Housing Orientations and Needs of Above-Average Length of Stay Hospitalized Psychiatric Patients

A small number of severely and persistently mentally ill in-patients awaiting residential or long-stay facilities represent an obstacle to the efficient utilization of acute care beds. These facilities are costly and currently reputed to be contrary to recovery principles. In 2013, all acute psychiatric care wards in Montreal identified 194 in-patients who could be discharged to residential or long-term nursing care facilities. Program clinical professionals of regional residential facilities sent adapted standardized questionnaires to ward staff. Evaluators also collected the residential preferences of both staff and patients, and then made their own assessments. The 194 in-patients were mostly middle-aged single men. Over 80% had a psychosis diagnosis and half had judicial constraints. The staff evaluated that 71.1% could be discharged from hospital within 24 h. Of these, 55% could be referred to group resources with continuous 24 h, 7 days a week staff presence, 32% could be transferred to apartments with 7-day continuous or non-continuous staff presence, 12% could be transferred to institutional care and only 2% could be moved to an apartment of their own. Evaluator and ward staff residential preferences were highly similar, but differed with patient preferences, half of whom prefer their own apartment. Discrepancy between staff evaluations and patient preferences were higher for longer stay patients with more severe symptoms and comorbidity of personality disorders.

Effect of psychosocial work factors on the risk of depression: a protocol of a systematic review and meta-analysis of prospective studies

INTRODUCTION

Depression is a common and disabling health problem that contributes to an important social and economic burden, particularly among the working age population. The deleterious effect of psychosocial work factors on depression has been documented. However, the most recent systematic reviews had restrictive eligibility criteria and, since their publications, several original studies have been published. The proposed systematic review aims to update, evaluate and synthesise the effect of psychosocial work factors from three recognised theoretical models, the demand-control-support, effort-reward imbalance and organisational justice models, on the risk of depression among workers.

METHOD AND ANALYSIS

A systematic literature search will be conducted in seven academic databases (Medline, Embase, CINAHL, Web of Science, PsycInfo, Sociological abstracts and IBSS) as well as three grey literature databases. The search strategy was first run on January 2017, updated in October 2017 and will be updated 6 months prior to submission for publication. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, study selection will be carried out using a rigorous multistep screening process in duplicate by independent reviewers. Prospective studies evaluating the effect of at least one psychosocial work factor from the three theoretical models on depression or antidepressant medication use among working adults will be included. Extracted data will be used for evidence synthesis as well as to assess risk of bias and methodological quality. Meta-estimates will be provided after considering homogeneity and number of studies.

ETHICS AND DISSEMINATION

This study will only draw from published studies and grey literature available in electronic databases; ethics approval is not required. The results of this review will be published in a peer review journal and presented at relevant conferences. Given that psychosocial work factors are frequent and modifiable, the results can help reduce the social and economic burden of depression and support public policy-makers to improve occupational health standards.

PROSPERO REGISTRATION NUMBER

CRD42018107666.

Prevalence of Mental Disorders and Suicidality in Canadian Provinces

OBJECTIVE

There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use disorders, and suicidality.

METHOD

Data were extracted from the 2012 Canadian Community Health Survey-Mental Health (n = 25,113), a representative sample of Canadians over the age of 15 years across all provinces. Cross tabulations and logistic regression were used to determine the prevalence and odds of the above disorders for each province. Adjustments for provincial sociodemographic factors were performed.

RESULTS

The past-year prevalence of all measured mental disorders and suicidality, excluding GAD, demonstrated significant interprovincial differences. Manitoba exhibited the highest prevalence of any mental disorder (13.6%), reflecting high prevalence of MDD and alcohol use disorder compared to the other provinces (7.0% and 3.8%, respectively). Nova Scotia exhibited the highest prevalence of substance use disorders (2.9%). Quebec and Prince Edward Island exhibited the lowest prevalence of any mental disorder (8.5% and 7.7%, respectively). Manitoba also exhibited the highest prevalence of suicidal ideation (5.1%); however, British Columbia and Ontario exhibited the highest prevalence of suicidal planning (1.4% and 1.3%, respectively), and Ontario alone exhibited the highest prevalence of suicide attempts (0.7%).

CONCLUSIONS

Significant interprovincial differences were found in the past-year prevalence of mental disorders and suicidality in Canada. More research is necessary to explore these differences and how they impact the need for mental health services.

