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Bédard A, Bernard C, Meilleur D, Taddeo D, Pesant C, Di Meglio G, Gingras N, Thibault I, Agostino H, Bélanger R, Nadeau PO, Frappier JY, Stheneur C, Dufresne L, Bégin C. Recovery Trajectories in Adolescent Girls with Anorexia Nervosa. J Clin Med 2024; 13:778. [PMID: 38337472 PMCID: PMC10856320 DOI: 10.3390/jcm13030778] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.
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Affiliation(s)
- Alexandra Bédard
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
| | - Catherine Bernard
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
| | - Dominique Meilleur
- Département de Psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada;
| | - Danielle Taddeo
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
| | - Caroline Pesant
- Hôpital Fleurimont, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada;
| | - Giuseppina Di Meglio
- Hôpital de Montréal pour Enfants/Montreal Children’s Hospital, Centre Universitaire de Santé McGill, Montréal, QC H4A 3J1, Canada; (G.D.M.); (H.A.)
| | - Nathalie Gingras
- Centre de Pédopsychiatrie, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, QC G1N 2W1, Canada;
- Département de Psychiatrie et de Neurosciences, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Isabelle Thibault
- Département de Psychoéducation, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada;
| | - Holly Agostino
- Hôpital de Montréal pour Enfants/Montreal Children’s Hospital, Centre Universitaire de Santé McGill, Montréal, QC H4A 3J1, Canada; (G.D.M.); (H.A.)
| | - Richard Bélanger
- Département de Pédiatrie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre Hospitalier Universitaire de Québec, Québec, QC G1V 4G2, Canada
| | - Pierre-Olivier Nadeau
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
| | - Jean-Yves Frappier
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Chantal Stheneur
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Laurie Dufresne
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
| | - Catherine Bégin
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
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Moubayed D, Piché-Renaud PP, Provost C, Faure C, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. Faecal calprotectin: Marker of intestinal inflammatory process in anorexia nervosa? A preliminary study. Eur Eat Disord Rev 2023. [PMID: 37194134 DOI: 10.1002/erv.2983] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Anorexia Nervosa (AN) is a serious and potentially lethal mental disorder characterised by a deliberate quest to reduce one's weight. It can have multiple physical and psychological consequences. The clinical presentation of AN can include gastrointestinal symptoms, however, the pathophysiology of these symptoms in the context of AN remains uncertain. It is hypothesised that patients with AN may have an increase in intestinal permeability, which could lead to an increase in faecal calprotectin (fCP), a marker of intestinal inflammation. No relation between AN and elevation of fCP has been previously described in literature. METHODS Eight patients hospitalised for AN have a dosage of fCP. RESULTS Calprotectine was found to be elevated in 50% of cases, with or without any underlying comorbid gastrointestinal disease. Only the duration of illness tended to be associated with the increase in fCP suggesting a greater alteration as a function related to the time of denutrition. CONCLUSION Although these findings provide insights in the potential pathophysiology of gastrointestinal symptoms in AN, further studies that evaluate the factors associated with elevated fCP in patients with AN are needed.
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Affiliation(s)
- Dina Moubayed
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | | | | | - Christophe Faure
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Danielle Taddeo
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Olivier Jamoulle
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Jean-Yves Frappier
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
| | - Chantal Stheneur
- Paris Saclay University, UVSQ, INSERM, CESP, Villejuif, France
- Clinique FSEF Varennes Jarcy, Varennes Jarcy, France
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Dufresne L, Meilleur D, Gingras N, Di Meglio G, Pesant C, Taddeo D, Nadeau PO, Bélanger R, Lavoie E, Thibault I, Agostino H, Stheneur C, Frappier JY, Bédard A, Bégin C. Personality heterogeneity in adolescents with anorexia nervosa: a factor-mixture analysis. Curr Psychol 2023. [DOI: 10.1007/s12144-022-04216-2] [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: 01/11/2023]
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Proulx-Cabana S, Metras ME, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol. Nutrients 2022; 14:nu14010229. [PMID: 35011105 PMCID: PMC8747364 DOI: 10.3390/nu14010229] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.
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Affiliation(s)
- Stephanie Proulx-Cabana
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
- Correspondence: (S.P.-C.); (C.S.)
| | - Marie-Elaine Metras
- Pharmacy Department, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada;
| | - Danielle Taddeo
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
| | - Olivier Jamoulle
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
| | - Jean-Yves Frappier
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, QC H3T 1C5, Canada; (D.T.); (O.J.); (J.-Y.F.)
| | - Chantal Stheneur
- CESP, UVSQ, INSERM U 1178, Paris-Saclay University, 94805 Villejuif, France
- Clinique FSEF Varennes Jarcy, Fondation Sante des Etudiants de France, 91480 Varennes-Jarcy, France
- Simone Veil Health Science Training and Research Unit, Saint-Quentin-en-Yvelines University, 78180 Montigny-le-Bretonneux, France
- Correspondence: (S.P.-C.); (C.S.)
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Kern A, Frederickson A, Hébert M, Bernier A, Frappier JY, Langevin R. Exploring the relationships between child maltreatment and risk factors for pregnancy complications. J Obstet Gynaecol Can 2021; 44:496-502. [PMID: 34920188 DOI: 10.1016/j.jogc.2021.11.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the pathway underlying the relationships between child maltreatment (CM) subtypes (i.e., physical, sexual, and emotional abuse and neglect) and factors associated with a heightened risk of pregnancy complications by examining post-traumatic stress disorder (PTSD) symptoms as a potential mediator. METHODS A sample of 98 pregnant parents between the ages of 18 and 29 years was recruited through social media and community organizations throughout Canada. Participants completed a series of surveys on their exposure to CM, PTSD symptoms, and pregnancy experiences on a secure online platform. Following data cleaning procedures, 85 participants were included in this study. RESULTS Four separate mediation analyses were conducted with child neglect, physical abuse, sexual abuse, and emotional abuse as factors associated with a heightened risk of pregnancy complications (i.e., a congregate score of limited prenatal care, weight gain concerns, smoking, second-hand smoke, alcohol consumption, substance use, and insufficient food intake during pregnancy). Each CM subtype was associated with increased PTSD symptoms, which were in turn associated with the presence of more factors known for increasing the risk of pregnancy complications. Neglect, physical abuse, sexual abuse, and emotional abuse were all indirectly associated with the presence of more factors associated with a heightened risk of pregnancy complications through their association with PTSD symptoms. CONCLUSIONS Findings from this study could encourage prenatal care providers to screen for CM history and PTSD symptoms. Furthermore, mental health treatment early in the prenatal period may improve pregnant parents' health and lower their risk of pregnancy complications.
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Affiliation(s)
- Audrey Kern
- Department of Educational and Counselling Psychology, McGill University, Montréal, QC
| | - Alesha Frederickson
- Department of Educational and Counselling Psychology, McGill University, Montréal, QC
| | - Martine Hébert
- Department of Sexology, Université du Québec à Montréal, Montréal, QC
| | - Annie Bernier
- Department of Psychology, Université de Montréal, Montréal, QC
| | - Jean-Yves Frappier
- Pediatric Department, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, QC
| | - Rachel Langevin
- Department of Educational and Counselling Psychology, McGill University, Montréal, QC.
