A cross-sectional study of the relationship between frequency of cannabis use and psychiatric symptoms among people seeking mental health and addiction services in Nova Scotia (2019-21)

BACKGROUND

Cannabis use may be a modifiable risk factor for mental health problems; however, the role of cannabis use frequency in population seeking mental health and addiction services remains unclear. This study aimed to: 1) compare the prevalence and functional impact of psychiatric symptoms among frequent, infrequent, and non-users of cannabis; and 2) evaluate the associations between cannabis use frequency and functional impact of psychiatric symptoms in help-seeking individuals.

METHODS

Data from the Mental Health and Addictions (MHA) Central Intake system in Nova Scotia, Canada was used. Participants aged 19-64 who received MHA Intake assessments from September 2019 to December 2021 with complete information about substance use were included (N = 20,611). Cannabis use frequency over past 30 days was categorized into frequent (>4 times a month), infrequent (≤4 times a month), and non-use. Psychiatric symptomatology consists of five domains: mood, anxiety, psychosis, cognition, and externalizing behaviors. Multivariate ordinal logistic regression was used to examine the associations between cannabis use frequency and functional impact of psychiatric symptoms.

RESULTS

Frequent and infrequent cannabis users had a higher prevalence of psychiatric symptoms in each domain than non-users, while no significant differences were found between frequent and infrequent users. Frequent cannabis use was associated with greater functional impact of psychiatric symptoms in each domain compared to non-users, while infrequent use was only associated with greater functional impact of externalizing behaviors.

CONCLUSION

Frequent cannabis use is associated with increased prevalence and functional impact of psychiatric symptoms among adults seeking mental health services.

Increasing access to mental health supports for 12-17-year-old Indigenous youth with the JoyPop mobile mental health app: study protocol for a randomized controlled trial

BACKGROUND

Indigenous youth in Northwestern Ontario who need mental health supports experience longer waits than non-Indigenous youth within the region and when compared to youth in urban areas. Limited access and extended waits can exacerbate symptoms, prolong distress, and increase risk for adverse outcomes. Innovative approaches are urgently needed to provide support for Indigenous youth in Northwestern Ontario. Using a randomized controlled trial design, the primary objective of this study is to determine the effectiveness of the JoyPop app compared to usual practice (UP; monitoring) in improving emotion regulation among Indigenous youth (12-17 years) who are awaiting mental health services. The secondary objectives are to (1) assess change in mental health difficulties and treatment readiness between youth in each condition to better understand the app's broader impact as a waitlist tool and (2) conduct an economic analysis to determine whether receiving the app while waiting for mental health services reduces other health service use and associated costs.

METHODS

A pragmatic, parallel arm randomized controlled superiority trial will be used. Participants will be randomly allocated in a 1:1 ratio to the control (UP) or intervention (UP + JoyPop) condition. Stratified block randomization will be used to randomly assign participants to each condition. All participants will be monitored through existing waitlist practices, which involve regular phone calls to check in and assess functioning. Participants in the intervention condition will receive access to the JoyPop app for 4 weeks and will be asked to use it at least twice daily. All participants will be asked to complete outcome measures at baseline, after 2 weeks, and after 4 weeks.

DISCUSSION

This trial will evaluate the effectiveness of the JoyPop app as a tool to support Indigenous youth waiting for mental health services. Should findings show that using the JoyPop app is beneficial, there may be support from partners and other organizations to integrate it into usual care pathways.

TRIAL REGISTRATION

https://clinicaltrials.gov/study/NCT05898516 [registered on June 1, 2023].

Do anxiety symptoms and coping motives serially mediate the association between psychotic-like experiences and cannabis-related problems in undergraduate recent cannabis users?

Many Canadian emerging adults (ages 18-25 years) use cannabis, with 60 % of past-three-month users experiencing one or more cannabis-related problems (i.e., adverse consequences of use). While psychotic-like experiences (PLEs) and cannabis problems overlap, little is known about the mechanisms explaining this link. One hypothesis is that PLEs are distressing and give rise to anxiety, with which emerging adults attempt to cope through increased cannabis use, in turn increasing their risk for cannabis-related problems. We tested a chained-mediational model to determine if anxiety and coping-with-anxiety motives for cannabis use sequentially mediated the link between PLEs and cannabis problems in emerging adult undergraduates; a conditional process model tested for moderation by sex. Emerging adult cannabis users (N = 413; mean [SD] age = 19.1 [1.5] years; 71.9 % female) from five Canadian universities provided cross-sectional, self-report survey data in fall 2021. Validated measures of PLEs, anxiety, cannabis coping-with-anxiety motives, and cannabis-related problems were administered. Path analyses supported the hypothesized chained mediational indirect effect (b = 0.027, 95 % bootstrap CI [0.012, 0.050]). No direct effect was found (p =.698), suggesting that the PLEs-to-cannabis problems association is fully explained by anxiety and cannabis coping-with-anxiety motives. Inconsistent with hypotheses, mediation did not depend on sex (95 % CIs crossed zero); therefore, anxiety and cannabis coping-with-anxiety motives explain the link between PLEs and cannabis problems in emerging adults regardless of their sex. Results highlight anxiety and cannabis coping-with-anxiety motives as potentially important intervention targets in cannabis-using emerging adults with PLEs, possibly preventing the development/worsening of cannabis-related problems.

Can scent-detection dogs detect the stress associated with trauma cue exposure in people with trauma histories? A proof-of-concept study

Introduction

Post-traumatic stress disorder (PTSD) is an impairing mental health condition with high prevalence among military and general populations alike. PTSD service dogs are a complementary and alternative intervention needing scientific validation. We investigated whether dogs can detect putative stress-related volatile organic compounds (VOCs) in the breath of people with trauma histories (54% with PTSD) exposed to personalized trauma cues.

Methods

Breath samples were collected from 26 humans over 40 experimental sessions during a calm (control breath sample) and stressed state induced by trauma cue exposure (target breath sample). Two scent detection canines were presented with the samples in a two alternative forced choice (2AFC) discrimination and yes/no detection task. The 2AFC task assessed the dogs' ability to discriminate between the two states within the breath samples of one individual. The detection task determined their ability to generalize the target odour across different individuals and different stressful events of one individual. Signal Detection Theory was applied to assess dogs' sensitivity, specificity, precision, and response bias.

Results

The dogs performed at ∼90% accuracy across all sample sets in the discrimination experiment, and at 74% and 81% accuracy, respectively, in the detection experiment. Further analysis of dog olfactory performance in relation to human donor self-reported emotional responses to trauma cue exposure suggested the dogs may have been detecting distinct endocrine stress markers. One dog's performance correlated with the human donors' self-reported fear responses and the other dog's performance correlated with the human donors' self-reported shame responses. Based on these correlations between dog performance and donor self-report measures, we speculate that the VOCs each dog was detecting likely originated from the sympathetico-adreno-medullary axis (SAM; adrenaline, noradrenaline) in the case of the first dog and the hypothalamo-pituitary-adrenal axis (HPA; glucocorticoids) in the case of the second dog.

Conclusion

Our proof-of-concept study is the first to demonstrate that some dogs can detect putative VOCs emitted by people with trauma histories when experiencing distress theoretically associated with the intrusion and arousal/reactivity symptoms of PTSD. Results have potential to improve the effectiveness and training protocol of PTSD service dogs with a focus on enhancing their alert function.

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults

BACKGROUND

Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates.

METHOD

We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18-25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire.

RESULTS

Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour.

CONCLUSION

Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.

