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Gholi Zadeh Kharrat F, Gagne C, Lesage A, Gariépy G, Pelletier JF, Brousseau-Paradis C, Rochette L, Pelletier E, Lévesque P, Mohammed M, Wang J. Explainable artificial intelligence models for predicting risk of suicide using health administrative data in Quebec. PLoS One 2024; 19:e0301117. [PMID: 38568987 PMCID: PMC10990247 DOI: 10.1371/journal.pone.0301117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Suicide is a complex, multidimensional event, and a significant challenge for prevention globally. Artificial intelligence (AI) and machine learning (ML) have emerged to harness large-scale datasets to enhance risk detection. In order to trust and act upon the predictions made with ML, more intuitive user interfaces must be validated. Thus, Interpretable AI is one of the crucial directions which could allow policy and decision makers to make reasonable and data-driven decisions that can ultimately lead to better mental health services planning and suicide prevention. This research aimed to develop sex-specific ML models for predicting the population risk of suicide and to interpret the models. Data were from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), covering up to 98% of the population in the province of Quebec and containing data for over 20,000 suicides between 2002 and 2019. We employed a case-control study design. Individuals were considered cases if they were aged 15+ and had died from suicide between January 1st, 2002, and December 31st, 2019 (n = 18339). Controls were a random sample of 1% of the Quebec population aged 15+ of each year, who were alive on December 31st of each year, from 2002 to 2019 (n = 1,307,370). We included 103 features, including individual, programmatic, systemic, and community factors, measured up to five years prior to the suicide events. We trained and then validated the sex-specific predictive risk model using supervised ML algorithms, including Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGBoost) and Multilayer perceptron (MLP). We computed operating characteristics, including sensitivity, specificity, and Positive Predictive Value (PPV). We then generated receiver operating characteristic (ROC) curves to predict suicides and calibration measures. For interpretability, Shapley Additive Explanations (SHAP) was used with the global explanation to determine how much the input features contribute to the models' output and the largest absolute coefficients. The best sensitivity was 0.38 with logistic regression for males and 0.47 with MLP for females; the XGBoost Classifier with 0.25 for males and 0.19 for females had the best precision (PPV). This study demonstrated the useful potential of explainable AI models as tools for decision-making and population-level suicide prevention actions. The ML models included individual, programmatic, systemic, and community levels variables available routinely to decision makers and planners in a public managed care system. Caution shall be exercised in the interpretation of variables associated in a predictive model since they are not causal, and other designs are required to establish the value of individual treatments. The next steps are to produce an intuitive user interface for decision makers, planners and other stakeholders like clinicians or representatives of families and people with live experience of suicidal behaviors or death by suicide. For example, how variations in the quality of local area primary care programs for depression or substance use disorders or increased in regional mental health and addiction budgets would lower suicide rates.
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Affiliation(s)
- Fatemeh Gholi Zadeh Kharrat
- Institut Intelligence et Données (IID), Université Laval, Québec, Québec, Canada
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Christian Gagne
- Institut Intelligence et Données (IID), Université Laval, Québec, Québec, Canada
| | - Alain Lesage
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Québec, Canada
| | - Geneviève Gariépy
- Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
- Montreal Mental Health University Institute Research Center, Montreal, Canada
| | - Jean-François Pelletier
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Québec, Canada
| | - Camille Brousseau-Paradis
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Québec, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Eric Pelletier
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Pascale Lévesque
- Institut National de Santé Publique du Québec (INSPQ), Québec, Québec, Canada
| | - Mada Mohammed
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Vincent PD, Lesage A, Lalonde P, Lipp O, De Guire V, Desbiens MP, Schoretsanitis G. A Short Turnaround of Clozapine Blood Level Results Within 6 hours is Essential for Effective Management of Severely Ill Persons with Treatment-Resistant Schizophrenia. Ther Drug Monit 2024; 46:274-275. [PMID: 38347672 DOI: 10.1097/ftd.0000000000001188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Affiliation(s)
- Philippe D Vincent
- Department of Pharmacy, Institut universitaire en santé mentale de Montréal, Montréal, Canada
- Faculty of Pharmacy, Université de Montréal, Montréal, Canada
| | - Alain Lesage
- Department of Psychiatry, Institut universitaire en santé mentale de Montréal, Montréal, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Pierre Lalonde
- Department of Psychiatry, Institut universitaire en santé mentale de Montréal, Montréal, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Olivier Lipp
- Department of Psychiatry, Institut universitaire en santé mentale de Montréal, Montréal, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Vincent De Guire
- Faculty of Medicine, Université de Montréal, Montréal, Canada
- Department of Biochemistry, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Marie-Pierre Desbiens
- Department of Pharmacy, Institut universitaire en santé mentale de Montréal, Montréal, Canada
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York and
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
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Corbeil O, Brodeur S, Courteau J, Béchard L, Huot-Lavoie M, Angelopoulos E, Di Stefano S, Marrone E, Vanasse A, Fleury MJ, Stip E, Lesage A, Joober R, Demers MF, Roy MA. Treatment with psychostimulants and atomoxetine in people with psychotic disorders: reassessing the risk of clinical deterioration in a real-world setting. Br J Psychiatry 2024; 224:98-105. [PMID: 38044665 PMCID: PMC10884826 DOI: 10.1192/bjp.2023.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Although attention-deficit hyperactivity disorder (ADHD) is often comorbid with schizophrenia spectrum and other psychotic disorders (SZSPD), concerns about an increased risk of psychotic events have limited its treatment with either psychostimulants or atomoxetine. AIMS To examine whether the risk of hospital admission for psychosis in people with SZSPD was increased during the year following the introduction of such medications compared with the year before. METHOD This was a retrospective cohort study using Quebec (Canada) administrative health registries, including all Quebec residents with a public prescription drug insurance plan and a diagnosis of psychotic disorder, defined by relevant ICD-9 or ICD-10 codes, who initiated either methylphenidate, amphetamines or atomoxetine, between January 2010 and December 2016, in combination with antipsychotic medication. The primary outcome was time to hospital admission for psychosis within 1 year of initiation. State sequence analysis was also used to visualise admission trajectories for psychosis in the year following initiation of these medications, compared with the previous year. RESULTS Out of 2219 individuals, 1589 (71.6%) initiated methylphenidate, 339 (15.3%) amphetamines and 291 (13.1%) atomoxetine during the study period. After adjustment, the risk of hospital admission for psychosis was decreased during the 12 months following the introduction of these medications when used in combination with antipsychotics (adjusted HR = 0.36, 95% CI 0.24-0.54; P < 0.0001). CONCLUSIONS These findings suggest that, in a real-world setting, when used concurrently with antipsychotic medication, methylphenidate, amphetamines and atomoxetine may be safer than generally believed in individuals with psychotic disorders.
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Affiliation(s)
| | - Sébastien Brodeur
- Department of Psychiatry and Neurosciences, Laval University, Quebec, Canada; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Josiane Courteau
- PRIMUS Research Group, Research Centre of Sherbrooke University Hospital Center (CRCHUS), Sherbrooke, Canada
| | | | | | | | | | - Erica Marrone
- Faculty of Pharmacy, Laval University, Quebec, Canada
| | - Alain Vanasse
- PRIMUS Research Group, Research Centre of Sherbrooke University Hospital Center (CRCHUS), Sherbrooke, Canada; and Department of Family Medicine and Urgent Medicine, University of Sherbrooke, Sherbrooke, Canada
| | - Marie-Josée Fleury
- Douglas Research Centre, Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Montreal, Canada
| | - Emmanuel Stip
- Department de Psychiatry and Addictology, University of Montreal, Montreal, Canada; and Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, UAE
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada; and Research Centre, Montreal University Institute of Mental Health, Montreal, Canada
| | - Ridha Joober
- Douglas Research Centre, Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-France Demers
- Faculty of Pharmacy, Laval University, Quebec, Canada; and CERVO Research Centre, Quebec, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Quebec, Canada; and CERVO Research Centre, Quebec, Canada
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Vasiliadis HM, Lunghi C, Rahme E, Rochette L, Gignac M, Massamba V, Diallo FB, Fansi A, Cortese S, Lesage A. ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study. Transl Psychiatry 2024; 14:128. [PMID: 38418443 PMCID: PMC10901868 DOI: 10.1038/s41398-024-02825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/01/2024] Open
Abstract
We assessed the association between the use of medications for attention-deficit/hyperactivity disorder (ADHD) and the risk of all-cause mortality and unintentional injuries leading to emergency department (ED) or hospital admission in individuals aged ≤24 years with ADHD. We conducted a population-based retrospective cohort study between 2000 and 2021 using Quebec health administrative data. Individuals were followed from the first ADHD diagnosis or ADHD medication claim until turning 25, death, or study end. Exposure was defined as mutually exclusive episodes of ADHD medication use and/or coverage under the public provincial drug plan (PDP): 1) covered and not treated with ADHD medication; 2) covered and treated with ADHD medication; and 3) not covered under the PDP. The risk of all-cause mortality and unintentional injuries associated with exposure episodes was estimated using multivariable survival analyses. The cohort included n = 217 192 individuals aged 1-24 years with a male to female ratio of close to 2:1. Compared to non-medication use, episodes of ADHD medication use, overall, were associated with reduced all-cause mortality (adjusted hazard ratio, aHR 0.61, 95% CI 0.48-0.76) and unintentional injury leading to ED (0.75, 0.74-0.77) or hospitalisation (0.71, 0.68-0.75). Episodes of stimulants were associated with a lower risk of all-cause mortality and reduced risk of unintentional injuries, while episodes with non-stimulants and with both stimulants and non-stimulants concomitantly were associated with reduced risk of unintentional injuries, but not of all-cause mortality. Although residual confounding cannot be excluded, stimulants may have a protective effect in terms of risk of all-cause mortality and both stimulants and non-stimulants for ADHD may reduce the risk of unintentional injuries. The findings of the current study should inform clinical decision making on the choice of starting a pharmacological treatment for ADHD, when a balance needs to be struck between expected benefits and possible risks.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Department of Community Health Science, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueil, QC, J4K 0A8, Canada.
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueil, QC, J4K 0A8, Canada.
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A5, Canada
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio, 48 - 40126, Bologna, Italy
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Martin Gignac
- Montreal Children's Hospital, McGill University Montreal, 1001 Décarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - Victoria Massamba
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Fatoumata Binta Diallo
- Institut National de Santé Publique du Québec (National Public Health Institute of Quebec), 945, avenue Wolfe, Quebec, QC, G1V 5B3, Canada
| | - Alvine Fansi
- Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal /Montreal West Island Integrated University Health and Social Services Centre, Montreal, QC, Canada
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Building 44, Room 4059, University Rd, Southampton, SO171PS, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, HighPoint Venue, Bursledon Rd, Southampton, SO19 8BR, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, One Park, New York City, NY, 10016, USA
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari "Aldo Moro", Bari, Italy
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Research Centre of the Institut universitaire en santé mentale de Montréal, 7401, rue Hochelaga, Montreal, QC, H1N 3M5, Canada
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McSween-Cadieux E, Lane J, Hong QN, Houle AA, Lauzier-Jobin F, Saint-Pierre Mousset E, Prigent O, Ziam S, Poder T, Lesage A, Dagenais P. Production and use of rapid responses during the COVID-19 pandemic in Quebec (Canada): perspectives from evidence synthesis producers and decision makers. Health Res Policy Syst 2024; 22:22. [PMID: 38351054 PMCID: PMC10863098 DOI: 10.1186/s12961-024-01105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has required evidence to be made available more rapidly than usual, in order to meet the needs of decision makers in a timely manner. These exceptional circumstances have caused significant challenges for organizations and teams responsible for evidence synthesis. They had to adapt to provide rapid responses to support decision-making. This study aimed to document (1) the challenges and adaptations made to produce rapid responses during the pandemic, (2) their perceived usefulness, reported use and factors influencing their use and (3) the methodological adaptations made to produce rapid responses. METHODS A qualitative study was conducted in 2021 with eight organizations in the health and social services system in Quebec (Canada), including three institutes with a provincial mandate. Data collection included focus groups (n = 9 groups in 8 organizations with 64 participants), interviews with decision makers (n = 12), and a document analysis of COVID-19 rapid responses (n = 128). A thematic analysis of qualitative data (objectives 1 and 2) and a descriptive analysis of documents (objective 3) were conducted. RESULTS The results highlight the teams and organizations' agility to deal with the many challenges encountered during the pandemic (e.g., increased their workloads, adoption of new technological tools or work processes, improved collaboration, development of scientific monitoring, adaptation of evidence synthesis methodologies and products). The challenge of balancing rigor and speed was reported by teams and organizations. When available at the right time, rapid responses have been reported as a useful tool for informing or justifying decisions in a context of uncertainty. Several factors that may influence their use were identified (e.g., clearly identify needs, interactions with producers, perceived rigor and credibility, precise and feasible recommendations). Certain trends in the methodological approaches used to speed up the evidence synthesis process were identified. CONCLUSIONS This study documented rapid responses producers' experiences during the COVID-19 pandemic in Quebec, and decision makers who requested, consulted, or used these products. Potential areas of improvements are identified such as reinforce coordination, improve communication loops, clarify guidelines or methodological benchmarks, and enhance utility of rapid response products for decision makers.
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Affiliation(s)
- Esther McSween-Cadieux
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada.