Retraction: Caractérisation des premiers épisodes de schizophrénie à partir de bases de données administratives de santé jumelées. [Characterization of First Episodes of Schizophrenia from Combined Administrative Databases]. Beaudoin, M., Potvin, S., Dellazizzo, L., Surprenant, M., Lesage, A., Vanasse, A., Ngamini-Ngui, A.† et Dumais, A. Santé mentale au Québec. 2018 Fall ; 43(2) : 83-105.PMID : 32338687

This corrects the article DOI: https://doi.org/10.7202/1058611ar.

Survey evidence of the decline in child abuse in younger Canadian cohorts

Physical and sexual abuse in childhood is a worldwide phenomenon with potentially dramatic consequences of both a psychological and physical nature. Measures of primary prevention have been developed in some countries. In the USA, child protection services reports and research surveys indicate that child sexual abuse has been on the decline in recent decades. Results are less clear for physical and overall abuse. The aim of this study was to describe how childhood abuse has changed over the years in Canada through an analysis of the 2012 Canadian Community Health Survey: Mental Health Edition data. The sample comprised 22,775 respondents ages 20 and over who completed a child abuse questionnaire. Respondents born from 1983 to 1992 reported significantly less overall abuse, physical abuse, and sexual abuse than did older generations, with the exception of people born in 1942 or earlier. The decrease was observed among men and women and across all the regions of Canada.Conclusion: The results are encouraging in that they may have an impact on life expectancy, severity of various chronic disorders, and suicide in the population. They also support policies that have focused on improving the childhood environment in the 1990s. Results also underline the importance of using different kinds of data sources for evaluating child abuse. What is Known: • Physical and sexual abuse in childhood has been associated with lower life expectancy in connection with an array of chronic diseases, including mental disorders, and with suicide. • Measures of primary prevention have been developed in some countries, such as the USA and Canada. What is New: • Canadians born from 1983 to 1992 report significantly less overall abuse, physical abuse, and sexual abuse than older generations do. • These encouraging results support policies implemented in the 1990s focused on improving the childhood environment.

Factors associated with emergency department use for mental health reasons among low, moderate and high users

OBJECTIVES

This study identified factors associated with frequency of emergency department (ED) use for mental health (MH) reasons in Quebec during 2015-2016.

METHODS

Participants (n = 115,066) were categorized as: 1) low (1 visit/year; 76%); 2) moderate (2 visits/year; 14%); and 3) high (3+ visits/year; 10%) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Variables significantly associated with frequency of ED use were entered into a multinomial logistic regression.

RESULTS

Patients with mental illness (MI), especially substance-related disorders (SRD) and schizophrenia spectrum disorders; bipolar, depressive, anxiety or personality disorders; and those with severe chronic physical illness (needs factors) were more likely to use ED for MH reasons, as were male participants 18-64 years old, and those living in metropolitan areas with high social or material deprivation (predisposing factors). Regarding enabling factors, consultations with outpatient psychiatrists and not seeing a general practitioner (GP) in the year prior to ED visit were associated with high ED use.

CONCLUSION

The severity of MI/SRD contributed most to frequent ED use, while social and material deprivation in metropolitan areas, and intensity of medical care also influenced ED use for MH reasons.

The Public Cost of Mental Health- and Addiction-Related Services for Youth (Ages 12-17) in Alberta

OBJECTIVE

To measure the provincial government cost of mental health-related activities for youth ages 12 to 17 in Alberta in 2014 to 2015.

METHODS

The target population was Alberta youth ages 12 to 17 (the federal justice definition) who received or were funded for mental health-related or complementary services from Alberta Health Services, Alberta Health, Alberta Human Services, Alberta Justice and Solicitor General, and Alberta Education (public schools). Data on services and expenditures were obtained from each source for the target youth population.

RESULTS

Costs for mental health-related services for all ministries were $175 million for 27,169 youth who used mental health services as defined by Policy Wise, $6460 per youth. Public school special education supplements for youth with emotional problems was the largest group, amounting to 30% of all costs. Other prominent sources of expenditures were hospital inpatient mental health services (18%), community mental health services (11%), physician mental health services (10%), and secure services with treatment requiring judicial approval (9%).

CONCLUSION

Economists in several countries have developed countrywide measures of mental health expenditures and have used these to generate national benchmarks for mental health spending. We have estimated spending for Alberta provincial mental health and addiction services for a distinct and highly vulnerable group. This measure can be used to develop measures and benchmarks for other provinces, which will be valuable policy indicators.

