A recent article in CMAJ, Mental health service use among Black adolescents in Ontario by sex and stress level: a cross-sectional study, reveals how patterns of mental health service use among Black youth shift with the level of psychological distress. Lead author Mercedes Sobers, a PhD candidate in epidemiology at the Dalla Lana School of Public Health and research coordinator at the Centre for Addiction and Mental Health, joins the podcast to unpack the findings and their implications.

The study found that Black male youth had higher odds of accessing services than white male youth when at low levels of distress but lower odds of accessing services at high levels. Black female youth had lower odds of service use than white female youth at both low and high distress levels. Mercedes explains how these patterns may reflect how behaviour is interpreted: Black boys may be referred to services more often at lower distress levels but steered toward more punitive responses when distress rises. For Black girls, she points to adultification and cultural mismatches in care.

Dr. Amy Gajaria, a psychiatrist at the Centre for Addiction and Mental Health and associate scientist in the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, describes how programs like AMANI aim to provide culturally adapted care and build trust with Black youth. She shares how early encounters with the system can shape future engagement with care.

For physicians, the discussion underscores the importance of culturally sensitive care that embraces and reflects the experiences of Black youth, creating more meaningful and effective pathways to support.

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Rates of depression in Canada are rising, but a new CMAJ guideline advises against universal screening in primary care. The Canadian Task Force on Preventive Health Care found no evidence that routinely administering depression questionnaires to all adults improves outcomes and raised concerns about false positives, overdiagnosis, and strain on limited mental health resources.

Dr. Eddy Lang, lead author of the guideline and professor of emergency medicine at the Cumming School of Medicine, University of Calgary, explains the rationale behind the Task Force’s recommendation. He describes how the review found no benefit from universal screening in improving depressive symptoms or quality of life and that commonly used questionnaires frequently misidentify patients, generating false positives and false negatives. Lang emphasizes that while physicians should remain attentive to patients’ mental health, questionnaires are not the answer to identifying depression in the general population.

Dr. Jennifer Young, a family physician in Collingwood, Ontario, and past president of the Ontario College of Family Physicians, reflects on what this recommendation means for everyday practice. She agrees that routine screening would add little value, pointing out that vigilance and continuity of care already allow family doctors to identify depression through clinical judgment and patient relationships. She underscores that time spent on universal questionnaires could displace care for patients with other pressing needs.

For physicians, the key takeaway is clear: be alert to signs of depression, especially in vulnerable patients, but don’t rely on blanket screening tools. Thoughtful conversation, familiarity with patients, and clinical intuition remain the best ways to identify those who need help.

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Evidence is mounting that cannabis use can trigger first episode psychosis, particularly among young people. On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with researchers and a patient with lived experience about what the data show, who is most at risk, and how clinicians should respond.

Bailey Peterson, a 26-year-old student from Mississauga, Ontario, describes how her cannabis consumption progressed from casual use to daily, all-day use of high-potency products. She recounts her experience with psychosis, the challenges of her hospitalization, and what she wishes she and her clinicians had known earlier.

Sophie Li, a fourth-year medical student at the University of Ottawa and an author of the CMAJ article Cannabis and psychosis, explains how rates of schizophrenia associated with cannabis use disorder have risen sharply in recent years and notes that young men in their late teens and early 20s are most at risk. For women, the highest risk tends to occur later, in their late 20s and 30s. Dr. Marco Solmi, psychiatrist and medical director of On Track: The Champlain First Episode Psychosis Program, reviews the evidence supporting a causal link between cannabis and psychosis and discusses how clinicians can distinguish cannabis-induced psychosis from schizophrenia, as well as approaches to treatment and patient education.

For physicians, the takeaway is clear: cannabis use—particularly before age 25—carries worrisome psychiatric risks, and psychosis can occur even without very high levels of consumption. Detailed cannabis histories, psychoeducation, and early counseling should be part of routine care for patients at risk of psychosis.

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