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada.
| | - Julie Lane
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
| | - Quan Nha Hong
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Andrée-Anne Houle
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
| | - François Lauzier-Jobin
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
| | - Eliane Saint-Pierre Mousset
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
- Centre RBC d'expertise Universitaire en Santé Mentale, Université de Sherbrooke, Sherbrooke, Canada
| | - Ollivier Prigent
- Department of School and Social Adaptation Studies, Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
| | - Saliha Ziam
- School of Business Administration, Université TÉLUQ, Montreal, Canada
| | - Thomas Poder
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), CIUSSS-de-l'Est-de-l'île-de-Montréal, Montreal, Canada
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, Canada
| | - Alain Lesage
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), CIUSSS-de-l'Est-de-l'île-de-Montréal, Montreal, Canada
| | - Pierre Dagenais
- Department of Medicine, Faculty of Medicine and Health Science, University of Sherbrooke, Sherbrooke, Canada
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Fleury MJ, Rochette L, Gentil L, Grenier G, Lesage A. Predictors of Physician Follow-Up Care Among Patients Affected by an Incident Mental Disorder Episode in Quebec (Canada). Can J Psychiatry 2024; 69:100-115. [PMID: 37357714 PMCID: PMC10789227 DOI: 10.1177/07067437231182570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVES This study identified predictors of prompt (1+ outpatient physician consultations/within 30 days), adequate (3+/90 days) and continuous (5+/365 days) follow-up care from general practitioners (GPs) or psychiatrists among patients with an incident mental disorder (MD) episode. METHODS Study data were extracted from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), which covers 98% of the population eligible for health-care services under the Quebec (Canada) Health Insurance Plan. This observational epidemiological study investigating the QICDSS from 1 April 1997 to 31 March 2020, is based on a 23-year patient cohort including 12+ years old patients with an incident MD episode (n = 2,670,133). Risk ratios were calculated using Robust Poisson regressions to measure patient sociodemographic and clinical characteristics, and prior service use, which predicted patients being more or less likely to receive prompt, adequate, or continuous follow-up care after their last incident MD episode, controlling for previous MD episodes, co-occurring disorders, and years of entry into the cohort. RESULTS A minority of patients, and fewer over time, received physician follow-up care after an incident MD episode. Women; patients aged 18-64; with depressive or bipolar disorders, co-occurring MDs-substance-related disorders (SRDs) or physical illnesses; those receiving previous GP follow-up care, especially in family medicine groups; patients with higher prior continuity of GP care; and previous high users of emergency departments were more likely to receive follow-up care. Patients living outside the Montreal metropolitan area; those without prior MDs; patients with anxiety, attention deficit hyperactivity, personality, schizophrenia and other psychotic disorders, or SRDs were less likely to receive follow-up care. CONCLUSION This study shows that vulnerable patients with complex clinical characteristics and those with better previous GP care were more likely to receive prompt, adequate or continuous follow-up care after an incident MD episode. Overall, physician follow-up care should be greatly improved.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - Lia Gentil
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Alain Lesage
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
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Cabet S, Putoux A, Lesca G, Lesage A, Massoud M, Guibaud L. Prenatal diagnosis of microcephaly with simplified gyral pattern: series of eight cases. Ultrasound Obstet Gynecol 2024; 63:271-275. [PMID: 37551048 DOI: 10.1002/uog.27450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
Microcephaly with simplified gyral pattern (MSG) is an intrinsic genetic central nervous system disorder, characterized by microcephaly (a reduction of brain volume) and a simplified gyral pattern (a reduced number of gyri and shallow sulci associated with normal cortical thickness and neuroanatomical architecture), related to a reduced number of neuronal progenitors in the germinal matrix. We report the first prenatal series of MSG and define the prenatal imaging pattern, which should inform diagnosis and guide prenatal counseling in cases of fetal microcephaly. In this single-center retrospective study of fetuses with MSG, we assessed features on ultrasound and magnetic resonance imaging (MRI), as well as genetic and neuropathological/postnatal data. We included eight patients who had been referred following observation of microcephaly. Ultrasound examination confirmed microcephaly, with a mean growth delay in head circumference of 3.4 weeks, associated with both a lack of gyration and a lack of opercularization of the Sylvian fissure and without any extracephalic anomaly. Fetal brain MRI confirmed lack of gyration with normal cortical thickness and normal intensity of the white matter in all cases. These MRI features led to exclusion of migration/corticogenesis disorders (lissencephaly/polymicrogyria), instead suggesting MSG. The posterior fossa was normal in seven of the eight cases. The corpus callosum was thin in four cases, hypoplastic in two and dysgenetic in two. In four cases, the pregnancy was terminated. The diagnosis of MSG was confirmed from neuropathological and postnatal MRI data. MSG was associated with a genetic diagnosis of RTTN (n = 1) and ASPM (n = 2) biallelic variants in three of the six cases in which genetic work-up was performed. Mild or moderate intellectual deficit with speech delay was present in the three surviving children who were at least 5 years of age at their last examination, without seizures. In conclusion, in the presence of isolated fetal microcephaly with lack of gyration on ultrasound, fetal cerebral MRI is key to diagnosing MSG, which, in the majority of cases, affects the supratentorial space exclusively, and to ruling out other cortical malformations that show a similar sonographic pattern. In addition to imaging, genetic assessment may guide prenatal counseling, since the prenatal prognosis of MSG is different from that of both diffuse polymicrogyria and lissencephaly. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Cabet
- Pediatric and Fetal Imaging Department, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
- Institut NeuroMyoGène, CNRS UMR5292, INSERM U1028, Claude Bernard Lyon 1 University, Lyon, France
- Multidisciplinary Center for Prenatal Diagnosis, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - A Putoux
- Multidisciplinary Center for Prenatal Diagnosis, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
- Department of Genetics, Groupement Hospitalier Est, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - G Lesca
- Institut NeuroMyoGène, CNRS UMR5292, INSERM U1028, Claude Bernard Lyon 1 University, Lyon, France
- Department of Genetics, Groupement Hospitalier Est, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - A Lesage
- Department of Medical Imaging, CHU Sainte-Justine, Montréal, QC, Canada
| | - M Massoud
- Department of Gynecology and Obstetrics, Multidisciplinary Center for Prenatal Diagnosis, CHLS, Hospices Civils de Lyon, Lyon, France
| | - L Guibaud
- Pediatric and Fetal Imaging Department, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
- Multidisciplinary Center for Prenatal Diagnosis, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
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Kerr P, Le Page C, Giguère CÉ, Marin MF, Trudel-Fitzgerald C, Romain AJ, Taschereau-Dumouchel V, Ouellet-Morin I, Lecomte T, Potvin S, Geoffrion S, Sasseville M, Caihol L, Lipp O, Pelletier JF, Dumais A, Lesage A, Labelle R, Lavoie M, Godbout R, Vincent P, Boissonneault J, Findlay H, Lupien SJ, Guay S, Juster RP, Consortium S. The Signature Biobank: A longitudinal biopsychosocial repository of psychiatric emergency patients. Psychiatry Res 2024; 332:115718. [PMID: 38198857 DOI: 10.1016/j.psychres.2024.115718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The Signature Biobank is a longitudinal repository of biospecimen, psychological, sociodemographic, and diagnostic data that was created in 2012. The Signature Consortium represents a group of approximately one hundred Quebec-based transdisciplinary clinicians and research scientists with various expertise in the field of psychiatry. The objective of the Signature Biobank is to investigate the multi-faceted underpinnings of psychiatric disorders among patients in crisis. The Signature Consortium is expanding and includes new active members that seek to highlight the contributions made by Signature Biobank since its inception. This article details our research protocol, directions, and summarizes contributions. To date, we have collected biological samples (n = 1,986), and questionnaire data (n = 2,085) from psychiatric emergency patients of the Institut universitaire en santé mentale de Montréal (Quebec, Canada), with a large proportion from whom both data types were collected (n = 1,926). In addition to this, a subsample of patients was followed-up at hospital discharge, and two additional outpatient clinic appointments (n = 958 with at least one follow-up). In addition, a socio-demographically matched comparison group of individuals who were not hospitalized for psychiatric disorders (n = 149) was recruited from the surrounding catchment area. To summarize, a systematic review of the literature shows that the Signature Biobank has contributed to better characterizing psychiatric comorbidities, biological profiles, and psychosocial functioning across some of the most common psychiatric disorders, including psychosis, mood, anxiety, and substance use disorders. The Signature Biobank is now one of the world's largest repositories of data collected from patients receiving care at a psychiatric emergency unit.
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Affiliation(s)
- Philippe Kerr
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Cécile Le Page
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Charles-Édouard Giguère
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Marie-France Marin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Claudia Trudel-Fitzgerald
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Ahmed Jérôme Romain
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, Québec, Canada
| | - Vincent Taschereau-Dumouchel
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Ouellet-Morin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; School of Criminology, Université de Montréal, Montréal, Québec, Canada
| | - Tania Lecomte
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Steve Geoffrion
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Marc Sasseville
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Lionel Caihol
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Olivier Lipp
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Pelletier
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry, Yale University, New Haven, Connecticut, United States; CISSS de la Montérégie-Ouest, Québec, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Réal Labelle
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Marc Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Roger Godbout
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Vincent
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Janick Boissonneault
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Helen Findlay
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Sonia J Lupien
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Stéphane Guay
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada; School of Criminology, Université de Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada.
| | - Signature Consortium
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
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Pena-Gralle APB, Talbot D, Trudel X, Milot A, Gilbert-Ouimet M, Lavigne-Robichaud M, Ndjaboué R, Lesage A, Lauzier S, Vézina M, Siegrist J, Brisson C. Socioeconomic inequalities, psychosocial stressors at work and physician-diagnosed depression: Time-to-event mediation analysis in the presence of time-varying confounders. PLoS One 2023; 18:e0293388. [PMID: 37878641 PMCID: PMC10599565 DOI: 10.1371/journal.pone.0293388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES There is evidence that both low socioeconomic status (SES) and psychosocial stressors at work (PSW) increase risk of depression, but prospective studies on the contribution of PSW to the socioeconomic gradient of depression are still limited. METHODS Using a prospective cohort of Quebec white-collar workers (n = 9188 participants, 50% women), we estimated randomized interventional analogues of the natural direct effect of SES indicators at baseline (education level, household income, occupation type and a combined measure) and of their natural indirect effects mediated through PSW (job strain and effort-reward imbalance (ERI) measured at the follow-up in 1999-2001) on incident physician-diagnosed depression. RESULTS During 3 years of follow-up, we identified 469 new cases (women: 33.1 per 1000 person-years; men: 16.8). Mainly in men, low SES was a risk factor for depression [education: hazard ratio 1.72 (1.08-2.73); family income: 1.67 (1.04-2.67); occupational type: 2.13 (1.08-4.19)]. In the entire population, exposure to psychosocial stressors at work was associated with increased risk of depression [job strain: 1.42 (1.14-1.78); effort-reward imbalance (ERI) 1.73 (1.41-2.12)]. The estimated indirect effects of socioeconomic indicators on depression mediated through job strain ranged from 1.01 (0.99-1.03) to 1.04 (0.98-1.10), 4-15% of total effects, and for low reward from 1.02 (1.00-1.03) to 1.06 (1.01-1.11), 10-15% of total effects. DISCUSSION Our study suggests that PSW only slightly mediate the socioeconomic gradient of depression, but that socioeconomic inequalities, especially among men, and PSW both increase the incidence of depression.
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Affiliation(s)
- Ana Paula Bruno Pena-Gralle
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- VITAM – Centre de Recherche en Santé Durable, Québec, Québec, Canada
| | - Denis Talbot
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Xavier Trudel
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Alain Milot
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Mahée Gilbert-Ouimet
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Québec, Canada
| | - Mathilde Lavigne-Robichaud
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Ruth Ndjaboué
- School of Social Work, Sherbrooke University, Sherbrooke, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Michel Vézina
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Johannes Siegrist
- Faculty of Medicine, Department of Medical Sociology, Heinrich-Heine-University, Duesseldorf, Germany
| | - Chantal Brisson
- Centre hospitalier universitaire (CHU) de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- VITAM – Centre de Recherche en Santé Durable, Québec, Québec, Canada
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Neumane S, Lesage A, Dangouloff-Ros V, Levy R, Roux CJ, Robert MP, Bremond-Gignac D, Boddaert N. Arterial Spin-Labeling in the Assessment of Pediatric Nontraumatic Orbital Lesions. AJNR Am J Neuroradiol 2023; 44:1219-1223. [PMID: 37652581 PMCID: PMC10549944 DOI: 10.3174/ajnr.a7977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023]
Abstract
Benign and malignant pediatric orbital lesions can sometimes have overlapping features on conventional MR imaging sequences. MR imaging of 27 children was retrospectively reviewed to describe the signal of some common pediatric extraocular orbital lesions on arterial spin-labeling and to evaluate whether this sequence helps to discriminate malignant from benign masses, with or without ADC value measurements. Qualitative and quantitative assessments of arterial spin-labeling CBF and ADC were performed. All lesions were classified into 3 arterial spin-labeling perfusion patterns: homogeneous hypoperfusion (pattern 1, n = 15; benign lesions), heterogeneous hyperperfusion (pattern 2, n = 9; cellulitis, histiocytosis, malignant tumors), and homogeneous intense hyperperfusion (pattern 3, n = 3; infantile hemangiomas). Arterial spin-labeling can be a valuable tool to improve the diagnostic confidence of some orbital lesions, including infantile hemangioma. An algorithm is proposed.
