Background: Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions. Objective: The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness. Methods: A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. Results: In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected. Conclusions: eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954

This doctoral research highlights Indigenous women’s experiences of stress and postpartum depression (PPD) through secondary quantitative analysis of the Public Health Agency of Canada’s Canadian Maternity Experiences Survey (2009) and qualitative Indigenous maternity narratives. Indigenous women’s responses to the survey demonstrate that Indigenous women experience 1.9 times higher odds of PPD and are 1.5 times as likely to be diagnosed with depression prior to pregnancy, compared to Canadian women. Indigenous women are also 1.3 times as likely to experience higher levels of stress and 3.3 times as likely to experience three or more stressful life events. While the survey demonstrates higher rates of stress and PPD, it is not culturally or contextually relevant. Therefore, Indigenous maternity narratives from 10 Indigenous mothers in 2015 further contextualize experiences of stress and PPD to include narratives related to adverse social determinants of health and impacts of colonialism. The research includes a discussion on the limitations of previous maternity research and the limits of clinical-medical assessments and diagnosis of stress and PPD in Indigenous populations. The research concludes with recommendations for additional maternity experiences research and ways to support Indigenous women, infants and children, birth partners, families, and communities.

Background: Canada continues to experience a national overdose crisis. While studies are available at the regional, provincial, and territorial levels, detailed national data regarding the burden and context of substance-related acute toxicity deaths are limited, particularly in subpopulations. In response to the overdose crisis, the Public Health Agency of Canada, in collaboration with provincial and territorial ministries of health and chief coroner and chief medical examiner offices, has undertaken a national chart review study. Objective: This study was conducted to describe and compare the characteristics of substance-related acute toxicity deaths that occurred in Canada between 2016 and 2017, including descriptions of those who died, the substances involved, and the circumstances surrounding their deaths. This paper describes the study methodology in detail. Methods: This retrospective, population-based, and cross-sectional study involved the review of coroner and medical examiner files for deaths that met the study case definition. Data were collected on demographic and socioeconomic characteristics, medical and substance use history, proximal circumstances surrounding the death, and toxicology findings using a standardized data collection tool that underwent 2 pilot studies. Data abstractors underwent training and regular intrarater reliability exercises with a fictitious death investigation file. Data quality was assessed based on the consistency of abstractor intrarater reliability scores and the completeness of core variables and variables for key concepts. Data were linked to national datasets to allow for the examination of area-level geographic and socioeconomic characteristics. Descriptive analyses will examine differences across subpopulations and the general Canadian population. Latent class, spatiotemporal, qualitative, and premature death analyses are also planned. Where possible, analyses will be stratified by the manner of death and sex. Results: The study began in the summer of 2018, and abstraction was delayed due to the COVID-19 pandemic. All activities are expected to be completed by early 2025. A total of 9414 coroner and medical examiner files met the study case definition. Most abstractors (25/26, 96%) met the established threshold for consistency throughout abstraction without the need for remedial training. In general, core study variables, including geographic variables and substances contributing to death, had very good availability. Study variables related to the person’s health, history of substance use, and events surrounding the acute toxicity event were available for most records. Socioeconomic variables and variables describing socially constructed identities and potentially traumatic life events were mostly unavailable. Conclusions: This study provides the most detailed national information on substance-related acute toxicity deaths in Canada to date and can serve as a pre–COVID-19 pandemic baseline for assessing the evolution of the overdose crisis. Results can inform policies and programs to address the overdose crisis, the development of common approaches to medicolegal death investigations, and future research activities.

Objective: For First Nations people and Inuit who live on reserves or in rural and remote areas, a guideline requires their travel to urban centres once their pregnancy reaches 36–38 weeks gestation age to await labour and birth. While not encoded in Canadian legislation, this guideline—and invisible policy—is reinforced by the lack of alternatives. Research has repeatedly demonstrated the harm of obstetric evacuation, causing emotional, physical, and financial stress for pregnant and postpartum Indigenous women and people. Our objective was to describe the costs of obstetric evacuation, as reported in the literature. Methods: We conducted a systematic review using online searches of electronic databases (Ovid EMBASE, CINAHL, Ovid Healthstar, PubMed, ScienceDirect, PROSPERO, and Cochrane Database of Systematic Reviews) and identified studies that reported costs related to medical evacuation or transportation in rural and remote Indigenous communities. We performed critical appraisal of relevant studies. Synthesis: We identified 19 studies that met the inclusion criteria. The studies reported various types of cost, including direct, indirect, and intangible costs. Medical evacuation costs ranged from CAD $7714 to CAD $31,794. Indirect and intangible costs were identified, including lost income and lack of respect for cultural practices. Conclusion: Costs associated with obstetric evacuation are high, with medical evacuation as the most expensive direct cost identified. Although we were able to identify a range of costs, information on financing and funding flows was unclear. Across Canada, additional research is required to understand the direct costs of obstetric evacuation to Indigenous Peoples and communities.

