@article{pmid42863337,

title = {On the research on youth mental health: A scientometric analysis across mental disorders},

author = {Gabriele Lo Buglio and Srividya N Iyer and Muhammad Omair Husain and Tommaso Boldrini and Chaomei Chen and Olivier Corbeil and Logos Curtis and Gyselle de Geus and Saguna Katyal and Vittorio Lingiardi and Patrick D McGorry and Norman Nassisi and Barnaby Nelson and Jai L Shah and Annalisa Tanzilli and Josephine Zein and Christoph U Correll and Michel Sabé and Marco Solmi},

doi = {10.1016/j.euroneuro.2026.113884},

issn = {1873-7862},

year  = {2026},

date = {2026-10-01},

journal = {Eur Neuropsychopharmacol},

volume = {114},

pages = {113884},

abstract = {In youth-i.e., adolescents and young adults-mental disorders represent a major burden on well-being and quality of life. This scientometric study aimed to map research trends concerning any mental disorder in youth. We searched the Web of Science Core Collection for studies published between 01/01/1985 and 28/08/2025, using keywords on mental disorders and youth. Co-citation reference networks were extracted. R-bibliometrix/CiteSpace were used. 65,684 studies were included, forming a well-structured co-reference network. A trend in the 1980s concerned the prevalence/outcomes of specific mental disorders such as depressive and anxiety disorders. In the 1990s/2000s, research trends concerned assessment tools, pharmacotherapy (e.g., antidepressants, antipsychotics), bipolar disorders and schizophrenia. In the 2010s, early intervention for psychosis was a dominant focus, influencing prevention in mental health. The 2010s also focused on ADHD, eating disorders, gaming disorder, autism, depression and suicide, fMRI, and transgender health, beyond gender dysphoria. In the 2020s, a recent trend has increasingly focused on global evidence on the age at onset and burden across mental disorders, access to care, network analysis, and COVID-19. Over time, research has broadened the focus from adolescence to youth across mental health problems. Both disorder-specific and transdiagnostic research trends were observed. Novel trends in 2023-2025 included substance use, lifestyle psychiatry, evidence synthesis and non-suicidal self-injury. Most studies were conducted in Western countries. Underrepresented research areas included the involvement of youth with lived/living experience in identifying meaningful outcomes, open science, implementation research, economic evaluations, machine-learning approaches, and social determinants of mental health.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42778287,

title = {Long-Term Trajectories of Multidimensional Outcomes in Psychosis Following Early Intervention During the Critical Period: The PEPP-Montreal 10+ Study Protocol},

author = {Olivier Percie du Sert and Joseph Ghanem and Vanessa McGrory and Karyne Anselmo and Kelly K Anderson and Srividya Iyer and Ridha Joober and Jai Shah and Ashok Malla and Martin Lepage},

doi = {10.1111/eip.70258},

issn = {1751-7893},

year  = {2026},

date = {2026-09-01},

journal = {Early Interv Psychiatry},

volume = {20},

number = {9},

pages = {e70258},

abstract = {INTRODUCTION: While early intervention services (EIS) have demonstrated short-term benefits, the long-term maintenance of these gains remains uncertain. Individuals with first-episode psychosis exhibit significant variability in their course of recovery. Understanding the risk and protective factors that shape long-term outcome trajectories is essential to predicting and promoting sustained recovery. Here, we present the protocol for an extended 10-year follow-up study of social, mental, cognitive, and physical health outcomes, supplemented through linkage with health administrative databases to offer a holistic perspective on long-term outcome trajectories.nnAIM: The primary objective of the study is to model the heterogeneity of long-term trajectories across multiple outcome dimensions over a 10-year follow-up period using data-driven methods.nnMETHOD: The Prevention and Early Intervention Program for Psychoses (PEPP-Montreal) is a well-established, high-fidelity EIS program operating within a universal healthcare system and an epidemiologically defined catchment area in South-West Montréal, Canada. Between 2003 and 2018, PEPP-Montreal conducted a detailed two-year longitudinal assessment of 689 individuals aged 14-35 with first-episode affective or non-affective psychosis.nnDISCUSSION: This study will help distinguish clinically meaningful subgroups, characterize their profiles, and identify early predictors of long-term outcomes while providing insight into the mechanisms of change within trajectories. In particular, the study will assess whether trajectories shaped during the critical period are sustained over the long term. To our knowledge, this represents the most comprehensive investigation of long-term trajectories following EIS in North America and is expected to lay the groundwork for optimizing EIS and developing personalized interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42472313,

title = {Health service utilization by people with psychosis during Peru's mental health reform and the COVID-19 pandemic: a population-based study},

author = {Ruben Valle and Juan P Murillo and Peiyuan Huang and Cesar Gutierrez and Srividya N Iyer},

