth outcomes. Data were analyzed using bivariate analysis and multiple linear regression. Findings did not reveal any modifiable protective factors. Perceived stress, active depression, and number of people living in the home were the only statistically significant predictors of pregnancy-related anxiety in our sample. Findings indicated that pregnancy-related anxiety may be associated with cultural factors such as family dynamics, and stigmatization of fear or anxiety. Before protective factors can be identified, more qualitative research may be needed in these countries to better understand the cultural nuances of pregnancy-related anxiety in low-and-middle income countries.
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    Family-based treatment for transition age youth: parental self-efficacy and caregiver accommodation
    (2018-06-06) Dimitropoulos, Gina; Landers, Ashley L; Freeman, Victoria E.; Novick, Jason; Cullen, Olivia; Engelberg, Marla; Steinegger, Cathleen; Le Grange, Daniel
    Abstract Background Family-Based Treatment (FBT) is the first line of care in paediatric treatment while adult programs focus on individualized models of care. Transition age youth (TAY) with Anorexia Nervosa (AN) are in a unique life stage and between systems of care. As such, they and their caregivers may benefit from specialized, developmentally tailored models of treatment. Methods The primary purpose of this study was to assess if parental self-efficacy and caregiver accommodation changed in caregivers during the course of FBT-TAY for AN. The secondary aim was to determine if changes in parental self-efficacy and caregiver accommodation contributed to improvements in eating disorder behaviour and weight restoration in the transition age youth with AN. Twenty-six participants (ages 16–22) and 39 caregivers were recruited. Caregivers completed the Parents versus Anorexia Scale and Accommodation and Enabling Scale for Eating Disorders at baseline, end-of-treatment (EOT), and 3 months follow-up. Results Unbalanced repeated measures designs for parental self-efficacy and caregiver accommodation towards illness behaviours were conducted using generalized estimation equations. Parental self-efficacy increased from baseline to EOT, although not significantly (p = .398). Parental self-efficacy significantly increased from baseline to 3 months post-treatment (p = .002). Caregiver accommodation towards the illness significantly decreased from baseline to EOT (p = 0.0001), but not from baseline to 3 months post-treatment (p = 1.000). Stepwise ordinary least squares regression estimates of eating disorder behaviour and weight restoration did not show that changes in parental-self efficacy and caregiver accommodation predict eating disorder behaviour or weight restoration at EOT or 3 months post-treatment. Conclusions Our findings demonstrate, albeit preliminary at this stage, that FBT-TAY promotes positive increases in parental self-efficacy and assists caregivers in decreasing their accommodation to illness behaviours for transition age youth with AN. However, changes in the parental factors did not influence changes in eating and weight in the transition age youth.
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    Health care stakeholder perspectives regarding the role of a patient navigator during transition to adult care
    (2019-06-17) Dimitropoulos, Gina; Morgan-Maver, Elizabeth; Allemang, Brooke; Schraeder, Kyleigh; Scott, Shannon D; Pinzon, Jorge; Andrew, Gail; Guilcher, Gregory; Hamiwka, Lorraine; Lang, Eddy; McBrien, Kerry; Nettel-Aguirre, Alberto; Pacaud, Daniele; Zwaigenbaum, Lonnie; Mackie, Andrew; Samuel, Susan
    Abstract Background Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. Methods Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. Results A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. Conclusions The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.
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    Identifying Effective Psychotherapeutic Interventions and Preferences in Emotional Care: Reducing Psychological Distress and Promoting Emotional Health in Women who have Experienced Perinatal Loss
    (2022-01-26) Charrois, Elyse Mireille; Kingston, Dawn; Giallo, Rebecca; Dimitropoulos, Gina
    Perinatal loss is a challenging experience because of the unexpected nature through which the loss of an unborn or recently born child commonly occurs. At present, evidence-based interventions to support women affected by perinatal loss are scarce. Understanding psychological distress after perinatal loss and identifying effective psychotherapeutic interventions and preferences in emotional care will likely improve emotional health for women across time. The purpose of this doctoral thesis is to provide the evidence needed to inform the development of, and improve women’s access to, a universal, integrated emotional health screening, referral and intervention initiative that is responsive to the needs of women who have experienced perinatal loss. This thesis contains a secondary data analysis (Chapter 2), a systematic review protocol (Chapter 3), a systematic review and meta-analysis (Chapter 4), and a cross-sectional descriptive survey (Chapter 5). The secondary analysis examined the trajectory patterns of depressive and anxiety symptoms following miscarriage and stillbirth from early pregnancy up to when the mother’s child was 11 years old and identified early factors predictive of elevated symptom trajectory patterns. This is the first latent class analysis to identify longitudinal symptom trajectories and early factors predictive of elevated trajectories. The review and meta-analysis analysed and synthesized research evaluating the effectiveness of psychotherapeutic interventions to treat or decrease psychological distress in women after perinatal loss and outlined the content and delivery method of effective interventions. This is the first review to identify effective psychotherapeutic interventions and summarize their characteristics. The survey study explored women’s perception of the barriers and facilitators in discussing their emotional health with a healthcare provider after prenatal loss and identified their preferences in emotional care. This is the first study to identify women’s influences and preferences in accessing emotional care surrounding a pandemic. In summary, the studies within this research program provide evidence needed to develop a universal, integrated screening, referral and intervention initiative. This initiative empowers women to monitor and manage their emotional health after a perinatal loss. By engaging in discussions related to emotional health, healthcare providers facilitate women’s early access to resources and improve their emotional health.
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    Investigating Post-sport Adjustment Experiences of Former Canadian Major Junior Hockey Players
    (2018-12-18) McCoy, Lauren K.; Arthur, Nancy Marie; Moules, Nancy Jean; Paskevich, David M.; Kerr, Gretchen; Dimitropoulos, Gina
    This project explored the post-sport adjustment experiences of former Canadian major junior hockey (CHL) players in the years following their athletic retirement. This study was conducted using a qualitative, within-subjects, longitudinal research design to understand the manner by which elite CHL athletes make sense of their athletic retirement experiences across time. Four former CHL players participated in two semi-structured interviews; one occurred shortly after their athletic retirement and the next was conducted approximately 24 months later. Interviews were then analyzed in accordance with the interpretative phenomenological analysis (IPA) method. Themes identified in each participant’s account were compared and contrasted across all participants to generate an in-depth portrayal that gave voice to participants’ athletic retirement and subsequent post-sport adjustment transitions. Results revealed that participants continued to have unresolved feelings about their athletic retirement and experienced conflicting emotions of both pride and embarrassment in relation to their athletic identity. Participants post-sport adjustment experiences focused on attempts to renegotiate self-worth and prove their worth off the ice. As the post-sport adjustment period progressed, participants described moving from avoidance-based coping strategies to increasing action-oriented coping strategies which facilitated feelings of control and autonomy. Recommendations for helping professionals are provided and highlight the need for person-centred and multi-level interventions to support athletic retirement transitions. Additional longitudinal research is required to further develop understanding of the ongoing effects of athletic retirement and elite athletes’ post-sport adjustment experiences across time.