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Girard M, Hébert M, Godbout N, Cyr M, Frappier JY. A Longitudinal Study of Suicidal Ideation in Sexually Abused Adolescent Girls: Depressive Symptoms and Affect Dysregulation as Predictors. J Trauma Stress 2021; 34:1132-1138. [PMID: 33078516 DOI: 10.1002/jts.22608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 09/23/2019] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 11/11/2022]
Abstract
Child sexual abuse (CSA) is associated with many repercussions on adolescents' mental health, including suicidal ideation. Yet, the mechanisms linking CSA to adverse outcomes have rarely been investigated within a longitudinal design. The current study aimed to examine the role of affect dysregulation in the association between depressive symptoms and suicidal ideation 1year after the first assessment in a sample of 119 sexually abused adolescent girls. An integrative mediational model was conceptualized to examine the explicatory role of affect dysregulation (Time 2) in the association between depressive symptoms (Time 1) and suicidal ideation (Time 3). Approximately 31% of the girls reported suicidal ideation at Time 3. Path analysis with logistic regressions revealed that the association between depressive symptoms and suicidal ideation presence was partly explained by affect dysregulation, which increased the risk of suicidal ideation presence by 18.4%, OR = 1.18, 95% CI [1.07, 1.33]. The integrative model explained 21.5% of the variance in suicidal ideation. These findings identify potential predictors of suicidal ideation among sexually abused adolescent girls. This present study highlights the role of affect dysregulation in the presence of suicidal ideation and provides potential targets for intervention practices when working with adolescent girl victims of CSA. As such, interventions for this vulnerable population should aim to decrease depressive symptoms and affect dysregulation to reduce suicidal risk.
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Affiliation(s)
- Marianne Girard
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
| | - Martine Hébert
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
| | - Natacha Godbout
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
| | - Mireille Cyr
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Jean-Yves Frappier
- Pediatric Department, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
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Proulx-Cabana S, Taddeo D, Jamoulle O, Frappier JY, Tremblay-Racine F, Stheneur C. Initial inpatient management of adolescents and young adults admitted with severe malnutrition due to anorexia nervosa: protocol for a systematic review. J Eat Disord 2021; 9:36. [PMID: 33691797 PMCID: PMC7944889 DOI: 10.1186/s40337-021-00389-6] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a highly prevalent disease in adolescents and young adults (AYAs). The quality of initial inpatient medical management in a patient with severe malnutrition due to AN is crucial to prevent further medical instability. This review aims to inventory evidence regarding initial refeeding and management of AYAs with AN in an inpatient setting, in order to avoid medical complications. METHODS A systematic review will be conducted using PubMed, MEDLINE, All EBM Reviews, Embase, PsycINFO, Cochrane Database and CINAHL. The search strategy consists of terms related to anorexia, hospitalization and Pediatrics. Randomized controlled trials, case-control studies, cross-sectional and cohort studies will be included. Participants will include adolescents and adults 18-24 years old diagnosed with AN and meeting criteria for severe disease. The primary outcome will be any of the following complications: hypophosphatemia, refeeding syndrome, hypoglycemia, cardiac arrythmia, hepatic cytolysis or death. Data will be extracted and the risk of bias will be assessed by one author and reviewed by a second author. Results will be presented in a systematic narrative synthesis format. The quality of evidence for all outcomes will be evaluated using the GRADE methodology. DISCUSSION This systematic review will examine current evidence on initial inpatient refeeding and help to document effectiveness of initial inpatient management in AYAs with severe AN in avoiding further medical complications. TRIAL REGISTRATION This study is registered on PROSPERO under the reference number CRD42019123608 .
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Affiliation(s)
- Stéphanie Proulx-Cabana
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada.
| | - Danielle Taddeo
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Olivier Jamoulle
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Jean-Yves Frappier
- Pediatrics Department, Division of Adolescent Medicine, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Fannie Tremblay-Racine
- Librarian, Sainte-Justine University Hospital Center, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1C5, Canada
| | - Chantal Stheneur
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], 94805, Villejuif, France.,Clinique FSEF Varennes Jarcy, Fondation Sante des Etudiants de France, 91480, Varennes-Jarcy, France.,UFR des Sciences de la Santé Simone Veil [Simone Veil Health Science Training and Research Unit], Université de Versailles Saint-Quentin-en-Yvelines [Versailles Saint-Quentin-en-Yvelines University], Versailles, France
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Maalouf O, Daigneault I, Dargan S, McDuff P, Frappier JY. Relationship between Child Sexual Abuse, Psychiatric Disorders and Infectious Diseases: A Matched-Cohort Study. J Child Sex Abus 2020; 29:749-768. [PMID: 32045342 DOI: 10.1080/10538712.2019.1709242] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/01/2019] [Accepted: 12/08/2019] [Indexed: 06/10/2023]
Abstract
Child sexual abuse (CSA) has been strongly associated with a range of psychological and physical problems in childhood and adulthood, such as anxiety, post-traumatic stress disorder (PTSD), and infectious diseases. Despite the strength of these associations, no studies to date have investigated psychobiological processes that might underlie the relationship between CSA and physical health problems occurring during childhood, such as infectious diseases. The goal of the current study is to evaluate PTSD as a potential mediator between CSA and the occurrence of infectious diseases among children and adolescents. Furthermore, we postulate that PTSD plays a specific role as an indicator of chronic stress during childhood, in comparison to other mental disorders, such as anxious and non-anxious disorders (e.g., depression). Via a prospective matched-cohort design, administrative data were used to document PTSD, anxious and non-anxious disorders, and infectious diseases. The sample size was 882 persons with a substantiated report of sexual abuse and 882 matched controls. Negative binomial regressions revealed that CSA is associated with a greater number of anxious diseases diagnoses that, in turn, predict more infectious diseases diagnoses. These findings highlight the importance of preventing and intervening among sexually abused youth with anxious disorder symptoms to limit negative outcomes on physical health.
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Alix S, Cossette L, Cyr M, Frappier JY, Caron PO, Hébert M. Self-Blame, Shame, Avoidance, and Suicidal Ideation in Sexually Abused Adolescent Girls: A Longitudinal Study. J Child Sex Abus 2020; 29:432-447. [PMID: 31692417 DOI: 10.1080/10538712.2019.1678543] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/25/2019] [Revised: 09/12/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.
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Affiliation(s)
- Stéphanie Alix
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Louise Cossette
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Mireille Cyr
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Jean-Yves Frappier
- Pediatric Department, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Pier-Olivier Caron
- Department of Human Sciences, Letters and Communications, Université TÉLUQ, Montreal, Canada
| | - Martine Hébert
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
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Clément MÈ, Gagné MH, Dufour S, Frappier JY. Opinions et positions de médecins à l’endroit de la punition corporelle comme pratique parentale disciplinaire. Paediatr Child Health 2019; 24:502-508. [DOI: 10.1093/pch/pxz060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
RésuméContexte de l’étudeLes médecins sont parmi les professionnels les plus sollicités par les parents pour obtenir des conseils sur l’exercice du rôle parental. Pourtant, ils sont rarement formés pour informer les parents, et particulièrement en ce qui concerne la légitimité des pratiques disciplinaires comme la punition corporelle (PC).ObjectifsCette étude vise à documenter les attitudes de médecins québécois en faveur de la PC ainsi que leur pratique de soutien auprès des parents.MéthodesAu total 113 médecins œuvrant au moins 20% du temps avec des enfants mineurs ou leurs parents ont complété un sondage en ligne sur leurs caractéristiques personnelles et professionnelles, leurs connaissances et attitudes face à la PC et leurs pratiques de soutien.RésultatsLes résultats montrent que les répondants connaissent bien les balises légales de l’article 43 du Code criminel canadien qui encadrent le recours aux PC et qu’ils sont en désaccord avec cette méthode disciplinaire. Lorsqu’ils soupçonnent une situation de PC envers un enfant, les médecins répondants offrent diverses modalités de soutien aux parent (ex.: aborder le sujet, proposer d’autres pratiques disciplinaires), ce qui est moins souvent le cas lorsque la situation implique un adolescent. Enfin, les résultats montrent que certains facteurs sont associés aux pratiques de soutien des répondants, dont les attitudes face aux PC et le sentiment d’être suffisamment formé pour aborder les pratiques disciplinaires avec les parents.ConclusionsCes résultats soulignent l’importance d’outiller et de soutenir les médecins dans leurs interventions auprès des parents en difficulté.