doi = {10.1016/j.lana.2026.101542},

issn = {2667-193X},

year  = {2026},

date = {2026-09-01},

journal = {Lancet Reg Health Am},

volume = {61},

pages = {101542},

abstract = {BACKGROUND: Individuals with psychosis face persistent barriers to care. Peru's recent mental health reform expanded services nationwide but coincided with the COVID-19 pandemic. We hypothesized that service utilization among individuals with psychosis would increase between 2018 and 2024, particularly in underserved regions.nnMETHODS: We analyzed outpatient morbidity data from the Peruvian National Superintendence of Health (2018-2024). Sex was available as binary male/female coding; gender identity and race/ethnicity data were not available. Service utilization was compared across three groups: psychosis, non-psychotic mental disorders, and general medical conditions. We examined changes in access (rate ratios, rate differences), the impact of the pandemic (interrupted time series), and decentralization trends (Poisson regression), separately for each disorder group.nnFINDINGS: In 2024 compared with 2018, monthly service utilization per 100,000 declined for psychosis (28.2 in 2018-19.2 in 2024; rate ratio 0.68), rose for non-psychotic mental disorders (225.2 in 2018-304.6 in 2024; 1.35), and slightly fell for general medical conditions (12,688.1 in 2018-12,370.4 in 2024; 0.97). The pandemic caused a comparable immediate drop in service utilization, with rates falling to 37.9%, 37.0%, and 35.3% of expected levels for the three groups in March 2020, followed by gradual monthly increases (psychosis 1.3%, non-psychotic mental disorders 2.6%, general medical conditions 2.2%). A shift from tertiary to primary and regional facilities was seen for both mental disorder groups, but greater utilization in underserved regions was observed only for non-psychotic mental disorders.nnINTERPRETATION: Despite nationwide expansion of mental health services, individuals with psychosis did not experience higher service use. The pandemic's impact was acute and enduring for this group. Findings underscore the need to examine reasons for this stagnation in service utilization and evaluate the acceptability and appropriateness of Peru's current service model for psychosis.nnFUNDING: Canadian Institutes of Health Research, Canada Research Chairs program.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42413522,

title = {Return on investment of enhanced primary youth mental health services in a large Canadian urban centre: a retrospective cohort study},

author = {Jai L Shah and Nguyen Xuan Thanh and Shireen Surood and Surya Poudel and Liana Urichuk and Giuseppe D'Andrea and Eric Latimer and Neil Andersson and Patricia Boksa and Ridha Joober and Shalini Lal and Srividya N Iyer and Ashok Malla and Philip Jacobs and },

doi = {10.1016/S2215-0366(26)00165-3},

issn = {2215-0374},

year  = {2026},

date = {2026-08-01},

journal = {Lancet Psychiatry},

volume = {13},

number = {8},

pages = {657--668},

abstract = {BACKGROUND: Many youth mental health reforms aim to shift care away from acute, hospital, or institutional settings and into community-based services, but few such initiatives have been subject to economic evaluations. We aimed to examine service utilisation and the corresponding return on investment for individuals receiving care via an enhanced primary-care youth mental health service.nnMETHODS: We conducted a retrospective cohort study of an enhanced primary-care youth mental health service transformation in a major urban site of the pan-Canadian ACCESS Open Minds network, which provides assessment and interventions for all types and severities of mental health problems, with priorities co-designed by individuals with lived experience (young people, families, and carers). Administrative datasets were used to determine service utilisation and the associated costs, including programme implementation, for help-seeking youth aged 15-25 years with any mental health problem. A difference-in-differences approach compared outcomes pre-exposure with outcomes post-exposure to the ACCESS Open Minds service over 1 year, in relation to youth receiving a non-transformed service. Propensity score matching and sensitivity analyses ensured bias reduction and robustness of observations, respectively.nnFINDINGS: Between April 6, 2016, and Sept 30, 2019, 10 632 help-seeking youth (4821 [45·4%] males and 5801 [54·6%] females) were included. 1415 youths (mean age 20·1 years) received care from ACCESS Open Minds, and 9217 youths (19·3 years) received standard community mental health services. No ethnicity data were available in this administrative dataset. Compared with those receiving services in community mental health clinics, those receiving ACCESS Open Minds had more intensive service needs throughout the study period and had greater and statistically significant reductions in hospital admissions (CA$1961 savings); outpatient ($613 savings), specialist ($432 savings), and general practitioner visits ($47 savings); and public residential admissions ($1256 savings) per-person per-year. There were no significant differences in emergency department visits, the number of prescriptions dispensed, community mental health visits, or contracted residential admissions. Net cost reduction associated with ACCESS Open Minds was $4355 per-person per-year, with implementation costs of $448, representing a net benefit of $3907 (return on investment 9·7).nnINTERPRETATION: Consistent with principles of early intervention in mental health, ACCESS Open Minds implementation resulted in improved or equivalent outcomes but also shifted care towards community-based settings, with substantial net cost savings. These cost savings can be realised if novel services identify and treat not only new cases but also include those who were previously intensive users of standard services. The long-term return on investment of enhanced primary youth mental health models such as ACCESS Open Minds will likely rest on their commitment to including this population.nnFUNDING: Canadian Institutes of Health Research and the Graham Boeckh Foundation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42635791,

title = {Feeling out of place: a qualitative study on pathways from social adversities to early psychosis},

author = {Adrianne P Both and Salomé M Xavier and Nicole van den Bogerd and Arzu R Salmanova and Jolanda Maas and Els van der Ven and Srividya N Iyer and Imke L J Jansen},

doi = {10.1007/s00127-026-03199-w},

issn = {1433-9285},

year  = {2026},

date = {2026-08-01},

journal = {Soc Psychiatry Psychiatr Epidemiol},

abstract = {PURPOSE: Socioenvironmental adversities play an important role in psychosis aetiology, yet the pathways that link them to psychosis development remain poorly understood. This qualitative study explored how individuals with early psychosis make sense of psychosis its emergence in relation to socioenvironmental circumstances across their life course.nnMETHODS: Twenty-one participants were recruited from an outpatient early intervention service in the Netherlands. They participated in semi-structured biographical interviews. Interviews were analysed inductively using thematic analysis.nnRESULTS: Participants' (12 men; 11 first or second generation immigrants; aged 20-34 years; 2 months-5.5 years since first psychosis treatment) life stories were marked by a sense of insecurity and out-of-placeness in the world, which they connected to childhood experiences of rejection and loneliness, as well as to difficulties in finding their place in school and work. Participants also highlighted losing a sense of themselves (or not feeling present as themselves) throughout the years preceding psychosis onset. This they connected to childhood environments that felt unsafe, and to stress and overwhelming external stimuli in adulthood. Disruptions shortly before onset, such as a relationship breakup, were described as culminating these experiences into a sense of seeing no path forward.nnCONCLUSION: Our findings illustrate how participants connected socioenvironmental circumstances across their life course to psychosis through experiences that preceded psychosis onset, sometimes by many years. The evolvement of these pre-onset experiences throughout the biographical contexts of patients' lives warrants further in-depth research. Attending to these pre-onset experiences may help clinicians to find resonance with patients' understanding of their difficulties.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42599709,

