“I really like the process of collecting data and seeing the story behind it,” Leong says. “When I started the PharmD program at the University of Toronto, doing various clinical rotations, I noticed a lot of gaps in knowledge. I felt like research was a great tool to address those gaps.”

Leong grew up in Winnipeg and earned her bachelor’s degree in pharmacy at UM. She joined the faculty in 2013, is cross-appointed in the department of psychiatry, and is a researcher with the Children’s Hospital Research Institute of Manitoba. She appreciates that Manitoba has a world-class repository of rich, anonymized health data.

During the COVID-19 pandemic, Leong wanted to determine what impact the virus was having on prescriptions for psychotropic medications.

Using health databases housed at the Manitoba Centre for Health Policy at UM, she and her team found that in the three months after pandemic public-health restrictions took effect in 2020, new prescriptions for antidepressants and anti-anxiety medications significantly declined.

Then, near the end of 2020, as they reported in the study in Frontiers in Pharmacology, the researchers saw a spike in new prescriptions for antidepressants and anti-psychotics in women and older adults.

Leong suspects that during the uncertain times early in the pandemic, patients were seeking stability, and that made them less likely to switch or start new medications.

“Then, near the end of 2020, the increase in prescriptions for women may reflect that women’s mental health was under more strain than men’s from pressures such as home-schooling children, juggling child-care and working from home.

“A possible reason for the rise in prescriptions for older adults is that during the pandemic they had reduced access to non-drug supports, such as companionship and psychosocial therapy.”

Although the data can’t reveal the reasons for the dip and surge in prescriptions, Leong says, this kind of study is important for uncovering whether a global event like the pandemic changes prescription patterns. This knowledge can point researchers to questions for further study.

The next step in this project, she says, is to try to understand why certain populations are accessing medications but not going for follow-up care.

“In older adults, for example, antipsychotic drug use has to be evaluated every three months because of the risk of side effects. Since we saw a rise in antipsychotic prescriptions toward the end of 2020, we want to know whether those prescriptions were evaluated regularly.”

Leong’s overall goal is for her research to influence public policy and improve access to services like mental health care.

She is currently training 25 community pharmacists in mental health first aid. This form of care aims to help a person who is experiencing worsening mental health problems until they can find long-term treatment.

“Pharmacists often encounter patients who are experiencing a mental health crisis. I wanted to provide this training so they can identify when someone is experiencing a deterioration in mental health and connect them to resources.”

And before the Eastland even left the wharf, the lifeboats caused it to list, and then it capsized so quickly that one reporter said it rolled over like “a dead jungle monster shot through the heart.” Eight hundred and forty-four passengers died, a passenger death toll higher than the Titanic’s.

What was meant to save lives, ended up harming and killing many others. Indeed, in 1638, scientist Galileo Galilei warned in his final book that cautionary measures can in turn cause disaster.

When the COVID-19 virus first moved across the globe, governments quickly implemented lockdowns and social distancing rules. As supply chains broke, they worried about material shortages, including prescriptions drugs, and so enacted precautionary measures. In Canada, for instance, some patients received a one-month refill rather than the usual three-month extension. Factors such as this, and the general fear people have of contracting the virus in medical facilities, has changed how people are using the health care system, but we don’t know exactly who is being affected, or how. That, however, is about to change.

“A UM team led by assistant professor Christine Leong in the College of Pharmacy is starting a novel study to see if our cautionary measures are enabling a disaster somewhere else.”

Thanks to the anonymized administrative health data held in the Manitoba Centre for Health Policy (MCHP) at the University of Manitoba (UM), a UM team led by assistant professor Christine Leong in the College of Pharmacy, is starting a novel study to see if our cautionary measures are enabling a disaster somewhere else. We need to know because more pandemics are inevitable.

Christine Leong

Leong and her collaborators received $100,000 in funding from the Research Manitoba COVID-19 Rapid Response Grant to study the changes in med­ication dispensation, health service use (physician visits, hospital visits, emergency department visits), and death rates before—and during—the COVID-19 pandemic in the general population, and in those with a history of mental illness. And in Manitoba, the latter category holds a lot of people: A past UM study found that 28 per cent of our population (or roughly 300,000 individuals) has been diagnosed with a mental disorder within the last five years. So, the potential impact of these restrictions on our society is enormous.

“Obviously a lot of things have changed since COVID happened, and the ways in which people can access in-person health care has shifted, and visits to the Crisis Response Centre for example has gone down. Where are these individuals going? I felt like these changes are a very important area that needed to be looked at,” Leong says.

“I’ve done research in the past looking at health service use and psychotropic medication use in the general population. I was also a primary care pharmacist, working at the Family Medical Centre from 2014 up until it closed in 2019. And I’ve encountered many patients struggling with mental illness, and sometimes the resources available to them are quite limited. So when COVID-19 happened, I was quite interested in studying this further,” she says.

Leong and her team will use the rich data contained within MCHP to see the real-world effects the pandemic has had on those with a psychiatric diagnosis, and the general population.

A key aspect of this study is that it focuses on data from the past five years, including the four years leading up to the pandemic. This enables the research team to establish a solid baseline pattern—which is helpful to policy-makers concerned with everyday planning—and then see how things change during the pandemic, which is key information we need to prepare for the next pandemic. We need to know where to direct resources, both during, and after pandemics: when restrictions lift, people may flood into the system again, potentially creating new resource problems.

James Bolton, a professor of psychiatry at UM, has used MCHP data in other studies and is excited to be collaborating on this specific project.

“I think there’s huge potential for this study to really uncover a lot of important information about how the pandemic is influencing mental health,” he says. “The early signs are that people with mental illnesses are facing unique challenges during the pandemic. And so I think this study is extremely important to take a look at what happens with people’s medication use and their connections with services, to really see what the impacts of COVID are on mental health. And it’s hard to anticipate which direction things will go.”