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Affiliation(s)
- Marie-Ève Clément
- Département de psychologie et de psychoéducation, Université du Québec en Outaouais, St-Jérôme, Québec
| | | | - Sarah Dufour
- École de psychoéducation, Université de Montréal, Montréal, Québec
| | - Jean-Yves Frappier
- Département de pédiatrie, Université de Montréal et CHU Sainte-Justine, Montréal, Québec
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Dargan S, Daigneault I, Ovetchkine P, Jud A, Frappier JY. Association between child sexual abuse and infectious disease diagnoses. Child Abuse Negl 2019; 97:104142. [PMID: 31479954 DOI: 10.1016/j.chiabu.2019.104142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/21/2018] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Though many studies have linked child sexual abuse (CSA) to psychological health problems, little is known regarding the relationship between CSA and children and adolescents' physical health. OBJECTIVE The objective of this study was to assess the relationship between CSA and infectious disease diagnoses. PARTICIPANTS Of the 955 eligible children and adolescents who had a substantiated report of sexual abuse between 2001 and 2010, medical data was retrieved for 882 individuals, who formed the sexually abused group. These 882 participants were matched to 882 participants on age, gender, and administrative healthcare region to form the general population group. SETTING AND METHODS This matched-cohort study, conducted in a large Canadian city, compared the number of infectious disease diagnoses between the date of the substantiated sexual abuse report and August 1, 2013, between the two groups. RESULTS Results indicate that sexually abused participants had 1.27 times more (95% CI - 1.13 to 1.42) infectious diseases diagnoses than those from the general population. They received 1.83 times more genitourinary infection diagnoses (95% CI - 1.43 to 2.33), 1.31 times more diagnoses for other types of infections (95% CI - 1.11 to 1.55) and 1.21 times more respiratory and ear infection diagnoses (95% CI - 1.05 to 1.40). There was no statistically significant difference regarding skin infection diagnoses. These results indicate an association between CSA and more frequent infectious diseases diagnoses.
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Affiliation(s)
- Sonia Dargan
- Department of psychology, Université de Montréal, 90 avenue Vincent d'Indy, Montreal, Quebec H2V 2S9, Canada
| | - Isabelle Daigneault
- Department of psychology, Université de Montréal, 90 avenue Vincent d'Indy, Montreal, Quebec H2V 2S9, Canada.
| | - Philippe Ovetchkine
- Department of psychology, Université de Montréal, 90 avenue Vincent d'Indy, Montreal, Quebec H2V 2S9, Canada; Centre hospitalier universitaire Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Andreas Jud
- Child and Adolescent Psychiatry / Psychotherapy, University of Ulm, Helmholtzstrasse 16, 89081, Ulm, Germany
| | - Jean-Yves Frappier
- Department of psychology, Université de Montréal, 90 avenue Vincent d'Indy, Montreal, Quebec H2V 2S9, Canada; Centre hospitalier universitaire Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
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Blondin S, Meilleur D, Taddeo D, Frappier JY. Caregiving experience and expressed emotion among parents of adolescents suffering from anorexia nervosa following illness onset. Eat Disord 2019; 27:453-470. [PMID: 30612513 DOI: 10.1080/10640266.2018.1553431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/27/2022]
Abstract
The aim of this study was to better understand the relationship between parents' experience of caregiving and expressed emotion during the early stage of their child's eating disorder. Fifty mothers and 38 fathers of adolescents suffering from anorexia nervosa and hospitalized for the first time participated in this study. They completed the Experience of Caregiving Inventory, a measure of the negative and positive aspects of the caregiving experience, and the Family Questionnaire, which measured the different dimensions of expressed emotion, namely emotional over-involvement and critical comments. Results showed that caregiving experience is significantly and positively correlated to expressed emotion. Among the negative aspects of caregiving, sense of loss contributed most to emotional over-involvement, while difficult behaviours contributed most to critical comments. The results suggest that parents' perceptions of their child and child's future are strongly related to their tendency to be over-involved. The perception of disruptive behaviours in their child could be one of the principal triggers or exacerbating factors of parents' critical attitudes.
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Affiliation(s)
- Soline Blondin
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Dominique Meilleur
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Danielle Taddeo
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
| | - Jean-Yves Frappier
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
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Paquin Hodge C, Meilleur D, Taddeo D, Frappier JY. The behavioral and affective profile of inpatient adolescent girls with restrictive anorexia nervosa. Eat Weight Disord 2019; 24:645-649. [PMID: 31218659 DOI: 10.1007/s40519-019-00727-3] [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: 02/22/2018] [Accepted: 06/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A better understanding of the individual difficulties reported by adolescents presenting with anorexia nervosa seems like an interesting avenue to refine our understanding of their psychological functioning. OBJECTIVE This study aimed to: (1) describe the behavioral and affective profile of difficulties of inpatient adolescent girls presenting a restricting type of anorexia (ANR); and (2) investigate the presence of a relationship between behavioral and affective problems and severity of the disorder. METHODS The sample consisted of 52 inpatient adolescent girls presenting an ANR. The youth self report assessed the behavioral and emotional profile of difficulties of participants while the Eating Disorder Risk Composite of the Eating Disorder Inventory measured the symptomatology of the disorder. A ratio between body mass index at admission and at the end of the treatment served as an indicator of weight gain. RESULTS The sample presented an internalized profile of problems. Individual differences were found and three profiles of difficulties were present in the sample: normative, pure internalizing and mixed (clinical on the internalizing and externalizing clusters). CONCLUSION This study provides information on the heterogeneity of this specific population otherwise quite similar and demonstrates how severity of the disorder can be associated with a wide range of other behavioral and affective difficulties. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
| | | | - Danielle Taddeo
- Sainte-Justine University Health Center Mother and Child, Montreal, QC, Canada
| | - Jean-Yves Frappier
- Sainte-Justine University Health Center Mother and Child, Montreal, QC, Canada
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Stheneur C, Bergeron SJ, Frappier JY, Jamoulle O, Taddeo D, Sznajder M, Lapeyraque AL. Renal injury in pediatric anorexia nervosa: a retrospective study. Eat Weight Disord 2019; 24:323-327. [PMID: 28550606 DOI: 10.1007/s40519-017-0401-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/30/2016] [Accepted: 05/11/2017] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Although primarily a mental health disorder, anorexia nervosa (AN) has many physical consequences. Among them, the consequences on kidney function are often underestimated. We evaluated renal function in adolescent AN inpatients and investigated the correlation between the GFR and intrinsic patient characteristics. METHODS A single-center retrospective study was conducted on 51 patients hospitalized for the restrictive type of AN in 2013. Data were divided into: (1) medical history of AN; (2) growth parameters and vital signs upon admission; and (3) blood tests. The glomerular filtration rate (GFR) was calculated using the Cockroft-Gault, MAYO Clinical Quadratic (MCQ), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), the Modification of Diet in Renal Disease (MDRD), and Schwartz equations. RESULTS The calculated percentages of patients with a GFR below 90 mL/min/1.73 m2 according to the different equations were as follows: Cockroft-Gault, 45%; MDRD, 28%; CKD-EPI, 14%; MCQ, 12%, and Schwartz, 4%. There was a strong association between the body mass index (BMI) and the GFR according to all equations (p < 0.0001). The lowest heart rate was significantly associated with a reduced GFR according to the Cockroft-Gault equation (p = 0.03). The GFR values did not differ significantly after rehydration. CONCLUSION Clinicians should evaluate AN patients for renal complications, especially when the BMI and heart rate are very low. Dehydration was not solely responsible for renal impairment. LEVEL OF EVIDENCE Level III, single-center retrospective cohort study.
