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Fleury MJ, Bamvita JM, Farand L, Aubé D, Fournier L, Lesage A. GP group profiles and involvement in mental health care. J Eval Clin Pract 2012; 18:396-403. [PMID: 21114798 DOI: 10.1111/j.1365-2753.2010.01597.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES Mental health is one of the leading causes of morbidity worldwide. Its impact in terms of cost and loss of productivity is considerable. Improving the efficiency of mental health care system has thus been a high priority for decision makers. In the context of current reforms that privilege the reinforcement of primary mental health care and integration of services, this article brings new lights on the role of general practitioners (GPs) in managing mental health, and shared-care initiatives developed to deal with more complex cases. The study presents a typology of GPs providing mental health care, by identifying clusters of GP profiles associated with the management of patients with common or serious mental disorders (CMD or SMD). METHODS GPs in Quebec (n = 398) were surveyed on their practice, and socio-demographic data were collected. RESULTS Cluster analysis generated five GP profiles, including three that were closely tied to mental health care (labelled, respectively: group practice GPs, traditional pro-active GPs and collaborative-minded GPs), and two not very implicated in mental health (named: diversified and low-implicated GPs, and money-making GPs). CONCLUSION The study confirmed the central role played by GPs in the treatment of patients with CMD and their relative lack of involvement in the care of patients with SMD. Study results support current efforts to strengthen collaboration among primary care providers and mental health specialists, reinforce GP training, and favour multi-modal clinical and collaborative strategies in mental health care.
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Routhier D, Leduc N, Lesage A, Benigeri M. Service utilization by hospitalized suicide attempters with schizophrenia or depression in Montreal. Psychiatr Serv 2012; 63:364-9. [PMID: 22476302 DOI: 10.1176/appi.ps.201000405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide. METHODS This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression). RESULTS Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women. CONCLUSIONS The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.
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Routhier D, Leduc N, Lesage A, Benigeri M. [Portrait of the use of mental health services before and after a suicide attempt requiring hospitalization]. SANTE MENTALE AU QUEBEC 2012; 37:223-237. [PMID: 23666290 DOI: 10.7202/1014953ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Health care systems play an important role in suicide prevention. Medical and administrative data allow analysis of patterns of mental health service use before and after hospitalization following a suicide attempt among Montreal residents diagnosed with schizophrenia or depression. Some results tend to show improvement in suicide prevention, especially among men with comorbid substance abuse disorders known to be particularly vulnerable. However, other observations are somewhat worrisome. The emergency room as an introduction to mental health services did not ensure adequate aftercare. Interventions are needed to improve access and coordination between different health care services.
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154
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Bonin JP, Lavoie-Tremblay M, Lesage A, Briand C, Piat M. P-590 - Situation of families of mentally ill persons in a context of change in mental health system: a time for stakeholders and families collaboration. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74757-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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155
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Lesage A, Moubarac JC, Desrochers L, Turecki G. [Interdisciplinary dialogue on the etiology and prevention of suicide in Quebec]. SANTE MENTALE AU QUEBEC 2012; 37:25-30. [PMID: 23666278 DOI: 10.7202/1014942ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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156
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Pelletier JF, Lesage A, Delorme A, Macaulay AC, Salsberg J, Valle C, Davidson L. User-led Research: A Global and Person-Centered Initiative. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2011. [DOI: 10.1080/14623730.2011.9715645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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157
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Corbière M, Zaniboni S, Lecomte T, Bond G, Gilles PY, Lesage A, Goldner E. Job acquisition for people with severe mental illness enrolled in supported employment programs: a theoretically grounded empirical study. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:342-354. [PMID: 21656251 DOI: 10.1007/s10926-011-9315-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The main purpose of this study was to test a conceptual model based on the theory of planned behaviour (TPB) to explain competitive job acquisition of people with severe mental disorders enrolled in supported employment programs. METHODS Using a sample of 281 people with severe mental disorders participating in a prospective study design, the authors examined the contribution of the TPB in a model including clinical (e.g., severity of symptoms), psychosocial (e.g., self-esteem) and work related variables (e.g., length of time absent from the workplace) as predictors of job acquisition. Path analyses were used to test two conceptual models: (1) the model of job acquisition for people with mental illness adapted from the TPB, and (2) the extended TPB including clinical, psychosocial, and work related variables recognized in the literature as significant determinants of competitive employment. RESULTS Findings revealed that both models presented good fit indices. In total, individual factors predicted 26% of the variance in job search behaviours (behavioural actions). However, client characteristics explained only 8% of variance in work outcomes, suggesting that environmental variables (e.g., stigma towards mental disorders) play an important role in predicting job acquisition. About 56% (N = 157) of our sample obtained competitive employment. CONCLUSION Results suggest that employment specialists can be guided in their interventions by the concepts found in the extended model of work integration since most of these are modifiable, such as perceived barriers to employment, self-efficacy, and self-esteem.
