Highlights of the #CundillatCAMH Conference

Researchers have identified the best guidelines for young people with depression; screening for adverse childhood events could lead to earlier identification of at-risk young people; and a more complete picture of young people with depression must be considered if treatment is to advance.

Those are just some of the key messages shared at New Directions for Adolescents and Young Adults with Depression, a #CundillatCAMH Conference, in June. More than 150 psychiatrists, psychologists, social workers, educators, policy makers and others in child and youth depression gathered in downtown Toronto to hear presentations by international experts alongside poetry performances by youth with lived experience.

“It is truly important that we are all here today, focused as we are on the topic of adolescent and young adult depression. Young people with depression need a strong team behind them,” Dr. Peter Szatmari, Director of the Cundill Centre for Child and Youth Depression, told the audience in the morning. “That we can get together like this to discuss new directions in depression treatments for this population is truly a sign of hope, and we should carry with us a sense of optimism throughout the day and into the future.”

The morning continued with a presentation by Dr. Kathleen Merikangas, Senior Investigator in the Intramural Research Program, National Institute of Mental Health. Through epidemiology, Dr. Merikangas explained, we’ll improve our understanding of the way depression presents in this population; be better able to predict demographic, psychosocial, neurobiologic and genetic risk factors and their combined influences; and better understand environmental risk factors such as sleep, stress, diet, viral exposure and toxins.

Mobile technology and tracking devices could also help provide a more complete picture of depression in young people, she said.

“We can use mobile technology to focus on sleep, mood regulation, anxiety, stress and so on to get a snapshot over 24 hours that looks at energy, motor activity, depressed mood and sleep across the day to see how these different systems are related,” Dr. Merikangas said. “We’ve found that motor activity predicts change in mood but mood doesn’t change patterns of physical activity. This suggests we may want to intervene with physical activity and sleep rather than simply treating depressed mood.”

Dr. Darren Courtney urged care providers to adhere to the NICE (National Institute for Health and Care Excellence) guidelines when making treatment decisions for young people with depression. 

“Evidence-based practice is intended to be an integrated model,” he said. “This is not necessarily a prescription or a mandate, but a guideline intended to guide discussions you have with patients.”

In her presentation of A Cross-sectoral Examination of Depression Services in Ontario, Dr. Joanna Henderson, director of the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, discussed her work in the Child and Youth Psychotherapy Experiences Project and explained why more information about depression services is needed.

“We don’t have an existing way for clinicians and service providers to actually understand a young person’s experience – to understand what questions should be asked about their experiences with psychotherapy that go beyond just our clinical interaction with them,” Dr. Henderson said.

Dr. Ian Goodyer, a member of the Cundill Centre International Advisory Board and a Child and Adolescent Psychiatrist from Cambridge University, was joined by Dr. Raphael Kelvin, National Clinical Lead for the Children and Young Persons Mental Health e-portal, to provide an overview of a Brief Psychosocial Intervention in children with depression and lead workshop discussions in how such an intervention could fit into participant’s own practices.

In Detecting Toxic Trauma: Screening Children and Youth for Adverse Childhood Experiences, Dr. Priya Watson discussed the benefits of screening for adverse childhood events in earlier identification of at-risk youth and adolescents.

“Ordinary trauma really matters,” said Dr. Watson, a child and adolescent psychiatrist at CAMH in the Mood and Anxiety Disorders clinic and Assistant Professor at the University of Toronto. “When it happens, it doesn’t just have immediate effects on the child with stress or emotional difficulties, but we see an enduring health impact that alters the child’s health trajectory in both their adult mental health and physical health.”

In their presentation, Daphne Korczak and Kate Stadelman suggested involving families could help create more promising opportunities for secondary prevention of suicide among high-risk youth presenting to  emergency departments. The SAFETY program is a new, standardized, patient and family-centred program currently under evaluation.

Youth played an important role in the day’s events, too. Dr. Courtney’s afternoon session was co-presented by Emma McCann, a CAMH Youth Engagement Coordinator that helps ensure research projects include the youth voice, and young people from CANVAS Arts Action Programs performed poetry about their experiences with mental illness. Presentations were captured visually by ThinkLink Graphics. Through youth involvement, conference-goers gained a greater understanding of the work still ahead.

To paraphrase one poet: “It hurts to heal – but it hurts so much more not to.”