title = {Mental Health Service Use in Sexually and Gender Diverse Youths and Cisgender Heterosexual Youths},

author = {Lauren Anzarouth and Sasha MacNeil and Natalie Castellanos Ryan and Alicia Martineau and Massimiliano Orri and Caroline Temcheff and Marc Dorais and Alain Girard and Srividya N Iyer and Ian Colman and Isabelle Ouellet-Morin and Nicholas Chadi and Robert-Paul Juster and Marie-Claude Geoffroy},

doi = {10.1001/jamanetworkopen.2026.26797},

issn = {2574-3805},

year  = {2026},

date = {2026-08-01},

journal = {JAMA Netw Open},

volume = {9},

number = {8},

pages = {e2626797},

abstract = {IMPORTANCE: Sexually and gender diverse (SGD) youths experience disproportionate mental health challenges, yet longitudinal evidence of their mental health service use remains limited.nnOBJECTIVE: To examine mental health outpatient, emergency, and inpatient service use among SGD youths compared with cisgender heterosexual youths from preschool to young adulthood.nnDESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included 1326 participants from the Quebec Longitudinal Study of Child Development who self-reported sexual orientation and gender identity at age 23 years. Participants were followed up from birth (between October 1997 and July 1998). The wave of data collection when they were 23 years old occurred in June 2023. Data analyses were conducted between September 2024 and June 2026.nnEXPOSURE: Self-reported sexual and gender diversity at age 23 years.nnMAIN OUTCOMES AND MEASURES: Mental health outpatient (age 1-23 years; 1997-1998 to 2021), emergency (age 18-23 years; 2016 to 2021), and inpatient (age 8-23 years; 2006 to 2021) service use extracted from 3 provincial administrative health databases: the Régie de l'Assurance Maladie du Québec, the Banque de Données Communes des Urgences, and the Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière.nnRESULTS: Of 1326 participants (691 [52.1%] assigned female at birth), 324 (24.4%) identified as sexually diverse and 32 (2.4%) identified as gender diverse. After controlling for sex assigned at birth and socioeconomic status, SGD youths were more likely than cisgender heterosexual youths to use outpatient services (adjusted odds ratio [AOR], 1.41 [95% CI, 1.09-1.83]) and emergency services (AOR, 1.99 [95% CI, 1.33-2.98]); the association was not present for inpatient services (AOR, 1.49 [95% CI, 0.87-2.54]). Growth curve models indicated a similar likelihood of outpatient service use between SGD youths and cisgender heterosexual youths in preschool, but steeper increases among SGD youths over time (b = 0.21 [SE, 0.11; 95% CI, -0.002 to 0.41]; P = .05]). SGD youths assigned female at birth had higher odds of emergency and inpatient service use compared with cisgender heterosexual females. SGD youths assigned male at birth had higher odds of outpatient service use compared with cisgender heterosexual males.nnCONCLUSIONS AND RELEVANCE: In this population-based cohort study, SGD youths showed greater use of mental health services across development, with disparities emerging early and widening over time. These findings highlight the need for early and sustained mental health support for SGD youths.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42545036,

title = {Understanding Heterogeneity and Patterns of Services Utilization of Homeless and at-Risk Youth: Results From the ACCESS-OM-RIPAJ Cohort: Comprendre l'hétérogénéité et les habitudes d'utilisation des services chez les jeunes en situation d'itinérance et à risque : Résultats de la cohorte ACCESS-OM-RIPAJ},

author = {Giuseppe D'Andrea and Charles Tessier and Diane Aubin and Marie-Eve Dupont and Camille Arbaud and Axel Glaize and Pasquale Bauco and Julie-Marguerite Deschenes and Jai L Shah and Ashok Malla and Srividya N Iyer and Amal Abdel-Baki and },

doi = {10.1177/07067437261468896},

issn = {1497-0015},

year  = {2026},

date = {2026-08-01},

journal = {Can J Psychiatry},

pages = {7067437261468896},

abstract = {IntroductionHomeless youth experience disproportionately high rates of mental disorders, suicidality, and overdose. Understanding their heterogeneous needs is essential for designing integrated care models. This study examined characteristics, help-seeking reasons, and service use among youth accessing ACCESS Open Minds (ACCESS-OM)- (RIPAJ), a Montréal-based network serving homeless and at-risk youth.MethodsWe analyzed sociodemographic and clinical data, presenting concerns, and services received by youth referred to ACCESS-OM-RIPAJ (2016-2020). Latent class analysis (LCA) identified clusters based on (1) presenting concerns and (2) service use.ResultsA total of 681 referrals were made to ACCESS-OM-RIPAJ. LCA identified 4 distinct help-seeking clusters: (1) a group characterized by severe material deprivation, including homelessness and unmet basic needs, alongside notable social isolation and higher prevalence of psychotic symptoms, who were more often referred to specialized psychiatric services; (2) a group defined by substance misuse with homelessness and financial instability, with fewer co-occurring concerns, requiring coordination across services; (3) a cluster marked by trauma-related experiences, family difficulties, and suicidality, with less clearly defined service use patterns; and (4) a group characterized by emotional distress, occurring alongside financial precarity and risk of homelessness, who were primarily offered psychological interventions.ConclusionThese findings highlight the heterogeneity of needs among homeless and at-risk youth and the importance of integrated, multi-component mental health programs. Improving access to care across the continuum of needs and presentation severities is essential for preventing adverse outcomes and addressing the cyclical relationship between mental health and homelessness.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41370074,