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Affiliation(s)
- S Neumane
- From the Department of Pediatric Radiology (S.N., A.L., V.D.-R., R.L., C.-J.R., N.B.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- NeuroSpin, UNIACT (S.N.), Commissariat à l'Énergie Atomique et aux Énergies Alternatives (CEA), Université Paris-Saclay, Gif-sur-Yvette, France
| | - A Lesage
- From the Department of Pediatric Radiology (S.N., A.L., V.D.-R., R.L., C.-J.R., N.B.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Department of Pediatric Radiology (A.L.), Centre Hospitalier Universitaire Saint-Justine, Montréal, Quebec, Canada
| | - V Dangouloff-Ros
- From the Department of Pediatric Radiology (S.N., A.L., V.D.-R., R.L., C.-J.R., N.B.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Imagine (V.D.-R., R.L., C.-J.R., N.B.), Institut National de la Santé et de la Recherche Médicale (INSERM) U1163 and U1299, Université Paris Cité, Paris, France
| | - R Levy
- From the Department of Pediatric Radiology (S.N., A.L., V.D.-R., R.L., C.-J.R., N.B.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Imagine (V.D.-R., R.L., C.-J.R., N.B.), Institut National de la Santé et de la Recherche Médicale (INSERM) U1163 and U1299, Université Paris Cité, Paris, France
| | - C-J Roux
- From the Department of Pediatric Radiology (S.N., A.L., V.D.-R., R.L., C.-J.R., N.B.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Imagine (V.D.-R., R.L., C.-J.R., N.B.), Institut National de la Santé et de la Recherche Médicale (INSERM) U1163 and U1299, Université Paris Cité, Paris, France
| | - M P Robert
- Department of Ophthalmology (M.P.R., D.B.-G.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Centre Borelli UMR 9010 (M.P.R.), Université Paris Cité, Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - D Bremond-Gignac
- Department of Ophthalmology (M.P.R., D.B.-G.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Team 17 (D.B.-G.), Institut National de la Santé et de la Recherche Médicale, UMRS1138, Université Paris Cité, Paris, France
| | - N Boddaert
- From the Department of Pediatric Radiology (S.N., A.L., V.D.-R., R.L., C.-J.R., N.B.), Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Imagine (V.D.-R., R.L., C.-J.R., N.B.), Institut National de la Santé et de la Recherche Médicale (INSERM) U1163 and U1299, Université Paris Cité, Paris, France
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Brousseau-Paradis C, Lesage A, Larue C, Labelle R, Giguère CÉ, Rassy J. Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ-R. Int J Ment Health Nurs 2023; 32:1301-1314. [PMID: 37150928 DOI: 10.1111/inm.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
Patients with mood disorders are at high risk of suicidality, and emergency departments (ED) are essential in the management of this risk. This study aims to (1) describe the suicidal thoughts and behaviours of patients with mood disorders who come to ED; (2) assess the psychometric properties of the Suicidal Behaviours Questionnaire-Revised (SBQ-R) in a psychiatric ED; and (3) determine the best predictors of suicidality for these patients. A total of 300 participants with mood disorders recruited for the Signature Bank of the Institut universitaire en santé mentale de Montréal (IUSMM) were retained. Suicidality was assessed using the SBQ-R. Other clinical and demographic details were recorded. Bivariate analyses, correlations and multivariate regression analyses were conducted. SBQ-R's internal consistency, construct and convergent validities were also tested. In the Patient Health Questionnaire-9 (PHQ-9), 53.3% of the sample stated they had suicidal or self-harm thoughts in the last 2 weeks. The mean score obtained at the SBQ-R was 8.3. Multivariate analysis found that SBQ-R scores were associated with depressive symptoms and substance use, especially alcohol, accounting for 44.3% of the model variance. Cronbach's alpha was 0.81 [0.78, 0.84] and factor loadings for items 1-4 were 0.68, 0.88, 0.54, and 0.85, respectively. The confirmatory factor analysis indicated that the model fit the data well. The SBQ-R is a brief and valid instrument that can easily be used in busy emergency departments to assess suicide risk. Depressive symptoms and alcohol use shall also be assessed, as they are determinants of increased risk of suicidality.
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Affiliation(s)
- Camille Brousseau-Paradis
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
| | - Alain Lesage
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
- Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montréal, Quebec, Canada
| | - Caroline Larue
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Faculty of Nursing, University of Montreal, Montréal, Quebec, Canada
- Quebec Network on Nursing Intervention Research, Montréal, Quebec, Canada
| | - Réal Labelle
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Charles-Édouard Giguère
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
| | - Jessica Rassy
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montréal, Quebec, Canada
- Quebec Network on Nursing Intervention Research, Montréal, Quebec, Canada
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Quebec, Canada
- School of Nursing, University of Sherbrooke, Montréal, Quebec, Canada
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Lesage A, Courteau J, Vanasse A. Erratum in Lesage A, Courteau J, Brodeur S, et al. Urbanicity, Schizophrenia and Equitable Specialist Services Allocation. Can J Psychiatry. 2022;67(2):160-161. doi: 10.1177/07067437211040606. Epub 2021 Sep 6. PMID: 34482764; PMCID: PMC8892047. Can J Psychiatry 2023; 68:701. [PMID: 37165518 PMCID: PMC10585134 DOI: 10.1177/07067437231173818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal (IUSMM), Montréal (QC), Canada
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal (QC), Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (QC), Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke (QC), Canada
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke (QC), Canada
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Wang J, Gholi Zadeh Kharrat F, Pelletier JF, Rochette L, Pelletier E, Lévesque P, Massamba V, Brousseau-Paradis C, Mohammed M, Gariépy G, Gagné C, Lesage A. A case-control study on predicting population risk of suicide using health administrative data: a research protocol. BMJ Open 2023; 13:e066423. [PMID: 36849211 PMCID: PMC9972456 DOI: 10.1136/bmjopen-2022-066423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Suicide has a complex aetiology and is a result of the interaction among the risk and protective factors at the individual, healthcare system and population levels. Therefore, policy and decision makers and mental health service planners can play an important role in suicide prevention. Although a number of suicide risk predictive tools have been developed, these tools were designed to be used by clinicians for assessing individual risk of suicide. There have been no risk predictive models to be used by policy and decision makers for predicting population risk of suicide at the national, provincial and regional levels. This paper aimed to describe the rationale and methodology for developing risk predictive models for population risk of suicide. METHODS AND ANALYSIS A case-control study design will be used to develop sex-specific risk predictive models for population risk of suicide, using statistical regression and machine learning techniques. Routinely collected health administrative data in Quebec, Canada, and community-level social deprivation and marginalisation data will be used. The developed models will be transformed into the models that can be readily used by policy and decision makers. Two rounds of qualitative interviews with end-users and other stakeholders were proposed to understand their views about the developed models and potential systematic, social and ethical issues for implementation; the first round of qualitative interviews has been completed. We included 9440 suicide cases (7234 males and 2206 females) and 661 780 controls for model development. Three hundred and forty-seven variables at individual, healthcare system and community levels have been identified and will be included in least absolute shrinkage and selection operator regression for feature selection. ETHICS AND DISSEMINATION This study is approved by the Health Research Ethnics Committee of Dalhousie University, Canada. This study takes an integrated knowledge translation approach, involving knowledge users from the beginning of the process.
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Affiliation(s)
- JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Louis Rochette
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | - Eric Pelletier
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | - Pascale Lévesque
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | - Victoria Massamba
- Institut national de sante publique du Quebec (INSPQ), Quebec City, Quebec, Canada
| | | | - Mada Mohammed
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Geneviève Gariépy
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Christian Gagné
- Department of Electrical Engineering and Computer Engineering, Laval University, Quebec, Quebec, Canada
| | - Alain Lesage
- Institut universitaire en sante mentale de Montreal, Montreal, Québec, Canada
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Lesage A, Fortin G, Ligier F, Van Haaster I, Doyon C, Brouillard C, Daneau D, Rassy J. Implementing a Suicide Audit in Montreal: Taking Suicide Review Further to Make Concrete Recommendations for Suicide Prevention. Arch Suicide Res 2023; 27:29-42. [PMID: 34470592 DOI: 10.1080/13811118.2021.1965058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A suicide audit was pilot implemented in order to generate recommendations on how to improve suicide prevention. METHODS Thirty-nine consecutive suicides that occurred in Montreal, Canada from January to October 2016 were audited. A retrospective analysis of their life trajectory and service utilization was conducted using the psychological autopsy method, which included interviewing suicide-bereaved survivors and examining health and social services records and the coroner's investigation file. A psychosocial and service utilization profile was drawn for each decedent. A multidisciplinary panel reviewed each case summary to identify gaps in terms of individual intervention, provincial public health and social services, and regional programs. RESULTS Five main suicide prevention recommendations were made to prevent similar suicides: (1) deploy mobile crisis intervention teams (short-term, high-intensity, home-based treatment) in hospital emergency departments; (2) train primary and specialized mental health care professionals to screen for and manage substance use disorders; and (3) implement public awareness campaigns to encourage help seeking for depression and substance use disorders; (4) access for all, regardless of age, to an effective psychosis treatment program; and (5) provide universal access to a general practitioner, especially for men. CONCLUSIONS The suicide audit procedure was implemented effectively and targeted recommendations were generated to prevent similar suicides. However, resistance from medical and hospital quality boards arose during the process, though these could be allayed if regional and provincial authorities actively endorsed the multidisciplinary and multi stakeholders suicide audit process. HighlightsA bottom-up approach to generate recommendations for suicide prevention.Implementation was challenging with resistance to our interdisciplinary approach.The audit needs the support of the regional health department to lift barriers.
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Girard A, Carrier JD, Poitras ME, Cormier C, Lesage A, Berbiche D, T. Vaillancourt V. The Psychological Health and Work-Family Balance of Ambulatory Care Nurses in the COVID-19 era: A Cross-Sectional Survey. Science of Nursing and Health Practices 2022. [DOI: 10.7202/1095198ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: The COVID-19 pandemic impacted nurses’ psychological health and work-family balance, including in ambulatory care settings. The results presented in this article are part of a study aiming to describe and contextualize the psychological health and changes in nurses’ follow-up practices in Quebec (Canada) during the COVID-19 pandemic.
Objective: Explore and describe factors that influenced ambulatory care nurses’ psychological health and work-family balance during the first wave of the COVID-19 pandemic.
Methods: Exploratory mixed data cross-sectional study using the SurveyMonkey platform. We collected data from July 2020 to September 2020. The target population comprised all practicing nurses in Quebec whose clinical activities included the follow-up of ambulatory patients, 200 of whom completed the survey.
Results: Multiple linear regression models indicated that anxiety (GAD-7 scores) and depressive symptoms (PHQ-9 scores) were associated with younger age, living alone, worries about transmitting COVID-19, and feeling that one’s work was not coherent with one’s values. Work-family balance was considered more difficult than before the pandemic by 54.5 % of participants. Factors perceived as influencing work-family balance were either related to work conditions (e.g., schedule and time at work, access to work from home, redeployment to another work setting), to family-related responsibilities/tasks or were specific to the pandemic.
Discussion and conclusion: Apart from age, the feeling that one’s work was not coherent with their values was the only variable correlated with both GAD-7 and PHQ-9 in multivariate models. Further research should investigate the relationships between sense of coherence, psychological health, and work conditions like schedule flexibility and access to work from home.
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Groen K, Crabbé R, Knolle J, Gibson C, Lesage A, Lu P. PHARMACOKINETICS OF PHVS719, EXTENDED-RELEASE TABLET FORMULATION OF PHA121, A FIRST-IN-CLASS ORAL HUMAN BRADYKININ B2-RECEPTOR ANTAGONIST. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Fleury MJ, Cao Z, Armoon B, Grenier G, Lesage A. Profiles of patients using emergency departments or hospitalized for suicidal behaviors. Suicide Life Threat Behav 2022; 52:943-962. [PMID: 35686920 DOI: 10.1111/sltb.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/07/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study identified profiles of patients with suicidal behaviors, their sociodemographic and clinical correlates, and assessed the risk of death within a 12-month follow-up period. METHODS Based on administrative databases, this 5-year study analyzed data on 5064 patients in Quebec who used emergency departments (ED) or were hospitalized for suicidal behaviors over a 2-year period. Latent class analysis was used for patient profiles, bivariate analysis for patient correlates over 2 years, and survival analysis for risk of death within a 12-month follow-up. RESULTS Four profiles were identified: high suicidal behaviors and high service use (Profile 1: 23%); low suicidal behaviors and moderate service use (Profile 2: 46%); low suicidal behaviors and low service use (Profile 3: 25%); and high suicidal behaviors and high acute care, but low outpatient care (Profile 4: 6%). Profiles 1 and 4 patients had more serious conditions, with a higher risk of death in Profile 1 versus Profiles 2 and 3. Profile 2 patients had relatively more common mental disorders, and Profile 3 patients had less severe conditions. Profiles 3 and 4 included more men and younger patients. CONCLUSION Programs better adapted to patient profiles should be deployed after ED use and hospitalization in coordination with outpatient services.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Bahram Armoon
- Douglas Hospital Research Centre, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut Universitaire en santé mentale de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
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Lafrenière S, Gholi-Zadeh-Kharrat F, Sirois C, Massamba V, Rochette L, Brousseau-Paradis C, Patry S, Gagné C, Lemasson M, Gariépy G, Mérette C, Rahme E, Lesage A. The 5-year longitudinal diagnostic profile and health services utilization of patients treated with electroconvulsive therapy in Quebec: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:629-639. [PMID: 36163429 DOI: 10.1007/s00127-022-02369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Electroconvulsive therapy (ECT) is effective for treating several psychiatric disorders. However, only a minority of patients are treated with ECT. It is of primary importance to characterize their profile for epidemiological purposes and to inform clinical practice. We aimed to characterize the longitudinal profile of psychopathology and services utilization of patients first treated with ECT. METHODS We conducted a population-based comparative study using data from a national administrative database in Quebec. Patients who received a first ECT between 2002 and 2016 were compared to controls who were hospitalized in psychiatry but did not receive ECT. We performed descriptive analyses to compare psychiatric diagnoses, domains of psychopathology (internalizing, externalizing and thought/psychotic disorders), medical services and medication use in the 5 years prior to the ECT or hospitalization. RESULTS 5 080 ECT patients were compared with 179 594 controls. Depressive, anxiety, bipolar and psychotic disorders were more frequent in the ECT group. 96.2% of ECT patients had been diagnosed with depression and 53.8% with a primary psychotic disorder. In the ECT group, 1.0% had been diagnosed exclusively with depression and 47.0% had disorders from that belong to all three domains of psychopathology. Having both internalizing and thought/psychotic disorders was associated with an increased likelihood of receiving ECT vs having internalizing disorders alone (unadjusted OR = 2.93; 95% CI = 2.63, 3.26). All indicators of mental health services utilization showed higher use among ECT patients. CONCLUSION Our results provide robust evidence of complex longitudinal psychopathology and extensive services utilization among ECT patients.
