Mental Health Service Utilization among Students and Staff in 18 Months Following Dawson College Shooting

Objectives

The aim of this study was to investigate service utilization by students and staff in the 18 months following the September 13, 2006, shooting at Dawson College, Montreal, as well as the determinants of this utilization within the context of Canada's publicly managed healthcare system.

Methods

A sample of 948 from among the college's 10,091 students and staff agreed to complete an adapted computer or web-based standardized questionnaire drawn from the Statistics Canada 2002 Canadian Community Health Survey cycle 1.2 on mental health and well-being.

Results

In the 18 months following the shooting, there was a greater incidence and prevalence not only of PTSD, but also of other anxiety disorders, depression, and substance abuse. Staff and students were as likely to consult a health professional when presenting a mental or substance use disorder, with females more likely to do so than males. Results also indicated that there was relatively high internet use for mental health reasons by students and staff (14% overall).

Conclusions

Following a major crisis event causing potential mass trauma, even in a society characterized by easy access to public, school and health services and when the population involved is generally well educated, the acceptability of consulting health professionals for mental health or substance use problems represents a barrier. However, safe internet access is one way male and female students and staff can access information and support and it may be useful to further exploit the possibilities afforded by web-based interviews in anonymous environments.

Recurrent subthreshold depression in type 2 diabetes: an important risk factor for poor health outcomes

OBJECTIVE To evaluate the association between recurrent subthreshold depressive episodes and functioning in a prospective community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A prospective community study in Quebec, Canada, was carried out between 2008 and 2013 (n = 1,064). Five yearly follow-up assessments (telephone interviews) were conducted. Baseline and the first three follow-up assessments were used to identify recurrent subthreshold depressive episodes (Patient Health Questionnaire [PHQ]-9). Functioning (World Health Organization Disability Assessment Schedule II [WHODAS-II]) and health-related quality of life (Centers for Disease Control and Prevention [CDC] unhealthy days) at 4- and 5-year follow-up assessments were the outcome measures. RESULTS Nearly half of the participants suffered from at least one episode of subthreshold depressive symptoms. After adjusting for potentially confounding factors, the risk of poor functioning/impaired health-related quality of life was nearly three times higher (relative risk = 2.86) for participants with four subthreshold depressive episodes compared with participants with no/minimal depression. Results suggest a dose-response relationship: the risk of poor functioning/impaired health-related quality of life increased with the number of recurrent subthreshold depressive episodes even after controlling for potentially confounding variables (significant linear trend, P < 0.001). CONCLUSIONS Recurrent subthreshold depressive symptoms might be an important risk factor for poor health outcomes in type 2 diabetes. Early identification, monitoring, and treatment of recurrent subthreshold depressive symptoms might improve functioning and quality of life in people with type 2 diabetes.

[Mental health services in Australia]

Canada is 1.5 times the size of Australia. Australia's population of 20 million is located principally on the east coast. Like Canada, the Australia has a federal system of Government with 5 States and two territories. Each State and territory has its own legislation on mental health. The federal (Commonwealth) Government is responsible for health care planning. In addition, the federal Government subsidizes an insurance program (Medicare) that covers visits to specialists and family physicians, while provincial governments are involved in the provision of hospital care and community mental health services. The Commonwealth government also subsidises the cost of medication through the Pharmaceutical Benefits Scheme. These funds are supplemented by private health insurance. Mental health costs account for 6.5 per cent of all health care costs. Primary care treats the majority of common psychological disorders such as anxiety or depression, while specialist mental health services concentrate on those with severe mental illness. There have been 4 national mental health plans since 1992 with the long term aims of promoting mental health, increasing the quality and responsiveness of services, and creating a consistent approach to mental health service system reform among Australian states and territories. These systematic cycles of planning have first allowed a shift from psychiatric hospitals to community services, from reliance on psychiatric hospitals as pivotal to psychiatric care system. Community care budgets have increased, but overall have decreased with money not following patients; but recent deployment of federally funded through Medicare access to psychotherapy by psychologists for common mental disorders in primary care have increased overall budget. Concerns remain that shift to youth first onset psychosis clinics may come from older long-term psychotic patients, a form of discrimination whilst evidence amount of excess mortality by cardio-vascular diseases and cancers, and due to poverty, poor health prevention and primary health care for these patients. From a system perspective, Australia has been inspired by Canada and created in 2012 its own mental health commission with a similar leading role for patients and families, aboriginal people representatives, but also a surveillance of the system with its own yearly report, like the Quebec Health Commissioner 2012 mental health system performance report.