title = {Family-Focused Recommendations in Canadian Guidelines for Early Intervention Services for Psychosis: A Systematic Review: Recommandations axées sur la famille dans les Lignes directrices canadiennes relatives aux services d'intervention précoce en cas de psychose : Une revue systématique},

author = {Helen Martin and Ruben Valle and Nicole Pawliuk and Srividya N Iyer},

doi = {10.1177/07067437251393981},

issn = {1497-0015},

year  = {2026},

date = {2026-08-01},

journal = {Can J Psychiatry},

volume = {71},

number = {8},

pages = {593--605},

abstract = {BackgroundDespite well-known benefits of family involvement and interventions, gaps remain in their implementation in early intervention for psychosis. Guidelines have been developed for early psychosis services to bridge evidence-implementation gaps. Little attention has been paid to their nature, quality and recommendations regarding family involvement and interventions. We aimed to identify, describe, and appraise family-focused recommendations in Canadian early psychosis guidelines.MethodsWe conducted a systematic review (PROSPERO#CR042020208974), including Canadian guidelines/standards for first-episode psychosis/early intervention in psychosis, or for psychosis/schizophrenia with a section on first-episode psychosis/early intervention for psychosis. The search was conducted in Google and Google Advanced of 58 websites (April 2024). From each document, bibliographic information and family-focused recommendations were extracted. All family-focused recommendations were subject to content analysis and mapped against a patient and family engagement framework. All guidelines were appraised using Appraisal of Guidelines Research & Evaluation-Recommendation EXcellence (AGREE-REX), assessing rigor and implementability. Family-focused recommendations were rated on three AGREE-REX items. Findings were narratively synthesized.ResultsSeven documents were included, with five provincial early psychosis guidelines and two Canada-wide schizophrenia-spectrum guidelines. 96 family-focused recommendations were extracted covering 21 themes (19 appeared in ≤4 guidelines; two (family psychoeducation; involving families in treatment-planning) in five guidelines). No guidelines had recommendations regarding families in inpatient care; only two guidelines had recommendations for navigating consent vis-à-vis family involvement. 77.4% of recommendations were about direct care; 22.5% about involving families in organizational design/governance; and none about policymaking involvement. AGREE-REX ratings for relevant outcomes and local applicability were lower for family-focused recommendations than overall guidelines. Most guidelines fared poorly in eliciting families' values/preferences.ConclusionFew family-focused recommendations featured consistently across early psychosis guidelines. There was little guidance on navigating barriers to family involvement. Our analysis revealed critical gaps, including in viewing families as partners in treatment decision-making and services/policy design. Future guidelines must integrate stakeholders' values/preferences and guidance on real-world implementation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42418951,

title = {An appraisal of practice guidelines for early intervention services for psychosis: Using AGREE II (Appraisal of Guidelines for Research and Evaluation) to enhance the quality and trustworthiness of guidelines in the future},

author = {Manuela Ferrari and Nicole Pawliuk and Jai Shah and Amal Abdel-Baki and Phil Tibbo and Donald Addington and Marc-André Roy and Ridha Joober and Kevin MacDonald and Srividya N Iyer},

doi = {10.1016/j.schres.2026.06.005},

issn = {1573-2509},

year  = {2026},

date = {2026-07-01},

journal = {Schizophr Res},

volume = {295},

pages = {282--291},

abstract = {BACKGROUND: Early intervention services (EIS) for psychosis have expanded internationally. Yet, the quality of the guidelines to support and monitor them has never been evaluated. We therefore aimed to systematically appraise the quality of EIS guidelines.nnSTUDY DESIGN: We conducted a systematic review of grey literature websites, supplemented by guidelines identified in a prior scoping review. Eligible documents were guidelines focused on/with a section on early intervention or first episode psychosis. Two independent reviewers appraised each guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE II).nnSTUDY RESULTS: Thirty-two guidelines were included. Guidelines varied widely on scores for the AGREE II domains. Many scored high (≥70%) on Scope and Purpose (24/32; 75%) and Clarity of Presentation (22/32; 69%). Only 22% (7/32) scored well on Rigour of Development, primarily due to the lack of methods for evidence identification and appraisal. The lowest scoring domain was Applicability; only two guidelines scored ≥70%, while more than half provided no information on barriers or facilitators to implementation. Stakeholder involvement, especially from service users, was limited in developing EIS-specific guidelines. Guidelines performing consistently well were from large guideline development groups and used established evidence-grading methods.nnCONCLUSIONS: This first systematic appraisal shows that while many EIS guidelines clearly articulate aims and recommendations, substantial methodological and implementation gaps remain. Nonetheless, EIS guidelines score like others in psychiatry. Still, limited stakeholder engagement and applicability may impede consistent, evidence-based EIS delivery. Future guidelines should explicitly describe evidence-based review processes, integrate service user input, and use AGREE II-like tools to enhance their usability and impact.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42484771,

title = {Mental health status of sexually diverse youth at age 23: Cross-sectional data from the Quebec Longitudinal Study of Child Development},

author = {Alicia Martineau and Sasha MacNeil and Srividya N Iyer and Kira London-Nadeau and Lauren Anzarouth and Élise Chartrand and Ian Colman and Massimiliano Orri and Nicholas Chadi and Isabelle Ouellet-Morin and Natalie Castellanos Ryan and Annie Pullen Sansfaçon and Robert-Paul Juster and Marie-Claude Geoffroy},