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Affiliation(s)
- Chantal Stheneur
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Sebastien J Bergeron
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Jean-Yves Frappier
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Olivier Jamoulle
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Danielle Taddeo
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Marc Sznajder
- Department of Pediatrics, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100, Boulogne, France
| | - Anne-Laure Lapeyraque
- Department of Nephrology, CHU Sainte-Justine, 3175 ch. de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
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Meierer K, Hudon A, Sznajder M, Leduc MF, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. Anorexia nervosa in adolescents: evolution of weight history and impact of excess premorbid weight. Eur J Pediatr 2019; 178:213-219. [PMID: 30397823 DOI: 10.1007/s00431-018-3275-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/12/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
The purpose of our study is to establish if the proportion of patients diagnosed with anorexia nervosa that have a history of excess weight has increased over a 10-year period and to study how different premorbid weight groups vary in terms of clinical characteristics. We performed a single-center, retrospective cohort study of all new patients presenting with anorexia nervosa, restrictive and binge/purge subtypes, in 2004 and 2014 at the Adolescent Medicine Clinic of Sainte-Justine University Health Centre (n = 172). The prevalence of excess premorbid weight was similar in both cohorts (32% in 2004 versus 29.5% in 2014). The historically overweight subgroup had a lower heart rate at intake (64.77 versus 69.75, p = 0.03). Patients with excess premorbid weight lost an average of 1 kg more per month than their historically thinner counterparts (2.6 kg versus 1.6 kg/month, p = 0.0011). The total decrease in BMI was much greater in patients with a history of excess weight (7 BMI points versus 3.8, p = 0.0001).Conclusion: Since overweight and obese patients present with significant weight suppression values, our study stresses the importance of screening for AN in all patients rather than in only the noticeably underweight. What is Known: • More than one third of patients presenting with AN have a history of overweight or obesity, which is comparable to the general population. • A delay between AN onset and diagnosis has been described in overweight adolescents. What is New: • Historically overweight patients presenting with AN demonstrate increased speed of weight loss, greater drop in BMI, and lower heart rate at presentation. • For patients with a history of excess weight considered as having recovered from AN, the average BMI at discharge was within normal limits.
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Affiliation(s)
- Klara Meierer
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Alexandre Hudon
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Marc Sznajder
- Department of Pediatrics, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Marie-France Leduc
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Danielle Taddeo
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Olivier Jamoulle
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Jean-Yves Frappier
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Chantal Stheneur
- University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada.
- Department of Pediatrics, Division of Adolescent Medicine, CHU Sainte-Justine, 3175 CH Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
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16
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Langevin R, Hébert M, Bergeron SJ, Duchesne M, Lambert Y, Chartrand R, Frappier JY. Sleep problems and interpersonal violence in youth in care under the Quebec Child Welfare Society. Sleep Med 2018; 56:52-56. [PMID: 30545802 DOI: 10.1016/j.sleep.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective this study was to investigate the relative contributions of gender, common mental health symptoms, and experiences of interpersonal violence to the presence of sleep disturbances in Youth in Care under Child Welfare Society admitted to residential facilities. METHODS A sample of 315 teenagers (14-18 years old) completed a self-reported questionnaire upon admission, followed by a medical consultation with a nurse and a physician. Information regarding experiences of interpersonal violence, mental health symptoms, and sleep disturbances was collected using a standardized questionnaire. RESULTS Anxiety, ADHD symptoms, and sexual abuse were associated with sleep disturbances, F(10, 264) = 5.95, p < 0.001. Results from hierarchical regression analyses revealed that experiences of interpersonal violence, more specifically sexual abuse, were associated with sleep disturbances over and beyond gender and the presence of mental health symptoms. CONCLUSIONS These results highlight practical implications for health professionals in terms of assessment and intervention for vulnerable youth exposed to interpersonal violence. Implications for research and practice are discussed.
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Affiliation(s)
- Rachel Langevin
- Department of Educational and Counselling Psychology, McGill University, Canada.
| | - Martine Hébert
- Department of Sexology, Université du Québec à Montréal, Canada
| | - Sébastien J Bergeron
- Adolescent Division, CHU Sainte-Justine, Mother and Child University Hospital Center, Canada
| | | | | | | | - Jean-Yves Frappier
- Adolescent Division, CHU Sainte-Justine, Mother and Child University Hospital Center, Canada
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17
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Pelletier Brochu J, Meilleur D, DiMeglio G, Taddeo D, Lavoie E, Erdstein J, Pauzé R, Pesant C, Thibault I, Frappier JY. Adolescents' perceptions of the quality of interpersonal relationships and eating disorder symptom severity: The mediating role of low self-esteem and negative mood. Eat Disord 2018; 26:388-406. [PMID: 29683772 DOI: 10.1080/10640266.2018.1454806] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/17/2022]
Abstract
Few studies have examined how the perceived quality of multiple interpersonal relationships is related to eating disorder (ED) symptom severity in adolescents and how psychological variables might influence these associations. The aim of this study is to determine whether the perceived level of trust, communication, and alienation in the relationship with one's mother, father, and peers are predictive of ED severity in adolescent females and to test the mediating effects of low self-esteem and negative mood on these associations. Adolescent females aged 12 to 18 (N = 186) with a diagnosis of Anorexia Nervosa (Restrictive; AN-R or Binge/Purge; AN-B/P) completed self-report measures evaluating the perceived quality of interpersonal relationships, ED symptom severity, low self-esteem, and negative mood. Multiple regressions revealed that the level of perceived alienation in the relationship with one's mother and peers was positively associated with ED symptom severity. Low self-esteem and negative mood acted as mediators of these associations. Considering that a high level of perceived alienation in the relationship with one's mother and peers appears to be associated with more severe ED symptoms through its impact on self-esteem and mood, improvements in the quality of these interactions are likely to be an effective target of intervention among adolescents.