Enhanced light extraction efficiency of Eu-related emission from a nano-patterned GaN layer grown by MOCVD

Eu-doped GaN is a promising material for the active layer in red light emitting diodes. Although the output power of LEDs based on GaN:Eu has been increasing by a combination of structural and growth optimizations, there is still a significant limitation resulting from a poor light extraction efficiency, typical for high refractive index materials. Here we studied nanostructuring of the top of the optical active layer by nano-cubes for enhancement of the light extraction efficiency, and its effect on the optical emission characteristics. By etching nano-cubes into the active layer, we observed an increase in directional light output power of Eu³⁺ ions of up to 60%, as well as a grating effect. Simultaneously, the absorption of excitation light into the optical active layer was improved, leading to a 12.8 times increase of output power per available Eu³⁺ ion.

Individual, programmatic and systemic indicators of the quality of mental health care using a large health administrative database: an avenue for preventing suicide mortality

Suicide is a major public health issue in Canada. The quality of health care services, in addition to other individual and population factors, has been shown to affect suicide rates. In publicly managed care systems, such as systems in Canada and the United Kingdom, the quality of health care is manifested at the individual, program and system levels. Suicide audits are used to assess health care services in relation to the deaths by suicide at individual level and when aggregated at the program and system levels. Large health administrative databases comprise another data source used to inform population-based decisions at the system, program and individual levels regarding mental health services that may affect the risk of suicide. This status report paper describes a project we are conducting at the Institut national de santé publique du Québec (INSPQ) with the Quebec Integrated Chronic Disease Surveillance System (QICDSS) in collaboration with colleagues from Wales (United Kingdom) and the Norwegian Institute of Public Health. This study describes the development of quality of care indicators at three levels and the corresponding statistical analysis strategies designed. We propose 13 quality of care indicators, including system-level and several population-level determinants, primary care treatment, specialist care, the balance between care sectors, emergency room utilization, and mental health and addiction budgets, that may be drawn from a chronic disease surveillance system.

Effect of psychosocial work factors on the risk of certified absences from work for a diagnosed mental health problem: a protocol of a systematic review and meta-analysis of prospective studies

INTRODUCTION

Mental health problems (MHPs) are frequent and disabling and are the first or second leading cause of certified sickness absences from work in industrialised countries. They are generally long lasting and generate a considerable human and socioeconomic burden. The deleterious effect of adverse psychosocial work factors on MHP has been documented. However, the evidence regarding the effect of these factors on absences from work for an MHP has not been synthesised since 2007. The proposed systematic review aims to synthesise the effect of adverse psychosocial work factors from three validated theoretical models (the demand-control-support, effort-reward-imbalance and organisational justice models) on the risk of certified absences from work for diagnosed MHP among workers.

METHOD AND ANALYSIS

A systematic search strategy will be conducted in seven databases: Medline, Embase, CINAHL, Web of Science, PsycInfo, Sociological abstracts and IBSS. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, a multistep screening process by independent reviewers will lead to study selection. The search strategy was first run in 16 January 2017 and will be updated in October 2018. Only quantitative, prospective studies evaluating the effect of at least one psychosocial work factor from the validated theoretical models on certified absence from work for a diagnosed MHP will be considered for inclusion. Extracted data will be used for quantitative and qualitative evidence synthesis as well as to assess risk of bias and methodological quality. Meta-estimates will be provided for high-quality studies and by each psychosocial work factor, after considering homogeneity and number of studies.

ETHICS AND DISSEMINATION

As this study will be based only on published studies, ethics approval is not required. Given that psychosocial works factors are frequent and modifiable, the results of this systematic review may provide evidence to support prevention strategies that can help to reduce the human social and economic burden associated with medically certified absences from work for an MHP.

PROSPERO REGISTRATION NUMBER

CRD42018091632.

Neighbourhood Material and Social Deprivation and Exposure to Antidepressant Drug Treatment: A Cohort Study Using Administrative Data

OBJECTIVE

To assess whether neighbourhood deprivation is associated with exposure to an antidepressant drug treatment (ADT) and its quality among individuals diagnosed with unipolar depression and insured by the Quebec public drug plan.