Posttraumatic stress and delay discounting: a meta-analytic review

Delay discounting-the extent to which individuals show a preference for smaller immediate rewards over larger delayed rewards-has been proposed as a transdiagnostic neurocognitive process across mental health conditions, but its examination in relation to posttraumatic stress disorder (PTSD) is comparatively recent. To assess the aggregated evidence for elevated delay discounting in relation to posttraumatic stress, we conducted a meta-analysis on existing empirical literature. Bibliographic searches identified 209 candidate articles, of which 13 articles with 14 independent effect sizes were eligible for meta-analysis, reflecting a combined sample size of N = 6897. Individual study designs included case-control (e.g. examination of differences in delay discounting between individuals with and without PTSD) and continuous association studies (e.g. relationship between posttraumatic stress symptom severity and delay discounting). In a combined analysis of all studies, the overall relationship was a small but statistically significant positive association between posttraumatic stress and delay discounting (r = .135, p < .0001). The same relationship was statistically significant for continuous association studies (r = .092, p = .027) and case-control designs (r = .179, p < .001). Evidence of publication bias was minimal. The included studies were limited in that many did not concurrently incorporate other psychiatric conditions in the analyses, leaving the specificity of the relationship to posttraumatic stress less clear. Nonetheless, these findings are broadly consistent with previous meta-analyses of delayed reward discounting in relation to other mental health conditions and provide further evidence for the transdiagnostic utility of this construct.

Clarifying the pathway from anxiety sensitivity to binge eating: The mediating role of depressive symptoms in a 3-week, 3-wave longitudinal study of undergraduates

Anxiety sensitivity (AS) - characterized by a persistent fear that arousal-related bodily sensations will lead to serious cognitive, physical, and/or social consequences - is associated with various psychopathologies, including depressive symptoms and binge eating. This 3-week, 3-wave longitudinal study examined the relation between AS (including its global AS factor and lower-order AS cognitive, physical, and social concern dimensions), depressive symptoms, and binge eating among 410 undergraduates from two universities. Using generalized estimating equation models, we found that global AS, AS social concerns, and depressive symptoms predicted binge eating during any given week. Mediation analyses showed that global AS (as a latent variable with its lower-order AS dimensions as indicators), AS cognitive concerns, and AS physical concerns at Wave 1 predicted subsequent increases in depressive symptoms at Wave 2, which, in turn, led to increases in binge eating at Wave 3. Findings contribute to a better understanding of the interplay between AS, depressive symptoms, and binge eating, highlighting the role of binge eating as a potential coping mechanism for individuals with high AS, particularly in managing depressive symptoms. This study underscores the importance of AS-targeted intervention and prevention efforts in addressing depressive symptoms and binge eating.

The impact of cannabidiol placebo on responses to an acute stressor: A replication and proof of concept study

BACKGROUND

Our group has previously reported that cannabidiol (CBD) expectancy alone blunts markers of stress, particularly during anticipation, but it is not clear the extent to which such findings were specific to the methods utilized.

AIMS

To examine CBD-related placebo effects on stress reactivity and anticipation and to validate a protocol to be used in a neuroimaging study.

METHODS

Forty-eight healthy adults (24 female) were randomly assigned to be informed that they ingested a CBD-containing oil or a CBD-free oil despite receiving the same oil (CBD-free). Following oil administration, participants engaged in a laboratory stressor and were then incorrectly informed that they would engage in a second more difficult task following a waiting period. Subjective state (sedation, energy, stress, anxiety) and heart rate were assessed at baseline, post-oil administration, immediately following the first stressor, and while anticipating the second stressor.

RESULTS

Subjective stress and anxiety were significantly elevated immediately following the stressor (p-values < 0.001). CBD expectancy was associated with increased subjective sedation (p < 0.01) and tended to be associated with blunted subjective stress (p = 0.053). Post hoc within-condition pairwise compassions suggested a return to pre-stressor levels during the anticipation period in the CBD condition for subjective stress and anxiety (p = 0.784, 0.845), but not the CBD-free condition (p = 0.025, 0.045).

CONCLUSION

Results replicate and extend previous findings that CBD expectancy alone can impact stress- and anxiety-relevant responses in the laboratory context.

Corrigendum: What explains the link between romantic conflict with gambling problems? Testing a serial mediational model

[This corrects the article DOI: 10.3389/fpsyg.2023.1018098.].

Do Anxiety Symptoms Mediate the Association Between Cannabis Use Frequency and Psychotic-Like Experiences in Emerging Adult Undergraduates?

OBJECTIVE

Cannabis is commonly used by Canadian emerging adults (ages 18-25 years), many of whom attend post-secondary institutions. Frequent cannabis use is linked with psychotic-like experiences (PLEs); however, the exact nature of this association remains unclear. Anxiety symptoms may mediate this association, as they are prevalent in emerging adults and have been independently linked with both cannabis use and PLEs. Past work found that anxiety mediated the association between cannabis use frequency and attenuated positive psychotic symptoms (further along the psychosis continuum than PLEs), however this research had yet to be validated in the Canadian population, and trait rather than state anxiety (frequency of anxiety symptoms) was studied. Thus, our primary objective was to examine if anxiety symptoms mediated the association between cannabis use frequency and PLEs in Canadian emerging adult undergraduates. Despite known sex differences in cannabis use, expression of anxiety, and PLEs, past work did not evaluate the potential impact of biological sex on the anxiety-mediated model, and thus is the secondary objective of the present study.

METHODS

1,266 first-/second-year emerging adult undergraduates from five Canadian universities provided cross-sectional, self-report survey data in fall 2021 semester. Validated measures of cannabis use frequency, anxiety, and PLEs were administered.

RESULTS

Path analyses supported mediation from cannabis use to PLEs through anxiety (b  =  0.07, P < 0.001, 95% bootstrap CI [0.03, 0.10]). No direct effect was found (P  =  0.457), suggesting that the cannabis-to-PLEs association was mediated by anxiety. Mediation did not depend on biological sex (i.e., bootstrapped 95% CIs crossed zero).

CONCLUSIONS

Anxiety symptoms mediated the association between cannabis use and PLEs in emerging adults regardless of their biological sex. Assuming replication in prospective research, results highlight anxiety as an important intervention target in frequent cannabis-using emerging adults, to potentially prevent development/worsening of PLEs, and in turn psychotic illness.

Social norms of college students engaging in non-medical prescription drug use to get high: What's sex got to do with it?

Background: Relationships exist between perceived peer and own use of alcohol, cannabis, and tobacco, particularly when peers and participants are sex-matched. We investigated sex influences on social norms effects for college students' non-medical prescription drug use (NMPDU). Methods: N = 1986 college students reported on their perceptions of male and female peers' NMPDU frequency and their own past-month NMPDU. Results: Approximately 3% of students self-reported past month NMPDU, with no sex differences. In a linear mixed model, participants who engaged in NMPDU perceived significantly more frequent peer use. Female participants perceived more frequent peer NMPDU than did male participants, particularly when perceiving male peers' NMPDU. Significant positive correlations were found between perceived peer NMPDU frequency and participants' own NMPDU for all peer-participant sex combinations, with no evidence for stronger correlations with sex-matched pairs. Conclusions: While social norm interventions may be effective for college student NMPDU, sex-matching of these interventions is likely unnecessary.

Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?

Trauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = .36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = .19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.

Fostering resilience and countering stigma: A qualitative exploration of risk and protective factors for negative psychological consequences among alcohol-involved sexual assault survivors

The social-ecological resilience framework posits that the development of negative psychological outcomes (NPO) following alcohol-involved sexual assault (AISA) is influenced by the interaction of sociocultural and individual risk and protective factors. AISA survivors may be particularly vulnerable to AISA stigma (e.g., victim-blaming rape myths), a sociocultural risk factor which, if internalized, may increase individual risk factors such as self-blame, low-self-compassion, and fear of self-compassion (FOSC), in turn contributing to subsequent NPO.

OBJECTIVE

This qualitative study explored AISA survivors' lived experiences regarding AISA stigma, self-blame, self-compassion, and FOSC as interrelated risk and protective factors in fostering or impeding resilience.