Network collaboration of organisations for homeless individuals in the Montreal region

INTRODUCTION

We know little about the intensity and determinants of interorganisational collaboration within the homeless network. This study describes the characteristics and relationships (along with the variables predicting their degree of interorganisational collaboration) of 68 organisations of such a network in Montreal (Quebec, Canada).

THEORY AND METHODS

Data were collected primarily through a self-administered questionnaire. Descriptive analyses were conducted followed by social network and multivariate analyses.

RESULTS

The Montreal homeless network has a high density (50.5%) and a decentralised structure and maintains a mostly informal collaboration with the public and cross-sectorial sectors. The network density showed more frequent contacts among four types of organisations which could point to the existence of cliques. Four variables predicted interorganisational collaboration: organisation type, number of services offered, volume of referrals and satisfaction with the relationships with public organisations.

CONCLUSIONS AND DISCUSSION

The Montreal homeless network seems adequate to address non-complex homelessness problems. Considering, however, that most homeless individuals present chronic and complex profiles, it appears necessary to have a more formal and better integrated network of homeless organisations, particularly in the health and social service sectors, in order to improve services.

Redevelopment of tertiary psychiatric services in British Columbia: a prospective study of clinical, social, and residential outcomes of former long-stay inpatients

OBJECTIVE

The objective of this study is to assess the clinical and social outcomes for a cohort of patients who were part of the redevelopment of psychiatric services in British Columbia.

METHOD

This study used a naturalistic, quasi-experimental design, to examine the outcomes of a cohort of 189 long-stay patients at Riverview Hospital (RVH), some of whom moved into Tertiary Psychiatric Residential Facilities (TPRFs), some into the community in less structured facilities, and some remained at RVH. Data was collected from clinical files at RVH and at each participating site, semi-structured interviews and self-report measures were completed with patients. In addition, semi-structured interviews were also conducted with staff members.

RESULTS

There was very minimal evidence of transinstitutionalization to prisons or homelessness; one participant resided in a correctional facility, one resided in a forensic facility, and one participant spent some time homeless. In addition, the majority of participants remained in residences that provided 24h care. Eighty percent of our population was diagnosed with a schizophrenia spectrum disorder. Psychiatric symptoms remained fairly stable; some embarrassing social behaviors increased; however, aggressive behaviors showed no increase; neuropsychological deficits did not deteriorate, there were even some improvements. Participants demonstrated increases in several independent living skills including: money management, food preparation and storage, job skills, and transportation skills. In addition, participants experienced a significant increase in their perceived quality of life.

CONCLUSIONS

This study builds on existing research demonstrating that well-planned and appropriately resourced hospital closures can lead to positive psycho-social outcomes for participants and can successfully avoid negative outcomes such as transinstitutionalization to the judiciary system and homelessness.

The adequacy of pharmaceutical treatment of schizophrenia in Quebec varies with age, but is not influenced by sex or neighbourhood deprivation

OBJECTIVE

Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.

METHODS

We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.

RESULTS

Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).

CONCLUSIONS

In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.

[Suicide prevention from a public health perspective]

Suicide and suicide prevention represent major public health challenges. The public health perspective juxtaposes a multifactor understanding of society's health phenomena to a mobilization around determinants on which actions can be taken. Public health has encountered success with infectious diseases as well as chronic diseases such as hypertension. In this article, the phenomenon of suicide is detailed with data drawn from Quebec, Canada and international research. Population-based suicide prevention policies are generally multimodal, and often involve strategies aiming at improving mental health services. The success of these strategies lies in their steady application and in the close surveillance of this application.

Spatio-temporal clustering of the incidence of schizophrenia in Quebec, Canada from 2004 to 2007

Exploring spatio-temporal patterns of disease incidence can help to identify areas of significantly elevated or decreased risk, providing potential etiologic clues. In this study, we present a spatio-temporal analysis of the incidence of schizophrenia in Quebec from 2004 to 2007 using administrative databases from the Régie de l'Assurance Maladie du Quebec and the hospital discharge database. We conducted purely spatial analyses for each age group adjusted by sex for the whole period using SatScan (version 9.1.1). Findings from the study indicated variations in the spatial clustering of schizophrenia according to sex and age. In term of incidence rate, there are high differences between urban and rural-remote areas, as well as between the two main metropolitan areas of the province of Quebec (Island of Montreal and Quebec-City).