METHOD

We conducted an administrative database cohort study of adults covered by the Quebec public drug plan who were diagnosed with a new episode of unipolar depression. We assessed material and social deprivation using an area-based index. We considered exposure to an ADT as having ≥1 claim for an ADT within the 365 days following depression diagnosis. Among those exposed to ADT, ADT quality was assessed with 3 indicators: first-line recommended ADT, persistence with the ADT, and compliance with the ADT. Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI).

RESULTS

Of 100,432 individuals with unipolar depression, 65,436 (65%) were exposed to an ADT in the year following the diagnosis. Individuals living in the most materially deprived areas were slightly more likely to be exposed to an ADT than those living in the least deprived areas (aPR, 1.04; 95% CI, 1.03 to 1.06). The likelihoods of being exposed to a first-line ADT, persisting for the minimum recommended duration and complying with the ADT were independent of the deprivation levels.

CONCLUSIONS

Neighbourhood deprivation was not associated with ADT quality among individuals insured by the Quebec public drug plan. It might be partly attributable to the public drug plan whose goal is to provide equitable access to prescription drugs regardless of income.

Multi-province epidemiological research using linked administrative data: a case study from Canada

Background

Canada has a publicly-funded universal healthcare system with information systems managed by 13 different provinces and territories. This context creates inconsistencies in data collection and challenges for research or surveillance conducted at the national or multi-jurisdictional level.

Objective

Using a recent Canadian research project as a case study, we document the strengths and challenges of using administrative health data in a multi-jurisdictional context. We discuss the implications of using different health information systems and the solutions we adopted to deal with variations. Our goal is to contribute to better understanding of these challenges and the development of a more integrated and harmonized approach to conducting multi-jurisdictional research using administrative data.

Context and model

Using data from five separate provincial healthcare data systems, we sought to create and report on a set of provincially-comparable mental health and addiction services performance indicators. In this paper, we document the research process, challenges, and solutions. Finally, we conclude by making recommendations for investment in national infrastructure that could help cut costs, broaden scope, and increase use of administrative health data that exists in Canada.

Conclusions

Canada has an incredible wealth of administrative data that resides in 13 territorial and provincial government systems. Navigating access and improving comparability across these systems has been an ongoing challenge for the past 20 years, but progress is being made. We believe that with some investment, a more harmonized and integrated information network could be developed that supports a broad range of surveillance and research activities with strong policy and program implications.

Over-the-Counter Drugs and Other Substances Used in Attempted Suicide Presented to Emergency Departments in Montreal, Canada

Background: Over-the-counter (OTC) analgesics are frequently used in suicide attempts. Accessibility, toxicity, and unsupervised acquisition of large amounts may be facilitators. Aims: To identify patient characteristics associated with OTC drug use as a suicide attempt method among adults. Method: A cross-sectional study was conducted using chart review of all individuals who presented to the emergency department (ED) of two adult general hospitals following a suicide attempt during 2009-2010 in Montreal, Canada. Results: Among the 369 suicide attempters identified, 181 used overdosing, 47% of whom used OTC drugs. In logistic regression, women and those with medical comorbidity were more likely to use overdosing, while those with substance use disorders were less likely to do so. Among those who overdosed, women were more likely to use OTC drugs, while those who were Caucasian, had children, comorbidities, diagnoses with substance use disorders, and made attempts in the Fall were less likely to do so. Substances most frequently used were: acetaminophen among OTC drugs (30%); antidepressants (37%), anxiolytics (30%), opioids (10%), and anticonvulsants (9%) among prescription drugs; and cocaine (10%) among recreational drugs. Limitations: Reasons for the suicide method choice were not available. Conclusion: OTC drugs, in particular acetaminophen, are frequently used in suicide attempts. Accessibility to these drugs may be an important contributor.

Electroconvulsive Therapy Practice in the Province of Quebec: Linked Health Administrative Data Study from 1996 to 2013

OBJECTIVE

As part of a quality improvement process, we propose a model of routinely monitoring electroconvulsive therapy (ECT) in Canadian provinces using linked health administrative databases to generate provincial periodic reports, influence policy, and standardise ECT practices.

METHODS

ECT practice in Quebec was studied from 1996 to 2013, using longitudinal data from the Quebec Integrated Chronic Disease Surveillance System of the Institut National de Santé Publique du Québec, which links 5 health administrative databases. The population included all persons, aged 18 y and over, eligible for the health insurance registry, who received an ECT treatment at least once during the year.