METHOD

Eight participants (M = 25.8 years old) who survived AISA completed individual qualitative interviews that were later coded using thematic analysis.

RESULTS

Analyses produced three interrelated main themes, where AISA survivors described experiencing: (a) various NPO corresponding to PTSD, anxiety, and depression symptoms; (b) risk factors that undermined resilience, including internalized self-blame secondary to sociocultural AISA stigma, low self-compassion, FOSC, and preexisting maladaptive tendencies; and (c) protective factors contributing to resilience, including resisting self-blame and facilitating self-compassion by living according to one's values and challenging FOSC.

CONCLUSIONS

Consistent with the social-ecological framework, AISA survivors' resilience toward NPO was undermined by the interrelated constructs of AISA stigma, internalized self-blame, and low self-compassion. In contrast, survivors' values, including being empathic and committed to feminism, fueled motivation to resist victim-blaming stigma and internalized self-blame and to practice self-compassion, ultimately countering the negative psychological effects of AISA. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Suicidal Ideation, Planning, and Attempts Among new Royal Canadian Mounted Police Cadets

BACKGROUND

Royal Canadian Mounted Police (RCMP) report diverse occupational stressors and repeated exposures to potentially psychologically traumatic events, which may increase the odds of screening positive for a mental disorder, and increase the risk of death by suicide. The current study was designed to provide prevalence information regarding suicidal behaviours (i.e., ideation, planning, attempts) and assess for sociodemographic differences among cadets at the start of the RCMP Cadet Training Program (CTP).

METHOD

Cadets (n = 736, 74.0% male) were administered the structured Mini International Neuropsychiatric Interview by a mental health clinician or a supervised clinical psychologist trainee. The interview includes an assessment of past month suicidal ideation, planning, attempts and lifetime suicide attempts.

RESULTS

Within 1 month of starting the CTP, a small percentage of cadets reported past month suicidal ideation (1.6%) and no cadets reported any suicidal planning (0%) or attempts (0%). Lifetime suicide attempts were reported by (1.5%) of cadets.

CONCLUSIONS

The current results provide the first information describing the prevalence of suicidal ideation, planning, and attempts among RCMP cadets starting the CTP. The estimates of suicidal behaviours appear lower than the general population and lower than reports from serving RCMP. Higher prevalence estimates of suicidal behaviours reported by serving RCMP, relative to lower estimates among cadets starting the CTP in the current study, may be related to age, cumulative experiences or protracted exposures to operational and organizational stressors, rather than insufficient screening of recruits.

Mental Health of Royal Canadian Mounted Police at the Start of the Cadet Training Program

OBJECTIVE

Serving Royal Canadian Mounted Police (RCMP) have screened positive for one or more mental disorders based on self-reported symptoms with substantial prevalence (i.e., 50.2%). Mental health challenges for military and paramilitary populations have historically been attributed to insufficient recruit screening; however, cadet mental health when starting the Cadet Training Program (CTP) was unknown. Our objective was to estimate RCMP Cadet mental health when starting the CTP and test for sociodemographic differences.

METHOD

Cadets starting the CTP completed a survey assessing self-reported mental health symptoms (n = 772, 72.0% male) and a clinical interview (n = 736, 74.4% male) with a clinician or supervised trainee using the Mini-International Neuropsychiatric Interview to assess current and past mental health.

RESULTS

The percentage of participants screening positive for one or more current mental disorders based on self-reported symptoms (15.0%) was higher than the diagnostic prevalence for the general population (10.1%); however, based on clinical interviews, participants were less likely to screen positive for any current mental disorder (6.3%) than the general population. Participants were also less likely to screen positive for any past mental disorder based on self-report (3.9%) and clinical interviews (12.5%) than the general population (33.1%). Females were more likely to score higher than males (all ps<.01; Cohen's ds .23 to .32) on several self-report mental disorder symptom measures.

CONCLUSIONS

The current results are the first to describe RCMP cadet mental health when starting the CTP. The data evidenced a lower prevalence of anxiety, depressive, and trauma-related mental disorders than the general population based on clinical interviews, contrasting notions that more rigorous mental health screening would reduce the high prevalence of mental disorders among serving RCMP. Instead, protecting RCMP mental health may require ongoing efforts to mitigate operational and organizational stressors.

What explains the link between romantic conflict with gambling problems? Testing a serial mediational model

Introduction

While individuals have many motives to gamble, one particularly risky motive for gambling is to cope with negative affect. Conflict with one's romantic partner is a strong predictor of negative affect, which may elicit coping motives for gambling and, in turn, gambling-related problems. Support for this mediational model was demonstrated in relation to drinking-related problems. We extended this model to gambling.

Method

Using a cross-sectional design, we examined links between romantic conflict (Partner-Specific Rejecting Behaviors Scale), negative affect (Depression, Anxiety, and Stress Scales-21), coping gambling motives (Gambling Motives Questionnaire, coping subscale), and gambling-related problems [Problem Gambling Severity Index (PGSI)] in 206 regular gamblers (64% men; mean age = 44.7 years; mean PGSI = 8.7) who were in a romantic relationship and recruited through Qualtrics Panels in July 2021.

Results

Results supported our hypothesis that the association between romantic conflict and gambling-related problems would be sequentially mediated through negative affect and coping gambling motives, β = 0.38, 95% CI [0.27, 0.39], and also showed a strong single mediation pathway through negative affect alone, β = 0.27, 95% CI [0.17, 0.38].

Discussion

Negative affect and coping gambling motives partially explain the link between romantic conflict and gambling-related problems. Interventions should target both negative affect and coping gambling motives in response to romantic conflict to reduce gambling-related problems in partnered gamblers.

Drinking to Cope Mediates the Association between Dyadic Conflict and Drinking Behavior: A Study of Romantic Couples during the COVID-19 Pandemic

The COVID-19 pandemic spurred public health measures to reduce viral spread. Concurrently, increases in alcohol consumption and conflict in romantic partnerships were observed. Pre-pandemic research demonstrated a bidirectional association between couples' conflict and drinking. Recent research shows one's drinking motives (proximal predictors of drinking behavior) can influence another person's drinking in close relationships. It is possible that individuals are drinking to cope with distress following romantic conflict. The current study examined 348 cohabitating couples during the first lockdown in the spring of 2020. Our analyses examined coping motives as a mediator between dyadic conflict and drinking behavior using actor-partner interdependence models. Results showed that conflict was associated with greater reports of own drinking in gendered (distinguishable) and nongendered (indistinguishable) analyses through coping motives. Further, in mixed-gender couples, men partners' coping motives predicted less drinking in women, while women partners' coping motives predicted marginally more drinking in men. Partner effects may have been observed due to the increased romantic partner influence during the COVID-19 lockdown. While these results suggest that men's coping motives may be protective against women's drinking, more concerning possibilities are discussed. The importance of considering dyadic influences on drinking is highlighted; clinical and policy implications are identified.

Do we really need two sessions?: The use of a structured interview as a trauma cue reactivity paradigm

OBJECTIVES

Derived from classical conditioning theory and rooted in motivational mechanisms, cue reactivity paradigms (CRPs) are used in addictions research to measure participants' propensities for substance-relevant responses (e.g., craving) during exposure to substance-relevant cues (e.g., drug paraphernalia). CRPs are also useful in PTSD-addiction comorbidity research, allowing the study of affective and substance-relevant responses to trauma cues. However, studies using traditional CRPs are time-consuming with high attrition rates due to repeat testing. Thus, we sought to test whether a single session semi-structured trauma interview could serve as a CRP in terms of eliciting theorized cue exposure effects on craving and affect measures.

METHOD

Fifty regular cannabis users with trauma histories provided detailed descriptions of their most traumatic lifetime experience, and a neutral experience, according to an established interview protocol. Linear mixed models examined the effect of cue type (trauma vs. neutral) on affective and craving responses.