doi = {10.17269/s41997-026-01235-5},

issn = {1920-7476},

year  = {2026},

date = {2026-07-01},

journal = {Can J Public Health},

abstract = {OBJECTIVES: Canadian population-based data show that sexually diverse youth face greater mental health challenges than their heterosexual peers. However, nuances within sexual diversity-particularly among mostly heterosexual persons-are overlooked, and psychotic-like experiences remain underexplored. We examined the mental health of sexually diverse young adults from Quebec, spanning indicators from well-being to psychotic-like experiences.nnMETHODS: Data were drawn from 1324 youth from the Quebec Longitudinal Study of Child Development-a representative cohort born in 1997/98 and followed up until age 23. Participants self-reported their sexual orientation and mental health across nine indicators: suicidality, depression, anxiety, binge drinking, cannabis, other drug use, psychotic-like experiences, well-being, and help-seeking. Standardized mean differences (SMD) assessed group differences, stratified by assigned sex at birth and sexual orientation.nnRESULTS: A total of 324 (24.47%) youth identified as non-heterosexual. These youth reported poorer outcomes across all indicators (SMDs ranged from 0.19 for cannabis use to 0.52 for suicidality) and had higher odds of seeking psychological help (OR = 2.09, 95% CI [1.52-2.89]). Sexually diverse females reported poorer outcomes across all indicators compared to heterosexual females. Sexually diverse males had elevated risks for suicidality, depression, anxiety, and reduced well-being compared to heterosexual males. Mostly heterosexual (N = 156, 48.15%) and bisexual persons (N = 85, 26.23%) reported more symptoms than heterosexuals.nnCONCLUSION: Despite Canada's inclusive stance on sexual diversity, sexually diverse youth-especially those identifying as mostly heterosexual and bisexual-continue to face significant mental health disparities. Our findings highlight the need for accessible, tailored mental health services to support this population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40971561,

title = {Subcategories of the Clinical High-Risk State for Psychosis and Their Relationship to a Full First-Episode Psychosis Sample: An Exploratory Analysis of Longitudinal Outcomes},

author = {Olivier Renaud-Charest and Vincent Paquin and Jean-Gabriel Daneault and Ashok K Malla and Ridha Joober and Srividya N Iyer and Martin Lepage and Jai L Shah},

doi = {10.1093/schbul/sbaf155},

issn = {1745-1701},

year  = {2026},

date = {2026-07-01},

journal = {Schizophr Bull},

volume = {52},

number = {4},

abstract = {BACKGROUND AND HYPOTHESIS: Subcategories of the Clinical High-Risk state for psychosis (CHR-P) have been associated with differential risk for transition to first-episode psychosis (FEP), but their relevance for longer term FEP outcomes remains unclear. We aimed to determine the prevalence of 2 CHR-P subcategories - attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BIPS) - in a full sample of FEP patients, along with their association with outcome trajectories following psychosis onset.nnSTUDY DESIGN: Participants were recruited from an early intervention service and followed over 2 years, with repeated measures of psychotic symptoms, affective symptoms, and functioning. Pre-onset symptoms were assessed using follow-back methods to reconstruct subgroups and their prevalence within the sample. Linear mixed models were applied to examine associations between putative CHR-P subcategories and longitudinal outcomes.nnSTUDY RESULTS: Of 319 patients, 240 (75.24%) experienced subthreshold psychotic symptoms indicative of a CHR-P state; of these, 51 (21.25%) had potential BIPS (either alone or with APS) and 189 (78.75%) potential APS only. There were no mean differences in scores for psychotic symptoms, affective symptoms, or functioning between subgroups. However, there was a slower improvement in Global Assessment of Functioning (GAF) scores in the putative APS subgroup, which converged with the putative BIPS subgroup by year 2.nnCONCLUSIONS: Putative CHR-P subcategories of APS and BIPS exhibited similar outcome trajectories beyond psychosis onset, except for a possibly slower functional recovery in the putative APS subgroup. Longer term studies across stages of illness are needed to better understand the prognostic utility of these identifiers after FEP.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42126077,

title = {Fostering Accessibility to Mental Health Services for Youth Experiencing Homelessness in Montreal, Canada: A Historical Cohort Comparison Study},

author = {Amal Abdel-Baki and Giuseppe D'Andrea and Charles Tessier and Diane Aubin and Nora Morrison and Marie-Eve Dupont and Camille Arbaud and Pasquale Bauco and Jai L Shah and Ashok Malla and Srividya N Iyer},

doi = {10.1177/00207640261446109},

issn = {1741-2854},

year  = {2026},

date = {2026-05-01},

journal = {Int J Soc Psychiatry},

pages = {207640261446109},

abstract = {BACKGROUND: Youth experiencing homelessness face significant barriers to mental healthcare. To address this gap, the  (RIPAJ) was established in Montréal in 2003 through collaboration between community and governmental health organizations. In 2016, RIPAJ joined the national Adolescent/Young Adult Connections to Community-driven Early Strengths-based Stigma-free services-Open Minds (ACCESS-OM) initiative, aiming to enhance mental healthcare accessibility for youth experiencing homelessness.nnAIMS: This study evaluates the impact of this integrated approach on referral trends and wait times before and during ACCESS-OM RIPAJ implementation.nnMETHOD: Monthly referrals and wait times for first appointment were recorded for a historical cohort (2014-2015) and the ACCESS-OM RIPAJ period (2016-2020). We used Poisson and Cox regression models to analyze trends in referral rates and wait times, with 2014 as reference period. Seasonality was controlled by incorporating calendar month in the models. Additional Cox regressions examined individual-level sociodemographic and clinical factors associated with post-implementation wait times.nnRESULTS: We analyzed 158 referrals for 2014 to 2015 and 681 for 2016 to 2020. Monthly referrals increased significantly, peaking at 2.5 times the 2014 level. Wait times remained stable, with 73.5% evaluated within 72 hr. The hazard ratio for wait times during the peak period was 0.87 (95% CI [0.63, 1.20]) indicating no significant change despite the surge in referrals. Older age and self-referral were associated with reduced wait times.nnCONCLUSIONS: This collaborative model successfully increased mental healthcare utilization among youth experiencing homelessness, providing valuable insights for addressing the unmet needs of this vulnerable population and potentially reducing homelessness perpetuation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41632632,