“I think there’s huge potential for this study to really uncover a lot of important information about how the pandemic is influencing mental health.”

It’s possible the distress caused by social isolation is leading to more people seeking help. Or, the opposite: Because of COVID restricting our ability to connect, people might be avoiding treatments and not renewing prescriptions.

“I think this study will give us a story as to where vulnerable people are going and how they are impacted,” Leong says. “Even before the pandemic, how were they doing? I think this study is going to give us a clearer idea of how we can better care for these patients. This data will let us dig deeper into seeing how can we actually support these patients, whether we are in a pandemic or not.”

Population-level effects

The coronavirus disease 2019 (COVID-19) pandemic is anticipated to have both short-and long-term effects on the mental health and wellbeing of individuals at a population level. Physical distancing, changes in financial circumstances and fears associated with the virus itself can impact mental health. Understanding the psychiatric effects of COVID-19 has become an important research priority. Many shifts in the way individuals access care have occurred.

Using health data from Manitoba, Leong and her team are studying changes in medication adherence, health service use and death rates before and during the COVID-19 pandemic in the general population and in those with a history of mental illness. This study will help us under­stand how the healthcare system can help individuals living with mental illness.

Leong’s team includes collaborators at the Rady Faculty of Health Sciences: Silvia Alessi-Severini, James Bolton, Daniel Chateau, Joseph Delaney, Sherif Eltonsy, Murray Enns, Jamison Falk, Kaarina Kowalec and Jitender Sareen.

Preventing Unintended Disaster is one of the feature stories in the Winter 2021 issue of ResearchLIFE magazine.

Uma Yakandawala

Last fall, Yakandawala joined the College of Pharmacy master’s program to begin her research studying medications in breast milk and has recently received the 2020 Canada Graduate Scholarships – Masters (CGS M) award which will support her in her studies. The value of the award is $17,500 for 12 months.

“Through communicating with people at community engagement events, I’ve found that there’s a limited amount of knowledge that they have on making a decision whether or not to take a medication and how much medication to take,” says Yakandawala.

She will be working at the Manitoba Interdisciplinary Lactation Centre (MILC), led by Dr. Meghan Azad, Dr. Nathan Nickel, and Dr. Lauren Kelly. All three are assistant professors in the departments of pediatrics and child health and community health sciences and research scientists at the Children’s Hospital Research Institute of Manitoba. Nickel is an associate director at the Manitoba Centre for Health Policy.

She will be supervised by Kelly and Dr. Christine Leong, assistant professor, College of Pharmacy.

MILC is a research centre building a novel biorepository to study breast milk linked to administrative data.

“Manitoba has a unique opportunity to lead medication in breast milk research in Canada with the development of MILC,” says Yakandawala.

There are two components to Yakandawala’s project. The first part will be a systematic review to understand the collection methods and analytical techniques used to study medications in breast milk. This will help to inform the development of analytical techniques in order to quantify levels of medications excreted in breast milk.

The second part is a scoping review and a questionnaire. This will help researchers to understand the preference factors of mothers that contribute to their decisions to take medications during pregnancy and breastfeeding.

Yakandawala started down this research path last summer while doing an undergraduate research award project with Leong. She decided to continue studying the topic.

“I’m especially interested in the knowledge translation piece, how we’re able to translate the research we do in the lab to the community,” she says.

The community engagement aspect is something Yakandawala enjoys most about the project, which allows her to go out and speak with people about the subject face-to-face.

“We hold a lot of community engagement events to understand what people know about medication in breast milk and how they want to be involved in the research. There’s a holistic approach to our research which I really love,” she says.

Yakandawala hopes her study will one day help people who are pregnant and breastfeeding make more informed decisions about medications.

“There’s isn’t a lot of existing research in the literature,” she says. “It’s important to ensure that future research will study patient outcomes and what’s important to mothers and pregnant people when it comes to medications and breast milk. This study will hopefully lead to the development of a decision aid that may be used in clinical practice.”

Yakandawala says she was excited to find out the news that she received the Canada Graduate Scholarships-Master’s (CGS M) award, which aims to help develop research skills and assist in the training of highly qualified personnel by supporting students who demonstrate a high standard of achievement in early graduate studies.

“I was honoured and appreciative to be one of the students at UM that got chosen to receive this scholarship,” she says.

The CGS M program provides financial support for to up to 3,000 graduate students annually in all disciplines. It is administered jointly by Canada’s three federal agencies: Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research Council of Canada. More info: https://www.nserc-crsng.gc.ca/students-etudiants/pg-cs/cgsm-bescm_eng.asp

Nearly two-thirds of Canadians 65 years of age and older are receiving five or more different prescription drugs, which can increase the risk of side effects and interactions, leading to patient burden, morbidity and hospitalizations.

Join us on Oct. 29 to learn about the latest research on the use of medication and potential harm, while we discuss how research can drive advancement of clinical knowledge and improve patient care of older adults.

Café Scientifique – Polypharmacy: Are we overmedicating older Canadians?

Oct. 29  – 7 p.m.
McNally Robinson Booksellers, 1120 Grant Avenue, Winnipeg

Moderator: Dr. I fan Kuo
Assistant Professor, College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba

Panelists:

Dr. Silvia Alessi-Severini
Associate Professor, College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba

Dr. Jamie Falk
Assistant Professor, College of Pharmacy; Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba

Dr. Christine Leong
Assistant Professor, College of Pharmacy; Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Clinical Pharmacist, Family Medical Centre

To assist in planning seating, RSVP to: Research_Communications@umanitoba.ca or call 204-474-6689.