RESULTS

Among recorded cases, 75% were identified by physician claims and hospitalisation files, 19% exclusively by physician claims, and 6% by hospitalisation files. From 1996 to 2013, 8,149 persons in Quebec received ECT with an annual prevalence rate of 13 per 100,000. A decline was observed, which was more pronounced in women and in older persons. On average, each patient received 9.7 treatments of ECT annually. The proportion of acute ECT decreased whereas maintenance treatment proportions increased. A wide variation in the use of ECT was observed among regions and psychiatrists.

CONCLUSION

This study demonstrates the profitable use of administrative data to monitor ECT use in Quebec, and provides a reliable method that could be replicated in other Canadian provinces. Although Quebec has one of the lowest utilisation rates reported in industrialized countries, regional disparities highlighted the need for a deeper examination of the quality and monitoring of ECT care and services.

A Comparison of Mental Health Performance Indicators in Canada

BackgroundThere is growing recognition of the need for consistent and reliable reporting on mental health and addiction (MHA) services in Canada. While there have been improvements in the area of reporting within provinces, comparable measures across provinces are often confined to hospitalization data. The aim of this project was to test the feasibility of creating MHA performance indicators that could be compared across Canadian provinces. MethodsA team of scientists from five provinces collaboratively developed the following six MHA performance indicators for ages 10 and up, using hospital, emergency, physician billing and mortality data (pop. 33.2 million): Access to the same family physician for people with MHA problems First contact for MHA problems was in an emergency department Physician follow-up after hospitalization for MHA problems Rate of suicide attempts among people diagnosed with MHA problems Suicide rates among people diagnosed with MHA problems Mortality of people diagnosed with MHA problems To facilitate meaningful inter-provincial comparisons, consensus definitions and standardized analytic processes were developed. Within age groups, 95% CI’s were calculated to determine if there were significant differences across years within age bands. Results are presented in a comparative format. FindingsWe found similar patterns across provinces but significant variation in the absolute rates, with no province consistently best across all indicators. In general, outcomes were poor among adolescents and young adults compared to older groups. ConclusionsThe results of this pilot indicate the process is feasible and meaningful. Future work could include generating comparisons on a regular basis to track system improvement; development of other measures of importance to stakeholders; and the expansion of the process to other provinces and territories. To our knowledge, this is the first report of provincial teams working collaboratively to generate comparable data on the performance of mental health services in Canada.

Public Expenditures for Mental Health Services in Canadian Provinces: Dépenses publiques pour les services de santé mentale dans les provinces canadiennes

OBJECTIVE

The purpose of this study is to measure provincial spending for mental health services in fiscal year (FY) 2013 and to compare these cost estimates to those of FY 2003.

METHODS

This study estimated the costs of publicly funded provincial mental health services in FY 2013 and compared them to the estimates for FY 2003 from a previously published report. Our data were obtained from publicly accessible databases. The cross-year cost comparisons for provincial mental health services were restricted to general and psychiatric hospital inpatients, clinical payments to physicians and psychologists, and prescribed psychotropic medications. Total public expenditures were inflation adjusted and expressed per capita and as a percentage of the total provincial health spending.

RESULTS

Total public spending for mental health and addiction programs/services was estimated to be $6.75 billion for FY 2013. The largest component of the expenditures was hospital inpatient services ($4.02 billion, 59.6%), followed by clinical payments to physicians or psychologists ($1.69 billion, 25%), and then publicly funded prescribed psychotherapeutic medications ($1.04 billion, 15.4%). Nationally, the portion of total public spending on health that was spent on mental health decreased from FY 2003 to FY 2013 from 5.4% to 4.9%.

CONCLUSION

Our results reveal that mental health spending, as a proportion of public health care expenditures, decreased in the decade from FY 2003 to FY 2013. Due to large differences in how the provinces report community mental health services, we still lack a comprehensive picture of the mental health system.

Prevalence and Correlates of Autism Spectrum Disorders in Quebec: Prévalence et corrélats des troubles du spectre de l'autisme au Québec

OBJECTIVE

To estimate the prevalence, comorbidities, and service use of people with autism spectrum disorders (ASDs) based on data from Quebec Integrated Chronic Diseases Surveillance System (QICDSS).