title = {Health-Related Outcome Improvements Via the ACCESS Open Minds Youth Mental Health Service Transformation Project in Edmonton, Canada: Amélioration des résultats en matière de santé grâce au projet de transformation des services de santé mentale jeunes d'ACCESS Open Minds/Esprits ouverts à Edmonton, Canada},

author = {Jai L Shah and Nguyen Xuan Thanh and Shireen Surood and April Gusnowski and Surya Poudel and Liana Urichuk and Giuseppe D'Andrea and Srividya N Iyer and Ashok K Malla and Eric Latimer and Philip Jacobs and },

doi = {10.1177/07067437251412570},

issn = {1497-0015},

year  = {2026},

date = {2026-05-01},

journal = {Can J Psychiatry},

volume = {71},

number = {5},

pages = {359--368},

abstract = {ObjectiveGrowing efforts to transform youth mental health (YMH) services rest on the assumption that they will produce superior outcomes to those of traditional services. We therefore aimed to determine whether implementation of a broad YMH service model in Edmonton, Alberta (the largest site in the pan-Canadian ACCESS Open Minds [AOM] network) resulted in greater improvements in individual-level outcomes compared to a matched control group seen at non-AOM community mental health services.MethodThis retrospective cohort study used data on the Health of Nation Outcomes Scale (HoNOS) collected by trained clinicians, in youth aged 15-25 attending AOM or comparator services for any mental health problem between April 2016 and September 2019. A difference-in-differences approach compared HoNOS outcomes pre- versus post-exposure to the AOM service over a 1-year time horizon, in relation to youth attending a non-transformed service. Propensity score matching and sensitivity analyses were conducted to ensure bias reduction and robustness of observations, respectively.ResultsThe number of referrals to AOM Edmonton increased over time (36.3% [95%CI = 11.0%-68.0%] per month), and the site met benchmarks for rapid assessment (within 72 hours) and time to appropriate care (within 30 days). Of 1,078 youth (344 in the intervention [AOM] group and 734 in the control [non-AOM] group) aged 15-25 visiting community mental health centres, the intervention group had statistically greater improvements (7.4% absolute improvement or 1.2× relative improvement) in total HoNOS scores and its behavioural and symptom subscales.ConclusionsIn addition to improving the reach and timeliness of YMH services, AOM Edmonton produced greater improvements in HoNOS total scores (and two of four subscale scores) compared to a matched control group. Comparative evaluations such as these are essential to demonstrating the value of such services and generating continuous cycles of learning and improvement.Plain Language Summary TitleWhat are the outcomes of transforming youth mental health services in community settings?},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41983935,

title = {Developmental Trajectories of Suicidality in Sexually Diverse and Heterosexual Adolescents: Findings From the Quebec Longitudinal Study of Child Development: Trajectoires développementales de suicidalité chez les adolescents hétérosexuels et de la diversité sexuelle : Résultats de l'Étude longitudinale sur le développement des enfants du Québec},

author = {Sasha MacNeil and Roxanne Sicotte and Camille Davisse-Paturet and Elise Chartrand and Em Alexander and Myriam Lecousy and Alain Girard and Massimiliano Orri and Nicholas Chadi and Isabelle Ouellet-Morin and Annie Pullen Sansfaçon and Srividya N Iyer and Natalie Castellanos-Ryan and Ian Colman and Robert-Paul Juster and Marie-Claude Geoffroy},

doi = {10.1177/07067437261442420},

issn = {1497-0015},

year  = {2026},

date = {2026-04-01},

journal = {Can J Psychiatry},

pages = {7067437261442420},

abstract = {IntroductionSexually diverse adolescents report higher suicidality (ideation and attempts) than their heterosexual peers, but information on the onset and course of suicidality from early adolescence to young adulthood among contemporary sexually diverse individuals remains limited. This study traces suicidality trajectories across this critical developmental period, comparing sexually diverse and heterosexual adolescents both overall and by sex assigned at birth.MethodsData was drawn from the Quebec Longitudinal Study of Child Development, an ongoing population-based prospective birth cohort. This study included 1,505 participants who self-reported their sexual attraction at ages 15-17 (2013-2015) and past-year suicidal ideation and attempts using 3-items at ages 13, 15, 17 and 23 (2011-2021) from which a suicidality severity score was derived.Results11.5% of the sample (n = 173, 60.5% female) reported sexually diverse attraction. Growth curve modelling tested the random effect of sexually diverse (vs. heterosexual) attraction on suicidality severity intercept, linear and quadratic latent growth factors. Age-specific contrasts in suicidality severity between sexually diverse and heterosexual adolescents were also examined. Compared to heterosexual adolescents, sexually diverse adolescents showed a steeper increase in suicidality severity from ages 13 to 17, and declining yet persisting disparities from ages 17 to 23. Although developmental trajectories differed across sexually diverse males and females, both experienced greater suicidality severity during adolescence compared with heterosexual peers.DiscussionOur findings point to a developmental trajectory in which sexually diverse adolescents, particularly females assigned at birth, experience elevated suicidality that persists into young adulthood. Targeted and timely interventions during this critical developmental period are essential for suicide prevention.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42054343,

title = {The Readability of Patient-Reported Measures in Early Psychosis},

author = {Maria Abou Farhat and Negin Zamani and Simran Bajaj and Nicole Pawliuk and Navdeep Kaur and Jai Shah and Manuela Ferrari and Srividya N Iyer},