BACKGROUND Canada continues to experience a national overdose crisis. While studies are available at the regional, provincial, and territorial levels, detailed national data regarding the burden and context of substance-related acute toxicity deaths are limited, particularly in subpopulations. In response to the overdose crisis, the Public Health Agency of Canada, in collaboration with provincial and territorial ministries of health and chief coroner and chief medical examiner offices, has undertaken a national chart review study. OBJECTIVE This study was conducted to describe and compare the characteristics of substance-related acute toxicity deaths that occurred in Canada between 2016 and 2017, including descriptions of those who died, the substances involved, and the circumstances surrounding their deaths. This paper describes the study methodology in detail. METHODS This retrospective, population-based, and cross-sectional study involved the review of coroner and medical examiner files for deaths that met the study case definition. Data were collected on demographic and socioeconomic characteristics, medical and substance use history, proximal circumstances surrounding the death, and toxicology findings using a standardized data collection tool that underwent 2 pilot studies. Data abstractors underwent training and regular intrarater reliability exercises with a fictitious death investigation file. Data quality was assessed based on the consistency of abstractor intrarater reliability scores and the completeness of core variables and variables for key concepts. Data were linked to national datasets to allow for the examination of area-level geographic and socioeconomic characteristics. Descriptive analyses will examine differences across subpopulations and the general Canadian population. Latent class, spatiotemporal, qualitative, and premature death analyses are also planned. Where possible, analyses will be stratified by the manner of death and sex. RESULTS The study began in the summer of 2018, and abstraction was delayed due to the COVID-19 pandemic. All activities are expected to be completed by early 2025. A total of 9414 coroner and medical examiner files met the study case definition. Most abstractors (25/26, 96%) met the established threshold for consistency throughout abstraction without the need for remedial training. In general, core study variables, including geographic variables and substances contributing to death, had very good availability. Study variables related to the person’s health, history of substance use, and events surrounding the acute toxicity event were available for most records. Socioeconomic variables and variables describing socially constructed identities and potentially traumatic life events were mostly unavailable. CONCLUSIONS This study provides the most detailed national information on substance-related acute toxicity deaths in Canada to date and can serve as a pre–COVID-19 pandemic baseline for assessing the evolution of the overdose crisis. Results can inform policies and programs to address the overdose crisis, the development of common approaches to medicolegal death investigations, and future research activities.

Background: There is a lack of systematic data on children who experience parental incarceration in Canada. Objective: To use linked data to estimate the number of children who experienced parental incarceration in five Canadian provinces from 2015 to 2021, and to describe parent and child characteristics. Methods: We accessed data from the Canadian Correctional Services Survey, a Statistics Canada survey that included person-level administrative data for all people incarcerated in British Columbia, Alberta, Saskatchewan, Ontario, and Nova Scotia provincial correctional facilities between 2015 and 2021. We identified their children using three methods: children with a person in the Canadian Correctional Services Survey listed as a parent on their birth certificate, children of people in the Canadian Correctional Services Survey who had received child tax benefits, and children of females in the Canadian Correctional Services Survey with a live birth in hospital discharge records. We calculated the number and percentage of children <18 who experienced parental incarceration, and described parent and child characteristics. Results: For 2015–2021, we identified 93,090 incarcerated parents of children <18 and 169,740 children <18 who experienced parental incarceration. We found that per day in the included provinces, 0.23% of children <18 in 2016 and 0.27% in 2017 experienced parental incarceration, and per year, 1.2% of children <18 in 2016 and 1.3% in 2017 experienced parental incarceration. For children who experienced parental incarceration, 87.4% had one and 12.0% had two parents who experienced incarceration during the study period, and 5.9% had at least one Black parent and 30.5% at least one Indigenous parent. Children who experienced parental incarceration had a median of 60 (IQR 11–208) and a mean of 166.5 (SD 256.5) total days of parental incarceration during the study period. For parents who experienced incarceration, 22.6% were female, 77.4% were male, 6.0% were Black, and 31.6% were Indigenous. Significance: This is the first Canadian study to systematically estimate the number and percentage of children who experience parental incarceration. Given data limitations, our findings of the number and percentage of children should be treated as minimum estimates. While further research is needed to fully quantify the prevalence and burden of this adverse childhood experience, these minimum estimates can be used to raise awareness of the issue of parental incarceration in Canada. Evolving evidence, including this study, is instrumental to advancing work to measure, prevent, and mitigate the harms associated with parental incarceration for children and families.