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Affiliation(s)
- Simon Lafrenière
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada. .,Institut Universitaire en Santé Mentale de Québec, 2601, Chemin de La Canardière, Quebec, QC, G1J 2G3, Canada.
| | - Fatemeh Gholi-Zadeh-Kharrat
- Department of Electrical Engineering and Computer Engineering, Université Laval, Quebec, Qc, Canada.,Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | - Caroline Sirois
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada.,Faculty of Pharmacy, Université Laval, Quebec, Qc, Canada.,Centre of Excellence on Aging of Quebec, VITAM Research Centre on Sustainable Health, Quebec City, Qc, Canada
| | - Victoria Massamba
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, Qc, Canada
| | | | - Simon Patry
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada.,Institut Universitaire en Santé Mentale de Québec, 2601, Chemin de La Canardière, Quebec, QC, G1J 2G3, Canada
| | - Christian Gagné
- Computer Vision and Systems Laboratory, Université Laval, Quebec, Qc, Canada
| | - Morgane Lemasson
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Qc, Canada
| | - Geneviève Gariépy
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.,Institut Universitaire en Santé Mentale de Montréal Research Centre, Montreal, Qc, Canada
| | - Chantal Mérette
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Qc, Canada.,CERVO Research Centre, Quebec City, Canada
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Qc, Canada
| | - Alain Lesage
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, Qc, Canada.,Institut Universitaire en Santé Mentale de Montréal Research Centre, Montreal, Qc, Canada
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Rassy J, Lesage A, Labelle R, Saadi F, Goulet MH, Genest C, Maltais N, Larue C. Assessment and care of individuals at risk of suicide in Emergency Department: The SecUrgence protocol. Int Emerg Nurs 2022; 64:101199. [PMID: 36027701 DOI: 10.1016/j.ienj.2022.101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
Almost half (48,5%) of all individuals who die by suicide visited the Emergency Department (ED) in the year preceding their death by suicide and for almost a third (29,5%) of these individuals, the ED visit occurred within the month preceding their death by suicide. The ED is a key location for suicide prevention. The aim of this study was to develop and reach a consensus on the SecUrgence Protocol, a clinical protocol that intends to assess and provide care for individuals at risk of suicide that present themselves to the ED. This project was conducted in 3 stages: 1) Review of the literature, 2) Development of the list of the protocol statements by a first panel of experts, and 3) Validation, using the Delphi consensus method, on the final statements to include in the SecUrgence Protocol by a second panel of experts. Two rounds of the Delphi questionnaire were conducted until a final consensus of over 75% was reached. The SecUrgence Protocol is a first scientific step towards improving suicide prevention in the ED in Quebec as it was validated by a rigorous research process that included a consensus by all key stakeholders.
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Affiliation(s)
- Jessica Rassy
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; School of Nursing, University of Sherbrooke, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, QC, Canada; Charles-Le Moyne Research Centre, QC, Canada.
| | - Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Department of Psychiatry, University of Montreal, QC, Canada; Quebec Network on Suicide, Mood Disorders and Associated Disorders, QC, Canada
| | - Réal Labelle
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Department of Psychiatry, University of Montreal, QC, Canada; Department of Psychology, Université du Québec à Montréal, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada
| | - Farida Saadi
- Faculty of Nursing, University of Montreal, QC, Canada; CEMTL Maisonneuve Rosemont Hospital, CIUSSS de l'Est-de-l'île-de-Montréal, QC, Canada
| | - Marie-Hélène Goulet
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada
| | - Christine Genest
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada; Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada
| | - Nathalie Maltais
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, QC, Canada; Department of Health Sciences, Université du Québec à Rimouski, QC, Canada
| | - Caroline Larue
- Research Centre, Institut universitaire en santé mentale de Montréal, QC, Canada; Faculty of Nursing, University of Montreal, QC, Canada; Quebec Network on Nursing Intervention Research, QC, Canada
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Baltazar L, De Benedictis L, Abdel-Baki A, Lalonde P, Lesage A. Long term course and outcome of first episode schizophrenia: a 27-to-31-year follow-up. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1319-1328. [PMID: 34762145 DOI: 10.1007/s00127-021-02185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/31/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe long term clinical and functional outcomes of schizophrenia in a developed country. METHOD Long term longitudinal study of clinical and functional outcomes of incidence cohort of all consecutive admissions for a first hospitalization for schizophrenia between 1983 and 1987 in Montreal, Canada (n = 142). Data collection was conducted at admission, 5 years, 10-16 years and 27-31 years follow-up by reviewing hospital charts and government linked health administrative databases. RESULTS One fifth of patients were never re-hospitalized and 35% were still in contact with the same catchment area psychiatric services. Thirty-four (24%) died on average at 45.5 years. Fourteen (9.9%) died by suicide; half of them did so 10 years after their first hospitalization. Over 20% were exposed to clozapine and nearly 50% to long-acting injectable antipsychotic medication. There were no inmates; an estimated one fifth might be inferred to be living in supervised residential settings and the rest lived alone or with family. Approximately three quarters of the patients under 65 were receiving social assistance benefits at study's end. From 15 to 25% might have been employed (supported or competitive employment). CONCLUSION This study confirms that the long-term course of schizophrenia is heterogenous and mostly positive with most patients living in the community, although a significant proportion need long term support and an important proportion experience premature death. To mitigate the persistent suicide risk and to respond to their need for support, continuous mental health professional's involvement is required for many.
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Affiliation(s)
- Lori Baltazar
- Hôpital Rivières des Prairies, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada. .,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 7401 rue Hochelaga, Montréal, Québec, H1N 3M5, Canada.
| | - Luigi De Benedictis
- Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Centre Hospitalier Universitaire de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Pierre Lalonde
- Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Département de psychiatrie, Université de Montréal, Montréal, Québec, Canada
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Gabet M, Gentil L, Lesage A, Fleury MJ. Investigating characteristics of patients with mental disorders to predict out-patient physician follow-up within 30 days of emergency department discharge. BJPsych Open 2022; 8:e95. [PMID: 35579032 PMCID: PMC9169501 DOI: 10.1192/bjo.2022.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prompt follow-up at emergency department discharge is a key indicator of healthcare quality and patient recovery. To improve services, better knowledge of predictors for out-patient physician follow-up within 30 days after discharge is needed. AIMS We investigated clinical and sociodemographic characteristics and service use to predict patients with mental disorders with or without physician follow-up after emergency department use. METHOD This study used data extracted from clinical administrative databases for 9514 patients who attended an emergency department in Quebec (Canada) in 2014-2015 (index visit) for mental health reasons. Patient clinical and sociodemographic characteristics from 2012-2013 to 2014-2015, and service use 12 months before the index visit, were investigated as predictors for patients with or without prompt follow-up, using hierarchical logistic regression. RESULTS Two-thirds of patients did not receive prompt physician follow-up. Patients with level 1-2 illness acuity at emergency department triage (needing immediate or urgent care); those with adjustment or bipolar disorders, but without alcohol-related disorders (clinical characteristics); and patients with higher continuity of physician care, more psychosocial interventions in community healthcare centres and prior hospital admission (service use characteristics) were more likely to receive prompt out-patient follow-up. CONCLUSIONS Access to medical care was poor, considering the high needs of this population. The role of the emergency department as a gateway for accessing out-patient care may be strengthened by strategies like screening, brief intervention including motivational treatments, brief case management offered by emergency department staff, timely referral to services and better post-discharge planning. Collaborative care for patients attending emergency departments should also be improved.
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Affiliation(s)
- Morgane Gabet
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; and Douglas Hospital Research Center, Canada
| | - Lia Gentil
- Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
| | - Alain Lesage
- Department of Psychiatry, Université de Montréal, Canada; and Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Canada
| | - Marie-Josée Fleury
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
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Brodeur S, Vanasse A, Courteau J, Stip E, Lesage A, Fleury MJ, Courteau M, Roy MA. Comparative effectiveness and safety of antipsychotic drugs in patients with schizophrenia initiating or reinitiating treatment: A Real-World Observational Study. Acta Psychiatr Scand 2022; 145:456-468. [PMID: 35158404 DOI: 10.1111/acps.13413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of various second-generation antipsychotics (SGAs), newer oral and long-acting injectable (LAI) SGAs, and first-generation antipsychotics (FGAs) treatments in patients with schizophrenia or schizoaffective disorder (SCZ). METHODS This retrospective cohort study included medical administrative information for patients with a diagnosis of SCZ living in Quebec (Canada), initiating or reinitiating at least one antipsychotic (AP) drug (with a clearance baseline period of 12 months without any APs). Effectiveness was defined by a reduced risk of hospitalization for mental disorder and discontinuation, and safety by a reduced risk of all-cause death and hospitalization for non-mental disorder, 2 years after AP initiation or reinitiation. Cox proportional hazard models were used to estimate the events associated with different antipsychotics compared with oral olanzapine. RESULTS The study cohort included 19,615 patients initiating or reinitiating an antipsychotic drug between January 2006 and December 2015. Results showed better effectiveness of clozapine (adjusted HR 0.36, 95% CI 0.30-0.42, p < 0.0001) and LAI SGAs (adjusted HR 0.56, 95% CI 0.51-0.61, p < 0.0001) compared with oral olanzapine when adding discontinuation to hospitalizations for mental disorder as a composite measure of effectiveness, as opposed to oral FGAs (adjusted HR 1.36, 95% CI 1.27-1.46, p < 0.0001) and LAI FGAs (adjusted HR 1.22, 95% CI 1.12-1.32, p < 0.0001). Most APs were as safe as oral olanzapine. CONCLUSION The effectiveness of LAI SGAs and clozapine appears to justify their use and are as safe as a recognized treatment (oral olanzapine) in Quebec (Canada).
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, Québec, Canada
| | - Alain Vanasse
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada.,Département de Médecine de Famille et de Médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Josiane Courteau
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, Québec, Canada.,Research Centre, Institut Universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Mireille Courteau
- Groupe de Recherche PRIMUS, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, Québec, Canada.,Centre de Recherche CERVO, Québec City, Québec, Canada
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Brodeur S, Vanasse A, Courteau J, Courteau M, Stip E, Fleury MJ, Lesage A, Demers MF, Roy MA. Antipsychotic utilization trajectories three years after initiating or reinitiating treatment of schizophrenia: A state sequence analysis approach. Acta Psychiatr Scand 2022; 145:469-480. [PMID: 35152415 DOI: 10.1111/acps.13411] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aims to describe the utilization patterns of antipsychotic (AP) medication in patients with schizophrenia (SCZ), three years after initiating or reinitiating a given AP. METHODS Based on medico-administrative information on patients living in Quebec (Canada), this retrospective cohort study included 6444 patients with a previous diagnosis of SCZ initiating or reinitiating AP medication between January 1, 2012, and December 31, 2014, with continuous coverage by public drug insurance. For each day of follow-up (1092 days), patient was either exposed to one of the chosen categories of APs, or to none. This patient's sequence of AP exposure overtime has been referred to as the "antipsychotic utilization trajectory". These trajectories were analyzed using a State Sequence Analysis, an innovative approach which provides useful visual information on the continuation and discontinuation patterns of use over time. RESULTS Clozapine and long-acting injectable second-generation APs had the best continuation and discontinuation patterns over 3 years among all other groups, including less switching of APs, while oral first-generation APs had the poorest patterns. These findings were comparable among incident and non-incident cohorts. Oral second-generation antipsychotics, excluding clozapine, had a poorer continuation and discontinuation pattern than long-acting injectable antipsychotics. CONCLUSION State Sequence Analysis provides a clear representation of treatment adherence in comparison with dichotomous indicators of adherence or discontinuation. Consequently, this innovative method has shed light on the impact of the AP chosen to initiate or reinitiate treatment in SCZ, which has been identified as a key factor for long-term treatment continuation and discontinuation.
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, QC, Canada.,Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, Al Ain, UAE
| | - Marie-Josée Fleury
- Institut universitaire en santé mentale, Université McGill, Montréal, QC, Canada.,Département de Psychiatrie, Université McGill, Montréal, QC, Canada
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche, Institut universitaire en santé mentale de Montréal (IUSMM), Montréal, QC, Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Québec, QC, Canada.,Faculté de pharmacie, Université Laval, Québec, QC, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada.,Centre de Recherche CERVO, Québec, QC, Canada
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Diallo FB, Pelletier É, Vasiliadis HM, Rochette L, Vincent A, Palardy S, Lunghi C, Gignac M, Lesage A. Morbidities and mortality of diagnosed attention deficit hyperactivity disorder (ADHD) over the youth lifespan: A population-based retrospective cohort study. Int J Methods Psychiatr Res 2022; 31:e1903. [PMID: 34952999 PMCID: PMC8886284 DOI: 10.1002/mpr.1903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/07/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of ADHD, and related comorbidities, mortality, and type of health service use among children and young adults, using different case definitions. METHODS We conducted a population-based retrospective cohort study between 2000 and 2018, using the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database. All residents aged less than 25 years eligible for health insurance coverage were included. We compared outcomes of three indicators (morbidity, services use and mortality) according two different algorithms of ADHD definitions, to the general population. RESULTS The cumulative prevalence of ADHD has risen steadily over the past decade, reaching 12.6% in 2017-2018. People with ADHD have a higher prevalence of psychiatric comorbidities, make greater use of medical, mental health services, and are hospitalized more often. The comparison of prevalence between the two algorithms and the general population for the three indicators showed that the cohort having one claim was very close to that with two or more, and statistically significant higher to that of people without ADHD. CONCLUSION This finding support that a single claim algorithm for ADHD can be used for case definition. More research is needed on the impact of potentially effective treatments in improving consequences of ADHD.
