Dr. Simone Vigod, MD, MSc, FRCPC

Dr. Vigod_8536Chief, Department of Psychiatry, Women’s College Hospital

Shirley A. Brown Memorial Chair in Women’s Mental Health Research, Women’s College Research Institute

Associate Professor & Director of the Division of Equity, Gender and Population, Department of Psychiatry University of Toronto

Adjunct Scientist, ICES, Toronto, Ontario

Dr. Simone Vigod is an Associate Professor in the Department of Psychiatry at the University of Toronto, and Chief, Department of Psychiatry at Women’s College Hospital. Her background includes an Honours BSc in Psychology from McGill University (1999), MD from the University of Toronto, UofT (2003) and psychiatric residency at UofT (FRCPC, 2009) and a Masters of Science in Clinical Epidemiology from the UofT Institute for Health Policy, Management and Evaluation (IHPME) (2011). Dr. Vigod’s research addresses disparities in health and health care for individuals with psychiatric disorders, with a specific focus on women across the lifespan and on equity in access to treatment for diverse populations.  She is an Adjunct Scientist at ICES in Toronto, Ontario where she conducts her population-based epidemiological research focused on the health of women with mental illness and their children. In 2018, she obtained the Shirley A. Brown Memorial Chair in Women’s Mental Health Research at Women’s College Research Institute at Women’s College Hospital where she runs a clinical research program that focuses on novel health system interventions to improve access to and uptake of care for women with mental illness.

Here are the projects Dr. Vigod is currently working on:

2018-2023  An electronic patient decision aid for antidepressant drug use in pregnancy: A randomized controlled trial. Canadian Institutes of Health Research (CIHR), Project Grant. PI: Vigod, SN. Co-Is: Dennis CL, Grigoriadis S, Metcalfe K, Oberlander T, Stewart DE, Thorpe K, Parsons J, DeOliveira C.  Major depressive disorder is a debilitating and often chronic mental illness that affects 1 in 5 women over the lifespan. When depression is not treated effectively during pregnancy, the mother’s and her child’s health is at risk. Antidepressants are a mainstay of treatment for women whose depression is severe, or not adequately responsive to psychotherapy. Yet, it is very hard to determine when risks for relapse/ongoing depression definitely outweigh the small, but still uncertain risks of antidepressants. So, treatment decisions regarding antidepressant use in pregnancy must be guided not only by evidence about harms and benefits, but also by: (1) how a woman values the potential benefits and harms of the treatment options; (2) which option she prefers; and (3) the extent to which she wants to be involved in the treatment decision. Women have significant difficulty making this decision, but want to be active in decision-making. We designed an interactive electronic PDA to help women with depression make decisions about whether or not to use antidepressant medication in pregnancy, and successfully pilot-tested it with women across Canada. We are not conducting a randomized controlled trial to determine the efficacy of the online PDA in women with depression who are pregnancy-planning or in the early stages of pregnancy and facing decisions about use of antidepressants in pregnancy. The primary focus of the trial will be on whether the PDA can optimize decision-making effectively, as measured by the prevention of postpartum depression (PPD) since this clinical outcome is most directly linked to both ineffective management of depression in pregnancy, and to long-term negative impact for mothers and children. LINK TO STUDY FOR WOMEN TO PARTICIPATE:  https://www.womensresearch.ca/research-areas/mental-health/pda-for-antidepressant-use-in-pregnancy

2018-2021   Schizophrenia Understood in the Perinatal period: Psychiatric Outcomes and Reproductive Trajectories (SUPPORT) – Part 3: Child Health. Canadian Institutes of Health Research (CIHR). Project Grant. PI: Vigod, SN. Co-Is: Brown H, Dennis CL, Cohen A, Saunders N, Tu K, Holloway A, Morrison K, Ray JG, Oberlander T, Hanley G, Berard A, Kiss A. More than 50% of women with schizophrenia become pregnant, and birth rates have been steadily rising since the early 1990s. With appropriate supports and services, women with schizophrenia are often able to retain custody of their children, and maintain meaningful parenting capacity. Yet, early developmental exposures may put these children at risk for chronic health problems across the lifespan, including physical health and mental health problems. Such risk factors may include poverty, prenatal maternal health status including chronic cardio-metabolic diseases, and pregnancy-related exposures such as smoking, substance use and medications used for psychiatric illness. We previously showed that maternal schizophrenia is associated with a high risk of pregnancy complications and for infants being born preterm, too small and/or too large, and with serious neonatal medical problems, all implicated as markers for chronic disease across the lifespan. We propose the first comprehensive study of the long-term health of children born to women with schizophrenia by studying a sample of over 7000 such children born in Ontario, and focusing on their risk for developing chronic diseases up to age 19.

