Homewood Research Institute

Clinically complex adults referred to ECT for depression presented with prominent memory concerns and performed below expectation compared to their estimated premorbid cognitive functioning at baseline. Naturalistic delivery of ECT did not appear to be associated with prolonged adverse cognitive outcomes; however, subjective memory concerns and below-expected cognitive performance persisted during follow-up. Treatment response impacted subjective memory outcomes, with only 'Responders' endorsing slightly reduced, though still persistent, subjective memory concerns following ECT. Conclusions on the long-term impacts of ECT are tempered by the high lost to follow up (LTFU) rate observed across follow-up assessments (66% LTFU at 6-months, 81% LTFU at 12-months). Nonetheless, these findings emphasize the need to address subtle cognitive deficits and memory complaints that persist following ECT, even in individuals demonstrating clinical improvement.

Introduction: The use of measurement-based care (MBC) can significantly improve outcomes for patients, including symptom reduction, improved functioning, and quality of life. However, existing barriers can lead to low implementation rates, especially among first responders, military personnel, and Veterans (FRMV). Overcoming barriers and identifying ways to measure implementation using aggregate data is the next step in integrating MBC into mental health care. This article outlines the current state of MBC implementation at a mental health and addictions hospital in Canada. Methods: Aggregate data provided by an online MBC platform were used to review clinical outcomes (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, and Working Alliance Inventory-6) and implementation rates (patient adoption and continuous engagement) of a Guardians program tailored for FRMV and compare these outcomes with benchmarks of Canadian and U.S. organizations. Results: Clinical outcomes and MBC implementation rates for the program exceeded national median benchmarks. Patient adoption and engagement increased between 2022 and 2023 and dropped in 2024. Discussion: Results suggest that the program was aligned with patients’ clinical needs and addressed hospital needs for a MBC system because patient adoption and engagement exceeded national benchmarks. The consistent rise in patient participation since the implementation of MBC reflects the system’s relative success, although barriers such as limited familiarity and staff capacity likely persist. Future work addressing barriers through organizational training and MBC champions may enhance implementation. The complex treatment needs of FRMV underline the importance of evaluating the integration of MBC into programming for this population.

The etiological pathways through which structural determinants result in health inequities remain unclear. In adolescent populations, a sense of meaning and purpose in life has been hypothesized and considered cross-sectionally to represent an intermediary determinant in the pathway that connects wealth with mental health outcomes. The purpose of this study was to prospectively explore how life meaning and purpose contributes to disparities in mental health observed by affluence in an adolescent cohort. We used two-year linked survey data collected from a cohort of 17,745 students at Canadian secondary schools in 2020/2021 and 2021/2022. Structural equation models were used to examine the prospective associations between students' perceived relative family affluence and anxiety and depression symptoms, mediated by their sense of meaning and purpose in their lives. Models were stratified by gender identity. The prevalence of clinically-relevant depression and anxiety symptoms was lowest among cisgender boys and highest among transgender and gender diverse adolescents. Conversely, life meaning and purpose was reported most often by cisgender boys, followed by cisgender girls. Meaning and purpose inlife partially mediated associations between relative affluence anddepression and anxiety symptoms. Consistent with determinants of health models and past cross-national analyses of adolescent health survey data in Canada, results provide prospective evidence in support of life meaning and purpose as an intermediary determinant of mental health in adolescents. Experiences that foster a sense of meaning and purpose in life require recognition as determinants of health, and suggest an intangible resource that can be applied to clinical and public health initiatives that address adolescent mental health.

Background:Posttraumatic stress disorder (PTSD) is a severe, often difficult-to-treat condition, highlighting the need for innovative therapies. Interventional treatments, including neuromodulation, rapid-acting pharmacotherapies such as intravenous ketamine (IV-KET) and esketamine (ESK), and emerging psychedelic-assisted psychotherapies, offer promising solutions. This systematic review evaluates the efficacy, safety, and future research priorities of these treatments for PTSD.Methods:A search strategy was implemented across 3 electronic databases. Peer-reviewed articles written in English that focused on interventional psychiatry treatments for adult patients with PTSD were included.Results:The systematic review encompassed 94 studies, including 39 on transcranial magnetic stimulation (TMS), 8 on IV-KET, 3 on intranasal esketamine (IN-ESK), 4 on intravenous ketamine (IV-KET) assisted therapy (KET-AT), 1 on esketamine (ESK) assisted therapy (ESK-AT), and 14 on 3,4-methylenedioxymethamphetamine assisted therapy (MDMA-AT). Randomized controlled trials demonstrated response rates of 12.5%-80% for TMS, 17%-67% for IV-KET, and 50%-87% for MDMA. Additional treatments reviewed included Electroconvulsive Therapy, transcranial direct current stimulation, and other pharmacological and neurostimulation treatments. Most treatments were well tolerated, with only mild, transient adverse effects.Conclusions:This review highlights the heterogeneity in efficacy, safety, and tolerability across neuromodulation and pharmacologic treatments for PTSD. Variability in response rates reflects differences in patient populations, protocols, and comorbidities. While repetitive TMS, IV-KET, ESK, KET-AT, and MDMA-AT show symptom improvement, sustained efficacy varies, underscoring the need for maintenance strategies. Although direct evidence on stage-specific approaches is limited, these methods, guided by neuroscience-based nomenclature, may improve therapeutic precision, especially in complex cases.