RESULTS

As hypothesized, the trauma interview elicited significantly greater cannabis craving (and alcohol craving among the drinkers), and, greater negative affect among those with more severe PTSD symptoms, compared to the neutral interview.

CONCLUSION

Results suggest an established semi-structured interview may function effectively as a CRP for use in trauma and addictions research.

Losing sight of Luck: Automatic approach tendencies toward gambling cues in Canadian moderate- to high-risk gamblers - A replication study

Evidence for approach bias tendencies to underly automatic behavioural impulses towards seeking out gambling activities in the presence of appetitive salient cues was first shown by Boffo et al. (2018) in a Dutch sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers demonstrated stronger approach tendencies towards gambling-related stimuli compared with neutral ones. Moreover, gambling approach bias was associated with past-month gambling behaviour and predictive of gambling activity persistence over time. The current study aimed to replicate these findings within a Canadian sample evaluating the concurrent and longitudinal correlates of gambling approach bias. The study was conducted online, available throughout Canada. Twenty-seven non-treatment-seeking moderate-to-high-risk gamblers and 26 non-problem gamblers community-recruited via multiple channels (i.e., internet and newspaper advertisements, land-based flyers, and university recruitment portals). Participants completed two online assessment sessions 6-months apart. Each session included (1) self-report measures of gambling behaviour (frequency, duration, and expenditure), (2) self-report assessment of problem gambling severity (PGSI), and (3) a gambling approach-avoidance task, utilising culturally relevant stimuli tailored to individual gambling habits. However, our study failed to replicate Boffo et al. (2018) findings in a Canadian sample. Relative to non-problem gamblers, moderate-to-high-risk gamblers did not exhibit greater approach bias tendencies towards gambling-related stimuli compared to neutral stimuli. Moreover, gambling approach bias was not predictive of prospective gambling behaviour (frequency, duration, or expenditure) or severity of gambling problems. Reported results do not provide evidence for approach tendencies contributing to problematic gambling behaviour in a Canadian sample of moderate-to-high-risk gamblers compared to non-problematic gambler controls. Further replications on the topic are needed. Future research should evaluate approach tendencies within the gambling context, considering the potential impact of task reliability to assess approach bias in light of individual gambling modality preferences.

Associations of active and passive smartphone use with measures of youth mental health during the COVID-19 pandemic

Smartphone use provides a significant amount of screen-time for youth, and there have been growing concerns regarding its impact on their mental health. While time spent in a passive manner on the device is frequently considered deleterious, more active engagement with the phone might be protective for mental health. Recent developments in mobile sensing technology provide a unique opportunity to examine behaviour in a naturalistic manner. The present study sought to investigate, in a sample of 451 individuals (mean age 20.97 years old, 83% female), whether the amount of time spent on the device, an indicator of passive smartphone use, would be associated with worse mental health in youth and whether an active form of smartphone use, namely frequent checking of the device, would be associated with better outcomes. The findings highlight that overall time spent on the smartphone was associated with more pronounced internalizing and externalizing symptoms in youth, while the number of unlocks was associated with fewer internalizing symptoms. For externalizing symptoms, there was also a significant interaction between the two types of smartphone use observed. Using objective measures, our results suggest interventions targeting passive smartphone use may contribute to improving the mental health of youth.

The four-factor personality model and its qualitative correlates among opioid agonist therapy clients

Background

The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients' voice.

Method

Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis.

Results

Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected.

Conclusion

Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.

Hazardous Drinking Mediates the Relation Between Externalizing Personality and Reduced Adherence to COVID-19 Public Health Guidelines in University Students

Using a multigroup path analysis, we examined if hazardous alcohol use mediated the relations between elevated externalizing personality traits (i.e., impulsivity or sensation seeking) and reduced adherence to COVID-19 public health guidelines. We hypothesized that those high in externalizing personality traits would demonstrate less adherence to public health guidelines and that hazardous alcohol use would mediate this relationship. First- and second-year undergraduates (N = 1232; ages 18-25) from five Canadian universities participated in a cross-sectional survey between January to April 2021. Individuals with higher levels of impulsive or sensation seeking personality traits demonstrated poorer adherence to COVID-19 public health guidelines and these relations were mediated by hazardous alcohol use. Results suggest that hazardous drinking is an important target for students high in impulsivity and sensation seeking to increase their adherence to public health guidelines and thereby help control viral spread.

A systematic review on the impact of alcohol warning labels

Findings on the effects of alcohol warning labels (AWLs) as a harm reduction tool have been mixed. This systematic review synthesized extant literature on the impact of AWLs on proxies of alcohol use. PsycINFO, Web of Science, PubMED, and MEDLINE databases and reference lists of eligible articles. Following PRISMA guidelines, 1,589 articles published prior to July 2020 were retrieved via database and 45 were via reference lists (961 following duplicate removal). Article titles and abstracts were screened, leaving the full text of 96 for review. The full-text review identified 77 articles meeting inclusion/exclusion criteria which are included here. Risk of bias among included studies was examined using the Evidence Project risk of bias tool. Findings fell into five categories of alcohol use proxies including knowledge/awareness, perceptions, attention, recall/recognition, attitudes/beliefs, and intentions/behavior. Real-world studies highlighted an increase in AWL awareness, alcohol-related risk perceptions (limited findings), and AWL recall/recognition post-AWL implementation; these findings have decreased over time. Conversely, findings from experimental studies were mixed. AWL content/formatting and participant sociodemographic factors also appear to influence the effectiveness of AWLs. Findings suggest conclusions differ based on the study methodology used, favoring real-world versus experimental studies. Future research should consider AWL content/formatting and participant sociodemographic factors as moderators. AWLs appear to be a promising approach for supporting more informed alcohol consumption and should be considered as one component in a comprehensive alcohol control strategy.

Do anxiety sensitivity cognitive concerns and/or depression symptoms independently explain sleep disturbances in a high anxiety sensitive treatment-seeking sample?

Cognitive models of insomnia posit a role for anxiety sensitivity (AS) in sleep difficulties. While sleep disturbances have been linked to AS, particularly AS cognitive concerns, prior studies have rarely accounted for the correlated construct of depression. We used pre-treatment intervention trial data from 128 high AS, treatment-seeking adults with a DSM-5 diagnosis of an anxiety, depressive, or posttraumatic stress disorder to determine whether AS cognitive concerns and/or depression are independently associated with sleep impairment domains (e.g., sleep quality, latency, daytime dysfunction). Participants provided data on AS, depressive symptoms, and sleep impairments. AS cognitive concerns (but not other AS dimensions) were correlated with four of five sleep impairment domains; depression was correlated with all five. Multiple regressions revealed four of five sleep impairment domains were predicted by depression with no independent contribution of AS cognitive concerns. In contrast, AS cognitive concerns and depression were independently associated with daytime dysfunction. Results suggest previous findings linking AS cognitive concerns to sleep impairments may have been largely secondary to the overlap of cognitive concerns with depression. Findings demonstrate the importance of incorporating depression into the cognitive model of insomnia. Both AS cognitive concerns and depression may be useful targets for reducing daytime dysfunction.

A scoping review of the association between loot boxes, esports, skin betting, and token wagering with gambling and video gaming behaviors

Background and aims

Many new digital gambling-like activities such as loot boxes, esports betting, skin betting, and token wagering have recently emerged and grown in popularity. This scoping review aimed to: (a) synthesize the existing empirical research literature on gambling-like activities and their associations with gambling and video gaming behaviors, including problem gambling and video gaming; (b) identify sociodemographic, psychological, and motivational factors associated with engagement in gambling-like activities; and (c) identify research gaps and areas for further research.

Methods

A systematic search of Ovid, Embsco, and ProQuest databases and Google Scholar was conducted in May 2021 and last updated in February 2022. The search yielded a total of 2,437 articles. Articles were included in the review if they were empirical studies that contained quantitative or qualitative results regarding the relationship between gambling-like activities and gambling or gaming.