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Affiliation(s)
- Jade Pelletier Brochu
- a Department of Psychology, Adolescence and Eating Disorders Research Laboratory , Montreal University , Montreal , Quebec , Canada
| | - Dominique Meilleur
- a Department of Psychology, Adolescence and Eating Disorders Research Laboratory , Montreal University , Montreal , Quebec , Canada
| | - Giuseppina DiMeglio
- b Division of Adolescent Medicine and Pediatric Gynecology , Montreal Children's Hospital, McGill University , Montreal , Quebec , Canada
| | - Danielle Taddeo
- c Division of Adolescent Medecine , Sainte-Justine University Hospital Center , Montreal , Quebec , Canada
| | - Eric Lavoie
- d Eating Disorders Clinic, Sherbrooke University Hospital Center , Sherbrooke , Quebec , Canada
| | - Julius Erdstein
- b Division of Adolescent Medicine and Pediatric Gynecology , Montreal Children's Hospital, McGill University , Montreal , Quebec , Canada
| | - Robert Pauzé
- e Department of Psychoeducation , Sherbrooke University , Sherbrooke , Quebec , Canada
| | - Caroline Pesant
- d Eating Disorders Clinic, Sherbrooke University Hospital Center , Sherbrooke , Quebec , Canada
| | - Isabelle Thibault
- e Department of Psychoeducation , Sherbrooke University , Sherbrooke , Quebec , Canada
| | - Jean-Yves Frappier
- c Division of Adolescent Medecine , Sainte-Justine University Hospital Center , Montreal , Quebec , Canada
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18
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Proulx-Cabana S, Picard L, Fortin MC, Couillard JA, Taddeo D, Jamoulle O, Frappier JY, Stheneur C. PRISE EN CHARGE MULTIDISCIPLINAIRE D’ADOLESCENTS AVEC SYMPTÔMES DOULOUREUX FONCTIONNELS RÉFRACTAIRES. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
La douleur chronique, d’origine organique ou somatique, représente un fardeau financier important au niveau du système de santé. L’intervention multidisciplinaire a été démontrée efficace pour améliorer cliniquement l’impact fonctionnel de cette condition.
OBJECTIVES
Étude de l’impact d’une prise en charge multidisciplinaire pédiatrique et psychologique sur les symptômes douloureux fonctionnels et leur retentissement dans une population adolescente référée pour échec de prise en charge nitiale.
DESIGN/METHODS
Analyse rétrospective de dossiers d’adolescents, de 14 à 18 ans, suivis en clinique des adolescents pour des symptômes douloureux fonctionnels entre janvier 2016 et juin 2017. L’équipe multidisciplinaire est composée de pédiatre, psychologue en suivi individuel ou lors du groupe d’intervention en gestion de la douleur, physiothérapeute et infirmière.
RESULTS
24/36 adolescents ayant des symptômes réfractaires avaient des dossiers exploitables. L’âge médian était de 15,9 ans [14,9; 16,3] avec 87,5% de filles dans l’échantillon. Les principales plaintes rapportées étaient des céphalées (50%), nausées/vomissements (50%), douleurs abdominales (37,5%), douleurs musculo-squelettiques (37,5%), fatigue (37,5%) et symptômes neurologiques (20,8%). Le nombre médian de plaintes étaient de 2 par patient. À la consultation initiale, pour le symptôme principal, la durée médiane écoulée depuis l’apparition était de 13 mois [3,75; 34,5], l’intensité médiane de 6/10 et la fréquence médiane de 7 jours/semaine. Le nombre médian de consultations médicales avant la prise en charge spécialisée était de 3 [2; 5], dont 76,6% d’entre elles en surspécialité pédiatrique. Les patients avaient un nombre médian d’intervenants psychosociaux impliqués au dossier initial de 1, dont un psychologue dans 42,4%. Initialement, 83,3% des patients présentaient un absentéisme scolaire significatif. Suite à la prise en charge, nous avions une amélioration des symptômes pour 70,8% et de l’absentéisme scolaire pour 63,6%. Les symptômes de nausées/vomissements étaient les plus persistants. Sur notre petit groupe d’adolescents, il n’a pas été possible de mettre en évidence de différence significative entre ceux qui avaient bénéficié du groupe d’intervention et les autres.
CONCLUSION
Dans une population d’adolescents avec symptômes douloureux fonctionnels dont la prise en charge en première ligne n’a pas été efficace, une prise en charge multidisciplinaire spécialisée permet une amélioration des symptômes et de la fréquentation scolaire dans 2/3 des cas.
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Cyr M, Frappier JY, Hébert M, Tourigny M, McDuff P, Turcotte ME. Impact of child sexual abuse disclosure on the health of nonoffending parents: A longitudinal perspective. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/15379418.2018.1460649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mireille Cyr
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Yves Frappier
- Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Martine Hébert
- Département de Sexologie, UQAM, Montréal, Québec, Canada
| | - Marc Tourigny
- Département de Psychoéducation, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pierre McDuff
- Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Marie-Eve Turcotte
- Chaire de recherche Nicolas Steinmetz - Gilles Julien en Pédiatrie Sociale en Communauté, Université McGill, Montréal, Québec, Canada
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20
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Vézina-Gagnon P, Bergeron S, Frappier JY, Daigneault I. Genitourinary Health of Sexually Abused Girls and Boys: A Matched-Cohort Study. J Pediatr 2018; 194:171-176. [PMID: 29273174 DOI: 10.1016/j.jpeds.2017.09.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/20/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare genitourinary health problems of children and adolescents with a substantiated report of sexual abuse with those of the general pediatric population. STUDY DESIGN Via a prospective matched-cohort design, administrative databases between January 1996 and March 2013 were used to document genitourinary problems of 882 sexually abused children and those of 882 matched controls. Generalized linear mixed models determined the association between a substantiated sexual abuse and diagnoses for sexually transmitted infections and urinary and genital health problems. RESULTS Adjusted results revealed that up to 12 years after a sexual abuse was substantiated, abused girls had, respectively, 2.1 and 1.4 times more diagnoses for urinary and genital health problems compared with girls from the general population, whereas no difference was found for sexually transmitted infections. Sexually abused boys had an equivalent number of diagnoses as those from the general population for all 3 outcomes. Depending on the genitourinary health problem, abused girls and those from the general population had between 2.5 and 11 times more diagnoses than abused boys or those from the general population. CONCLUSIONS This study showed that substantiated childhood sexual abuse is associated with more urinary and genital health problems among girls but not boys. Early prevention and intervention efforts may mitigate the problems such that they do not persist or worsen over time and into adulthood.
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Affiliation(s)
| | - Sophie Bergeron
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
| | - Jean-Yves Frappier
- Department of Psychology, University of Montreal, Montreal, Québec, Canada
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Thibault I, Pauzé R, Bravo G, Lavoie É, Pesant C, Di Meglio G, Frappier JY, Meilleur D, Nadeau PO, Stheneur C, Taddeo D. [What Are the Individual, Family, and Social Characteristics Differentiating Prepubertal from Pubertal Anorexia Nervosa?]. Can J Psychiatry 2017; 62:837-844. [PMID: 28834466 PMCID: PMC5714118 DOI: 10.1177/0706743717727239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Prepubertal anorexia nervosa may entail multiple physical effects. When the onset occurs before puberty, the disorder might be associated with a poorer prognosis and a greater resistance to treatment. Until now, prepubertal anorexia nervosa studies have mostly dealt with symptomatology, but rarely with associated factors. OBJECTIVE: This study aims to differentiate prepubescent from pubescent anorexia nervosa regarding individual, family and social characteristics. METHOD: At admission in programs specialized in eating disorders, female patients (n = 19 prepubertal and 126 pubertal) and their parents filled in questionnaires (EDI-3, BDI II, IPPA, FACES IV, IDPESQ) on key individual, family and social characteristics associated with anorexia nervosa. Prepubertal and pubertal patient results were compared for each measured variable. Pubertal development and anorexia presence were assessed by a paediatrician in all patients. RESULTS: Prepubertal patients account for 13.8% of all cases and have a lower percentile rank than pubertal patients. The many questionnaire results showed little or no difficulty at personal, family or social level and no difference with older patients. CONCLUSIONS: These results contribute to challenge our current understanding of prepubertal anorexia nervosa and the prepubescent patient capacity to report their difficulties, which highlights the importance of using several respondents when defining clinical profiles.