METHODS

We included all residents up to age 24 eligible for health plan coverage who were in Quebec for at least 1 day from January 1, 1996, to March 31, 2015. To be considered as having an ASD, an individual had to have had at least 1 physician claim or hospital discharge abstract from 2000 to 2015 indicating one of the following ASD diagnosis codes: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents.

RESULTS

The QICDSS shows that the prevalence of ASD has risen steadily over the past decade to approximately 1.2% ( n = 16,940) of children and youths aged 1 to 17 years in 2014 to 2015. The same prevalence was obtained using Ministry of Education data. Common medical comorbidities included congenital abnormalities of the nervous system, particularly in the first year of life. Psychiatric comorbidity was much more highly prevalent, especially common mental disorders like anxiety and attention-deficit/hyperactivity disorder. Children and youths with ASDs made on average 2.3 medical visits per year compared with 0.2 in the general population. Between 18 and 24 years old, the mental health needs of individuals with ASDs were met less by medical specialists and more by general practitioners.

CONCLUSION

Information derived from this database could support and monitor development of better medical services coordination and shared care to meet the continuous and changing needs of patients and families over time.

Regional Variations in Suicide and Undetermined Death Rates among Adolescents across Canada

OBJECTIVE

Trends in rates of adolescent suicide and undetermined deaths in Canada from 1981 to 2012 were examined, focusing specifically on variations between Canadian regions. Exploratory hypotheses were formulated for regional variability in adolescent suicide rates over time in Canada.

METHODS

A descriptive time trend analysis using public domain vital statistics data was performed. All deaths from 1981 to 2012 among 15 to 19 year olds coded as suicides or undetermined intent according to the International Classification of Diseases, 9^th and 10^th Revisions were included.

RESULTS

While there was an overall stability in adolescent suicide and undetermined death rates across Canada, regional analyses showed that Quebec experienced a 7.6% annual reduction between 2001 and 2012 while the Prairies and Atlantic provinces experienced significant annual increases since 2001. Ontario and British Columbia have had non-significant fluctuations since 2001. The trends remained similar overall when excluding undetermined deaths from the analyses.

CONCLUSIONS

Variations in adolescent suicide trends across provinces were found. Factors such as provincial suicide action and prevention legislation contributing to these variations remain to be studied, but these regional differences point towards the need for better consistency of suicide prevention strategies across the country.

Revisiting the Link Between Depression Symptoms and High School Dropout: Timing of Exposure Matters

PURPOSE

Recent reviews concluded that past depression symptoms are not independently associated with high school dropout, a conclusion that could induce schools with high dropout rates and limited resources to consider depression screening, prevention, and treatment as low-priority. Even if past symptoms are not associated with dropout, however, it is possible that recent symptoms are. The goal of this study was to examine this hypothesis.

METHODS

In 12 disadvantaged high schools in Montreal (Canada), all students at least 14 years of age were first screened between 2012 and 2015 (N_screened = 6,773). Students who dropped out of school afterward (according to school records) were then invited for interviews about their mental health in the past year. Also interviewed were matched controls with similar risk profiles but who remained in school, along with average not at-risk schoolmates (N_interviewed = 545). Interviews were conducted by trained graduate students.

RESULTS

Almost one dropout out of four had clinically significant depressive symptoms in the 3 months before leaving school. Adolescents with recent symptoms had an odd of dropping out more than twice as high as their peers without such symptoms (adjusted odds ratio = 2.17; 95% confidence interval = 1.14-4.12). In line with previous findings, adolescents who had recovered from earlier symptoms were not particularly at risk.

CONCLUSIONS

These findings suggest that to improve disadvantaged youths' educational outcomes, investments in comprehensive mental health services are needed in schools struggling with high dropout rates, the very places where adolescents with unmet mental health needs tend to concentrate.

[Emergency Department Use in Quebec for Patients with Mental Disorders, including Substance use Disorders]