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Gariepy G, Malla A, Wang J, Messier L, Strychar I, Lesage A, Schmitz N. P2-94 Types of smokers, depression and disability in type 2 diabetes: a latent class analysis. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dumais A, Potvin S, Joyal C, Allaire JF, Stip E, Lesage A, Gobbi G, Côté G. Schizophrenia and serious violence: a clinical-profile analysis incorporating impulsivity and substance-use disorders. Schizophr Res 2011; 130:234-7. [PMID: 21441016 DOI: 10.1016/j.schres.2011.02.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 02/23/2011] [Accepted: 02/28/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study is an exploration of the role of SUD and impulsivity in individuals with schizophrenia who are at higher risk of serious violence (SV). METHODS Multiple correspondence analysis (MCA) and cluster analysis (CA) were performed on a sample of 139 males meeting DSM-IV diagnostic criteria for schizophrenia-spectrum disorders (SSD). RESULTS Impulsivity was the main dimension differentiating individuals. SUD and SV were strongly linked. CA yielded four clusters; one related to serious violence, SUD and a higher incarceration rate. CONCLUSIONS Subgroups of SSD at risk of SV were found. SUD appear to be a major risk factor for SV and incarceration.
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Schmitz N, Messier L, Nitka D, Ivanova A, Gariepy G, Wang J, Malla A, Boyer R, Lesage A, Strychar I. Factors associated with disability and depressive symptoms among individuals with diabetes: a community study in Quebec. PSYCHOSOMATICS 2011; 52:167-77. [PMID: 21397110 DOI: 10.1016/j.psym.2010.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 03/12/2010] [Accepted: 03/15/2010] [Indexed: 10/14/2022]
Abstract
BACKGROUND The prevalence of diabetes in Canada is increasing. Multiple factors have been identified in the development of disability in diabetic patients, but the interaction of those risk factors is not clear. OBJECTIVE The purpose of this paper was to assess the association between diabetes severity, health behavior, socioeconomic status, social support, depression, and disability simultaneously in a population-based study of individuals with diabetes in Quebec, Canada. METHOD Random digit dialing was used to select a sample of 2,003 adults with self-reported diabetes in Quebec. Health status was assessed by the World Health Organization Disability Assessment Schedule II and the CDC Healthy Days Measures. The Patient Health Questionnaire (PHQ-9) was used to assess depression. Potential risk factors included diabetes severity, social support, socioeconomic status, and health behavior factors. Structural equation models were used to identify risk factors that contributed to both depressive symptoms and disability. RESULTS The prevalence of major and minor depression was 8.7% and 10.9%, respectively, while the prevalence of severe disability was 6.7%. Diabetes severity and health behavior factors were associated with both depression and disability. Social support was associated with depression for women but not for men. DISCUSSION Our results suggest a complex interaction between health behavior factors, diabetes severity, social support, depression, and disability. Behavioral factors and diabetes-specific factors might have a direct effect on both depression and physical functioning.