Profiles and mental health correlates of alcohol and illicit drug use in the Canadian population: an exploration of the J-curve hypothesis

OBJECTIVE

Alcohol and (or) illicit drug use (AIDU) problems are associated with mental health difficulties, but low-to-moderate alcohol consumption may have mental health benefits, compared with abstinence. Our study aimed to explore the hypothesis of a nonlinear, or J-curve, relation between AIDU profiles and psychological distress, psychiatric disorders, and mental health service use in the general Canadian population.

METHODS

Data were collected from a representative sample of the Canadian population (n = 36 984). Multiple correspondence analyses and cluster analyses were used to extract AIDU profiles. Sociodemographics, psychological distress, psychiatric disorders, and mental health service use were assessed and compared between profiles.

RESULTS

Seven AIDU profiles emerged, including 3 involving risky or problematic AIDU that correlate with major affective disorders, anxiety disorders, suicidal behaviours, and higher levels of psychological distress. No J-curve relation was found for psychiatric disorders and mental health service use. The lifetime-abstainer profile correlates with the lowest rates of psychiatric disorders and mental health service use. Lifetime abstainers are also more often female, immigrant, and unemployed. Compared with other profiles, spirituality is more important in their life.

CONCLUSIONS

The hypothesis of a nonlinear relation between psychiatric disorders and AIDU was not supported. Lifetime AIDU abstainers have specific sociodemographic and cultural background characteristics in Canada.

Evaluation of the Dawson College Shooting Psychological Intervention: Moving Toward a Multimodal Extensive Plan

In 2006, following the shooting at Dawson College, the authorities implemented an intervention plan. This provided an opportunity to analyze the responses to services offered, and afforded a learning opportunity, which led to the proposal of an extensive multimodal short- and long-term psychological plan for future needs. Both quantitative and qualitative data were gathered 18 months after the event, involving the participation of 948 students and staff. Mental health problems and the perception of services offered after the shooting were investigated, using standardized measures. Second, focus groups and individual interviews were conducted among a subgroup of participants (support team members; teachers and employees; students and parents) and permitted to gather data on services received and services required. Individual report of events, the extent of psychological impact and services offered and received were analyzed in terms of the following dimensions: intervention philosophy, training, ongoing offer of services and finally, detection and outreach. A significant incidence of disorders and a high rate of exacerbation of preexisting mental disorders were observed within the 18 months following the shooting. Postimmediate and short-term intervention appeared adequate, but the long-term collective vision toward community support and availability of mental health services were lacking. Lessons learned from this evaluation and other school shootings suggest that preparedness and long-term community responses are often overlooked. A multimodal extensive plan is proposed based on a theoretical model from which interventions strategies could be drawn.

Self-rated health: a predictor for the three year incidence of major depression in individuals with Type II diabetes

BACKGROUND

To determine whether self-rated health was a predictor for the three year incidence of major depression in people with Type II diabetes.

METHODS

Data was collected as part a population-based telephone survey of adults with diabetes, in Québec, Canada (2008-2011). Adults with Type II diabetes who did not have major depression at baseline were assessed at three follow-up interviews conducted 12, 24 and 36 months after baseline. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Self-rated health status was determined by asking participants to rate their health on a scale from excellent to poor.

RESULTS

The sample consisted of 1265 adults with Type II diabetes who did not have major depression at baseline. 36% of individuals who had developed major depression at follow up rated their health as fair or poor at baseline compared to 14.4% of those who had not developed major depression. Logistic regression analyses indicated fair or poor self-rated health at baseline to be predictive of a twofold increased risk for major depression at follow-up, even after adjusting for socio-demographic characteristics, lifestyle-related behaviors, disability and diabetes characteristics (OR=2.05, 95% CI 1.20-3.48).

LIMITATIONS

We have focused on current depression (last two weeks) and we have used a questionnaire (PHQ-9) rather than a clinical interview for the assessment of depression.

CONCLUSIONS

Self-rated health status might be a predictor for developing major depression in people with diabetes in addition to well established risk factors.