Objectives This study investigated emergency department (ED) use, reasons for emergency visits, hospitalization rates, and duration of hospitalization in 2014-15 for a cohort of patients with mental disorders (MDs) including substance use disorders (SUDs), regarding sex, age and residential areas. Results were compared with data from patients without MDs for 2014-15, and with another cohort from 2000-01, which marked the beginning of primary care reform in Quebec and elsewhere, with the aim of measuring ED use over time. Methods Based on data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), participants included patients age 12 and over, diagnosed with at least one MD (or SUD) during an ED visit, hospitalization, or outpatient consultation in 2014-15 and 2000-01. Frequency distributions for ED visits and hospitalizations were produced, as well as for MDs or SUDs exclusively, or for co-occurring MDs-SUDs, and among high or very high ED users (4 to 11 visits/year, ≥12 visits/year), by gender, age (12-17, 18-24, 25-44, 45-64, and 65 and over) and residential area (Montreal, urban areas:>100,000, semi-urban areas: <100,000, and rural areas: <10,000). The age-standardized method based on the age structure of the 2014-15 population was used to compare data from 2014-15 to 2000-01. Frequency distributions for patients with and without MDs, and on ED and hospitalization rates were also produced for 2014-15. Results For the Quebec population, 12% had MDs including SUDs, of whom 39% had visited an ED, a decrease of 6% since 2000-01. Approximately twice as many patients with MDs had ED visits or hospitalizations, compared to patients without MDs. Nearly 17% of patients were high or very high ED users; and 34% were hospitalized. ED use was higher among patients 65 years and older, and those living in rural areas. Sixty-eight percent of ED visits for MDs exclusively were made by patients affected by anxiety-depression; whereas 51% of visits for SUDs exclusively were alcohol-related. Physical illnesses were the main reason for ED visits and hospitalizations; yet patients with severe MDs, co-occurring MDs and SUDs as well as those with more frequent ED visits tended to use EDs more for MD reasons. Conclusion This study demonstrated a very high volume of ED visits and hospitalizations among patients with MDs, including SUDs, compared to patients without MDs. Co-occurring disorders, especially physical conditions and multiple and severe MDs, contributed to frequent ED use and hospitalizations. Better care management, including more comprehensive personal care, for patients with MDs including SUDs and co-occurring disorders is needed, as well as the deployment of strategies that provide integrated mental health and medical care, particularly in Montreal where ED use by patients with predominantly severe and co-occurring MDs and physical illnesses, is more frequent.

[Defining substance related disorders in administrative health databanks]

Introduction Epidemiogical surveys in the general population can provide relevant information on substance use and substance-related disorders (SRD). However, because of time and resource constraints, this data is limited in its scope. Health administrative databanks consist of routinely collected data covering a large sample size, often representative of the general population. They allow for further longitudinal analyses of comorbidities patterns and health services utilization over decades in individuals with SRD. Developing algorithms to identify these individuals is crucial before being able to tap into these databanks. Objective To present and to reflect on the methodological process leading to the creation of SRD case definitions in administrative health databanks. Methods The Quebec Integrated Chronic Disease Surveillance System (QICDSS) contains five linked administrative health databanks that are updated annually and covers over 98% of the general population. Codes from the 9th and 10th revisions of the International Classification of Diseases (ICD-9 and ICD-10) were used to define individuals who have a SRD, according to diagnoses made by a physician. First, all ICD codes that could potentially define a SRD were identified through a literature review. Second, relevant codes were selected. Third, case definition algorithms were created by grouping codes that describe a similar concept. These three steps were performed by comparing our codes with previous propositions from other teams, and through group discussions with a committee of experts (one psychiatrist, two general practitioners, one emergency doctor, and two researchers). Results Relevant ICD codes were found in specific chapters on SRD, but also in different sections concerning physical diseases that are induced by substance use or concerning poisoning and intoxication. In total, 89 ICD-9 codes and 197 ICD-10 codes were identified. From this list, codes that were almost never used in the QICDSS, codes that were almost never reported by other research teams, codes that were not specific to substance use, and codes related to tobacco use were all excluded. Codes were first categorized if they were related to alcohol or to another substance. No distinction could be made according to a specific substance, mainly because of imprecision surrounding ICD-9 coding. From this retained list, six case definitions were created: 1) alcohol use disorders (i.e. abuse or dependence); 2) drug use disorders; 3) alcohol induced disorders (i.e. withdrawal, induced psychotic disorders and other mental disorders, physical diseases 100% attributable to alcohol); 4) drug induced disorders; 5) alcohol intoxication; 6) drug intoxication. Discussion and conclusion Although unanimous consensus by the expert committee had to be obtained during code selection and grouping to create these case definitions for SRD, further validation needs to be conducted to determine if these algorithms identify appropriately individuals with SRD. Once tested in other databanks using the ICD system, these case definitions can be used to perform analyses concerning prevalence and incidence, comorbidities patterns and health services utilization to obtain a more complete picture of SRD.