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Briand C, Reinharz D, Lesage A, Nicole L, Stip E, Lalonde P, Villeneuve K, Planet-Sultan S. [Implementation in Quebec of the Integrated Psychological Treatment (IPT) for people with schizophrenia: five years later]. SANTE MENTALE AU QUEBEC 2011; 35:145-62. [PMID: 21761090 DOI: 10.7202/1000557ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines the adoption in Québec of the evidence-based practice, Integrated Psychological Treatment (IPT) of people with schizophrenia and the longevity of this practice within nine clinical milieus in a context of transformation of services. A team of researchers of the Centre de recherche Fernand Seguin has closely followed the implementation and the maintenance of the IPT in nine clinical milieus. More specifically, this article presents the factors that have contributed, on a five year period, to the maintenance (or not) of the IPT in these settings. It raises the important question of longevity of an approach that is specialized and specific to a clientele in contexts of transformation of services.
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Séguin M, Renaud J, Lesage A, Robert M, Turecki G. Youth and young adult suicide: a study of life trajectory. J Psychiatr Res 2011; 45:863-70. [PMID: 21636096 DOI: 10.1016/j.jpsychires.2011.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/02/2011] [Accepted: 05/06/2011] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Explore the unique developmental challenges and early adversity faced by youth and young adult who died of suicide. METHOD Sixty-seven suicide victims (SG) were compared with 56 living control with no suicidal ideations in the last year, matched for age, gender, and geographical region. Mixed methods were used: consensus DSM-IV diagnoses were formulated based on Structured Clinical Interview for DSM-IV (SCID)-I and -II interviews complemented by medical charts. Life calendar method was conducted with closest third party informant. Life-history calendar served to measure life events and adversity throughout the life course and were analyzed by attributing burden of adversity score per five-year segment, which was then cluster-analyzed to define suicide victim profiles. RESULTS During the last year, mood disorders, abuse and dependence disorders, and anxiety disorder were between 8 and 63 times more likely to be present in the suicide group. Between 0 and 4 years old, 50% of children in the SG were exposed to abuse, physical and/or sexual violence; 60% between 5 and 9 years old; and by the time they were 10-14 years old, 77% were exposed to these forms of violence. In the control group, the respective figures were 14%, 18% and 34%. In the suicide group, the trajectories leading to suicide are different as we observe two different subgroups, one with early-onset and one with later-onset of adversity. To a large extent, people in the suicide group were exposed to major adversity and they were more likely to present cumulative comorbid disorders.
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Abstract
INTRODUCTION AND AIMS To conduct a systematic review of instruments for the clinical measurement of addictive behaviours and to determine whether substance addictive behaviours (SAB) and non-substance addictive behaviours (NSAB) are similarly conceptualised in clinical research. DESIGN AND METHODS The analytic strategy employed comprised three steps: (i) major search engines were used to take stock of available clinical instruments for assessing addictive behaviours; (ii) an analysis grid was developed and validated, covering 21 parameters under four heuristic categories: dependence, temperament, social handicap and cognitive behaviour; and (iii) all instruments were analysed and compared via the grid. RESULTS The search yielded 157 questionnaires covering 14 addictive behaviours.The analysis grid allowed rating all questionnaire items on one parameter only; very good interrater agreement was maintained throughout.The categories most evaluated by the questionnaires were dependence and cognitive behaviour; temperament and social handicap were much less frequently considered. Patterns were generally similar in terms of categories, whether questionnaires concerned SAB or NSAB; however, differences within categories indicated a greater frequency of psychologically oriented parameters for NSAB. CONCLUSIONS The measurement of addictive behaviours appears clinically cohesive, as determined by a validated analysis grid applied to an exhaustive set of questionnaires identified through a systematic literature review.
