Research Grants

CIHR Team Grant

Delivering online cognitive behavioural therapy (iCBT) to addressmental health challenges in correctional officers and other public safe personnel, $860,000.

SARS CoV-2/COVID-19 Research Funding

Online delivery of psychotherapy, tailored topatients' suffering from mental health problems due to COVID-19.

Providence Care Hospital Research Innovation Grant

Delivering ElectronicCognitive Behavioural Therapy to Patients with Bipolar Disorder and Residual DepressiveSymptoms funding, $58,300.

Mitacs Elevate

Internet-based mental state monitoring patient's textual data.

2020 Department of psychiatry, Queen's University, Internal grant

Developing and implementing an online psychotherapy program to address mental health challenges in oncology and palliative care.

2020 Department of psychiatry, Queen's University, Internal grant

Ketamine Infusions Combined with Online Cognitive Behavioural Therapy for treatment of Post-Traumatic Stress Disorder.

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Publications

The Efficacy of PowerPoint-based CBT Delivered Through Email: Breaking the Barriers to Treatment for Generalized Anxiety Disorder

A lack of resources and cultural stigma associated with mental health treatment necessitate the development of innovative and economical individualized treatments. This study evaluated the efficacy of delivering computer-based cognitive behavioral therapy (e-CBT) presented through Microsoft PowerPoint and delivered via email in the treatment of generalized anxiety disorder (GAD) to Iranian patients, as a means of overcoming treatment barriers. Participants (N=80) of Iranian descent were recruited through announcements on psychology websites, Iranian organization websites, weblogs, and in flyers. Participants were randomly assigned to either an e-CBT or a control group. The e-CBT group received 12 weekly modules and homework assignments through email, presented using PowerPoint. The control group received no treatment (individuals in the control group were able to pursue another treatment, but would then be excluded from the study although they could continue with the program). All emails were sent by an attending or resident psychiatrist, who also provided feedback on weekly homework via email. The Beck Anxiety Inventory was used to measure levels of anxiety before study onset and changes in levels of anxiety upon completion of the program at 12 weeks, and at 6-month and 1-year follow-up in both groups. Beck Anxiety Inventory scores were significantly reduced in the group who received PowerPoint e-CBT modules delivered via email, compared with the control group, following 12 weeks of treatment, and the reductions were maintained at both follow-up points. Delivery of PowerPoint e-CBT modules via email was found to be a viable method for delivering CBT to individuals with GAD and a simple method for overcoming language, cultural, and travel barriers to accessing mental health resources. This simplified approach to the individualization and delivery of treatment modules has the potential to improve access to CBT as a treatment option throughout the world.

Citation: Alavi, Nazanin & Hirji, Alyssa. (2020). The Efficacy of PowerPoint-based CBT Delivered Through Email: Breaking the Barriers to Treatment for Generalized Anxiety Disorder. Journal of psychiatric practice. 26. 89-100. 10.1097/PRA.0000000000000455.

Cognitive Behavioural Therapy through PowerPoint: Efficacy in an Adolescent Clinical Population with Depression and Anxiety

Background: Limited help-seeking behaviours, among adolescents with mental health concerns and many barriers to accessing mental health services, make innovative approaches to administering mental health therapies crucial. Therefore, this study evaluated the efficacy of e-CBT given via PowerPoint slides to treat adolescents with anxiety and/or depression. Method: 15 adolescents referred to an outpatient adolescent psychiatry clinic to treat a primary DSM-IV diagnosis of anxiety and/or depression chose between 8 weeks of e-CBT (n=7) or 7 weeks of live CBT (n=8). The e-CBT modules were presented using PowerPoint delivered weekly through email by either a senior psychiatry resident or an attending physician. Within each session, participants in both groups had personalized feedback on their mandatory weekly homework assignment from the previous week's module. BYIs were completed before treatment and and after final treatment within both groups to assess changes in depression, anxiety, anger, disruption, and self-concept. Findings: Before treatment, BYI scores did not sig. differ between groups. After treatment, e-CBT participants reported sig. improved depression, anger, anxiety, and self-concept BYI scores while live CBT participants did not report any sig. changes. Only the Beck Anxiety Inventory sig. differed between groups after CBT. Conclusion: Despite the low sample size within this study, using email to deliver e-CBT PowerPoint slides and individualized homework feedback shows promise as an alternate method of CBT delivery that reduces barriers to receiving mental health treatment that occur internationally.