The pattern of depressive symptoms in people with type 2 diabetes: a prospective community study

OBJECTIVE

The aim of the present study was to identify and describe longitudinal patterns of depression in a community sample of people with type 2 diabetes in Quebec, Canada.

METHODS

A prospective community based study in Quebec, Canada, was carried out between 2008 and 2011. Participants with diabetes were assessed at baseline and at 1, 2 and 3 years follow-up (n=1388). Depression was assessed using the patient health questionnaire (PHQ-9).

RESULTS

Longitudinal latent class analysis yielded four clusters representing different longitudinal patterns of depression: cluster 1 ("no depression"; 67%): participants had neither minor nor major depression over time. Cluster 2 ("slowly increasing prevalence of minor and major depression over time"; 20%): participants had low levels of depression at baseline but increasing levels of minor and major depression over time; while most of the Cluster 3 ("increasing major depression"; 6%) participants had high and increasing levels of major depression over time. Participants in cluster 4 ("improved depression"; 7%) started with high levels of depression but progressed to low levels of depression.

CONCLUSIONS

Our results provide important evidence of different longitudinal patterns of depression in people with type 2 diabetes. Identification of four distinct groups of participants might improve our understanding of the course of depression and may provide a basis of classification for intervention.

Factor analysis of the French version of the shorter 12-item Perception of Aggression Scale (POAS) and of a new modified version of the Overt Aggression Scale (MOAS)

Psychiatric staff perceptions of aggression by psychiatric patients may affect the therapeutic relationship between care providers and patients in institutions. Attitudes to and the subjective experience of violence may also differ substantially between members of a single care team. This study seeks to validate the French versions of scales of staff attitudes to and subjective experience of institutional violence: a new, modified version of the Overt Aggression Scale (MOAS) to measure the subjective perception of the frequency of aggression in the ward; and the Perception of Aggression Scale (POAS) to assess attitudes to the expression of violence by psychiatric patients. Frontline staff (n = 362) from eight French-language psychiatric institutions in the province of Quebec were surveyed. Factor analyses were performed to determine the validity of the French-language MOAS and POAS. As expected, a four-factor structure emerged for the MOAS. For the 12-item POAS, a three-factor structure was found: (1) 'Aggression as a dysfunctional/undesirable phenomenon'; (2) 'Aggression as a positive expression'; and (3) 'Aggression as a protective measure'. This study supports use of the French MOAS and POAS in assessing staff attitudes to and subjective experience of aggression in future projects to explore the perception and management of inpatient violence.

[Health inequities in mood disorders based on material and social deprivation in dwelling sectors ]

OBJECTIVE

To compare mood disorder (MD) prevalence in Quebec in 2006, and compare health services and medication use, mortality and morbidity in patients with MD based on sex and the dwelling sector level of material and social deprivation. The objective was also to identify subgroups of individuals using health services in a larger proportion and having a higher risk of morbidity and mortality.

METHOD

We conducted a secondary analysis of the Régie de l’assurance maladie du Québec medico-administrative data. The cohort is composed of adults diagnosed with MD and living in Quebec in 2006. Variables include: physician consultation, medication demand, consultation for substance or alcohol abuse, emergency visit, hospitalization for a mental disorder, and death. Dwelling sector types are defined by crossing Pampalon material and social deprivation quintiles.

RESULTS

MD prevalence in 2006 was 3.06% (177 850 patients), with prevalence in women 1.7-fold with respect to men. Findings show a higher MD prevalence as well as a higher mortality and morbidity rate in materially and socially deprived dwelling sectors. Young men also represent a specifically vulnerable subgroup for many study variables.

CONCLUSION

Public policies aimed at improving material conditions (income, education, employment) and breaking out social isolation would have an important impact on the population mental health. Public health program development should pay close attention to young men population.

Families' and decision makers' experiences with mental health care reform: the challenge of collaboration

Family-driven collaboration is fundamental to developing a new model of health care and eliminating fragmented services in mental health. The province of Québec (Canada) recently undertook major transformations of its mental health care system. These transformations represent an opportunity to improve collaboration between families and health care practitioners and to understand which factors facilitate this collaboration. This article describes how families and decision makers perceive collaboration in the context of a major transformation of mental health services and identifies the factors that facilitate and hinder family collaboration.