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Affiliation(s)
- Fatoumata Binta Diallo
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Éric Pelletier
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Science, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis Rochette
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Annick Vincent
- Clinique FOCUS, Saint-Augustin-de-Desmaures, Quebec, Canada
| | - Sylvain Palardy
- Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Carlotta Lunghi
- Department of Health sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Martin Gignac
- Montreal Children's Hospital, McGill University Montreal, Montreal, Quebec, Canada
| | - Alain Lesage
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada.,Department of Psychiatry, University of Montreal, Research Centre of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
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25
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Lesage A, Courteau J, Brodeur S, Stip E, Fleury MJ, Courteau M, Roy MA, Vanasse A. Urbanicity, Schizophrenia and Equitable Specialist Services Allocation. Can J Psychiatry 2022; 67:160-161. [PMID: 34482764 PMCID: PMC8892047 DOI: 10.1177/07067437211040606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal
(IUSMM), Montréal, Quebec
- Département de Psychiatrie et d’Addictologie, Université de Montréal,
Montréal, Quebec
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
| | - Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, Quebec
| | - Emmanuel Stip
- Département de Psychiatrie et d’Addictologie, Université de Montréal,
Montréal, Quebec
- Department of Psychiatry and Behavioral Science, College of Medicine and
Health Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, Montréal,
Quebec
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, Quebec
- Centre de Recherche CERVO, Québec, Quebec
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier
universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec
- Département de médecine de famille et de médecine d’urgence, Université de
Sherbrooke, Sherbrooke, Quebec
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Huỳnh C, Kisely S, Rochette L, Pelletier É, Morrison KB, Li S, Hopkin G, Smith M, Burchill C, Lin E, Asbridge M, Jutras-Aswad D, Lesage A. Measuring Substance-Related Disorders Using Canadian Administrative Health Databanks: Interprovincial Comparisons of Recorded Diagnostic Rates, Incidence Proportions and Mortality Rate Ratios. Can J Psychiatry 2022; 67:117-129. [PMID: 34569874 PMCID: PMC8978214 DOI: 10.1177/07067437211043446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Assessing temporal changes in the recorded diagnostic rates, incidence proportions, and health outcomes of substance-related disorders (SRD) can inform public health policymakers in reducing harms associated with alcohol and other drugs. OBJECTIVE To report the annual and cumulative recorded diagnostic rates and incidence proportions of SRD, as well as mortality rate ratios (MRRs) by cause of death among this group in Canada, according to their province of residence. METHODS Analyses were performed on linked administrative health databases (AHD; physician claims, hospitalizations, and vital statistics) in five Canadian provinces (Alberta, Manitoba, Ontario, Québec, and Nova Scotia). Canadians 12 years and older and registered for their provincial healthcare coverage were included. The International Classification of Diseases (ICD-9 or ICD-10 codes) was used for case identification of SRD from April 2001 to March 2018. RESULTS During the study period, the annual recorded SRD diagnostic rates increased in Alberta (2001-2002: 8.0‰; 2017-2018: 12.8‰), Ontario (2001-2002: 11.5‰; 2017-2018: 14.4‰), and Nova Scotia (2001-2002: 6.4‰; 2017-2018: 12.7‰), but remained stable in Manitoba (2001-2002: 5.5‰; 2017-2018: 5.4‰) and Québec (2001-2002 and 2017-2018: 7.5‰). Cumulative recorded SRD diagnostic rates increased steadily for all provinces. Recorded incidence proportions increased significantly in Alberta (2001-2002: 4.5‰; 2017-2018: 5.0‰) and Nova Scotia (2001-2002: 3.3‰; 2017-2018: 3.8‰), but significantly decreased in Ontario (2001-2002: 6.2‰; 2017-2018: 4.7‰), Québec (2001-2002: 4.1‰; 2017-2018: 3.2‰) and Manitoba (2001-2002: 2.7‰; 2017-2018: 2.0‰). For almost all causes of death, a higher MRR was found among individuals with recorded SRD than in the general population. The causes of death in 2015-2016 with the highest MRR for SRD individuals were SRD, suicide, and non-suicide trauma in Alberta, Ontario, Manitoba, and Québec. DISCUSSION Linked AHD covering almost the entire population can be useful to monitor the medical service trends of SRD and, therefore, guide health services planning in Canadian provinces.
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Affiliation(s)
- Christophe Huỳnh
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,School of Psychoeducation, University of Montréal, Montréal, Québec, Canada.,Recherche et Intervention sur les Substances Psychoactives - Québec, Trois-Rivières, Québec, Canada.,54470Institut National de Santé Publique du Québec, Québec, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, 12361Dalhousie University, Halifax, Nova Scotia, Canada.,School of Medicine, University of Queensland, Queensland, Australia
| | - Louis Rochette
- 54470Institut National de Santé Publique du Québec, Québec, Canada
| | - Éric Pelletier
- 54470Institut National de Santé Publique du Québec, Québec, Canada
| | | | - Shelley Li
- 151965Alberta Health, Edmonton, Alberta, Canada
| | - Gareth Hopkin
- Institute of Health Economics & University of Alberta, Edmonton, Alberta, Canada.,Health Technology Wales, 1029NHS Wales/GIG Cymru, Cardiff, Wales, UK
| | - Mark Smith
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, 50023University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles Burchill
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, 50023University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Lin
- 7978Centre for Addiction & Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, 12361Dalhousie University, Halifax, Nova Scotia, Canada
| | - Didier Jutras-Aswad
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,Research Centre, 5622Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Alain Lesage
- University Institute on Addictions, 49987CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Québec.,Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.,54470Institut National de Santé Publique du Québec, Québec, Canada.,25443Research Centre of the Montréal Mental Health University Institute, Montréal, Québec, Canada
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Lepeltier H, Lepetit A, Gauberti M, Escalard C, Salaun JP, Bénard C, Lesage A, Brossier D, Goyer I. Dexmedetomidine sedation vs. inhaled general anesthesia for pediatric MRI: A retrospective cohort study: Dexmedetomidine sedation vs. inhaled general anesthesia for MRI. Arch Pediatr 2022; 29:213-218. [PMID: 35115217 DOI: 10.1016/j.arcped.2022.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the feasibility and the efficacy of a dexmedetomidine-based protocol followed by anesthesiologists unaccustomed to using dexmedetomidine during pediatric magnetic resonance imaging (MRI) examinations compared to conventional halogenated general anesthesia. METHODS This was a single-center retrospective cohort study including patients younger than 18 years who underwent sedation for MRI between August 1, 2018 and March 31, 2019. Patients who received dexmedetomidine were included in the DEX group and patients who had general anesthesia formed the GA group. Patients were matched with a ratio of 2 GA:1 DEX, based on age and type of MRI examination. RESULTS Overall, 78 patients were included (DEX=26; GA=52). Dexmedetomidine was significantly associated with a decrease in invasive ventilation (p<0.001) with no impact on image quality. The sedation failure rate was 42% with dexmedetomidine vs. 0% with general anesthesia (p<0.001). All cases of failure followed the intranasal administration of dexmedetomidine. CONCLUSION Dexmedetomidine seems to be a suitable sedation option for pediatric MRI. It provides an alternative to halogenated general anesthesia with the aim of limiting exposure to conventional anesthetic agents and invasive ventilation.
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Affiliation(s)
- H Lepeltier
- Department of pediatrics, CHU de Caen, Caen, F-14000, France
| | - A Lepetit
- Department of anesthesia, CHU de Caen, F-14000, France
| | - M Gauberti
- Department of radiology, CHU de Caen, F-14000, France
| | - C Escalard
- Department of radiology, CHU de Caen, F-14000, France
| | - J-P Salaun
- Department of anesthesia, CHU de Caen, F-14000, France
| | - C Bénard
- Department of anesthesia, CHU de Caen, F-14000, France
| | - A Lesage
- Department of anesthesia, CHU de Caen, F-14000, France
| | - D Brossier
- University Caen Normandie, School of Medicine, Caen, F-14000, France; Pediatric Intensive Care Unit, CHU de Caen, Caen, F-14000, France.
| | - I Goyer
- Department of pediatrics, CHU de Caen, Caen, F-14000, France; Department of anesthesia, CHU de Caen, F-14000, France; Department of pharmacy, CHU de Caen, F-14000, France
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Brodeur S, Courteau J, Vanasse A, Courteau M, Stip E, Fleury MJ, Lesage A, Demers MF, Corbeil O, Béchard L, Roy MA. Association between previous and future antipsychotic adherence in patients initiating clozapine: real-world observational study. Br J Psychiatry 2022; 220:1-8. [PMID: 35082000 DOI: 10.1192/bjp.2022.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although recognised as the most effective antipsychotic for treatment-resistant schizophrenia, clozapine remains underused. One reason is the widespread concern about non-adherence to clozapine because of poor adherence before initiating clozapine. AIMS To determine if prior poor out-patient adherence to treatmentbefore initiating clozapine predisposes to poor out-patient adherence to clozapine or to any antipsychotics (including clozapine) after its initiation. METHOD This cohort study included 3228 patients with schizophrenia living in Quebec (Canada) initiating (with a 2-year clearance period) oral clozapine (index date) between 2009 and 2016. Using pharmacy data, out-patient adherence to treatment was measured by the medication possession ratio (MPR), over a 1-year period preceding and following the index date. Five groups of patients were formed based on their prior MPR level (independent variable). Two dependent variables were defined after clozapine initiation (good out-patient adherence to any antipsychotics and to clozapine only). Along with multiple logistic regressions, state sequence analysis was used as a visual representation of antipsychotic-use trajectories over time, before and after clozapine initiation. RESULTS Although prior poor adherence to antipsychotics was associated with poor adherence after clozapine initiation, the absolute risk of subsequent poor adherence remained low, regardless of previous adherence level. Most patients adhered to their treatment after initiating clozapine (>68% to clozapine and >84% to any antipsychotics). CONCLUSIONS Despite the fact that poor adherence prior to initiating clozapine is widely recognised by clinicians as a barrier for the prescription of clozapine, the current study supports the initiation of clozapine in all eligible patients.
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Affiliation(s)
- Sébastien Brodeur
- Département de Psychiatrie et Neurosciences, Université Laval, Canada
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada
| | - Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada and Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Canada and Department of Psychiatry and Behavioral Science, College of Medicine and Health Science, United Arab Emirates University, United Arab Emirates
| | - Marie-Josée Fleury
- Institut universitaire en santé mentale, Université McGill, Canada and Département de Psychiatrie, Université McGill, Canada
| | - Alain Lesage
- Département de Psychiatrie et d'Addictologie, Université de Montréal, Canada and Centre de Recherche, Institut universitaire en santé mentale de Montréal (IUSMM), Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Canada and Faculté de pharmacie, Université Laval, Canada
| | | | | | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Canada andCentre de Recherche CERVO, Canada
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Ligier F, Body Lawson F, Lamourette M, Giguère CE, Lesage A, Séguin M. Comparing Childhood Characteristics of Adopted and Non-adopted Individuals Deceased by Suicide. Front Psychiatry 2022; 13:756306. [PMID: 35722592 PMCID: PMC9203736 DOI: 10.3389/fpsyt.2022.756306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Across the globe more than 35,000 children a year are adopted by non-relatives, and some studies suggest that adopted individuals may be more vulnerable to developing mental disorders. To map the differences in suicide risk factors in adopted and non-adopted individuals, this study will compare the development of mental disorders as well as life events occurring before the age of 18 for both adopted and non-adopted individuals deceased by suicide. METHODS This study included 13 adopted and 26 non-adopted individuals deceased by suicide as well as 26 non-adopted living control individuals. Cases were taken from a data bank created over the last decade by researchers of [our institution] comprising a mixture of 700 suicide cases and living control individuals aged from 14 to 84. Adopted and non-adopted individuals deceased by suicide; adopted individuals deceased by suicide and non-adopted living control individuals were each compared on Axis I and II disorders, early life events, and burdens of adversity. RESULTS Results show significant differences, with a higher rate of Attention Deficit Hyperactivity Disorder, mental health comorbidity and Cluster C personality disorders among adopted individuals. Furthermore, adopted individuals have higher adversity scores prior to the age of 15. CONCLUSION This study underlines the fact that adoptive families need to be supported throughout adoption. Health care professionals need specialized training on this matter, and the psychological challenges adopted individuals face need to be treated at the earliest juncture.
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Affiliation(s)
- Fabienne Ligier
- McGill Group on Suicide Studies, Montréal, QC, Canada.,Psychiatry Department, Montréal University, Montréal, QC, Canada.,Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada.,EA 4360 APEMAC, Université de Lorraine, Nancy, France.,PUPEA, Centre Psychothérapique de Nancy, Laxou, France
| | | | | | - Charles-Edouard Giguère
- Banque Signature, Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Alain Lesage
- McGill Group on Suicide Studies, Montréal, QC, Canada.,Psychiatry Department, Montréal University, Montréal, QC, Canada.,Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada.,Québec Network on Suicide Research, Québec, QC, Canada
| | - Monique Séguin
- McGill Group on Suicide Studies, Montréal, QC, Canada.,Québec Network on Suicide Research, Québec, QC, Canada.,Department of Psychoeducation and Psychology, Québec University, Québec, QC, Canada.,Centre Intégré de Santé et Service Social de l'Outaouais (CISSSO), Gatineau, QC, Canada
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Touré M, Lesage A, Poder TG. Development of a balanced instrument to measure global health-related quality of life: The 13-MD. Front Psychiatry 2022; 13:837510. [PMID: 36147971 PMCID: PMC9485584 DOI: 10.3389/fpsyt.2022.837510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Generic instruments are of interest in measuring global health-related quality of life (GHRQoL). Their applicability to all patients, regardless of their health profile, allows program comparisons of whether the patients share the same disease or not. In this setting, quality-adjusted life-year (QALY) instruments must consider GHRQoL to allow the best programs to emerge for more efficiency in health resource utilization. However, many differences may be perceived among the existing generic instruments relative to their composition, where dimensions related to physical aspects of health are generally depicted more often than dimensions related to mental or social aspects. The objective of this study was to develop a generic instrument that would be complete in its covered meta-dimensions and reflect, in a balanced way, the important aspects of GHRQoL. To this end, a Delphi procedure was held in four rounds, gathering 18 participants, including seven patients, six caregivers, and five citizens. The structure of the instrument derived from the Delphi procedure was submitted to psychometric tests using data from an online survey involving the general population of Quebec, Canada (n = 2,273). The resulting questionnaire, the 13-MD, showed satisfying psychometric properties. It comprises 33 items or dimensions, with five to seven levels each. The 13-MD reflects, in a balanced form, the essential aspects of GHRQoL by including five meta-dimensions for physical health, four meta-dimensions for mental health, three meta-dimensions for social health, and one meta-dimension for sexuality and intimacy. The next step will involve the development of a value set for the 13-MD to allow QALY calculation.