Citation: Alavi, Nazanin & Stefanoff, Matthew & Hirji, Alyssa & Khalid-Khan, Sarosh. (2018). Cognitive Behavioural Therapy through PowerPoint: Efficacy in an Adolescent Clinical Population with Depression and Anxiety. International Journal of Pediatrics. 2018. 1-5. 10.1155/2018/1396216.

Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt

Objective: To determine the efficacy of two interventions on suicide risk assessment within emergency departments (EDs) on improving the documentation of suicide risk factors by emergency medicine and psychiatric physicians during suicide risk assessment. Method: An educational intervention on suicide was provided to all emergency medicine and psychiatry physicians and was followed by the placement of a suicide risk assessment prompt within local EDs. The medical charts of all ED patients presenting with suicidal ideation or behaviours were reviewed immediately and six months after the interventions and compared to pre-intervention. Differences in the documentation of 40 biopsychosocial suicide risk factors between specialties and after the interventions were determined. Results: The documentation of 34/40 (p ≤ 0.008) and 33/40 (p ≤ 0.009) suicide risk factors was significantly improved by emergency medicine and psychiatry physicians, respectively, after the interventions and maintained six months later. Immediately and six months after the interventions, the documentation of 8/40 (p ≤ 0.041) and 14/40 (p ≤ 0.048) suicide risk factors, respectively, significantly differed between specialties. Conclusion: This suggests that providing a brief educational intervention on suicide to emergency medicine and psychiatry physicians followed by placing a prompt for important, yet commonly undocumented risk factors within the ED is a low-cost and effective intervention for improving documentation of suicide risk assessments within the ED.

Citation: Reshetukha, Taras & Alavi, Nazanin & Prost, Eric & Kirkpatrick, Ryan & Sajid, Saad & Patel, Charmy & Groll, Dianne. (2018). Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt. General Hospital Psychiatry. 52. 10.1016/j.genhosppsych.2018.03.001.

Relationship between Bullying and Suicidal Behaviour in Youth presenting to the Emergency Department

Objective: Increasing numbers of adolescents are visiting emergency departments with suicidal ideation. This study examines the relationship between bullying and suicidal ideation in emergency department settings. Method: A chart review was conducted for all patients under 18 years of age presenting with a mental health complaint to the emergency departments at Kingston General or Hotel Dieu Hospitals in Kingston, Canada, between January 2011 and January 2015. Factors such as age, gender, history of abuse, history of bullying, type and time of bullying, and diagnoses were documented. Results: 77% of the adolescents had experienced bullying, while 68.9% had suicide ideation at presentation. While controlling for age, gender, grade, psychiatric diagnosis, and abuse, a history of bullying was the most significant predictor of suicidal ideation. Individuals in this study who reported cyber bullying were 11.5 times more likely to have suicidal ideation documented on presentation, while individuals reporting verbal bullying were 8.4 times more likely. Conclusions: The prevalence of bullying in adolescent patients presenting to emergency departments is high. The relationship found between suicidal ideation and bullying demonstrates that clinicians should ask questions about bullying as a risk factor for suicide ideation during the assessment of children and adolescents.

Citation: Alavi, Nazanin & Reshetukha, Taras & Prost, Eric & Antoniak, Kristen & Patel, Charmy & Sajid, Saad & Groll, Dianne. (2017). Relationship between Bullying and Suicidal Behaviour in Youth presenting to the Emergency Department. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent. 26. 70-77.

What is commonly missed in the suicidal risk assessments in the emergency room?

Introduction Suicidal behaviour remains the most common reason for presentation to the emergency rooms. In spite of identifiable risk factors, suicide remains essentially unpredictable by current tools and assessments. Moreover, some factors may not be included consistently in the suicidal risk assessments in the emergency room by either emergency medicine physicians or psychiatrists. Method Step 1 involved the administration of a survey on the importance of suicide predictors for assessment between psychiatry and emergency medicine specialties. In step 2 a chart review of psychiatric emergency room patients in Kingston, Canada was conducted to determine suicide predictor documentation rates. In step 3, based on the result of the first 2 steps a suicide risk assessment tool (Suicide RAP [Risk Assessment Prompt]) was developed and presented to both teams. A second patient chart review was conducted to determine the effectiveness of the educational intervention and suicide RAP in suicide risk assessment. Results Significant differences were found in the rating of importance and the documentation rates of suicide predictors between the two specialties. Several predictors deemed important, have low documentation rates. Thirty of the suicide predictors showed increased rates of documentation after the educational intervention and the presentation of the suicide RAP. Conclusion Though a surfeit of information regarding patient risk factors for suicide is available, clinicians and mental health professionals face difficulties in integrating and applying this information to individuals. Based on the result of this study suicide RAP and educational intervention could be helpful in improving the suicidal risk assessment.