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Affiliation(s)
- Isabelle Thibault
- 1 Département de psychoéducation, Faculté d'Éducation, Université de Sherbrooke, Sherbrooke, Québec
| | - Robert Pauzé
- 1 Département de psychoéducation, Faculté d'Éducation, Université de Sherbrooke, Sherbrooke, Québec
| | - Gina Bravo
- 2 Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec
| | - Éric Lavoie
- 3 Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec
| | - Caroline Pesant
- 3 Centre hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec
| | - Giuseppina Di Meglio
- 4 Hôpital de Montréal pour Enfants du Centre universitaire de Santé McGill, professeure agrégée, Université McGill, Montréal, Québec
| | - Jean-Yves Frappier
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
| | | | - Pierre-Olivier Nadeau
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
| | - Chantal Stheneur
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
| | - Danielle Taddeo
- 5 Centre hospitalier universitaire Sainte-Justine, professeur titulaire, Université de Montréal, Montréal, Québec
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Frappier JY. IMPACT OF VIOLENCE RELATED ADVERSE CHILDHOOD EXPERIENCES ON HEALTH. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.000] [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: 11/15/2022] Open
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Alix S, Cossette L, Hébert M, Cyr M, Frappier JY. Posttraumatic Stress Disorder and Suicidal Ideation Among Sexually Abused Adolescent Girls: The Mediating Role of Shame. J Child Sex Abus 2017; 26:158-174. [PMID: 28350260 PMCID: PMC5662426 DOI: 10.1080/10538712.2017.1280577] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/06/2023]
Abstract
Sexual abuse is associated with a host of negative repercussions in adolescence. Yet the possible mechanisms linking sexual abuse and negative outcomes are understudied. The purpose of this study was to investigate the relationships among self-blame, shame, coping strategies, posttraumatic stress disorder, depressive symptoms, and suicidal ideation. The sample included 147 sexually abused adolescent girls between 14 and 18 years of age. A total of 66% of girls reached clinical score for posttraumatic stress disorder, and 53% reached clinical score for depressive symptoms. Close to half (46%) reported suicidal thoughts in the past 3 months. Shame was found to partially mediate the relationship between self-blame and posttraumatic stress disorder. Shame and depressive symptoms were also found to partially mediate the relationship between self-blame and suicidal ideation. Results suggest that shame is a crucial target in interventions designed for sexually abused adolescent girls.
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Cyr M, Frappier JY, Hébert M, Tourigny M, McDuff P, Turcotte MÈ. Psychological and Physical Health of Nonoffending Parents After Disclosure of Sexual Abuse of Their Child. J Child Sex Abus 2016; 25:757-776. [PMID: 27802126 DOI: 10.1080/10538712.2016.1228726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Disclosure of child sexual abuse can be traumatic for nonoffending parents. Research has shown its impact on mothers' mental health, which includes heightened psychological distress, depression, and post-traumatic stress disorder. Very little is known, however, about its impact on their physical health or on fathers' health. The self-perceived mental and physical health of nonoffending parents after child sexual abuse disclosure was compared to determine gender-related differences in this regard. Interviews were conducted with 109 mothers and 43 fathers of 6- to 13-year-old sexually abused children. Bivariate analyses revealed that a fair proportion of parents reported psychological and physical problems after disclosure. However, proportionally more mothers than fathers reported psychological distress, depression, and use of professional services. Fathers were more likely to resort to health services instead of social services and to use medication for depression. Study findings provide leads for health and social service providers for the development of intervention protocols and referral procedures sensitive to gender issues, and they shed new light on specific needs of nonoffending parents.
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Affiliation(s)
- Mireille Cyr
- a Département de psychologie , Université de Montréal , Montréal , Canada
| | - Jean-Yves Frappier
- b Université de Montréal , Centre hospitalier universitaire Ste-Justine , Montréal , Canada
| | | | - Marc Tourigny
- d Département de psychoéducation , Université de Sherbrooke , Sherbrooke , Canada
| | - Pierre McDuff
- a Département de psychologie , Université de Montréal , Montréal , Canada
| | - Marie-Ève Turcotte
- a Département de psychologie , Université de Montréal , Montréal , Canada
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Caudron M, Gosselin-Papadopoulos R, Jamoulle O, Swaleh S, Taddeo D, Frappier JY. Characteristics and Trends in Intentional Acetaminophen Intoxication in Adolescents Over Two Decades. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Acetaminophen is a common drug used for self-poisoning in adolescents, and an important cause of acute liver failure in the pediatric population. Data regarding intentional acetaminophen intoxication in Canadian youths is limited.
OBJECTIVES: The purpose of the study was to describe the characteristics of intentional acetaminophen intoxications in Canadian adolescents and evaluate its evolution over two decades.
DESIGN/METHODS: We performed a retrospective chart review of intentional acetaminophen ingestions in adolescents (11-18 years old) hospitalized at a Canadian pediatric tertiary care centre between 1989 and 2009. We recorded the patients’ sociodemographic data, as well as the characteristics, complications and treatments of the intoxications. Data was compared across approximately five year periods as a group, then in both sexes separately.
RESULTS: A total of 383 cases were examined, 53 of which were in male patients and 330 in female patients. Given the small number of male patients, only female patients were included in this analysis. There were 200 cases within the time intervals 1 and 2 (1989-1993, 1994-1998) and 130 cases within the time intervals 3 and 4 (1999-2003, 2004-2009). Demographics were relatively constant across the time periods. Impulsive gestures were indicated as the motivation in almost 80% of cases, which remained stable over time (p=0.56). The ingestion of additional substances and the quantity of acetaminophen also remained constant over time (p=0.79 and p=0.46). Mean time to physician consultation significantly increased in time from 6h in interval 1 to 13.4h in interval 4 (p=0.0001). The proportion of ICU admissions, coagulopathy and multiple organ failures also increased across time intervals (p=0.01, 0.03 and 0.03 respectively). There was no definitive linear trend in cases of hepatitis, encephalopathy or acute kidney injury (p=0.26, 0.81 and 0.27 respectively). There were two deaths, and one liver transplant over the 21-year period. Treatment significantly changed over time with progressive increase in N-acetylcysteine use from 47.4% to 81.1% (p=<0.0001) and progressive decline in charcoal use from 70.2% to 17.6% (p<0.0001) in intervals 1 to 4. Poison centre consultations significantly increased in time from 14.4% in interval 1 to 67.7% in interval 4 (p<0.0001).
CONCLUSION: We suggest that the apparent severity increase in adolescent acetaminophen intoxication is related to the progressive increase in time to physician consultation with associated delays in treatment. The changes in management observed over the 21-year period is likely reflective of the evolution and availability of treatment protocols. Furthermore, the increase in poison centre consultations may account for part of the decrease in treatment variability across patients.