Results

Thirty-eight articles met inclusion criteria and were included in the review. Overall, the review results suggest that all forms of gambling-like activities were positively associated with gambling and gaming with small to medium effects. Gambling-like activity participation was also positively associated with mental distress and impulsivity. Gaps identified included a lack of inquiry into skin betting and token wagering, a lack of diversity in the research methods (i.e., mainly cross-sectional surveys), and a paucity of research that includes more ethnically, culturally, and geographically diverse populations.

Discussion

Longitudinal studies with more representative samples are needed to examine the causal link between gambling-like activities and gambling and video gaming.

Links Between Romantic Relationship Dysfunction and Drinking Behaviors Are Moderated by Gender and Age

OBJECTIVE

Romantic relationship dysfunction is a risk for subsequent alcohol use, with some research suggesting gender differences in this link. We evaluated how different aspects of relationship dysfunction are related to different drinking behaviors and whether these associations vary by gender. We further examined the role of age as a potential moderator of this gender difference.

METHOD

Qualtrics Panelists (N = 1,470; 50% women) who were in a romantic relationship and regularly consumed alcohol completed an online survey. The sample was wide-ranging in age (range: 18-85 years old; M = 46.64, SD = 11.95). Participants reported drinking about 10 drinks per week, on average (SD = 11.01).

RESULTS

Five factor scores were constructed from relationship predictors (relationship distress, intrusion/jealousy, and disagreements) and drinking outcomes (consumption and coping motives). Moderation analyses indicated several significant two-way interactions between relationship dysfunction, gender, and age when predicting alcohol outcomes. Of note, the positive associations between relationship distress and both consumption and coping motives were stronger among younger than older individuals and among men than women (consistent with an externalizing stress perspective). A significant three-way interaction suggested that, for women, associations between intrusion/jealousy and coping motives were strongest at younger ages, consistent with an interpersonal sensitivity perspective. Conversely, for men, these associations were stronger at older ages, consistent with an externalizing stress perspective.

CONCLUSIONS

Men and younger individuals should be of particular focus when designing and testing interventions for drinking in response to relationship distress and disagreements. Younger women and older men may benefit from interventions focused on drinking to cope with relationship jealousy and electronic intrusions.

Depression, Anxiety, and Stress among Hangover-Sensitive and Hangover-Resistant Drinkers

This study investigated potential differences in baseline (i.e., non-hangover-related) levels of depression, anxiety, and stress between individuals who are sensitive to and those resistant to hangovers after consuming alcohol. Participants included 5111 university students from the Netherlands and the U.K., including 3205 hangover-sensitive and 1906 hangover-resistant drinkers. All participants completed surveys on their demographics, alcohol consumption, and hangover susceptibility (whether they experienced a hangover in the past 12 months), as well as their baseline levels of depression, anxiety, and stress on the DASS-21 scale. The results showed that hangover-sensitive drinkers had significantly higher levels of anxiety and stress, but not depression, compared to hangover-resistant drinkers. However, the observed differences between the two groups were small, with a magnitude of less than 1 out of 42 points on the DASS-21 anxiety and stress subscales, and are thus unlikely to be clinically meaningful.

Coping and Conformity Motives Mediate the Joint Effects of the Behavioral Inhibition and Approach Systems on Alcohol Problems in Young Adults

Background: Gray's original Reinforcement Sensitivity Theory (RST) posits that an oversensitive behavioral inhibition system (BIS) may increase risk for negative-reinforcement-motivated drinking, given its role in anxiety. However, existing data provides mixed support for the BIS-alcohol use association. The inconsistent evidence is not surprising, as the revised RST predicts that the behavioral approach system (BAS) should moderate the effect of the BIS on alcohol use. A strong BAS is thought to bring attention to the negatively reinforcing effects of alcohol, leading to problem drinking among those with a strong BIS. While emerging results support this interaction, we still have much to learn about the mechanisms underlying this effect on alcohol use. Accordingly, we examined motives for alcohol use as mediators of the joint associations of the BIS and the BAS on drinking behaviors. Specifically, our central hypothesis was that individuals with a strong BIS and a strong BAS would endorse increased negative reinforcement motives for drinking (coping and conformity motives), which in turn would predict heavy drinking and alcohol problems. Method: Participants (N=346; 195 women) completed study measures as part of the baseline assessment for a larger study. Results: Overall, results partially supported the hypotheses. Mediated moderation analyses showed that the indirect effect of the BIS on alcohol problems, through coping and conformity motives, was strongest at high levels of the BAS. This effect was not supported for alcohol use. Conclusions: Our findings suggest that clinical interventions should target coping and conformity reasons for drinking among anxious, reward responsive, young adults.

Putative risk and resiliency factors among Royal Canadian Mounted Police cadets

Objective

Mental health disorders are prevalent among active-duty Royal Canadian Mounted Police (RCMP) officers. The current study was designed to assess whether RCMP cadets commencing the Cadet Training Program are inherently at greater risk of developing mental health challenges by statistically comparing cadet putative risk and resiliency scores to scores from young adult populations. The study was also designed to assess for sociodemographic differences in putative risk and resiliency variables among RCMP cadets in order to facilitate future comparisons.

Methods

Cadets (n = 772; 72.2% men) completed self-report measures of several putative risk variables (i.e., anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, and state anger) and resiliency. Scores were statistically compared to samples from Canadian, American, Australian, and European young adult populations.

Results

Cadets had statistically significantly lower scores on all putative risk variables and statistically significantly higher resiliency scores compared to the young adult populations. In the cadet sample, there were statistically significant differences in putative risk and resiliency variables across gender and sex.

Conclusion

Cadets’ significantly lower scores on putative risk variables and higher scores on resiliency suggest that they may be psychologically strong; as such, it may be that the nature of police work, as opposed to inherent individual differences in risk and resiliency, accounts for active-duty RCMP officers’ comparatively higher prevalence of mental health disorders over time.

Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT05527509.

Effects of mandatory homeschooling during COVID-19 on conflict in romantic couples

In early 2020, schools across Canada closed due to the COVID-19 pandemic, requiring parents to homeschool their children. We examined the association between homeschooling and romantic conflict among couples during the COVID-19 pandemic. Canadian couples (N = 756) completed online measures, including whether they were homeschooling, hours spent homeschooling, and romantic conflict during the month of April 2020. Two hundred ten couples (27.8%) reported that they were homeschooling their children during this period, with 173 (22.9%) couples homeschooling due to the pandemic. Multilevel regressions were used to examine the association between homeschooling status and romantic conflict, and actor-partner interdependence models (APIMs) were used to examine the association between homeschooling hours and romantic conflict among homeschoolers. In our APIM analyses, significant links between hours spent homeschooling and romantic conflict were observed, even when controlling for demographic variables. We found significant actor effects, where an individual's own homeschooling hours were positively related to the conflict they enacted toward their partner, and significant partner effects, where the partner's homeschooling hours were positively related to conflict received by the individual. Among all couples, we found significant positive associations between homeschooling status (i.e., nonhomeschooler or homeschooler) and both types of romantic conflict. However, these associations were nonsignificant when controlling for demographic variables. Our findings suggest the number of hours spent in homeschooling may be an important contributor to romantic conflict between partners during the pandemic. We discuss implications for schools and governments in providing additional support for families homeschooling children during mandated school closures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Efficacy of a novel online integrated treatment for problem gambling and tobacco smoking: Results of a randomized controlled trial

Background and aims

Problem gambling and tobacco use are highly comorbid among adults. However, there are few treatment frameworks that target both gambling and tobacco use simultaneously (i.e., an integrated approach), while also being accessible and evidence-based. The aim of this two-arm open label RCT was to examine the efficacy of an integrated online treatment for problem gambling and tobacco use.