2018-2020   Postpartum depression Action toward Causes and Treatment (PACT)- Canada: Predictive Analytic Models of Postpartum Depression Risk. Canadian Institutes of Health Research (CIHR). PI: Vigod, SN. Co-Is: Brown HK, Dennis CL, Gruneir A, Thombs B, Walker M. Postpartum depression (PPD) is the most common complication of childbirth, affecting up to 1 in 5 women in the year after delivery. It is associated with long-term maternal morbidity, child emotional, cognitive and behavioural difficulties, and even maternal and child mortality. The long-term cost of PPD and related perinatal mental illnesses is estimated at ~1.4 billion Canadian dollars per one-year cohort of children. Prevention of postpartum depression could avert a significant amount of this burden. Specific psychosocial and psychological interventions can prevent PPD, especially when delivered in the early postpartum (as opposed to in pregnancy) and in high-risk women. Yet, there is no evidence-based tool in common practice that can accurately predict the level of risk for PPD in an individual woman. The aim of this catalyst grant is to create a clinical risk index, to be used around the time of delivery, for determining the probability that a woman will develop depression in the first year postpartum. We will harmonize and analyze linked population-based clinical and health administrative datasets comprising key PPD risk factors in ~400,000 Ontario women, create a statistical model that predicts who will develop PPD, and convert the final model into a clinical tool that can estimate a woman’s PPD risk. Stakeholders, including women with lived experience, public health nurses, primary care and antenatal care providers will help create a clinically useful tool to optimize future integration into the health care system. To our knowledge, this will be the first research in Canada, and the largest and most comprehensive worldwide, that attempts to create a personalized tool for determining PPD risk, thereby making a significant contribution to knowledge and practice.

2018-2020  Automated screening, triage, and follow-up to facilitate proactive, personalized postpartum mental health treatment for new parents. Canadian Institutes of Health Research (CIHR). Catalyst Grant: Personalized Health. Co-PIs: Ivers N, Aggarwal P, Dennis CL, Vigod SN. Co-Is: Sacha Bhatia, Laura Desveaux, Janessa Griffith, Trevor Jamieson, Holly Witteman. Mental health symptoms – especially depression and anxiety – are very common in new parents, affecting close to 20% of mothers and at least 10% of fathers. When such symptoms progress to severe levels, they can be more difficult to treat. Early identification of symptoms and prompt treatment are ideal. Despite broad awareness that mental health symptoms in new parents are common, few systems are in place to automatically assess and monitor such symptoms. Evidence-based symptom surveys that can identify parents at risk for postpartum mental health disorders exist, and effective medication and non-medication treatment options are available. Yet, most primary care settings do not have systems in place to ensure that parents with mental health problems (and especially fathers) are identified and treated. This study will use a digital app with tablet computers and email integration to engage parents in assessing their mental health symptoms within weeks of the birth of their new baby. Electronic symptom surveys, sent on behalf of the family doctor, will be used to support proactive, personalized postpartum mental healthcare (P3MH). Responses will be used to enable a tailored care plan for the patient, including advice about options for referrals, treatment, and local community-based psycho-educational and/or social supports. This eHealth intervention includes a web-based application for parents and seamless integration in the electronic medical record, so that when the family doctor sees the patient in clinic, relevant information is ready to be discussed. In this study, we will carry a co-design process with patients and health professionals to refine this eHealth intervention, and determine the usability, user experience, and perceived value of this process in terms of whether it enables mental health symptoms to be caught early and managed in the best way possible for each parent. We will also pilot the procedures for a future large-scale evaluation.

2019-2020 Sexual health intervention for women with first-episode psychosis. PI: Vigod, SN. Co-Is: Gupta R, Zaheer J, Voineskos A, Dunn S, Dmytryshyn R, Barker L and Berkhout S. MOHLTC. AFP Innovation Fund. The World Health Organization (WHO) defines sexual health as a state of well-being in relation to sexuality that requires a positive and respectful approach to sexuality and sexual relationships, and safe sexual experiences. Sexual health promotion activities have been instituted globally in pursuit of sexual health for all, often with a focus on vulnerable populations. Schizophrenia is a complex chronic illness that is associated with significant disability for the 300,000 Canadians – and many more around the world – affected by it. While most women develop schizophrenia in their late teens or early 20s, a time when sexual health promotion is arguably of greatest importance, sexual health has not been systematically integrated into their care. This is a significant gap. Women with schizophrenia report negative subjective experiences around sex, and have high rates of adverse sexual health outcomes (e.g. sexually transmitted infections, unplanned pregnancy). We aim to develop and evaluate the user acceptability of a sexual health intervention for young women with schizophrenia that can ultimately be integrated into standard early psychosis care, and evaluated for its impact on improving their long-term sexual health trajectories.