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Cyr M, Hébert M, Frappier JY, Tourigny M, McDuff P, Turcotte ME. Parental Support Provided by Nonoffending Caregivers to Sexually Abused Children: A Comparison Between Mothers and Fathers. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/15379418.2014.954688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Daneman D, Kellner J, Bernstein M, Dow K, Dugas MA, Duffy C, Eddy A, Filler G, Frappier JY, Gilmour S, Givelichian L, Huang L, Rockman-Greenberg C, Shevell M, Vardy C, Walti H, Orrbine E, Williams M. Social paediatrics: From 'lip service' to the health and well-being of Canada's children and youth. Paediatr Child Health 2013; 18:351-352. [PMID: 24421706 PMCID: PMC3804632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2013] [Indexed: 06/03/2023] Open
Affiliation(s)
- Denis Daneman
- President, Paediatric Chairs of Canada, University of Toronto, Toronto, Ontario
| | - James Kellner
- Vice-President, Paediatric Chairs of Canada, University of Calgary, Calgary, Alberta
| | | | - Kim Dow
- Queen’s University, Kingston, Ontario
| | | | | | - Allison Eddy
- University of British Columbia, Vancover, British Columbia
| | | | | | | | | | | | | | | | - Cathy Vardy
- Memorial University of Newfoundland, St John’s, Newfoundland and Labrador
| | - Herve Walti
- Université de Sherbrooke, Sherbrooke, Quebec
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Lambert G, Haley N, Jean S, Tremblay C, Frappier JY, Otis J, Roy É. Sexual health of adolescents in Quebec residential Youth Protection Centres. Can J Public Health 2013; 104:e216-21. [PMID: 23823885 DOI: 10.17269/cjph.104.3577] [Citation(s) in RCA: 5] [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] [Received: 08/15/2012] [Revised: 05/01/2013] [Accepted: 02/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To document risk behaviours and prevalence of chlamydia and gonorrhoea infections among adolescents aged 14 to 17 years entering care in Quebec Youth Protection Centres (YPC). METHODS From July 2008 to May 2009, adolescents residing in six YPCs completed a questionnaire during a face-to-face interview. Questions covered sexual and substance use behaviours prior to admission, as well as other health issues affecting respondents' mental and physical health. Urine samples were tested for Chlamydia trachomatis genital infection (CTGI) and Neisseria gonorrhoea genital infection (NGGI). RESULTS Among 578 participants aged 14 to 17 years, 89% had had consensual sexual relations. Sexual risk behaviours included early sexual initiation (66% at <14 years); multiple partners (median lifetime number: girls 5, boys 8); 50% or more of sexual relations under the influence of drugs or alcohol (girls 43%, boys 48%); group sex (girls 38%, boys 43%); and sex in exchange for money or other goods (girls 27%, boys 8%). Only a quarter of boys and girls used double protection (condom and a contraceptive method) during the most recent vaginal relation. A history of pregnancy was reported by 28% of girls. Prevalence of CTGI was 9.3% (CI: 5.5-14.5) among girls and 1.9% (CI: 0.6-4.4) among boys. Prevalence of NGGI gonorrhoea was 1.7% (CI: 0.3-4.8) among girls and 0% (CI: 0.0-1.4) among boys.In multivariate analyses, factors significantly associated with chlamydia infection among sexually active girls were: hospitalization for alcohol intoxication; and a history of suicidal ideation with plan. CONCLUSION Sexual risk behaviours are common among adolescents entering YPCs, resulting in high levels of chlamydia infection. Mental health issues such as substance misuse and serious depressive symptoms are associated with these high rates. A youth's stay in these facilities is an opportune time to screen not only for sexual risk behaviours but also for mental health problems; appropriate risk reduction education and referrals can then be provided as needed.
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Affiliation(s)
- Gilles Lambert
- Direction de santé publique de l’Agence de la santé et des services sociaux de Montréal, Montréal, QC, Canada.
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Frappier JY, Lynk A. Combler l’écart entre ce que nous savons et ce que nous faisons pour les jeunes enfants du Canada. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.2.70] [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: 11/12/2022] Open
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Frappier JY, Lynk A. Closing the gap between what we know and what we do for Canada’s young children. Paediatr Child Health 2012; 17:69-70. [DOI: 10.1093/pch/17.2.69] [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: 11/13/2022] Open
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Daigneault I, Hébert M, McDuff P, Frappier JY. Evaluation of a sexual abuse prevention workshop in a multicultural, impoverished urban area. J Child Sex Abus 2012; 21:521-542. [PMID: 22994691 DOI: 10.1080/10538712.2012.703291] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Participants in the ESPACE sexual abuse prevention workshop were in grades 1 through 4 and attended three Montreal, Canada, public schools in low socioeconomic areas. The sample was culturally diverse, with half born outside of Canada. An evaluation was conducted to explore the effects associated with participating in the workshop and the effects of booster sessions conducted two years later. Outcomes included knowledge gained, the ability to offer behavioral responses to abusive situations, peer victimization, sense of safety, empathy, self-efficacy, and support. Results revealed that participants in this sample obtained low scores on measures of sexual abuse knowledge and that short booster sessions that elicit children's recall of the learned material might produce greater improvements.
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Frappier JY, Kaufman M, Baltzer F, Elliott A, Lane M, Pinzon J, McDuff P. Sex and sexual health: A survey of Canadian youth and mothers. Paediatr Child Health 2011; 13:25-30. [PMID: 19119349 DOI: 10.1093/pch/13.1.25] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2007] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Apparent changes in adolescent sexual behaviours have led to debate in recent years. A survey on adolescent sexuality was designed to determine mainstream Canadian adolescents' current knowledge and sources of sexual health information, to identify their needs, and to understand the perceptions and the role of parents in sexual health education. METHODOLOGY In October 2005, on-line interviews were conducted by Ipsos Reid (Ipsos Canada) with 1171 Canadian teenagers (14 to 17 years of age) and 1139 mothers of teenagers. RESULTS Twenty-seven per cent of teens were sexually active at a mean age of 15 years, with an average of 2.5 lifetime partners, and had been in their current relationship for longer than eight months. The last time that they had had sex, 76% had used a condom. Teens and mothers overestimated the percentages of teens sexually active at any age. Most valuable sources of information were school, parents, friends and doctors. Sixty-nine per cent of teens could not find the information that they were looking for, and 62% reported obstacles in getting information. Teens lacked knowledge about sexually transmitted infections and their consequences. Seventy-five per cent of mothers believed that their teenagers' friends were significant role models when it came to sexuality, and 50% mentioned entertainment celebrities at par with them. However, 45% of teenagers regarded their parents as their role models, far ahead of friends (32%) and entertainment celebrities (15%). Despite saying that they had positive relationships with their mothers, 38% of teens had not discussed sexuality with them. Most teens trusted the information given by health professionals (94%) and believed that it was their role to provide sexual health information. CONCLUSIONS Most adolescents are responsible when it comes to sexuality, but there are still areas of concern. Adolescents identify barriers to getting information and lack knowledge about sexually transmitted infections. Parents should feel more comfortable when it comes to discussing sexuality, especially the more value-based issues. Health care professionals and teachers have a role to play, and should ensure that teens are getting correct information. It is important to have diverse sources of information. All teens are not ready at the same time to receive the information; thus, it should be repeated. Governments, health, education and public health authorities have an essential role to play to make sexual health information accurate, accessible, inclusive and salient to the reality of Canadian adolescents.
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Affiliation(s)
- Jean-Yves Frappier
- Adolescent Medicine Division, Sainte-Justine UHC, University of Montreal, Montreal, Quebec
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Goulet C, Frappier JY, Fortin S, Déziel L, Lampron A, Boulanger M. Development and Evaluation of a Shaken Baby Syndrome Prevention Program. J Obstet Gynecol Neonatal Nurs 2009; 38:7-21. [DOI: 10.1111/j.1552-6909.2008.00301.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Health care professionals must be alert to the high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors to consider in teens are their developmental stage and challenges, emotional issues and family dysfunction. Direct and indirect methods have been described to assess adherence. Eliciting an adherence history is the most useful way for clinicians to evaluate adherence, and could be the beginning of a constructive dialogue with the adolescent. Interventions to improve adherence are multiple - managing mental health issues appropriately, building a strong relationship, customizing the treatment regimen if possible, empowering the adolescent to deal with adherence issues, providing information, ensuring family and peer support, and motivational enhancement therapy. Evaluation of adherence at regular intervals should be an important aspect of health care for adolescents.