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Affiliation(s)
- Moustapha Touré
- Department of Economics, Business School, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de Recherche de l'IUSMM, CIUSSS de l'Est de L'île de Montréal, Montréal, QC, Canada
| | - Alain Lesage
- Centre de Recherche de l'IUSMM, CIUSSS de l'Est de L'île de Montréal, Montréal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Thomas G Poder
- Centre de Recherche de l'IUSMM, CIUSSS de l'Est de L'île de Montréal, Montréal, QC, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada
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Rassy J, Daneau D, Larue C, Rahme E, Low N, Lamarre S, Turecki G, Bonin JP, Racine H, Morin S, Dasgupta K, Renaud J, Lesage A. Measuring Quality of Care Received by Suicide Attempters in the Emergency Department. Arch Suicide Res 2022; 26:81-90. [PMID: 32715983 DOI: 10.1080/13811118.2020.1793043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT Audits conducted on medical records have been traditionally used in hospitals to assess and improve quality of medical care but have yet to be properly integrated and used for suicide prevention purposes. We aimed to (1) revise a quality of care grid and adapt it to an adult population of suicide attempters and (2) identify quality of care deficits in managing adult suicide attempters at the emergency department (ED) in two different Montreal university hospitals. METHODS An existing checklist for quality of medical and social care in the ED was adapted. A systematic search and data extraction of all suicide attempters in two different Montreal university hospitals were then conducted. All identified individuals who attempted suicide were fully reviewed and quality of care was assessed. RESULTS Eleven criteria were kept by the expert focus group in the revised grid that was then used to rate 369 individuals that attempted suicide. Suicide risk assessment was only present in 63% of attempters before discharge. Although family history was documented for 90% of attempters, in only 41% of the cases were interviews conducted with relatives. Most discharged patient lacked proper follow-up considering 11% of their relatives received written information on resources in case of need. DISCUSSION Paper records may be used to systematically assess the quality of care for suicide attempters seen in ED. Results reiterate the need for better suicide prevention strategies for these individuals. The checklist proved to be an excellent assessment of best practices or identification of possible improvements.
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Cailhol L, Pelletier É, Rochette L, Renaud S, Koch M, David P, Villeneuve E, Lunghi C, Lesage A. Utilization of Health Care Services by Patients With Cluster B Personality Disorders or Schizophrenia. Psychiatr Serv 2021; 72:1392-1399. [PMID: 34281361 DOI: 10.1176/appi.ps.202000554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The comparable severities of cluster B personality disorders and schizophrenia are increasingly recognized. The authors sought to compare the general medical and psychiatric comorbid conditions and use of medical services among individuals with one or both of these disorders. METHODS Data were collected from the linked health administrative databases of Quebec's universal health plan in the Quebec Integrated Chronic Disease Surveillance System, which covers 99% of Quebec's population. The study cohort of 2016-2017 included almost 7.05 million people, and the study covered the 1996-2017 period. RESULTS Comorbid conditions were extremely prevalent in the three groups studied-persons with cluster B personality disorders, schizophrenia, or both-compared with the general population. People having both disorders had the highest prevalence of comorbid conditions. Psychiatric services were used more frequently by individuals in all three groups than among those in the general population, and use was especially high among people with both disorders. Medical care service use was heterogeneous, with patients with cluster B personality disorders using more medical care services but fewer specialized outpatient treatments and psychotherapy than those with schizophrenia or with both disorders. CONCLUSIONS The three cohorts had higher rates of comorbid conditions and health care service use than individuals in the general population. Patients with cluster B personality disorders used fewer psychiatric services than patients with schizophrenia or with both disorders. One explanation for this difference may be that people with cluster B personality disorders encounter more obstacles in accessing mental health care services.
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Affiliation(s)
- Lionel Cailhol
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Éric Pelletier
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Louis Rochette
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Suzane Renaud
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Marion Koch
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Pierre David
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Evens Villeneuve
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Carlotta Lunghi
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
| | - Alain Lesage
- Department of Psychiatry, Institut Universitaire de Santé Mentale, and Department of Psychiatry and Addiction, Université de Montréal, Montreal (Cailhol, David, Lesage); Evaluation of Programs and Surveillance of Chronic Diseases, Trauma and Their Determinants, Institut National de Santé Publique, Quebec (Pelletier, Rochette, Lesage); Department of Psychiatry, Institut Universitaire de Santé Mentale Douglas, Montreal (Renaud); Department of Psychiatry, Université McGill, Montreal (Renaud, Koch); Department of Psychiatry, Hôpital de Gatineau, Gatineau, Quebec (Koch); Department of Psychiatry, Institut Universitaire de Santé Mentale de Québec, and Department of Psychiatry, Université de Laval, Quebec (Villeneuve); Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, and Centre de Recherche de CISSS Chaudière-Appalaches, Lévis, Quebec (Lunghi)
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Pena-Gralle APB, Talbot D, Trudel X, Aubé K, Lesage A, Lauzier S, Milot A, Brisson C. Validation of case definitions of depression derived from administrative data against the CIDI-SF as reference standard: results from the PROspective Québec (PROQ) study. BMC Psychiatry 2021; 21:491. [PMID: 34620134 PMCID: PMC8496029 DOI: 10.1186/s12888-021-03501-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Administrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. However, the validity of administrative data in the correct identification of depression has not yet been studied in general populations. The present study aimed to 1) evaluate the sensitivity and specificity of administrative cases of depression using the validated Composite International Diagnostic Interview - Short Form (CIDI-SF) as reference standard and 2) compare the known-groups validity between administrative and CIDI-SF cases of depression. METHODS The 5487 participants seen at the last wave (2015-2018) of the PROQ cohort had CIDI-SF questionnaire data linked to hospitalization and medical reimbursement data provided by the provincial universal healthcare provider and coded using the International Classification of Disease. We analyzed the sensitivity and specificity of several case definitions of depression from this administrative data. Their association with known predictors of depression was estimated using robust Poisson regression models. RESULTS Administrative cases of depression showed high specificity (≥ 96%), low sensitivity (19-32%), and rather low agreement (Cohen's kappa of 0.21-0.25) compared with the CIDI-SF. These results were consistent over strata of sex, age and education level and with varying case definitions. In known-groups analysis, the administrative cases of depression were comparable to that of CIDI-SF cases (RR for sex: 1.80 vs 2.03 respectively, age: 1.53 vs 1.40, education: 1.52 vs 1.28, psychological distress: 2.21 vs 2.65). CONCLUSION The results obtained in this large sample of a general population suggest that the dimensions of depression captured by administrative data and by the CIDI-SF are partially distinct. However, their known-groups validity in relation to risk factors for depression was similar to that of CIDI-SF cases. We suggest that neither of these data sources is superior to the other in the context of large epidemiological studies aiming to identify and quantify risk factors for depression.
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Affiliation(s)
- Ana Paula Bruno Pena-Gralle
- CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC, Canada. .,Faculty of Medicine, Laval University, Québec, QC, Canada.
| | - Denis Talbot
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Xavier Trudel
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Karine Aubé
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Alain Lesage
- grid.14848.310000 0001 2292 3357Département de Psychiatrie et d’addictologie, Université de Montréal, Montréal, Canada
| | - Sophie Lauzier
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Pharmacy, Laval University, Québec, QC Canada
| | - Alain Milot
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada
| | - Chantal Brisson
- grid.411081.d0000 0000 9471 1794CHU de Québec Research Center, Population Health and Optimal Health Practices Unit, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Faculty of Medicine, Laval University, Québec, QC Canada ,grid.23856.3a0000 0004 1936 8390Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Québec, QC Canada
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Tousignant M, Séguin M, Turecki G, Chawky N, Vanier C, Morissette R, Lesage A. Adult men suicide: a developmental approach. J Mens Health 2021. [DOI: 10.31083/jomh.2021.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Roberge P, Vasiliadis HM, Lesage A, Labelle R, Haskelberg H, Grenier J, Drapeau M, Provencher M. Transdiagnostic internet cbt for mixed anxiety and depressive: Results from a feasibility study in primary care. Eur Psychiatry 2021. [PMCID: PMC9471309 DOI: 10.1192/j.eurpsy.2021.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionIn response to the treatment gap for anxiety and depressive disorders, psychological treatments with innovative modalities and high implementation potential are essential. Internet CBT (iCBT) is a cost/effective approach that could improve access to a low-intensity evidence-based CBT intervention.ObjectivesTo assess the feasibility and acceptability of the French adaptation of the physician-prescribed six-lesson This Way Up transdiagnostic iCBT program for mixed anxiety and depressive disorders developed in Australia.MethodsFeasibility study with pre- post-intervention evaluations, including an embedded qualitative study in Family Medicine Groups (Quebec, Canada). Inclusion criteria comprise a family physician diagnosis of Major Depression, Panic Disorder, Agoraphobia, Social Anxiety Disorder or Generalized Anxiety Disorder. Primary self-reported outcomes: PHQ-9 (depression) and GAD-7 (anxiety); secondary measures include diagnostic-specific scales and health service utilisation.ResultsFamily physicians (N=21) from five Family Medicine Groups prescribed iCBT to 45 patients (30 women, 15 men; mean age = 39.7), 31 initiated the program. To date, 20 patients completed 5 or 6 lessons, nine completed between 2 and 4. Intervention and post-treatment assessments are ongoing, results forthcoming. Results of semi-structured interviews with patients (N=15) and family physicians (ongoing) on iCBT acceptability indicate it is beneficial, practical and easy to use. Program adherence requires patient readiness and determination and could be fostered by motivational support from clinicians.ConclusionsResults support this French iCBT program’s scaling-up potential to contribute to reducing the gap in evidence-based treatments for common mental disorders. Its implementation in primary care could improve the effectiveness, efficiency and equity to a rapidly accessible treatment.
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Fortin G, Ligier F, Van Haaster I, Doyon C, Daneau D, Lesage A. Systematic Suicide Audit: An Enhanced Method to Assess System Gaps and Mobilize Leaders for Prevention. Qual Manag Health Care 2021; 30:97-103. [PMID: 33633004 DOI: 10.1097/qmh.0000000000000302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES In Quebec, Canada, several independent processes are in place to investigate cases of death by suicide. An enhanced multidisciplinary audit process was developed to analyze these cases more thoroughly, with the aim of generating recommendations for suicide prevention. A study was undertaken to evaluate the feasibility and implementability of this process. METHODS The life trajectories of 14 people who died by suicide in Montreal, Canada, in 2016 were reconstructed on the basis of information retrieved by interviewing bereaved relatives and examining coroner investigation files and other records. A multidisciplinary panel that included a representative of families bereaved by suicide then reviewed case summaries to determine unmet needs and service gaps at 3 levels: individual intervention, regional programs, and the provincial health and social services system. RESULTS The feasibility of the audit process was demonstrated in the context of a public health care system. Thirty-one distinct recommendations were made variably across 13 of the 14 cases reviewed, whereas none had originally been made by the coroner. The recommendations that recurred most often were (1) improve training for professionals and educate the general public regarding depression and substance-related disorders; (2) deploy mobile crisis intervention teams from emergency departments; and (3) provide access to a family physician to all, especially men. CONCLUSION Although the audit produced novel recommendations and is implementable, there was resistance from physicians and their hospital mortality review committee against this multidisciplinary audit involving families. These concerns could be alleviated by having the process endorsed by provincial authorities.
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Affiliation(s)
- Gabrielle Fortin
- Institut universitaire en santé mentale de Montréal Research Centre, Montreal, Quebec, Canada (Mss Fortin and Daneau, Mr Doyon, and Dr Lesage); Centre Psychothérapique de Nancy, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Laxou, Lorraine, France (Dr Ligier); Université de Lorraine, EA 4360 APEMAC, Nancy, Lorraine, France (Dr Ligier); CIUSSS de l'Est-de-l'Île-de-Montréal, CLSC St-Michel, Montreal, Quebec, Canada (Dr Van Haaster); and Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada (Dr Lesage)
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Vasiliadis HM, Spagnolo J, Lesage A. Public Funding of Evidence-Based Psychotherapy for Common Mental Disorders: Increasing Calls for Action in Canadian Provinces. Healthc Policy 2021; 16:16-25. [PMID: 33720820 PMCID: PMC7957359 DOI: 10.12927/hcpol.2021.26437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Canada's provinces are without a publicly funded psychotherapy program for common mental disorders despite evidence that psychological services help reduce the length and number of depressive episodes, symptoms of post-traumatic stress and associated negative outcomes (hospitalizations and suicide attempts). Studies also show that including psychological services as part of the service package offered under the public health plan for those without access pays for itself. We posit that a publicly funded psychotherapy program in Canada, including digitized self-guided psychotherapy platforms for common mental disorders, will lead to improved population health useful in the COVID-19 context and beyond.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Full Professor, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC
| | - Jessica Spagnolo
- Postdoctoral Fellow, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC
| | - Alain Lesage
- Full Professor, Departement of Psychiatry, University of Montreal, Centre de Recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC
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Huỳnh C, Kisely S, Rochette L, Pelletier É, Jutras-Aswad D, Larocque A, Fleury MJ, Lesage A. Using administrative health data to estimate prevalence and mortality rates of alcohol and other substance-related disorders for surveillance purposes. Drug Alcohol Rev 2021; 40:662-672. [PMID: 33432695 DOI: 10.1111/dar.13235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Administrative health databases (AHD) are critical to guide health service management and can inform the whole spectrum of substance-related disorders (SRD). This study estimates prevalence and mortality rates of SRD in administrative health databases. METHODS The Quebec Integrated Chronic Disease Surveillance System consists of linked AHD. Analyses were performed on data of all Quebec residents aged 12 and over and eligible for health-care coverage using the International Classification of Diseases (ninth or tenth revision) for case identification. Mortality rate ratios stratified by causes of death were obtained to calculate an excess of mortality. RESULTS Since 2001-2002, the annual age-adjusted prevalence rate of diagnosed overall SRD remained stable (8.6 per 1000 in 2017-2018). In any given year, the annual prevalence rate was significantly higher in males; adolescents had the lowest rate, while adults 65 years and older the highest. The annual 2017-2018 rate was 2.1 per 1000 for alcohol-induced disorder, 1.9 for other drug-induced disorder, 0.7 for alcohol intoxication and 0.6 for other drug intoxications. Cumulative rate of any diagnosis related to alcohol was 32 per 1000 females and 53 per 1000 males (2001-2018), and 33 per 1000 females and 49 per 1000 males for any diagnosis related to other drugs. There was an excess of all-cause mortality among individuals with SRD compared to the general population. DISCUSSION AND CONCLUSIONS AHD can complement epidemiological surveys in monitoring SRD jurisdiction-wide. Surveillance of services utilisation and interventions, coupled with health outcomes like mortality, could be useful in guiding health services planning.