doi = {10.1093/schbul/sbag018},

issn = {1745-1701},

year  = {2026},

date = {2026-04-01},

journal = {Schizophr Bull},

volume = {52},

number = {3},

abstract = {BACKGROUND: Patient-reported measures are increasingly central to early intervention in psychosis. Many persons with psychosis have lower educational attainment than the general population and cognitive difficulties, making the readability of measures salient for this population. However, the readability of patient-reported measures in psychosis has never been investigated. This study assessed the readability levels of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in early intervention in psychosis.nnSTUDY DESIGN: PROMs and PREMs were identified from a scoping review of measures used in early intervention services for psychosis (January 2000-January 2024). Of 111 measures identified, 104 (89 PROMs; 15 PREMs) were assessed using mean grade levels derived from 3 established readability formulas (Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook index, FORCAST formula), applied to instructions, items, and total scales.nnSTUDY RESULTS: Overall, 82.7% of patient-reported measures exceeded the recommended 6th-grade reading level. Instructions were harder to read than items (mean readability: 9.44 vs. 7.95; t(90) = 6.54, P < .001). PREMs demanded higher readability levels than PROMs. Readability scores were different across formulas, with Flesch-Kincaid consistently producing lower scores. Except for one, the strikingly few measures co-developed with patients (n = 14) also exceeded 6th-grade reading level.nnCONCLUSIONS: Most patient-reported measures in early psychosis exceed recommended readability levels, raising concerns about accessibility, validity, and whose experiences are represented in patient-reported data. This creates impetus for integrating readability assessments into measures development. More fundamentally, centering the participation of persons with lived experience can support readable, relevant, and patient-centered assessments reflecting the language, priorities, and realities of people with psychosis, and advance epistemic justice.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41992106,

title = {Satisfaction With Youth Mental Health Services in Diverse Settings: Results From a Pan-Canadian Initiative},

author = {John Bedirian and Tovah Cowan and Valérie Noël and Shalini Lal and Ridha Joober and Jai Shah and Amal Abdel-Baki and Rebecca Fuhrer and Patricia Boksa and Neil Andersson and Kathleen MacDonald and Charles-Albert Morin and Mary-Anne Levasseur and Helen Vallianatos and Lacey Augustine and Kevin Friese and Isabelle Godin and Liana Urichuk and Daphne Hutt-MacLeod and Vickie Plourde and Norma Rabbitskin and Paula Reaume-Zimmer and Cécile Rousseau and Ashok Malla and Srividya N Iyer},

doi = {10.1176/appi.ps.20250441},

issn = {1557-9700},

year  = {2026},

date = {2026-04-01},

journal = {Psychiatr Serv},

pages = {appips20250441},

abstract = {OBJECTIVE: Increasing concern about youth mental health has brought interest in service reform. Given the importance of positive care experiences, the authors aimed to study rates of satisfaction, as well as characteristics associated with satisfaction, in ACCESS Open Minds, a cocreated network of enhanced primary and community youth mental health services across Canada.nnMETHODS: A total of 482 youths receiving services at 10 ACCESS Open Minds sites (urban, rural, and Indigenous) completed the Client Satisfaction Questionnaire-4 and responded to additional demographic and service use questions.nnRESULTS: Ninety-one percent of youths were satisfied with their mental health services, substantially higher than the predefined goal of 75%. Youths who preferred virtual services (23%) were less satisfied than those who preferred in-person services.nnCONCLUSIONS: The findings are comparable with those from similar initiatives, highlighting the value of youth-friendly, holistic primary mental health care. High satisfaction across sociodemographic groups and sites suggests that such services are acceptable in diverse communities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41849914,

title = {How can school-based programmes improve physical and mental health outcomes in low-and-middle-income countries? An umbrella review and logic model},

author = {Catherine Winsper and Helena Tuomainen and Sagar Jilka and Sanjana Goutham and Dafne Morroni and Usoro Akpan and Domenico Giacco and Paramjit Gill and Srividya N Iyer and Isha Lohumi and Tolulope Bella-Awusah and J S Thakur and Olayinka Omigbodun and Shiva Prakash Srinivasan and Jasmine Kalha and Rangaswamy Thara and Soumitra Pathare and Swaran P Singh},

doi = {10.1016/j.cpr.2026.102727},

issn = {1873-7811},

year  = {2026},

date = {2026-04-01},

journal = {Clin Psychol Rev},

volume = {125},

pages = {102727},

abstract = {School-based programmes offer a promising approach for improving physical and mental health trajectories in low-and-middle-countries (LMICs). This umbrella review and logic model explores how and in which contexts these programmes are effective. A systematic search of electronic databases identified 20 systematic reviews (5 meta-analyses) on school based (SB) physical (n = 13; primary studies = 214) and mental (n = 7; primary studies = 120) health programmes across a range of low, lower-middle, and upper-middle income countries. Programmes included universal (all students), selective (e.g., high-risk students), and indicated (e.g., students with symptoms) approaches. Evidence was stronger for proximal (e.g., nutritional knowledge), and intermediate (e.g., dietary behaviour) outcomes than for distal (e.g., obesity reduction) outcomes, and there were some variations in outcome by geographical region. Evidence for combined physical and mental health programmes was scant, with limited overlap between the two types of programmes (i.e. some shared components and outcomes). Moderators of programme effectiveness included recipient (e.g., gender, age) and programme (e.g., longer duration, multi-component) characteristics, and inner (e.g., school resources, support for teachers) and outer (e.g., partnerships with Non-Governmental Organisations) settings. Cultural adaptations and implementation quality were highlighted as important (yet rarely fully reported) factors in ensuring programme sustainability and scaling-up. There is some supportive evidence for SB programmes in LMICs, though evidence for effectiveness varies by temporality of outcome and geographical location. This highlights the importance of considering implementation barriers across outcome trajectories and ensuring sufficient attention is given to cultural adaptations. Dual programmes combining balanced physical and mental health modules might offer promise for addressing the growing burden of non-communicable diseases in LMICs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41720568,