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Bonin JP, Lavoie-Tremblay M, Lesage A, Miquelon P, Briand C. Reorganization based on patient focused care programs, in the context of mental health services reform: Effects on patients. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BackgroundWHO (2001) suggested that the population should get easier and faster access to services improvements in the management of mental disorders in primary health care. In this context, the Government of Quebec (Canada) published in 2005 a Mental Health Action Plan, based on an organization into a hierarchy and some hospitals began to reorganize their mental health services into patient focused care programs.Aims of the studyThe presentation will focus on the effects on outpatients (N = 290) who were receiving mental health services from two hospitals in Montreal.MethodsAs part of a broader study on mental health services and patient outcomes, mental health services’ patients from a psychiatric hospital and a general university hospital in Montreal, were recruited to complete the Basis24, Euroqol, SF12 and other scales. A standard recruitment protocol was followed. All incoming patients at the outpatient clinics/programs during a typical week were considered eligible. This procedure was done before the reorganization of services, in 2006 (T1), and after the reorganization of services (T2; 2 years later), in 2008. We used T-test to assess the difference of a six-month evolution between the two-time measures.ResultsRespectively, 1057 (T1) and 557 (T2) participated to the project. Generally patients showed no significative differences between the two times in their symptoms, functioning and QOL. Only some marginal aspects changes in one site or another.ConclusionPatients were not very disturbed by changes and the new program were not fully implemented two years after T1.
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Abdel-Baki A, Lesage A, Nicole L, Cossette M, Salvat E, Lalonde P. Schizophrenia, an illness with bad outcome: myth or reality? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:92-101. [PMID: 21333036 DOI: 10.1177/070674371105600204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Different myths about schizophrenia endorsed by clinicians maintain the pessimism about outcome thus reducing chances of improvement. There are no recent North American studies on the long-term outcome of first-episode schizophrenia to clarify if these beliefs are myths or reality. Our study describes the long-term outcome (10 to 16 years) of a first-episode schizophrenia incidence cohort (n = 142) in a Canadian urban centre between 1983 and 1999. METHOD Clinical and social functioning at different time points were assessed retrospectively from medical files of a catchment area hospital in Montreal. Service use and deaths were noted from provincial databases of physician billings, hospitalization, and vital statistics. RESULTS Hospitalization days decreased considerably after the first year, with a small minority still needing it episodically after 4 years. Marital and occupational status were generally stable over time, but autonomy in living arrangements worsened. Thirty-three percent of subjects quit the Catchment Area Specialized Psychiatric Services. This group showed better social functioning while they were followed, were hospitalized less afterwards, and had fewer suicides, therefore indicating a better outcome for them. At the end of our study, 15% of the patients still alive were well enough to function without seeking medical help and 25% were not taking antipsychotic medication. Better outcome was predicted by older age at admission, being married, higher premorbid autonomy in living arrangements, and female sex. CONCLUSION A significant proportion of first-episode schizophrenia patients achieve moderate long-term outcome, and the stability of global functioning is more frequent than deterioration, as shown in most industrialized countries.
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Piat M, Sabetti J, Fleury MJ, Boyer R, Lesage A. "Who believes most in me and in my recovery": the importance of families for persons with serious mental illness living in structured community housing. JOURNAL OF SOCIAL WORK IN DISABILITY & REHABILITATION 2011; 10:49-65. [PMID: 21360400 PMCID: PMC4835237 DOI: 10.1080/1536710x.2011.546310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this article, the authors report on qualitative findings on the role of family in supporting recovery for mental health consumers living in structured, community housing in a large Canadian city. Despite living separately from families and relying heavily on formal services, residents identified their families more often than mental health professionals, friends, and residential caregivers as those who most believe in them and their recovery. Families supported recovery by providing affection and belonging, offering emotional and instrumental support, and by staying actively involved with residents. Families are a vital, untapped resource for social workers in promoting independent living.