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Affiliation(s)
- Christophe Huỳnh
- University Institute on Addictions, CIUSSS du Centre-Sud-de-l'Île-de-Montréal (Integrated University Centre of Health and Social Services of the Centre-South-of-the-Island-of-Montréal), Montreal, Canada.,Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,School of Psychoeducation, University of Montreal, Montreal, Canada.,Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada
| | - Didier Jutras-Aswad
- University Institute on Addictions, CIUSSS du Centre-Sud-de-l'Île-de-Montréal (Integrated University Centre of Health and Social Services of the Centre-South-of-the-Island-of-Montréal), Montreal, Canada.,Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,Research Centre, Centre Hospitalier de l'Université de Montréal (University of Montreal Health Centre), Montreal, Canada
| | - Alexandre Larocque
- Department of Emergency Medicine, Centre Hospitalier de l'Université de Montréal (University of Montreal Health Centre), Montreal, Canada.,Quebec Poison Control Center, Québec City, Canada
| | | | - Alain Lesage
- Department of Psychiatry and Addiction, University of Montréal, Montreal, Canada.,Bureau d'information et d'études en santé des populations (Bureau of Information and Studies on the Health of Populations), Institut National de Santé Publique du Québec (National Institute of Public Health of Quebec), Quebec City, Canada.,Research Centre of the Montreal Mental Health University Institute, Montreal, Canada
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Pelletier JF, Houle J, Goulet MH, Juster RP, Giguère CÉ, Bordet J, Hénault I, Lesage A, De Benedictis L, Denis F, Ng R. Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study. JMIR Res Protoc 2020; 9:e22500. [PMID: 33259326 PMCID: PMC7752185 DOI: 10.2196/22500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/20/2020] [Accepted: 11/24/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated. OBJECTIVE This paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting. METHODS PSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups-patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)-compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test. RESULTS This pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020. CONCLUSIONS Study results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study. TRIAL REGISTRATION ClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/22500.
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Affiliation(s)
- Jean-Francois Pelletier
- Department of Psychiatry and Addictology, Montreal Mental Health University Institute - Research Centre, University of Montreal, Montreal, QC, Canada
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | | | - Robert-Paul Juster
- Department of Psychiatry and Addictology, Montreal Mental Health University Institute - Research Centre, University of Montreal, Montreal, QC, Canada
| | | | - Jonathan Bordet
- Montreal Mental Health University Institute - Research Centre, Montreal, QC, Canada
| | - Isabelle Hénault
- Quebec Association of Peer Support Workers, Montreal, QC, Canada
| | - Alain Lesage
- Department of Psychiatry and Addictology, Montreal Mental Health University Institute - Research Centre, University of Montreal, Montreal, QC, Canada
| | - Luigi De Benedictis
- Montreal Mental Health University Institute - Research Centre, Montreal, QC, Canada
| | | | - Roger Ng
- Kowloon Hospital, Hong Kong, China
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Rapisarda F, Vallarino M, Cavallini E, Barbato A, Brousseau-Paradis C, De Benedictis L, Lesage A. The Early Impact of the Covid-19 Emergency on Mental Health Workers: A Survey in Lombardy, Italy. Int J Environ Res Public Health 2020; 17:ijerph17228615. [PMID: 33233513 PMCID: PMC7699473 DOI: 10.3390/ijerph17228615] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 01/12/2023]
Abstract
Lombardy was the epicenter of the Covid-19 outbreak in Italy, and in March 2020 the rapid escalation in cases prompted the Italian Government to decree a mandatory lockdown and to introduce safety practices in mental health services. The general objective of the study is to evaluate the early impact of the Covid-19 emergency and quarantine on the well-being and work practices of mental health service personnel and professionals. Data were collected through an online survey of workers and professionals working with people with mental health problems in Lombardy in several outpatient and inpatient services. Their socio-demographic characteristics, professional background, description of working conditions during lockdown and psychological distress levels were collected. All analyses were performed on a sample of 241. Approximately, 31% of the participants obtained a severe score in at least one of the burnout dimensions, 11.6% showed moderate or severe levels of anxiety, and 6.6% had a moderate or severe level of depression. Different work conditions and patterns of distress were found for outpatient service workers and inpatient service workers. The overall impact of the Covid-19 emergency on mental health workers' level of distress was mild, although a significant number of workers experienced severe levels of depersonalization and anxiety. More research is needed to assess specific predictive factors.
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Affiliation(s)
- Filippo Rapisarda
- Research and Development Team, Sociosfera ONLUS SCS, Via Antonio Gramsci 8, 20831 Seregno, Italy
- Correspondence:
| | - Martine Vallarino
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (M.V.); (E.C.)
| | - Elena Cavallini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (M.V.); (E.C.)
| | - Angelo Barbato
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Mario Negri 2, 20156 Milano, Italy;
| | - Camille Brousseau-Paradis
- Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est-de-l’Île-de-Montréal, 7401 Rue Hochelaga, Montreal, QC H1N 3M5, Canada; (C.B.-P.); (L.D.B.); (A.L.)
| | - Luigi De Benedictis
- Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est-de-l’Île-de-Montréal, 7401 Rue Hochelaga, Montreal, QC H1N 3M5, Canada; (C.B.-P.); (L.D.B.); (A.L.)
| | - Alain Lesage
- Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est-de-l’Île-de-Montréal, 7401 Rue Hochelaga, Montreal, QC H1N 3M5, Canada; (C.B.-P.); (L.D.B.); (A.L.)
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Derendorf H, Lesage A, Crabbé R, Lu P, Groen K, Rodriguez M, Leal N, Knolle J. P151 BRADYKININ CHALLENGE PROVIDES SURROGATE ENDPOINTS FOR HEREDITARY ANGIOEDEMA TREATMENT USING BRADYKININ-B2-RECEPTOR ANTAGONISTS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ligier F, Rassy J, Fortin G, van Haaster I, Doyon C, Brouillard C, Séguin M, Lesage A. Being pro-active in meeting the needs of suicide-bereaved survivors: results from a systematic audit in Montréal. BMC Public Health 2020; 20:1534. [PMID: 33036601 PMCID: PMC7547412 DOI: 10.1186/s12889-020-09636-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Suicide is a major public health concern. In 2017, the suicide rate in Canada was 11 per 100,000 inhabitants. According to literature, 1 in 5 people have experienced a death by suicide during their lifetime. The aim of this study was to describe the met and unmet needs of suicide-bereaved survivors and to provide postvention recommendations. METHODS Further to an exploratory mixed-method audit of 39 suicides that occurred in Montreal (Canada) in 2016, suicide-bereaved survivors (n = 29) participated in semi-structured interviews and completed instruments to discuss and assess potential pathological grief, depression (PHQ-9), and anxiety (GAD-7), as well as health and social services utilization. A panel then reviewed each case and provided recommendations. The mean age of participants was 57.7 years and 23 were women. RESULTS Although help was offered initially, in most cases by a health professional or service provider (16/29), 22 survivors would have liked to be contacted by telephone in the first 2 months post suicide. Four categories of individual unmet needs (medical/pharmacological, information, support, and outreach) and one collective unmet need (suicide pre/postvention training and delivery) emerged. CONCLUSIONS Although Quebec provincial services have been developed and offered to suicide-bereaved survivors in the past decade, many dwindled over time and none has been applied systematically. Recommendations for different stakeholders (Ministry of Health and Social Services, coroners, NGOs, and representatives of suicide-bereaved survivors) outlined in this study could be an interesting first step to help develop a suicide pre/postvention strategy.
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Affiliation(s)
- Fabienne Ligier
- Centre Psychothérapique de Nancy, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, 1 rue du Dr Archambault, F-54520, Laxou, France. .,EA 4360 APEMAC, Université de Lorraine, Vandoeuvre-lès-Nancy, France.
| | - Jessica Rassy
- School of Nursing, Université de Sherbrooke, Longueuil, Canada.,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Gabrielle Fortin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Ian van Haaster
- CIUSSS de l'Est de l'Ile de Montréal, CLSC St-Michel, Montreal, Canada
| | - Claude Doyon
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Charlie Brouillard
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Monique Séguin
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Canada.,Centre intégré de santé et service social de l'Outaouais (CISSSO), Outaouais, Quebec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry, Université de Montréal, Quebec, Canada
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Ligier F, Michaud L, Kabuth B, Lesage A, Corriveau P, Séguin M. A Quantitative and Qualitative Study of Notes Left by Youth Who Died by Suicide in Quebec from 1895 to 1985. Arch Suicide Res 2020; 24:554-567. [PMID: 31335304 DOI: 10.1080/13811118.2019.1645068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The study of suicide notes and the evolution of their content could contribute to a better understanding of reasons conducive to suicide mortality and offer further prevention strategies. From 1895 to 1985, 706 coroner's inquests of individuals who died by suicide and were 20 years old or younger were found in the province of Quebec. Quantitative analysis compared those who left notes (n = 47) to those who did not leave notes (n = 659). Furthermore, notes were subjected to inductive thematic analysis. Sociodemographic characteristics of the deceased individuals did not change over time. Qualitative analysis revealed four superordinate themes: (1) last wishes, (2) to those I leave behind, (3) about me and how and why I did it, and (4) self-positioning in the world. Only the last theme evolved over the time period considered. Suicide notes shed light on the psychological state of the majority of young note leavers and suggest the persistent feelings of distress and entrapment before the suicide, which may be important factors for caregivers and family members to monitor.
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Luigi M, Rapisarda F, Corbière M, De Benedictis L, Bouchard AM, Felx A, Miglioretti M, Abdel-Baki A, Lesage A. Determinants of mental health professionals' attitudes towards recovery: A review. Can Med Educ J 2020; 11:e62-e73. [PMID: 33062092 PMCID: PMC7522886 DOI: 10.36834/cmej.61273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The attitudes of mental health professionals towards consumers' recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals. METHODS A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included. RESULTS From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals' pessimistic attitudes towards recovery. CONCLUSIONS This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers.
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Affiliation(s)
- Mimosa Luigi
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Filippo Rapisarda
- Department of Psychology, Università degli Studi di Milano-Bicocca, Italy
| | - Marc Corbière
- Department of Education and Pedagogy – Faculty of the Sciences of Education, University of Quebec, Quebec, Canada
| | - Luigi De Benedictis
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
- Program for psychotic disorders, Institut Universitaire en Santé Mentale de Montréal, CIUSSS East-of-Montreal, Quebec, Canada
| | - Anne-Marie Bouchard
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Amélie Felx
- Mental health and substance abuse program, Institut Universitaire en Santé Mentale Douglas, CIUSSS West-of-Montreal, Quebec, Canada
| | | | - Amal Abdel-Baki
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
- Research Centre, Institut Universitaire en Santé Mentale de Montréal, CIUSSS East-of-Montreal, Quebec, Canada
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Duchaine CS, Aubé K, Gilbert-Ouimet M, Vézina M, Ndjaboué R, Massamba V, Talbot D, Lavigne-Robichaud M, Trudel X, Pena-Gralle APB, Lesage A, Moore L, Milot A, Laurin D, Brisson C. Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:842-851. [PMID: 32236498 PMCID: PMC7113841 DOI: 10.1001/jamapsychiatry.2020.0322] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. OBJECTIVE To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers. DATA SOURCES Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019. STUDY SELECTION Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review. DATA EXTRACTION AND SYNTHESIS This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. MAIN OUTCOMES AND MEASURES Sickness absence due to a mental disorder with a diagnosis obtained objectively. RESULTS A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]). CONCLUSIONS AND RELEVANCE This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.