Methods

A sample of 209 participants (Mage = 37.66, SD = 13.81; 62.2% female) from North America were randomized into one of two treatment conditions (integrated [n = 91] or gambling only [n = 118]) that lasted for eight weeks and consisted of seven online modules. Participants completed assessments at baseline, after treatment completion, and at 24-week follow-up.

Results

While a priori planned generalized linear mixed models showed no condition differences on primary (gambling days, money spent, time spent) and secondary outcomes, both conditions did appear to significantly reduce problem gambling and smoking behaviours over time. Post hoc analyses showed that reductions in smoking and gambling craving were correlated with reductions in days spent gambling, as well as with gambling disorder symptoms. Relatively high (versus low) nicotine replacement therapy use was associated with greater reductions in gambling behaviours in the integrated treatment condition.

Discussion and conclusions

While our open label RCT does not support a clear benefit of integrated treatment, findings suggest that changes in smoking and gambling were correlated over time, regardless of treatment condition, suggesting that more research on mechanisms of smoking outcomes in the context of gambling treatment may be relevant.

Mental health and social support among Royal Canadian Mounted Police cadets

Introduction

Certain populations, such as public safety personnel (PSP), experience frequent exposures to potentially psychologically traumatic events and other occupational stressors, increasing their risk for mental health challenges. Social support has been evidenced as a protective factor for mental health. However, research examining perceived social support and its associations with symptoms related to mental disorders among PSP recruits is limited.

Methods

RCMP cadets (n = 765, 72% male) completed self-report surveys assessing: sociodemographic information, social support, and symptoms related to posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and alcohol use disorder.

Results

The results indicated statistically significant associations between higher social support and decreased odds of positive screens for generalized anxiety disorder, social anxiety disorder, and panic disorder (i.e., significant Adjusted Odds Ratios = 0.90 to 0.95).

Discussion

Cadets' perceived levels of social support are comparable to the Canadian general population and higher than serving RCMP. Social support appears to offer a protective element against anxiety-related disorders among participating cadets. Reductions in perceived levels of social support may be a function of RCMP service. Factors contributing to decreased levels of perceived social support should be considered.

Psychometric properties of a brief version of the COVID‐19 Stress Scales (CSS‐B) in young adult undergraduates

We extracted items to create a brief version of the COVID-19 Stress Scale (i.e., CSS-B) and examined its psychometric properties in young adults. A sample of 1318 first- and second-year undergraduates from five Canadian universities (mean [SD] age = 19.27 [1.35] years; 77.6% women) completed an online cross-sectional survey that included the CSS-B as well as validated measures of anxiety and depression. The 18-item CSS-B fit well on both a 5-factor and a hierarchical model indicating that the five CSS-B dimensions may be factors of the same over-arching construct. The CSS-B factor structure displayed lower-order and higher-order configural and metric invariance across sites but not scalar invariance indicating that the intercepts/means were not consistent across sites. The CSS dimensions were positively related to measures of general anxiety and depression but not so strongly as to indicate that they are measuring the same construct. The CSS-B scale is a valid measure of COVID-19 stress among young adults. It is recommended that this shorter version of the scale be considered for use in longer surveys to avoid participant fatigue.

Perceptions about THC and CBD effects among adults with and without prior cannabis experience

BACKGROUND

Cannabis is associated with a range of therapeutic and non-therapeutic, positive and negative effects. While some benefits and harms may be specific to individual cannabinoid constituents (THC, CBD), individual expectancies may also play a role.

OBJECTIVES

Evaluate the extent to which individuals hold expectancies about the effects of CBD, THC, and THC & CBD combined, and whether this differs with prior cannabis experience.

METHODS

Canadian adults (N = 345; n = 58 no prior cannabis use, n = 287 prior cannabis use) completed a Qualtrics survey. Participants provided information regarding their expectancies about the effects of cannabinoids (THC, CBD, THC & CBD combined) via a 15-item questionnaire, which included various therapeutic (e.g., helps with pain) and non-therapeutic positive (e.g., enhances positive feelings) and negative (e.g., risk for addiction) effects. They recorded their perceptions about the effects of each cannabinoid on a scale (0="definitely not true", 10="definitely true"). Data was analyzed using linear mixed models.

RESULTS

For most therapeutic effects, CBD-containing products (CBD, THC & CBD) were rated higher than THC. For most positive and negative non-therapeutic effects, THC-containing products (THC, THC & CBD) were rated higher than CBD. Those with prior cannabis use (vs no prior use) rated all cannabinoids higher regarding their association with many therapeutic and positive effects, while endorsing weaker expectancies about their role in some negative effects.

CONCLUSIONS

Adults endorsed stronger expectancies that CBD-containing products are responsible for producing a rage of therapeutic effects. Those with prior cannabis use experience tended to emphasize the benefits and minimize potential harmful effects of cannabinoids.

Patient Satisfaction With Standard Methadone and Flexible Buprenorphine/Naloxone Models of Care: Results From a Pragmatic Randomized Controlled Clinical Trial

INTRODUCTION

Patient satisfaction is a critical measure of quality of care across health disciplines because it may affect clinical outcomes.

OBJECTIVES

This study aimed to examine longitudinal patient satisfaction in individuals with opioid use disorder (OUD) randomized to receive either standard methadone or flexible buprenorphine/naloxone models of care, its predictors, and association with dropout/illicit drug use.

METHODS

This study assessed patient satisfaction, using the 8-item version of the Client Satisfaction Questionnaire (CSQ), as a secondary outcome of a large phase IV pragmatic randomized controlled trial (OPTIMA). The effectiveness of standard methadone model of care was compared with flexible take-home buprenorphine/naloxone dispensation model of care in patients with prescription-type OUD. Of 272 participants recruited and followed up for 24 weeks, 183 were eligible for this study.

RESULTS

Throughout the study, patients were "satisfied" with their treatment. The average CSQ score was not significantly different between weeks 4, 12, and 24 in the total sample (χ 2 = 0.35; P = 0.84). There was no significant difference in CSQ based on treatment assignment (methadone vs flexible buprenorphine/naloxone) either overall ( z = 0.87; P = 0.38) or over time (χ 2 = 0.65; P = 0.72). High levels of depression at baseline and decreased depressive symptoms over the follow-up period predicted positive changes in patient satisfaction ( P = 0.03 and P = <0.01, respectively). Satisfaction was significantly associated with treatment retention but not illicit drug use.

CONCLUSIONS

This study demonstrates that patients with OUD on either standard methadone or flexible buprenorphine were generally satisfied with their treatment, with no difference in patient satisfaction based on treatment allocation. Given the ongoing opioid crisis, strategies to improve patient satisfaction should be further explored.

Perfectionistic concerns and binge eating in mother-daughter dyads: An actor-partner interdependence model

Perfectionism is linked to a range of psychopathology, including binge eating. Our study enhanced understanding of the role maternal perfectionistic concerns play in the maintenance of binge eating in emerging adult daughters. A sample of 73 mother-daughter dyads (mean age = 49.51 years for mothers and 19.89 years for daughters) reported on perfectionistic concerns (composite of doubt about actions and concern over mistakes), binge eating, and binge drinking (composite of frequency, severity, and perceptions). Using actor-partner interdependence modelling, mothers' and daughters' perfectionistic concerns were positively associated with their own binge eating (actor effects). Mothers' perfectionistic concerns were positively associated with daughters' binge eating (partner effect), but not vice versa. Perfectionistic concerns did not show significant actor or partner associations with binge drinking, supporting the specificity of our model. Findings suggest binge eating has characterological and interpersonal antecedents.