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167
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Messier L, Schmitz N, Elisha B, Garièpy G, Malla A, Lesage A, Boyer R, Li Wang J, Strychar I. Lifestyle Care Indicators in Individuals with Major, Minor No Depression: A Community-Based Diabetes Study in Quebec. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)51005-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Murphy JM, Gilman SE, Lesage A, Horton NJ, Rasic D, Trinh NH, Alamiri B, Sobol AM, Fava M, Smoller JW. Time trends in mortality associated with depression: findings from the Stirling County study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:776-83. [PMID: 21172098 PMCID: PMC3462356 DOI: 10.1177/070674371005501205] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to address the question of whether a mortality risk associated with depression in a 1952 representative sample of Stirling County adults changed in a new sample in 1970, and whether there was a change in associations with cigarette smoking and alcoholism. METHOD sample members were interviewed about depression and cigarette smoking. General physicians were interviewed by psychiatrists regarding alcoholism. Information about death as of December 31, 1992, was provided by Statistics Canada. Proportional hazards models were fitted in the 2 samples to assess the mortality risks associated with depression among men and women during 20 years of follow-up, and additionally among men with heavy smoking and alcoholism. Specific causes of death were investigated. RESULTS hazard ratios representing the association between depression and premature death among men were 2.6 (95% CI 1.4 to 4.9) and 2.8 (95% CI 1.5 to 5.1), respectively, in the 1952 and 1970 samples for the first 10 years of follow-up. Hazard ratios for women were 1.4 (95% CI 0.6 to 3.2) and 1.2 (95% CI 0.5 to 2.9). The risk associated with depression among men was independent of alcoholism and heavy smoking. Depression and alcoholism were significantly associated with death by external causes and circulatory disease; heavy smoking was significantly associated with malignant neoplasms. CONCLUSION the mortality associated with depression did not change during the period from 1952 to 1970. Depressed men experienced a significant mortality risk that was not matched among depressed women and also was not due to alcoholism and heavy smoking.
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Fleury MJ, Bamvita JM, Tremblay J, Lesage A. Extent and Determinants of General Practitioner Referrals and Contacts With Mental Health Care Providers. ACTA ACUST UNITED AC 2010. [DOI: 10.7870/cjcmh-2010-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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170
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Villeneuve K, Potvin S, Lesage A, Nicole L. Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder. Schizophr Res 2010; 121:266-70. [PMID: 20452749 DOI: 10.1016/j.schres.2010.04.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 04/06/2010] [Accepted: 04/08/2010] [Indexed: 11/15/2022]
Abstract
UNLABELLED Non-compliance with pharmacotherapy among persons suffering from schizophrenia disorders stands at an average rate of 42% and is the subject of numerous studies. However, no studies to date have addressed the specific question of non-compliance with psychosocial treatment. The present study therefore aimed to determine the rate of drop-out from psychosocial treatment and to assess the influence of factors on this rate. METHOD A meta-analysis was conducted based on 74 studies of randomized clinical trials on psychosocial treatment among persons suffering from schizophrenia spectrum disorder. RESULTS A drop-out rate of 13% was obtained. Age, gender, duration of illness, duration of treatment, treatment setting and study quality affected drop-out rates. CONCLUSION The 13% rate of drop-out from psychosocial treatment is markedly lower than the drop-out rate from pharmacotherapy studies. This finding supports the feasibility of evidence-based psychosocial treatment - which has, moreover, clearly been shown to be clinically effective - as part of a complete care program for schizophrenia.
