@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{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{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{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{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{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{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{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{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{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{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{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{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}

}

@article{pmid41961885,

title = {Exploring the preferences of multiple stakeholder groups for family involvement in early intervention services for psychosis: A cross-sectional mixed-methods study},

author = {Helen Martin and Salome Xavier and Aarati Taksal and Mary Anne Levasseur and Srividya N Iyer},

doi = {10.1371/journal.pmen.0000430},

issn = {2837-8156},

year  = {2026},

date = {2026-01-01},

journal = {PLOS Ment Health},

volume = {3},

number = {4},

pages = {e0000430},

abstract = {There is consistent evidence that family involvement leads to improved outcomes in psychosis. However, less is known about various stakeholders' (patients, families, clinicians) preferences. This study aimed to understand stakeholders' views about involving families in care for youth experiencing early psychosis using a cross-sectional mixed-methods design. The study was conducted at an early intervention service for psychosis in Montreal. Nine participants (patients, family members, clinicians) were purposively recruited. They participated in a one-day workshop using nominal group technique, whose discussion was subjected first to thematic and then content analysis to develop statements/recommendations regarding family involvement, which were ranked by participants. Three themes were identified from the thematic analyses of the discussion: Meaning and value of family involvement, Factors influencing family involvement, and Preferred ways and methods of family involvement. Thereafter, 40 statements under 4 questions related to family involvement were extracted from the discussion and ranked by participants from 1-10 in decreasing order of importance through an e-survey. The ranking indicated stakeholder consensus that: families be involved during crises/relapse; maintaining contact with each other is the responsibility of treating teams and families; there be guidelines for family involvement; and even when patients are disinclined to involve families in treatment, teams could receive information from and share general information with families. Patients, families, and clinicians agreed that contact between families and treating teams needs to continue throughout treatment. There were differences among them about the method, frequency, and content of contacts, which were seen as varying based on clinical, familial, and developmental factors. While all agreed that consent/confidentiality be respected, there was consensus that these need not deter family involvement. Our findings highlight the value of trialogue(s) between patients, families and treating teams regarding family involvement in treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41886474,

title = {The Implementation of Early Intervention Initiatives for Psychosis in Latin America and the Caribbean: A Case Study},

author = {Ruben Valle and Camila Velez and Srividya N Iyer},

doi = {10.1371/journal.pgph.0005531},

issn = {2767-3375},

year  = {2026},

date = {2026-01-01},

journal = {PLOS Glob Public Health},

volume = {6},

number = {3},

pages = {e0005531},

abstract = {Psychosis is a serious mental illness, with onset in adolescence and young adulthood. Few early intervention for psychosis (EIP) programs exist in the Global South, where most of the world's youth live. Addressing this gap requires understanding implementation contexts, pathways, and challenges. This study examines EIP initiatives in Latin America and the Caribbean (LAC) and explores implementers' perspectives on scaling them. A single-case study design was employed. Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we conducted semi-structured interviews with EIP implementers across LAC and gathered policy documents. Data was coded and analyzed using thematic analysis. Twenty-five participants from 10 countries described 26 initiatives, including clinical and research programs, guidelines, and a technical standard. Themes were mapped onto the EPIS framework. In Exploration, participants highlighted key motivators, the influence of collaborations with foreign researchers, contextual adversity (e.g., poverty, stigma), and the role of Indigenous cosmologies and religious traditions in shaping care pathways. In Preparation, they emphasized difficulties in culturally adapting models from high-income countries (HICs), limited staff awareness, and resource shortages. In Implementation, participants described how initiatives operated in local contexts (e.g., research programs offering care to address unmet needs), how they were generally well received by patients and staff, and the shortage of psychosocial interventions. In sustainment, few initiatives persisted; participants pointed to dependence on international funding, limited policy support, capacity, and awareness. While EIP was valued, national dissemination of HIC-based programs was considered unfeasible. EIP development in LAC has occurred amid structural and resource limitations affecting many LMICs. Implementers' proposals-task-shifting; simplified care packages; leveraging extant services; and enhancing early psychosis literacy- represent feasible strategies to support EIP across LAC. Recommendations for future research, including the involvement of service users and their families and the adaptation of implementation frameworks to context, are shared.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42010387,

title = {Advancing Integrated Care for Youth: The Role of Family Physicians in an Urban, Multidisciplinary Service},

author = {Anne-Sophie Thommeret-Carrière and Julie Cotton and Nicolas Girard and Kathleen MacDonald and Sarah Ben-Nouna and Jérémy Boisvert-Viens and Martin Goyette and Srividya N Iyer},

