For a child or teen struggling with depression, the world can be a dark place. Depression, combined with the daily ups and downs of school, and life, can become overwhelming, or even paralyzing. Accessing the mental health care they need can be challenging at best. Any concerns about their physical health, as well as warning signs for serious future health problems, are often overlooked.
To address this often-disjointed approach to care, and to try to obtain a clearer picture of the health of the whole child, The Hospital for Sick Children (SickKids) has launched a new program that aims to provide holistic care to children and teens with depression. The first of its kind in Canada, the Children’s Integrated Mood and Body (CLIMB) program provides comprehensive mental health care for paediatric depression, while also screening for risk factors that may result in serious heart and related health problems as the patient grows up. The program is funded by the Medical Psychiatry Alliance, an Ontario initiative dedicated to transforming the delivery of mental health services for patients who are living with both physical and mental health conditions.
Cardiovascular disease is known to be a leading cause of death in individuals with depression, and research has shown that teens with depression are at higher risk of dying younger from cardiovascular causes than their non-depressed peers.
“Youth with mood disorders like depression are often not accessing the care they need. By the time they experience symptoms in adulthood, the window of prevention for cardiovascular problems has long passed,” says Dr. Daphne Korczak, Director of the CLIMB program, Child and Adolescent Psychiatrist and Clinician-Researcher at SickKids, who is also a trained general paediatrician.
CLIMB was designed to integrate physical health care and mental health care by an interdisciplinary team, which includes experts in psychiatry, cardiology, endocrinology, obesity and health systems. In addition to addressing the primary diagnosis of depression, the team aims to identify early signs of cardiovascular disease risk in children and teens. Armed with this information, they can determine opportunities for effective intervention early on, with the hope of reducing the severity of future cardiac problems, or eliminating them altogether.
“SickKids is uniquely positioned to do this because we already have the expertise in all of these related areas,” Korczak explains. The program is both a clinical initiative and a three-year research project. A clinical research registry is in development, through which clinical assessments, cardiometabolic markers, treatments and depression outcomes can be examined. When complete, all CLIMB patients will be invited to participate. This research, Korczak hopes, will be an important step toward addressing a critical gap in scientific knowledge about how and when depression first presents an increased risk of cardiovascular disease. The team is also studying how early treatment of depression can impact cardiovascular risk.
“The CLIMB program will address this important question head-on, and pave the way for us to ensure that youth with mental health issues have excellent physical health as well. Recent research has suggested that youth with mental illness may have a higher chance of having risk factors for adult heart disease,” says CLIMB team Dr. Brian McCrindle, Staff Cardiologist and Section Head of Preventative Cardiology at SickKids and Professor of Paediatrics at the University of Toronto.
One in 15 Canadian children and teens are diagnosed with depression every year. CLIMB began seeing patients in June and feedback from families and clinicians alike has been positive so far.
“By bringing together experts in both mental and physical health, we can look more broadly at what’s going on for the child or youth as a whole, and be better equipped to help them thrive in the future,” says Korczak, who is also Assistant Professor of Psychiatry at the University of Toronto.
CLIMB is one of several innovative pilot programs rolling out at SickKids under the mandate of the Medical Psychiatry Alliance, a collaborative partnership between The Centre for Addiction and Mental Health, SickKids, Trillium Health Partners and the University of Toronto, in conjunction with the Ministry of Health and Long-Term Care and an anonymous donor.