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Fleury MJ, Piat M, Grenier G, Bamvita JM, Boyer R, Lesage A, Tremblay J. Components Associated with Adequacy of Help for Consumers with Severe Mental Disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:497-508. [DOI: 10.1007/s10488-010-0292-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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172
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Dumais A, Côté G, Lesage A. Clinical and sociodemographic profiles of male inmates with severe mental illness: a comparison with voluntarily and involuntarily hospitalized patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:172-9. [PMID: 20370968 DOI: 10.1177/070674371005500309] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the clinical specificity of men with severe mental illness (aged 18 to 40 years) by legal status. METHOD Our study compared 85 inmates with 66 involuntarily hospitalized patients (IHPs) and 50 voluntarily hospitalized patients (VHPs) with at least one Axis I diagnosis of psychosis or major affective disorder. Sociodemographics, medical information, and criminal history were drawn from interviews, medical records, and official criminal records. We used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders to determine Axis I disorders and antisocial personality disorder (ASPD). Psychopathy was measured with the Psychopathy Checklist--Revised. RESULTS We found that inmates had a lower level of schooling (P = 0.001), were more likely to have been in an intimate relationship (P < 0.001), and were less likely to have a psychiatric hospitalization history (P < 0.001), compared with hospitalized patients. Inmates were also more likely to meet criteria for delusional disorders or psychosis not otherwise specified (P < 0.001) and major depression (P = 0.001). IHPs were more likely to meet schizophrenia spectrum disorder criteria (P < 0.001). Inmates had a higher level of comorbidity involving ASPD (P < 0.001), psychopathy (P < 0.001), and substance misuse (P < 0.001). IHPs showed an intermediate level between inmates and VHPs for these comorbid disorders. VHPs had the lowest level of comorbidity with Axis I psychiatric diagnosis. CONCLUSION Our clinical specificity hypothesis was supported: different psychopathological characteristics and social functioning profiles were identified by legal status. Specific integrated treatments should be considered for inmates and IHPs.
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Bonin JP, Dominique T, Lesage A, Fortier M, Roch L, Vadeboncoeur A, Pélissier E, Perreault M, Poirier LR, Semaan W, Noiseux S. [Mental health. Difficulties in evaluation in triage]. PERSPECTIVE INFIRMIERE : REVUE OFFICIELLE DE L'ORDRE DES INFIRMIERES ET INFIRMIERS DU QUEBEC 2010; 7:42-48. [PMID: 20120177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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174
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Séguin M, Boyer R, Lesage A, McGirr A, Suissa A, Tousignant M, Turecki G. Suicide and gambling: Psychopathology and treatment-seeking. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2010; 24:541-7. [DOI: 10.1037/a0019041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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175
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Schmitz N, Nitka D, Gariepy G, Malla A, Wang J, Boyer R, Messier L, Strychar I, Lesage A. Association between neighborhood-level deprivation and disability in a community sample of people with diabetes. Diabetes Care 2009; 32:1998-2004. [PMID: 19675192 PMCID: PMC2768195 DOI: 10.2337/dc09-0838] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of the present study was to analyze the association between neighborhood deprivation and self-reported disability in a community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS Random digit dialing was used to select a sample of adults with self-reported diabetes aged 18-80 years in Quebec, Canada. Health status was assessed by the World Health Organization Disability Assessment Schedule II. Material and social deprivation was measured using the Pampalon index, which is based on the Canadian Census. Potential risk factors for disability included sociodemographic characteristics, socioeconomic status, social support, lifestyle-related factors (smoking, physical activity, and BMI), health care-related problems, duration of diabetes, insulin use, and diabetes-specific complications. RESULTS There was a strong association between disability and material and social deprivation in our sample (n = 1,439): participants living in advantaged neighborhoods had lower levels of disability than participants living in disadvantaged neighborhoods. The means +/- SD disability scores for men were 7.8 +/- 11.8, 12.0 +/- 11.8, and 18.1 +/- 19.4 for low, medium, and high deprivation areas, respectively (P < 0.001). The disability scores for women were 13.4 +/- 12.4, 14.8 +/- 15.9, and 18.9 +/- 16.2 for low, medium, and high deprivation areas, respectively (P < 0.01). Neighborhood deprivation was associated with disability even after controlling for education, household income, sociodemographic characteristics, race, lifestyle-related behaviors, social support, diabetes-related variables, and health care access problems. CONCLUSIONS The inclusion of neighborhood characteristics might be an important step in the identification and interpretation of risk factors for disability in diabetes.
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