doi = {10.12927/hcq.2026.27805},

issn = {1929-6347},

year  = {2026},

date = {2026-01-01},

journal = {Healthc Q},

volume = {28},

number = {4},

pages = {69--75},

abstract = {Integrated Youth Services (IYS) are increasingly implemented across Canada to address the intersecting mental, physical and social needs of young people, yet the integration of primary care within IYS remains under-documented. This article presents a qualitative, practice-based case study of Aire ouverte Montréal-Métro Berri, an urban IYS site where family physicians have been embedded as permanent members of a multidisciplinary team since 2022. Serving diverse youth aged 12-25 in a downtown context, this site offers an exemplar of integrating family medicine within a publicly funded youth service model. Drawing on an ongoing evaluation, the paper describes the implementation model, roles of family physicians and enabling organizational conditions, based on document analysis and perspectives from clinicians, managers and team members. Findings highlight how co-location, collaborative practices, shared care planning and flexible administrative arrangements supported the integration of family physicians. Reported impacts include timely access to primary and mental healthcare, improved care coordination, enhanced team capacity to manage risk and earlier engagement of youth who might otherwise not access services or access care through crisis-driven pathways. This case offers transferable insights into integrating family physicians within IYS, at a time of rapid national scaling and persistent challenges in youths' access to primary care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42010383,

title = {A Journey of Integrating Indigenous Ways of Knowing in an Urban Integrated Youth Service in Manitoba},

author = {Stephanie Ens and Kendra Monk and Corey Mohr and Kathleen MacDonald and Gina Marandola and Srividya N Iyer},

doi = {10.12927/hcq.2026.27809},

issn = {1929-6347},

year  = {2026},

date = {2026-01-01},

journal = {Healthc Q},

volume = {28},

number = {4},

pages = {42--48},

abstract = {Our case study presents insights from our experiences of "integrating" Indigenous ways of knowing and being into integrated youth services (IYS), a growing Canadian model for offering a range of services to youth aged 11-25. Huddle NorWest, one of Manitoba's IYS hubs, serves a diverse population of youth, with ∼30-40% identifying as Indigenous. Recognizing the importance of culturally safe care, Huddle NorWest seeks to understand the factors that contribute to Indigenous youths' comfort in accessing its services. Current engagement strategies include an on-site Indigenous Elder, culturally relevant programming such as beading and ribbon skirt making, and the integration of Indigenous art and teachings throughout the space. As part of its broader commitment to reconciliation, NorWest Co-op Community Health actively supports a Truth and Reconciliation Commission (TRC) Committee and has signed the Winnipeg Indigenous Accord, outlining a three-year action plan to align with the TRC's Calls to Action. Indigenous perspectives are embedded in the organization's governance and advisory structures since 2017, including community and youth advisory councils, half of whom identify as Indigenous. This work reflects an ongoing effort to build trust and provide culturally safe, inclusive services for Indigenous youth, and can inspire other urban IYS serving Indigenous youth.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41868958,

title = {Exploring the Presenting Problems and Services Received by Youth with Diverse Mental Health Presentations in Integrated Youth Mental Health Services Across Canada},

author = {Sarah Mughal and Alba Sanchez-Allakhverdieva and Amal Abdel-Baki and Neil Andersson and Patricia Boksa and Daphne Hutt-Macleod and Ridha Joober and Shalini Lal and Jessica Chisholm-Nelson and Nora Morrison and Alyssa Frampton and Mary Anne Levasseur and Lacey Augustine and Kevin Friese and Isabelle Godin and Katherine Hay and Norma Rabbitskin and Paula Reaume-Zimmer and Helen Vallianatos and Srividya N Iyer and Ashok Malla and Jai L Shah and },

doi = {10.5334/ijic.10147},

issn = {1568-4156},

year  = {2026},

date = {2026-01-01},

journal = {Int J Integr Care},

volume = {26},

number = {1},

pages = {11},

abstract = {BACKGROUND: Integrated youth mental health (YMH) primary care initiatives have the potential to improve Canada's treatment gap. However, there is no current standard for implementing these services, and offerings vary greatly across models and sites. This has equity implications for the care received by youth with severe presentations.nnMETHODS: We describe the provider-rated problems with which 2995 youth presented to ACCESS Open Minds, a multi-site, Canadian YMH integrated care initiative and the services they received, based on the severity of their needs at intake.nnRESULTS: The largest proportion of youth had both moderate-severe presentations and moderate-to-significant difficulties in functioning (41.67%). The first instance of receiving services following intake for most participants (71.42%) entailed a single service. The highest proportion of youth for whom the type of service received was not documented was those who presented with neither moderate-severe presentations nor poor functioning (15.01%). There was substantial variability in services provided across sites.nnCONCLUSION: Variability in service delivery confirms the need for greater standardization of core service offerings across sites. Future research should assess the appropriateness of services for different presentations to ensure equitable support is provided for all youth.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}