Division of Labour and Parental Mental Health and Relationship Well-Being during COVID-19 Pandemic-Mandated Homeschooling

While the COVID-19 pandemic has impacted the way parents partition tasks between one another, it is not clear how these division of labour arrangements affect well-being. Pre-pandemic research offers two hypotheses: economic theory argues optimal outcomes result from partners specialising in different tasks, whereas psychological theory argues for a more equitable division of labour. The question of which approach optimizes well-being is more pressing in recent times, with COVID-19 school closures leaving many couples with the burden of homeschooling. It is unknown whether specialisation or equity confer more benefits for mandated homeschoolers, relative to non-homeschoolers or voluntary homeschoolers. Couples (n = 962) with children in grades 1-5 completed measures of workload division and parental well-being. A linear mixed modelling in the total sample revealed that specialisation, but not equity, promoted increased parental emotional and relationship well-being. These relations were moderated by schooling status: voluntary homeschoolers' well-being benefitted from specialisation, whereas mandated homeschoolers' well-being did not benefit from either strategy; non-homeschoolers well-being benefitted from both strategies. Across the mixed-gender couples, mothers' and fathers' well-being both benefitted from specialisation; equity was only beneficial for mothers' well-being. Overall, couples might be advised to adopt highly equitable and specialised arrangements to promote both parents' well-being.

Inhibited personality traits, internalizing symptoms, and drinking to cope during the COVID-19 pandemic among emerging adults

Emerging adults with high levels of inhibited personality traits may be at-risk for drinking to cope during the COVID-19 pandemic. The current research explored mediational pathways between two inhibited personality traits (anxiety sensitivity (AS) and hopelessness (HOP)), internalizing symptoms (anxiety, depression, and COVID-19 distress), and coping drinking motives (drinking to cope with anxiety and drinking to cope with depression) during the pandemic. Cross-sectional data were collected from 879 undergraduate drinkers (79% female, 83% White, 18-25 years old) at five Canadian universities from January-April 2021. Participants self-reported on their personality, anxiety (GAD-7), depressive symptoms (PHQ-9), COVID-19 distress, and coping drinking motives. Mediational path analyses provided evidence of both specific and non-specific pathways between personality and coping motives via internalizing symptoms. Depressive symptoms partially mediated the link between HOP and drinking to cope with depression motives. While anxiety symptoms did not significantly mediate links between AS and coping with anxiety motives in the full model, evidence of mediation was found in a post-hoc sensitivity analysis. COVID-19 distress served as a non-specific mediator. AS and HOP are critical transdiagnostic risk factors that increase vulnerability for internalizing psychopathology and, in turn, risky drinking motives, in the context of the COVID-19 pandemic.

A multiple baseline trial of adapted prolonged exposure psychotherapy for individuals with early phase psychosis, comorbid substance misuse, and a history of adversity: A study protocol

Background

Adversity is prevalent among people with psychotic disorders, especially those within the first 5 years of a psychotic disorder, called early phase psychosis. Although adversity can lead to many negative outcomes (e.g., posttraumatic stress symptoms), very few treatments for adversity-related sequelae have been tested with individuals with psychotic disorders, and even fewer studies have specifically tested interventions for people in early phase psychosis. Furthermore, people who misuse substances are commonly excluded from adversity treatment trials, which is problematic given that individuals with early phase psychosis have high rates of substance misuse. For the first time, this trial will examine the outcomes of an adapted 15-session prolonged exposure protocol (i.e., PE+) to observe whether reductions in adversity-related psychopathology occurs among people with early phase psychosis and comorbid substance misuse.

Methods

This study will use a multiple-baseline design with randomization of participants to treatment start time. Participants will complete baseline appointments prior to therapy, engage in assessments between each of the five therapy modules, and complete a series of follow-up appointments 2 months after the completion of therapy. Primary hypothesized outcomes include clinically significant reductions in (1) negative psychotic symptoms measured using the Positive and Negative Syndrome Scale, (2) adversity-related sequelae measured using the Trauma Symptom Checklist-40, and (3) substance use frequency and overall risk score measured with the Alcohol, Smoking, and Substance Involvement Screening Test. We also anticipate that clinically significant reductions in hopelessness and experiential avoidance, measured with the Beck Hopelessness Scale and Brief Experiential Avoidance Questionnaire, the theorized mechanisms of change of PE+, will also be observed. A secondary outcome is a hypothesized improvement in functioning, measured using the Clinical Global Impression and Social and Occupational Functioning Assessment scales.

Discussion

The results of this treatment trial will contribute to the advancement of treatment research for individuals in early phase psychosis who have current substance misuse and a history of adversity, and the findings may provide evidence supporting the use of hopelessness and experiential avoidance as mechanisms of change for this treatment.

Clinical trial registration

Clinicaltrials.gov, NCT04546178; registered August 28, 2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1.

Depressive Symptoms and Conflict Behaviors: A Test of the Stress Generation Hypothesis in Romantic Couples During the COVID-19 Pandemic

Introduction: In early 2020, North American jurisdictions required households (e.g., romantic couples) to isolate together to help mitigate the spread of COVID-19. This study provides a first look at the interplay of depressive symptoms and conflict behaviors among isolating couples, including tests of predictions of the stress generation hypothesis. Methods: Mixed-gender couples residing in Canada (N = 711) completed online measures across two waves. We used the actor-partner interdependence mediation model, with Wave 1 depressive symptoms as the predictor, Wave 1 conflict enactment as the mediator, and Wave 2 depressive symptoms as the outcome. Results: Depressive symptoms showed stability across Wave 1 and 2. Wave 1 depressive symptoms showed associations with Wave 1 conflict enactment. For men (but not women), Wave 1 conflict enactment was associated with their own and their partner's Wave 2 depressive symptoms. For both partners, Wave 1 conflict enacted by men mediated the association between Wave 1 depressive symptoms and Wave 2 depressive symptoms. Discussion: Our study confirms and extends the stress generation hypothesis to the pandemic context, showing that depressive symptoms may partially contribute to conflict for isolating couples and that conflict behaviors enacted by men toward their partner can exacerbate depressive symptoms in both partners.

Interventions to Reduce Opioid Use in Youth At-Risk and in Treatment for Substance Use Disorders: A Scoping Review

BACKGROUND

Youth and young adults have been significantly impacted by the opioid overdose and health crisis in North America. There is evidence of increasing morbidity and mortality due to opioids among those aged 15-29. Our review of key international reports indicates there are few youth-focused interventions and treatments for opioid use. Our scoping review sought to identify, characterize, and qualitatively evaluate the youth-specific clinical and pre-clinical interventions for opioid use among youth.

METHOD

We searched MedLine and PsycInfo for articles that were published between 2013 and 2021. Previous reports published in 2015 and 2016 did not identify opioid-specific interventions for youth and we thus focused on the time period following the periods covered by these prior reports. We input three groups of relevant keywords in the aforementioned search engines. Specifically, articles were included if they targeted a youth population (ages 15-25), studied an intervention, and measured impacts on opioid use.

RESULTS

We identified 21 studies that examined the impacts of heterogeneous interventions on youth opioid consumption. The studies were classified inductively as psycho-social-educational, pharmacological, or combined pharmacological-psycho-social-educational. Most studies focused on treatment of opioid use disorder among youth, with few studies focused on early or experimental stages of opioid use. A larger proportion of studies focused heavily on male participants (i.e., male gender and/or sex). Very few studies involved and/or included youth in treatment/program development, with one study premised on previous research about sexual minority youth.

CONCLUSIONS

Research on treatments and interventions for youth using or at-risk of opioids appears to be sparse. More youth involvement in research and program development is vital. The intersectional and multi-factorial nature of youth opioid use and the youth opioid crisis necessitates the development and evaluation of novel treatments that address youth-specific contexts and needs (i.e., those that address socio-economic, neurobiological, psychological, and environmental factors that promote opioid use among youth).