Les conditions d’hébergement favorables au rétablissement : perspective des usagers et usagères

The aim of this study is to better understand the role of housing in the recovery of people living with severe mental illness. Forty residents of various kinds of structured community housing facilities were questioned about housing conditions that were favourable to their recovery. The results indicate that, for the residents, material conditions have a determining influence on recovery. Their concerns are related to basic needs such as food, costs, conveniences and quality of housing. Social relationships with their immediate circle also have a strong influence on people's recovery, and they want above all to preserve the modest gains that they have made, both material and social. This stability is a prerequisite for their recovery.

Types of smokers in a community sample of individuals with Type 2 diabetes: a latent class analysis

AIMS

Despite the detrimental effects of smoking on their health, a high number of adults with Type 2 diabetes continue to smoke. Identifying distinct types of smokers within this population could help tailor and target intervention programmes. This study examined whether smokers with Type 2 diabetes could be classified into different profiles based on smoking habits, socio-economic characteristics and lifestyle factors.

METHODS

A sample of adults with self-reported diabetes was selected from random-digit dialing. Analyses included 383 participants with Type 2 diabetes who were current smokers. Information related to smoking, socio-economic status, health and lifestyle was collected by phone interview at baseline and 1 year later. Latent class analysis was used to identify subgroups of smokers.

RESULTS

We uncovered three meaningful classes of smokers: class 1, long-time smokers with long-standing diabetes (n = 105); class 2, heavy smokers with deprived socio-economic status, poor health and unhealthy lifestyle characteristics (n = 105); class 3, working and active smokers who were more recently diagnosed with diabetes (n = 173). Members of class 2 were significantly more likely to be disabled and depressed at baseline and 1 year later compared with other classes.

CONCLUSIONS

Different profiles of smokers exist among adults with Type 2 diabetes, each suggesting different cessation treatment needs. Distinguishing between these types of smokers may enable clinicians to tailor their approach to smoking cessation.

[Alcohol and drug consumption in students exposed to the Dawson College shooting: a gender-based analysis]

OBJECTIVE

To study alcohol and drug addiction incidence in students exposed to the Dawson College shooting within the 18 months following the event, to identify the precursors of a psychoactive substance addiction development while considering the severity of event exposure, and to examine whether alcohol use, 18 months after the event, is related to any of the various posttraumatic stress disorder (PTSD) symptom groups.

METHOD

The population of this study was comprised of all the Dawson College students at the time of the event. Analyses were conducted with 854 students enrolled in the college at the time of the shooting.

RESULTS

Five per cent of women and 7% of men showed, for the first time in their life, a problem with substance addiction following the shooting. In men, young age, lifetime suicidal ideation, and having seen the killer during the shooting are the main precursors of incident accident cases. None of the studied precursors were significant in women. Men and women were also different in terms of PTSD symptoms predicting alcohol use 18 months after the shooting.

CONCLUSION

The study highlights the importance of considering a person's sex when studying their psychoactive substance use following a trauma.

Treatment prevalence and incidence of schizophrenia in Quebec using a population health services perspective: different algorithms, different estimates

PURPOSE

Using a population health services perspective, this article defines and assesses an efficient criteria-based algorithm to identify treatment prevalent and incident cases of schizophrenia. We refer here "treatment" prevalence and incidence since its evaluation depends on a patient receiving a health care service with a diagnosis of schizophrenia.

METHODS

A population-based cohort study was conducted among all adults having a hospital discharge or a physician claim for schizophrenia in the public health plan databases between January 1996 and December 2006. Four algorithms to characterize patients with schizophrenia were defined. To identify treatment incident cases in 2006, we removed from the treatment prevalent pool patients with a previous record of schizophrenia between 1996 and 2006 (10-year clearance period). Using this 10-year period as reference, Kappa coefficients (KC) and positive predictive values (PPV) were calculated to determine the "optimal" length of clearance period to identify incident cases.

RESULTS

The lifetime treatment prevalence and incidence of schizophrenia varied from 0.59 to 1.46% and from 42 to 94 per 100,000, respectively. When compared to the 10-year clearance period, the KC is excellent in a clearance period of 6-7 years. To achieve a PPV of 90%, a clearance period of 7-8 years would be necessary.

CONCLUSIONS

With an appropriate algorithm, treatment prevalence and incidence of schizophrenia can be conveniently estimated using administrative data. These estimates are a vital step toward appropriate planning of services for schizophrenia.