Citation: Alavi, Nazanin & Reshetukha, Taras & Prost, Eric & Kristen, A. & Groll, Dianne. (2017). What is commonly missed in the suicidal risk assessments in the emergency room?. European Psychiatry. 41. S562. 10.1016/j.eurpsy.2017.01.815.

Online clinic, a new method of delivering psychotherapy

Introduction Psychotherapy is one of the most widely investigated and practiced forms of treatment used in the treatment of different mental health problems. However, there are some barriers in delivering this treatment, including long waiting lists, therapist shortage and lack of access to therapists in remote areas. Therefore, using alternative methods to overcome these barriers seems necessary. Method The division of psychiatry at Queen's university provides different psychotherapy groups for individuals suffering from different kinds of mental health problem. We gave the participants the opportunity to choose online psychotherapy through an online clinic or the live group sessions. All the patients were assessed by different questionnaires for evaluation of the efficacy of the treatment. The online clinic was designed to facilitate the communication between patients and clinicians and the material was delivered in PowerPoint format through the online platform. All user activities were logged for security purposes. Results Statistical analysis showed that this method of delivering psychotherapy significantly reduced patients’ symptoms and also decreased the number of people on the waiting list and increased the amount of compliance in patient's taking part in psychotherapy and number of people who were able to receive psychotherapy. Conclusion Despite the proven short and long-term efficacy of psychotherapy, there are some barriers in delivering this treatment. It is an unequivocal public health needs to overcome these barriers through alternative methods of therapy. With Internet use ever rising, developing an online clinic could be a new way in delivering different kinds of psychotherapy.

Citation: Omrani, M. & Alavi, Nazanin & Rivera, Margo & Khalid-Khan, Sarosh. (2017). Online clinic, a new method of delivering psychotherapy. European Psychiatry. 41. S148. 10.1016/j.eurpsy.2017.01.1997.

Outcomes of involuntary hospital admission. Satisfaction with treatment and the effect of involuntary admissions on patients

Introduction Involuntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be. Method All patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization. Results Although psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients. Discussion The results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.


Citation: Reshetukha, Taras & Alavi, Nazanin & Prost, Eric & Groll, Dianne & Cardy, Robyn & Mofidi, Naser & Wang, P. & Patel, Charmy & Sajid, Saad. (2017). Outcomes of involuntary hospital admission. Satisfaction with treatment and the effect of involuntary admissions on patients. European Psychiatry. 41. S328-S329. 10.1016/j.eurpsy.2017.02.264.

Assessing Suicide Risk: What is Commonly Missed in the Emergency Room?

Objective: Although risk assessment for suicide has been extensively studied, it is still an inexact process. The current study determined how busy emergency clinicians actually assessed and documented suicide risk, while also examining the differences between psychiatric and emergency medicine opinions on the importance of various suicide predictors. Method: Phase 1 of the study involved the administration of a survey on the relative importance of various suicide predictors for the specialties of psychiatry and emergency medicine. In phase 2 of the study, a chart review of psychiatric emergency room patients was conducted to determine the actual documentation rates of the suicide predictors. Results: Several predictors that were deemed to be important, including suicidal plan, intent for suicide, having means available for suicide, and practicing suicide (taking different steps leading up to suicide but not actually attempting suicide), had low documentation rates. Conclusions: Medical specialties have different opinions on the importance of various suicide predictors. Also, some predictors deemed important had low documentation rates. Educational interventions and simple assessment tools may help to increase documentation rates of several suicide predictors in busy clinical settings.


Citation: Alavi, Nazanin & Reshetukha, Taras & Prost, Eric & Antoniak, Kristen & Groll, Dianne. (2017). Assessing Suicide Risk: What is Commonly Missed in the Emergency Room?. Journal of Psychiatric Practice. 23. 82-91. 10.1097/PRA.0000000000000216.