LAY SUMMARY Public safety personnel (PSP), like police officers, firefighters, and paramedics, often face stressful situations at work in which their moral values are violated. These experiences place PSP at risk for moral injury. Moral injury is a type of mental health experience that can greatly affect how someone feels and behaves. This study aimed to understand whether and how moral injury relates to different coping methods and supports that PSP may regularly use. The results showed that organizational support, spiritual well-being, self-compassion, and social support were each associated with less moral injury. These results will help inform prevention and intervention strategies for PSP experiencing moral injury.

In the present study, we extend previous psychometric evaluations of the DSM-5 alcohol use disorder (AUD) criteria using Rasch analysis in a large clinical sample. Adult patients with AUD (N = 1101) completed the DSM-5 AUD symptom checklist as part of routine clinical assessment upon admission to an inpatient substance use disorder treatment program. We conducted Rasch analysis of responses to the 11 criteria, examining model fit and item severities. We also examined whether there was evidence of differential item functioning based on sex and age. Results supported the unidimensionality and local independence of the criteria, although some items were a suboptimal fit to the Rasch model. In particular, across all indicators, hazardous use exhibited misfit with model expectations. Additionally, the range of item severities did not span the full range of problem severity within this clinical sample, with many patients at the high end of the severity continuum and no items to differentiate them. There was evidence of differential item functioning by both sex and age, but effect size indices suggested that differences were unlikely to be clinically meaningful. The present study supports the unidimensionality of the DSM-5 AUD diagnosis, but the misfit of certain items to the Rasch model and the narrow range of item severities suggest that more granular distinctions in AUD may be limited in high-severity samples. The results also suggest that the assumptions of interval-level measurement may not hold in clinical populations.

Objective:The Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) defines cannabis use disorder as a polythetic unidimensional diagnosis (>2 symptoms from up to 11), but few studies have empirically evaluated the latent structure of CUD. Rasch analysis is a psychometric technique that has previously been used to validate unidimensional scales, like DSM-5 CUD.Method:In this study, the Rasch model was used to evaluate the DSM-5 CUD criteria in a clinical sample of adults receiving inpatient treatment for substance use disorder (n = 249) reporting active cannabis use at admission. The unidimensionality of the criteria was evaluated using the Martin-Löf test and the nonparametric –T2 test of Ponocny. Model fit was assessed using the χ2 goodness of fit test for individual items.Results:Results supported the unidimensional structure of the criteria. Symptom # 3 was the least endorsed, highest severity item. Conversely, symptom #9 was the most endorsed and had the lowest severity estimate. Overall, the data fit the Rasch model well, although misfit was observed for symptom # 8.Conclusions:Rasch's analysis of CUD symptoms in an inpatient sample broadly supports the DSM-5 CUD syndrome. Further examination is needed to determine if removing or revising the hazardous use symptom criterion in future DSM revisions would improve diagnostic measurement.

Individuals with histories of complex psychological trauma, such as those with dissociative disorders, are often high utilizers of inpatient services and thus warrant further research attention. The present study sought to examine whether treatment on a specialized inpatient trauma unit was associated with improvements in adaptive functioning, emotion regulation, and dissociation among patients experiencing complex posttraumatic and dissociative symptoms. This study used archival data collected as part of treatment provided to inpatients (N = 54), the majority of whom had a dissociative disorder, at a specialized trauma disorders unit to analyze differences in scores between intake and discharge on measures of adaptive functioning, emotion regulation, and dissociation. Adaptive functioning and emotion regulation were significantly improved at discharge compared to intake, t(299) = -11.28, p < .001; t(305) = 8.54, p < .001, respectively, with very large effect sizes (d = 1.60; d = 1.20), and there was a significant decrease, t(311) = 2.15, p = .032, d = .30, in dissociative absorption. Our findings suggest that inpatient treatment modeled after expert consensus treatment guidelines is associated with significant improvements in adaptive functioning and emotion regulation and reduced dissociative absorption in individuals experiencing severe and acute complex posttraumatic and dissociative symptoms. Appropriate screening and symptom-specific treatment of complex posttraumatic and dissociative symptoms are recommended to improve outcomes for this population during inpatient hospital admission. (PsycInfo Database Record (c) 2025 APA, all rights reserved).