Changes in sports gambling behavior during the COVID-19 pandemic in Canada

Sports betting is one of the most popular forms of gambling in Canada; recent prevalence estimates indicate that 7.9% of Canadian adults endorsed gambling on sports in the past year. The ongoing COVID-19 pandemic led to the temporary closure of most major sports leagues worldwide beginning in March of 2020. These sudden closures created a dramatic decrease in the availability of sports betting opportunities in the early stages of the pandemic, followed by a subsequent increase in availability as most sport leagues returned during the summer of 2020. Using a retrospective self-report measure of gambling participation, the present study investigated how the gambling behaviors of N = 85 past-year sports gamblers changed over the course of the pandemic. It was hypothesized that sports gamblers would report an initial decrease in gambling behaviors from pre-pandemic baseline levels to the early stages of the pandemic in May of 2020 when the availability of sports gambling was heavily restricted, followed by an increase in gambling behaviors from May to August, in accordance with the re-emergence of live sporting events. The general pattern of results supported the hypotheses, though gambling behaviors did not completely return to baseline levels. Beyond quantifying the changes in gambling behaviors over the early stages of the pandemic in Canada, results may have implications regarding the utility of voluntary gambling exclusion programs as well as legislation concerning gambling access.

Drinking among university students with a history of reading difficulties: motivational and personality risk factors for hazardous levels of consumption

An increasing number of students are entering university with reading difficulties-whether they be diagnosed or self-reported. Research demonstrates that university students who self-report a history of reading difficulties (HRD) have lower academic achievement and higher anxiety about academic performance as compared to peers without this history (NRD). Here we study other aspects of HRD students' university experiences, focusing on alcohol consumption. Specifically, we investigated the drinking motives and personality characteristics likely to increase risk of hazardous alcohol consumption among HRD vs. NRD undergraduates. We identified 42 HRD and 54 NRD participants based on responses to a reading history questionnaire. Participants completed questionnaires assessing hazardous drinking, drinking motives, and alcohol-risk personality traits. Both groups reported similarly high levels of hazardous drinking. HRD students reported drinking more to conform with peers, and less to enhance positive moods, than NRD students. HRD students also scored higher in the alcohol personality risk of impulsivity. Our results support a unique pattern of motives and personality risks among HRD students, a pattern that likely puts them at increased risk for sustained hazardous drinking. Clinical implications for preventing problem drinking among HRD undergraduates are considered.

Health psychology and behavioral medicine researchers in Canada: An environmental scan

The purpose of this study is to characterize contemporary Canadian health psychology through an environmental scan by identifying faculty, research productivity and strengths, and collaborator interconnectivity. Profiles at Canadian universities were reviewed for faculty with psychology doctorates and health psychology research programs. Publications were obtained through Google Scholar and PubMed (Jan/18-Mar/21). A total of 284 faculty were identified. Cancer, pain, and sleep were key research topics. The collaborator network analysis revealed that most were linked through a common network, with clusters organized around geography, topic, and trainee relationships. Canada is a unique and productive contributor to health psychology.

The Royal Canadian Mounted Police (RCMP) Study: protocol for a prospective investigation of mental health risk and resilience factors

The Royal Canadian Mounted Police (RCMP), like all public safety personnel (PSP), are frequently exposed to potentially psychologically traumatic events that contribute to posttraumatic stress injuries (PTSI). Addressing PTSI is impeded by the limited available research. In this protocol paper, we describe the RCMP Study, part of the concerted efforts by the RCMP to reduce PTSI by improving access to evidence-based assessments, treatments and training as well as participant recruitment and RCMP Study developments to date. The RCMP Study has been designed to (1) develop, deploy and assess the impact of a system for ongoing annual, monthly and daily evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; (4) augment the RCMP Cadet Training Program with skills to proactively mitigate PTSI; and (5) assess the impact of the augmented training condition (ATC) versus the standard training condition (STC). Participants in the STC (n = 480) and ATC (n = 480) are assessed before and after training and annually for 5 years on their deployment date; they also complete brief monthly and daily surveys. The RCMP Study results are expected to benefit the mental health of all participants, RCMP and PSP by reducing PTSI among all who serve.

Alcohol use and death by suicide: A meta-analysis of 33 studies

INTRODUCTION

Decades of research show an association between alcohol use and death by suicide. However, findings on the temporal link between alcohol use and death by suicide are unclear. In the most comprehensive meta-analysis on the topic to date, we analyzed data from longitudinal studies to determine if alcohol use is a risk for death by suicide. We also explored moderators to uncover conditions where the alcohol use-suicide link is strengthened/weakened.

METHODS

Our literature search of six databases yielded 33 eligible studies involving 10,253,101 participants (community, psychiatric, and military samples).

RESULTS

Alcohol use was associated with a 94% increase in the risk of death by suicide. Specifically, random-effects meta-analysis revealed alcohol use displayed small-to-large significant risk and odds ratios with suicide for quantity of alcohol use and alcohol use diagnosis/alcohol-related problems. Meta-regression generally indicated larger effect sizes for studies with a higher percentage of women, younger age, unadjusted estimates, longer follow-up periods, military samples, and higher frequencies and quantities of alcohol use (relative to drinker/non-drinker status).

CONCLUSION

Our study highlights alcohol use as a substantive risk factor for death by suicide and underscores the importance of monitoring alcohol use among suicidal individuals and screening for suicidality among heavier alcohol users.

Pain and Fear of Cancer Recurrence in Survivors of Childhood Cancer

OBJECTIVES

Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pain catastrophizing, and FCR in childhood cancer survivors and their parents and to examine whether pain catastrophizing predicts increased FCR beyond anxiety symptoms and pain intensity.

METHODS

The participants were 54 survivors of various childhood cancers (Mage=13.1 y, range=8.4 to 17.9 y, 50% female) and their parents (94% mothers). Children reported on their pain intensity in the past 7 days. Children and parents separately completed measures of anxiety symptoms, pain catastrophizing, and FCR.

RESULTS

Higher anxiety symptoms were associated with increased pain intensity, pain catastrophizing, and FCR in childhood cancer survivors. Higher anxiety symptoms and pain catastrophizing, but not child pain intensity, were associated with FCR in parents. Hierarchical linear regression models revealed that pain catastrophizing explained unique variance in both parent (ΔR2=0.11, P<0.01) and child (ΔR2=0.07, P<0.05) FCR over and above the effects of their own anxiety symptoms and child pain.

DISCUSSION

The results of this study provides novel data on the association between pain and FCR and suggests that a catastrophic style of thinking about pain is more closely related to heightened FCR than one's anxiety symptoms or the sensory pain experience in both childhood cancer survivors and their parents. Pain catastrophizing may be a novel intervention target for survivors and parents struggling with fears of recurrence.

Do symptoms of depression and anxiety contribute to heavy episodic drinking? A 3-wave longitudinal study of adult community members

Heavy episodic drinking (or binge drinking) is a significant public health concern. Self-medication using alcohol is often thought to explain the co-occurrence of heavy episodic drinking with depression and anxiety. Yet, there is little longitudinal work examining both depressive and anxiety symptoms and how they are independently related to heavy episodic drinking in adult community samples. To this end, we invited adult community members (N = 102) to come to the lab to complete validated measures of depressive symptoms (composite of CES-D-SF, SCL-90-D, and DASS-21-D), anxiety symptoms (DASS-21-A), and heavy episodic drinking (composite of frequency, severity, and perceptions) at baseline, and again three and six months later. Using a three-wave cross-lagged panel model, we tested reciprocal relations between heavy episodic drinking and each internalizing symptom. We found strong temporal stability in our study variables. Depressive symptoms were associated with increases in heavy episodic drinking, and anxiety symptoms were associated with decreases in heavy episodic drinking. In contrast, heavy episodic drinking did not predict either internalizing symptom over time. Results are consistent with the notion that individuals with greater depressive symptoms use alcohol to self-medicate, and that anxiety symptoms (particularly autonomic arousal) may be potentially protective against future heavy episodic drinking.