Online CBT Is Effective in Overcoming Cultural and Language Barriers in Patients With Depression

Objective: The goal of this study was to evaluate the efficacy of weekly email in delivering online cognitive behavioral therapy (CBT) to treat mild to moderately depressed individuals. The effectiveness of the online CBT was measured following treatment and then again at a 6-month follow-up and was compared with outcomes in a waitlist control group. Methods: Participants were recruited through announcements on psychology Web sites, Iranian organization Web sites, and weblogs and flyers. Ninety-three individuals who met inclusion criteria, including a score >18 on the Beck Depression Inventory (BDI), participated in the study, with 47 randomly assigned to the CBT group and 46 to the control group. The CBT group received 10 to 12 sessions of online CBT conducted by a psychiatrist and a psychiatry resident. Following completion of the CBT, a second BDI was sent to participants. Another BDI was then sent to participants 6 months after the completion of treatment. Results: Email-based CBT significantly reduced BDI scores compared with results in a waitlist control group following 10 to 12 weeks of treatment and at 6-month follow-up. Conclusions: Email is a viable method for delivering CBT to individuals when face-to-face interaction is not possible. Limitations and future directions are discussed.

Citation: Alavi, Nazanin & HIRJI, ALYSSA & Sutton, Chloe & Naeem, Farooq. (2016). Online CBT Is Effective in Overcoming Cultural and Language Barriers in Patients With Depression. Journal of Psychiatric Practice. 22. 2-8. 10.1097/PRA.0000000000000119.

Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality

Objective: To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality. Method: A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen's University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age. Results: The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04). Conclusions: Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment.


Citation: Alavi, Nazanin & Roberts, Nasreen & Sutton, Chloe & Axas, Nicholas & Repetti, Leanne. (2015). Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality. Canadian Journal of Psychiatry. 60. 427-431. 10.1177/070674371506001003.

Maintenance Repetitive Transcranial Magnetic Stimulation (RTMS) in Relapse Prevention of Depression

Introduction Depression is the most prevalent mental health condition with high morbidity and mortality. rTMS is an alternative treatment of acute depression validated in controlled trials. rTMS was approved by FDA for treatment of unipolar non-psychotic depression in patients who have failed one adequate antidepressant trial (Lisanby, 2009). Maintenance application of rTMS in depression remains under – researched. Objectives To investigate published evidence of maintenance rTMS in unipolar and bipolar depression. Methods Systematic review of maintenance rTMS studies in unipolar and bipolar depression was conducted. An electronic search was carried out including The Cochrane Library, MEDLINE (1988-2014), EMBASE (1974-2014), and Psych Lit (1980-2014). References of selected articles were searched manually. English-language case reports, case series, cohort studies and controlled trials were selected. Studies reporting maintenance rTMS equal or less then 3 month were excluded. Results 8 case reports, 5 case series, 1 retrospective cohort study and 4 prospective open-label studies were critically appraised. No RCTs were available. Most patients reported had prolonged treatment-resistant depression. Considerable heterogeneity in maintenance rTMS frequency and parameters was observed. All studies reported short-term prolongation of remission period or preservation of acute treatment gains. Few rTMS studies reported longer-term maintenance treatment. Conclusions rTMS appears to be a viable well-tolerated option for maintenance treatment of unipolar and bipolar depression either as monotherapy or as an adjunct to maintenance pharmacotherapy. Absence of consistent stimulation parameters makes it difficult to discuss rTMS relapse prevention effectiveness in systematic way. Large sample long-term sham control studies are needed.


Citation: Reshetukha, Taras & Alavi, Nazanin & Milev, Roumen. (2015). Maintenance Repetitive Transcranial Magnetic Stimulation (RTMS) in Relapse Prevention of Depression. European Psychiatry. 30. 836. 10.1016/S0924-9338(15)30652-0.