title = {How public policies can influence the landscape of psychosis},

author = {Giuseppe D'Andrea and Jai L Shah and Didier Jutras-Aswad and Srividya N Iyer and Amal Abdel-Baki},

doi = {10.1016/S2215-0366(26)00020-9},

issn = {2215-0374},

year  = {2026},

date = {2026-03-01},

journal = {Lancet Psychiatry},

volume = {13},

number = {3},

pages = {179--180},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41816188,

title = {Availability and effectiveness of multicomponent interventions for early psychosis in 20 low-income and middle-income countries: a systematic review},

author = {Ruben Valle and Nora Morrison and Vijaya Raghavan and Srividya N Iyer},

doi = {10.1016/j.eclinm.2026.103795},

issn = {2589-5370},

year  = {2026},

date = {2026-03-01},

journal = {EClinicalMedicine},

volume = {93},

pages = {103795},

abstract = {BACKGROUND: Most individuals with psychosis live in low and middle-income countries (LMICs) where treatment delays and gaps are common. Little is known about the types of interventions for first-episode psychosis (FEP) and clinical high-risk (CHR) for psychosis in LMICs and their effectiveness. This systematic review aimed to identify treatment components delivered for FEP or CHR in LMICs and evaluate their effectiveness.nnMETHODS: In this systematic review, we searched PsycINFO, Embase, and Medline for relevant studies published, without any language restrictions, between database inception and Jan 23, 2022. This search was updated on May 15, 2024 and on January 2, 2026. Records were included if they evaluated at least one more intervention beyond medication and assessment for FEP and beyond assessment for CHR, in LMICs with at least one follow-up. Included papers were classified as programmes (offering FEP/CHR services) or research studies of intervention(s)/outcomes in FEP/CHR. Treatment components were categorised as guideline-based or additional. Effectiveness was assessed across 15 outcomes defined . Study quality was evaluated using the Mixed Methods Appraisal Tool, and findings were synthesised narratively. This study was pre-registered with PROSPERO, CRD42022308467.nnFINDINGS: Of 6046 screened records, 125 were included (average: 152 participants; range: 10-1268) across 20 countries and five languages (English, Spanish, Portuguese, Turkish, and Persian). These comprised 10 programmes and 30 studies for FEP in 16 countries (11.7% of LMICs), and eight programmes and eight studies for CHR across eight countries (5.8%). They delivered guideline-based and additional components; however, psychological and psychosocial components were scarce. For FEP, the addition of any psychological or psychosocial component was associated with improved outcomes relative to medication alone. Patient psychoeducation and family interventions were the most frequently implemented components. For CHR, limited data prevented conclusions about the effectiveness of treatment components in LMICs.nnINTERPRETATION: Despite limited and moderate-quality evidence, our findings suggest that early intervention can improve outcomes in FEP. However, coverage remains limited to few LMICs and even they struggle to provide comprehensive care. Further research is needed to strengthen, scale, and culturally adapt such services.nnFUNDING: Canadian Institutes of Health Research, Canada Research Chairs program.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41667176,

title = {Rapid realist review of organisational supports for youth peer support workers},

author = {Julia Hews-Girard and Tanya Halsall and Emma Cullen and Amanda Bellefeuille and Mardi Daley and Charlotte Evans and Vanessa Sandoval and Allison Dunning and Jayden Lee and Brittany Carde and Jennifer Couturier and Manuela Ferrari and Melissa Kimber and Scott B Patten and Srividya Iyer and Gina Dimitropoulos},

doi = {10.1136/bmjopen-2025-111837},

issn = {2044-6055},

year  = {2026},

date = {2026-02-01},

journal = {BMJ Open},

volume = {16},

number = {2},

pages = {e111837},

abstract = {OBJECTIVES: Providing peer support can benefit youth peer support workers (peers)et by supporting self-determination, recovery and resilience to self-stigma. There is a need to clarify the role of the organisation in providing benefits for peers. We aimed to identify the organisational contexts and mechanisms that result in the creation of healthy workplaces for peers.nnDESIGN: Rapid realist review guided by the Realist and Meta-Narrative Evidence Syntheses-Evolving Standards guidelines and Pawson's iterative approach.nnDATA SOURCES: MEDLINE, CINAHL, PsycINFO, ERIC, SocINDEX, Google Scholar and Embase were searched from 1979 to 2025.nnELIGIBILITY CRITERIA: We included qualitative and quantitative peer-reviewed studies and grey literature that captured characteristics of organisational practices and employment considerations in youth peer support programmes.nnDATA EXTRACTION AND SYNTHESIS: Articles were screened independently by multiple reviewers. Inclusion criteria were adjusted to capture literature on organisational practices, and employment considerations for youth peer support programmes. Data were extracted and analysed retroductively to develop Context-Mechanism-Outcome Configurations (CMOCs).nnRESULTS: Five employment-related risks to peer well-being were identified: (1) difficulty entering the job market, (2) lack of role clarity, (3) pressure to live up to ideals, (4) retraumatisation and (5) stigma. Six CMOCs were developed; all focused on the creation of equitable employment and supporting peer development and empowerment were developed.nnCONCLUSIONS: Community-based mental health organisations can facilitate equitable peer employment through strategies that reduce professional stigma, enhance peer resilience and promote professional and personal development. Policy reform that addresses precarious work conditions is needed to support healthy work environments.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}