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Affiliation(s)
- Caroline S. Duchaine
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
| | - Karine Aubé
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada
| | | | - Michel Vézina
- Institut national de santé publique du Québec, Quebec City, Québec, Canada
| | - Ruth Ndjaboué
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
| | - Victoria Massamba
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Denis Talbot
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Mathilde Lavigne-Robichaud
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Xavier Trudel
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Ana-Paula Bruno Pena-Gralle
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montreal, Québec, Canada
| | - Lynne Moore
- Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Alain Milot
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Danielle Laurin
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada,Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada
| | - Chantal Brisson
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
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Abstract
OBJECTIVES To determine whether studying aetiological pathways of depression, in particular the well-established determinant of childhood trauma, only in a specialised mental healthcare setting can yield biased estimates of the aetiological association, given that the majority of individuals are treated in primary care settings. DESIGN AND SETTING Two databanks were used in this study. The Canadian Community Health Survey (CCHS) on Mental Health and Well-Being 2012 is a national survey about mental health of adult Canadians. It measured common mental disorders and utilisation of services. The Signature mental health biobank includes adults from the Island of Montreal recruited at the emergency department of a major university mental health centre. After consent, participants filled standardised psychosocial questionnaires, gave blood samples, and their clinical diagnosis was recorded. We compared the cohort of depressed individuals from CCHS and Signature in contact with specialised services with those in contact with primary care or not in treatment. PARTICIPANTS There were 860 participants with depression in the CCHS and 207 participants with depression in the Signature Bank. PRIMARY AND SECONDARY OUTCOMES The Childhood Experiences of Violence Questionnaire was used to measure childhood trauma in both settings. Childhood trauma is associated with depression as with other common mental and physical disorders. RESULTS Individuals with depression in the CCHS who reported having been hospitalised for psychiatric treatment or having seen a psychiatrist or those from Signature were found to be more strongly associated with childhood abuse than individuals with depression who were treated in primary care settings or did not seek mental healthcare in the preceding year. CONCLUSIONS Berkson's bias limits the generalisability of aetiological associations observed in such university-hospital-based biobanks, but the problem can be remedied by broadening recruitment to primary care settings and the general population.
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Affiliation(s)
- Vincent Laliberté
- Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Charles-Edouard Giguère
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
- Département de Psychiatrie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
- Département de Psychiatrie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
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Felx A, Kane M, Corbière M, Lesage A. Using Group Concept Mapping to Develop a Conceptual Model of Housing and Community-Based Residential Settings for Adults With Severe Mental Illness. Front Psychiatry 2020; 11:430. [PMID: 32636764 PMCID: PMC7319103 DOI: 10.3389/fpsyt.2020.00430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/27/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Most existing conceptual models of residential environments and housing programs were developed over a decade ago or lack comprehensiveness. The attributes to be used to describe housing programs with adequate specification remain unclear including the attributes that mediate service user outcomes. In this study, group concept mapping was used to develop a conceptual model of housing and community-based residential settings for adults with severe mental illness based on stakeholder perceptions and values. METHODS Participants were selected through purposive sampling and included service users, family members, staff working in residential facilities, mental health workers and managers. Participants (n=221) generated 1,382 statements describing attributes of housing and community-based residential settings for adults with severe mental illness (99% saturation). Thematic content analysis was conducted to analyze the statements and create a list of 140 selected statements. Participants then rated (n=416) and sorted into categories (n=73) the selected statements. Descriptive statistics were computed for each statement relative importance. Multidimensional scaling and hierarchical cluster analysis were used to produce the conceptual model (maps). Stakeholders (n=12) were also involved in the interpretation of the maps. RESULTS The findings show overall concordance between stakeholders in relation to statements perceived importance (rating) and the statements inter-relationships (sorting). The stress value of 0.23 indicates that the two-dimensional solution of the multidimensional scaling analysis fits the data set (goodness of fit). The final conceptualization includes 12 clusters: (1) A balanced and healthy housing system; (2) Quality and management practices (facility/local level); (3) Physical external environment; (4) Services tailored to needs and preferences; (5) Services and interventions provided (linkage); (6) Equality, policies and availability of activities; (7) Organizational structure and staff qualities; (8) Services and interventions (learning skills); (9) Services and interventions (daily living support); (10) Personal space and right to privacy; (11) Physical interior environment; (12) Respect, functioning and atmosphere. CONCLUSION The results illustrate the multifaceted and multilevel nature of community-based residential settings through a visual representation. They articulate a number of attributes, clusters and dimensions that could be included in a common conceptual model of community-based residential settings and housing for adults with severe mental illness.
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Affiliation(s)
- Amélie Felx
- Research Centre, Institut universitaire en santé mentale de Montréal (IUSMM), Montreal, QC, Canada
- Mental Health and Addiction Programs, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Mary Kane
- Concept Systems Incorporated, Ithaca, NY, United States
| | - Marc Corbière
- Department of Education and Pedagogy – Career Counselling, Université du Québec à Montréal, Research Centre of IUSMM, Montreal, QC, Canada
- Mental Health and Work Foundation of IUSMM, Montreal, QC, Canada
| | - Alain Lesage
- Research Centre, Institut universitaire en santé mentale de Montréal (IUSMM), Montreal, QC, Canada
- Department of Psychiatry and Addictions, Faculty of Medicine, Montreal University, Montreal, QC, Canada
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Gaulin M, Simard M, Candas B, Lesage A, Sirois C. Combined impacts of multimorbidity and mental disorders on frequent emergency department visits: a retrospective cohort study in Quebec, Canada. CMAJ 2020; 191:E724-E732. [PMID: 31266786 DOI: 10.1503/cmaj.181712] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multimorbidity and mental disorders are independently associated with frequent visits to the emergency department (≥ 3 visits/yr), but their interaction has been little studied. We aimed to measure the interaction between mental disorders and physical multimorbidity with respect to frequent visits to the emergency department. METHODS We conducted a population-based cohort study of adults in Quebec from 2012 to 2016, using the Quebec Integrated Chronic Disease Surveillance System. We assessed multimorbidity as the number of physical illnesses and mental disorders as serious (psychotic or bipolar disorders), common or absent, using data from 2012 to 2014. We counted emergency department visits from 2014 to 2015. We used logistic regression to estimate interaction on frequent visits to the emergency department from 2 perspectives: of public health (additive scale as differences in risk) and of individual patients (multiplicative scale as odds ratios). RESULTS Each additional physical illness was associated with a greater increase in the absolute risk of frequent visits to the emergency department for people with mental disorders. Between 0 and ≥ 4 physical conditions, the absolute risk increased more for individuals with serious mental disorders (16.2%) than common (15.3%) or no disorders (11.4%). On the relative scale, for people with no mental disorders and ≥ 4 physical conditions, odds of frequent visits to the emergency department were 6.2 (95% confidence interval [CI] 6.08-6.35) times the odds for people with no physical conditions. For individuals with common and serious mental illnesses, corresponding odds ratios were 4.75 (95% CI 4.60-4.90) and 3.7 (95% CI 3.18-3.57), respectively. INTERPRETATION Mental disorders interact with physical multimorbidity to increase the odds of frequent visits to the emergency department. More research is needed on interventions that promote high-quality care for mental illness, especially in the context of physical multimorbidity.
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Affiliation(s)
- Myles Gaulin
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
| | - Marc Simard
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que.
| | - Bernard Candas
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
| | - Alain Lesage
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
| | - Caroline Sirois
- Département de médecine sociale et préventive (Gaulin, Candas, Sirois), Faculté de médecine, Université Laval, Québec, Que.; Institut national de santé publique du Québec (INSPQ) (Gaulin, Simard, Lesage, Sirois), Montréal, Que.; Institut national d'excellence en santé et services sociaux (INESSS) (Candas), Québec, Que.; Département de psychiatrie (Lesage), Université de Montréal, Montréal, Que
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Leclerc J, Lesage A, Rochette L, Huỳnh C, Pelletier É, Sampalis J. Prevalence of depressive, bipolar and adjustment disorders, in Quebec, Canada. J Affect Disord 2020; 263:54-59. [PMID: 31818796 DOI: 10.1016/j.jad.2019.11.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of mood disorders was estimated at 5.4% according to the latest Canadian survey. It has been suggested to use administrative data and self-reported data to optimize the estimation for mental health care in the population. Using administrative data, algorithms (combination of codes from the International Classification of Diseases) had been previously developed to identify the population with mood and anxiety disorders. However, the specific prevalence of each component of mood disorders (depressive, bipolar and adjustment disorders) are still unknown in Quebec, Canada. OBJECTIVE To 1) identify the population diagnosed respectively with depressive, bipolar and adjustment disorders in administrative data, and 2) provide annual prevalence estimates of each component. METHOD Data were extracted from the Quebec Integrated Chronic Disease Surveillance System and the entire population of Quebec (2000-2017) was included in this study (8.3 million; 2017). The prevalence of depressive, bipolar and adjustment disorders were estimated using specific algorithms. RESULTS The annual prevalence of depressive disorders was 3.7% in 2000-2001; it decreased to 2.8% in 2016-2017. In comparison, the prevalence of bipolar disorders was 0.8% in 2000-2001, decreasing to 0.6% in 2016-2017, and the prevalence of adjustment disorders was 1.3% in 2000-2001 and increased to 1.6% in 2016-2017. CONCLUSION Using specific algorithms, we observed that the trend of adjustment disorders is increasing while trends of depressive and bipolar disorders are decreasing. Further studies should assess if the related burden of care respectively follows the same trends as policy makers' allocations of resources may need to be adapted.
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Affiliation(s)
- Jacinthe Leclerc
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada; Faculty of Medicine, Department of Surgery, McGill University, Canada; Nursing department, Université du Québec à Trois-Rivières, Canada.
| | - Alain Lesage
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Canada
| | - Louis Rochette
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada
| | - Christophe Huỳnh
- Département de psychiatrie et d'addictologie, Université de Montréal, Canada; Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Institut universitaire sur les dépendances, Canada
| | - Éric Pelletier
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Canada
| | - John Sampalis
- Faculty of Medicine, Department of Surgery, McGill University, Canada
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Ligier F, Giguère CE, Notredame CE, Lesage A, Renaud J, Séguin M. Are school difficulties an early sign for mental disorder diagnosis and suicide prevention? A comparative study of individuals who died by suicide and control group. Child Adolesc Psychiatry Ment Health 2020; 14:1. [PMID: 31956339 PMCID: PMC6958641 DOI: 10.1186/s13034-019-0308-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/30/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Suicide is the third leading cause of death worldwide among youth aged 10- to 19, and mental disorders are often associated in the etiology of suicidal behavior. Mental disorders are often under-diagnosed and under-treated in young people, a situation likely to increase the severity of the disorder and suicide risk. Presence of school difficulties may, in some cases, be a consequence of mental disorder, and theses difficulties are observable. Therefore, early detection and early intervention of school difficulties may alleviate the development of mental disorders and suicide vulnerability. The aim of this study is to understand the link between school difficulties and suicide risk. METHODS We used the data bank gathered by the McGill Group on Suicide Studies over the past two decades through interviews with the relatives of individuals who died by suicide and with individuals from the community as a control group. We included data on common sociodemographic characteristics, life events and mental health characteristics identified before age 18, among individuals who died before the age of 35 or were interviewed before the age of 35. We identified 200 individuals who died by suicide and 97 living controls. We compared groups according to gender and characteristics. RESULTS Within the total sample, 74% were male, 13% had met with academic failure, 18% had engaged in inappropriate behavior at school, and 18% presented combined school difficulties. Combined school difficulties (academic failure and inappropriate behavior) for both sexes and academic failure alone for males were associated with higher suicide risk before the age of 35. School difficulties generally began in early childhood and were linked to mental disorders/difficulties and substance abuse before age 18. CONCLUSIONS This study underlines the importance for parents, teachers, and educators to identify children with school difficulties-academic failure and behavioral difficulties at school-as early as possible in order to be able to propose adapted interventions. Early identification and proper diagnosis may prevent chronicity of some disorders, accumulation of adverse events, and even suicide.
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Affiliation(s)
- Fabienne Ligier
- 0000 0001 2353 5268grid.412078.8McGill Group on Suicide Studies, Douglas Hospital, 6875, Boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.498824.bQuébec Network on Suicide Research, Mood Disorders and Related Disorders (RQSHA), Montreal, QC Canada ,0000 0001 2194 6418grid.29172.3fEA 4360 APEMAC, Faculty of Medicine, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France ,Centre Psychothérapique de Nancy, PUPEA, rue du Dr Archambault, 54520 Laxou, France ,0000 0004 1765 1301grid.410527.5Département Pédopsychiatrie, CHRU Nancy, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - Charles-Edouard Giguère
- 0000 0001 2292 3357grid.14848.31Banque Signature, Research Center, Institut Universitaire en Santé Mentale de Montréal, 7401 Rue Hochelaga, Unit 218, Montreal, QC H1N 3M5 Canada
| | - Charles-Edouard Notredame
- 0000 0001 2353 5268grid.412078.8McGill Group on Suicide Studies, Douglas Hospital, 6875, Boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,0000 0004 0471 8845grid.410463.4Centre Hospitalier Régional Universitaire de Lille, 2 Avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Alain Lesage
- 0000 0001 2353 5268grid.412078.8McGill Group on Suicide Studies, Douglas Hospital, 6875, Boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.498824.bQuébec Network on Suicide Research, Mood Disorders and Related Disorders (RQSHA), Montreal, QC Canada ,0000 0001 2292 3357grid.14848.31Department of Psychiatry, Université de Montréal, Montreal, QC Canada ,0000 0001 2292 3357grid.14848.31Institut Universitaire en Santé Mentale de Montréal, 7401 Rue Hochelaga, Unit 218, Montreal, QC H1N 3M5 Canada
| | - Johanne Renaud
- 0000 0001 2353 5268grid.412078.8McGill Group on Suicide Studies, Douglas Hospital, 6875, Boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.498824.bQuébec Network on Suicide Research, Mood Disorders and Related Disorders (RQSHA), Montreal, QC Canada ,0000 0004 4910 4652grid.459278.5Manulife Centre for breackthroughs in Teen Depression and Suicide Prevention, Douglas Institute, 7070, Boulevard Champlain, Montreal, QC H4H 1R3 Canada
| | - Monique Séguin
- 0000 0001 2353 5268grid.412078.8McGill Group on Suicide Studies, Douglas Hospital, 6875, Boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.498824.bQuébec Network on Suicide Research, Mood Disorders and Related Disorders (RQSHA), Montreal, QC Canada ,0000 0001 2112 1125grid.265705.3Department of Psychoeducation and Psychology, Université du Québec en Outaouais, 283 Boulevard Alexandre-Taché, Gatineau, QC J8X 3X7 Canada ,Centre intégré de santé et service social de l’Outaouais (CISSSO), Outaouais, Canada
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