Bullying Including Cyber Bullying Increases the Risk of Suicidal Behaviour

Introduction Suicidal behaviour is one of the most common reasons for presentation to the emergency rooms. Bullying is a universal public health concern that affects significant number of adolescents. Many children and adolescents are recurrently involved in school bullying. Research suggests that both bullies and victims are overrepresented amongst those seen by mental health professionals. Objectives Understand the the relationship between bullying and suicidal behaviour, prevalence of different kinds of bullying in patients with mental health problems and prevalence of cyber bullying and it's affect on the victim Aim Increase public awareness on importance of cyber bullying. We feel that many patients won't disclose that they had been or are being cyber bullied because the characteristics are unclear. Method Charts of all patients who visited emergency room from 2011 to 2013 with a mental health complaint were reviewed. Variables understudy were gender, history of bullying, type of bullying (verbal, physical, emotional), DSM-IV-TR diagnosis and outcome following the assessment. Results Our study shows significant association between bullying, and suicidal behaviours, although based on our study, this predictor was not commonly assessed . Conclusion Our study showed that there was a significant link between bullying and future suicidal behaviour which is not commonly assessed. It is important that physicians identify these risk factor while assessing suicidality. Involvement in current cyber bullying was found to be less frequent than other forms of bullying such as verbal and physical. However, significant links were observed between cyber bullying and suicidal behaviour.


Citation: Alavi, Nazanin & Reshetukha, Taras & Prost, Eric. (2015). Bullying Including Cyber Bullying Increases the Risk of Suicidal Behaviour. European Psychiatry. 30. 209. 10.1016/S0924-9338(15)30169-3.

Multifamily psychoeducation groups: comparing email psychoeducation to live groups

Citation: Khalid-Khan, Sarosh & Alavi, Nazanin & Odejayi, Gbolahan & Arachna, P. & Choi, E.. (2014). EPA-0917 - Multifamily psychoeducation groups: comparing email psychoeducation to live groups. European Psychiatry. 29. 1. 10.1016/S0924-9338(14)78242-2.

Outcome Study of Intensive Day treatment for Children with Pervasive Developmental Disorders.

Abstract Objectives: a) To study the characteristics of children referred to day treatment for Pervasive Developmental Disorders (PDD). b) To study association between outcome and the variables understudy. Method: This was a retrospective chart review of all children and adolescents with PDD, who attended a hospital based Day treatment program. Demographic data and variables such as type of community classroom they came from, Length of Stay (LOS), full scale IQ scores, DSM-IV Diagnosis and type of placement at discharge were extracted. Descriptive statistic was used for categorical data and multinomial logistic regression was used for association between outcome and variables understudy. Results: There was an association between gender and outcome, females had better outcome than males. 2/3 of the patients with and without comorbidities had a significant reduction in behavioral symptoms allowing successful reintegration into community schools. Conclusions: A proportion of children with Autistic Spectrum Disorder (ASD) present with severe emotional and behavioral dysregulation which are unmanageable. These children have multiple comorbidities and require more intensive longitudinal assessment by a skilled multidisciplinary team and specific evidence -based interventions to enable them to return to community school. Intensive Day treatment in a therapeutic classroom by skilled multidisciplinary staff reduces the impairing behaviors and allows families and schools to better manage these children.


Citation: Alavi, Nazanin & Roberts, Nasreen & deGrace, Elizabeth. (2013). Outcome Study of Intensive Day treatment for Children with Pervasive Developmental Disorders.. Autism-Open Access.

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Do we need to write a business plan?

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Gender Differences in Life Events Prior to Onset of Major Depressive Disorder: The Moderating Effect of Age

Theoretical models attempting to explain why approximately twice as many women as men suffer from depression often involve the role of stressful life events. However, detailed empirical evidence regarding gender differences in rates of life events that precede onset of depression is lacking, due in part to the common use of checklist assessments of stress that have been shown to possess poor validity. The present study reports on a combined sample of 375 individuals drawn from 4 studies in which all participants were diagnosed with major depressive disorder and assessed with the Life Events and Difficulties Schedule (Bifulco et al., 1989), a state-of-the-art contextual interview and life stress rating system. Women reported significantly more severe and nonsevere, independent and dependent, and other-focused and subject-focused life events prior to onset of depression than did men. Further, these relations were significantly moderated by age, such that gender differences in rates of most types of events were found primarily in young adulthood. These results are discussed in term of their implications for understanding the etiological role of stressful life events in depression.

Citation: Harkness, Kate & Alavi, Nazanin & Monroe, Scott & Slavich, George & Gotlib, Ian & Bagby, R.. (2010). Gender Differences in Life Events Prior to Onset of Major Depressive Disorder: The Moderating Effect of Age. Journal of abnormal psychology. 119. 791-803. 10.1037/a0020629.

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Why is Webflow so amazing?

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How can we get funding for our start up?

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Why is Webflow so amazing?

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Do we need to write a business plan?

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How can we get funding for our start up?

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