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Affiliation(s)
- Danielle Taddeo
- Adolescent Medicine Division, Sainte-Justine UHC, University of Montreal, Montreal
| | - Maud Egedy
- Adolescent Medicine, Quebec City, Quebec
| | - Jean-Yves Frappier
- Adolescent Medicine Division, Sainte-Justine UHC, University of Montreal, Montreal
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Katzman DK, Frappier JY, Goldberg E. Adolescent medicine: A new paediatric subspecialty in Canada. Paediatr Child Health 2008; 13:12-4. [PMID: 19119346 PMCID: PMC2528813 DOI: 10.1093/pch/13.1.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2007] [Indexed: 11/13/2022] Open
Affiliation(s)
- Debra K Katzman
- Division of Adolescent Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | | | - Eudice Goldberg
- Division of Adolescent Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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Findlay SM, Frappier JY. Adolescent medicine in Canada: A positive step for paediatricians and adolescents. Paediatr Child Health 2008; 13:11. [DOI: 10.1093/pch/13.1.11] [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] [Accepted: 12/14/2007] [Indexed: 11/12/2022] Open
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Gilbert A, Maheux B, Frappier JY, Haley N. Adolescent care. Part 1: are family physicians caring for adolescents' mental health? Can Fam Physician 2006; 52:1440-1. [PMID: 17279202 PMCID: PMC1783702] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To investigate how often family physicians see adolescents with mental health problems and how they manage these problems. DESIGN Mailed survey completed anonymously. SETTING Province of Quebec. PARTICIPANTS All 358 French-speaking family physicians who practise primarily in local community health centres (CLSCs), including physicians working in CLSC youth clinics, and 749 French-speaking practitioners randomly selected from private practice. MAIN OUTCOME MEASURES Frequency with which physicians saw adolescents with mental health problems, such as depression, suicidal thoughts, behavioural disorders, substance abuse, attempted suicide, or suicide, during the last year or since they started practice. RESULTS Response rate was 70%. Most physicians reported having seen adolescents with mental health problems during the last year. About 10% of practitioners not working in youth clinics reported seeing adolescents with these disorders at least weekly. Anxiety was the most frequently seen problem. A greater proportion of physicians working in youth clinics reported often seeing adolescents for all the mental health problems examined in this study. Between 8% and 33% of general practitioners not working in youth clinics said they had not seen any adolescents with depression, behavioural disorders, or substance abuse. More than 80% of physicians had seen adolescents who had attempted suicide, and close to 30% had had adolescent patients who committed suicide. CONCLUSION Family physicians play a role in adolescent mental health care. The prevalence of mental health problems seems higher among adolescents who attend youth clinics. Given the high prevalence of these problems during adolescence, we suggest on the basis of our results that screening for these disorders in primary care could be improved.
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Affiliation(s)
- Andrée Gilbert
- Public Health Department, Montreal Regional Health Board, Quebec, Canada.
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Maheux B, Gilbert A, Haley N, Frappier JY. Adolescent care. Part 2: communication and referral practices of family physicians caring for adolescents with mental health problems. Can Fam Physician 2006; 52:1442-3. [PMID: 17279203 PMCID: PMC1783708] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To document with whom family physicians communicate when evaluating adolescents with mental health problems, to whom they refer these adolescents, and their knowledge and perceptions of the accessibility of mental health services in their communities. DESIGN Mailed survey completed anonymously. SETTING Province of Quebec. PARTICIPANTS All general practitioners who reported seeing at least 10 adolescents weekly (n = 255) among 707 physicians who participated in a larger survey on adolescent mental health care in general practice. MAIN OUTCOME MEASURES Whether family physicians communicated with people (such as parents, teachers, or school nurses) when evaluating adolescents with mental health problems. Number of adolescents referred to mental health services during the last year. Knowledge of mental health services in the community and perception of their accessibility. RESULTS When asked about the last 5 adolescents seen with symptoms of depression or suicidal thoughts, depending on type of practice, 9% to 19% of physicians reported routinely communicating with parents, and 22% to 32% reported not contacting parents. Between 16% and 43% of physicians referred 5 adolescents or fewer to mental health services during a 12-month period. Most practitioners reported being adequately informed about the mental health services available in their local community clinics. Few physicians knew about services offered by private-practice psychologists, child psychiatrists, or community groups. Respondents perceived mental health services in community clinics (CLSCs) as the most accessible and child psychiatrists as the least accessible services. CONCLUSION Few physicians routinely contact parents when evaluating adolescents with serious mental health problems. Collaboration between family physicians and mental health professionals could be improved. The few referrals made to mental health professionals might indicate barriers to mental health services that could mean many adolescents do not receive the care they need. The lack of access to mental health services, notably to child psychiatrists, reported by most respondents could explain why some physicians choose not to refer adolescents.
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Affiliation(s)
- Brigitte Maheux
- Department of Social and Preventive Medicine, University of Montreal, Quebec, Canada.
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Frappier JY, Austin Leonard K, Sacks D. Les jeunes et les armes à feu au Canada. Paediatr Child Health 2005. [DOI: 10.1093/pch/10.8.479] [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: 11/14/2022] Open
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Frappier JY, Goldberg E, Lynk A, Sacks D, Tonkin R, Walker RC. Canada's youth up in smoke: The decriminalization of cannabis. Paediatr Child Health 2003; 8:553. [PMID: 20019820 DOI: 10.1093/pch/8.9.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jean-Yves Frappier
- Hôpital Sainte-Justine, Montreal, Quebec (CPS Adolescent Health Committee co-chair)
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Nguyen UP, Carceller AM, Chevalier I, Weber ML, Frappier JY. Observation Directe: Effet De La RéTroaction Sur La Technique D’Entrevue Des RéSidents En PéDiatrie. Paediatr Child Health 2003. [DOI: 10.1093/pch/8.suppl_b.18b] [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: 11/14/2022] Open
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Roy E, Haley N, Leclerc P, Lemire N, Boivin JF, Frappier JY, Claessens C. Prevalence of HIV infection and risk behaviours among Montreal street youth. Int J STD AIDS 2000; 11:241-7. [PMID: 10772087 DOI: 10.1258/0956462001915778] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.
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Affiliation(s)
- E Roy
- Montreal Regional Public Health Department, Quebec, Canada
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Poulin C, Alary M, Ringuet J, Frappier JY, Roy E, Lefebvre J. Prevalence of chlamydial infection and frequency of risk behaviours for STDs and HIV infection among adolescents in public juvenile facilities in the province of Quebec. Can J Public Health 1997. [PMID: 9336096 DOI: 10.1007/bf03404794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to determine the prevalence of chlamydial infection in adolescents entering public juvenile facilities in the province of Quebec and the frequency of their risk behaviours for STDs and HIV infection. Adolescents were asked to complete an anonymous self-administered questionnaire and to be screened for Chlamydia trachomatis. Of 731 sexually active adolescents, 62% agreed to be tested. The overall prevalence rate was 7.7% (95% confidence interval: 5.1%-10.3%). The prevalence was significantly higher in female than in male teenagers: 12% vs 3% (p < 0.001, Fisher's exact test). These results suggest that screening for chlamydial infection should be offered to all sexually active female teenagers admitted into juvenile facilities. For males, selective screening taking into account sexual history would be a more realistic approach. The frequency of high risk activities for STDs and HIV infection points to the importance of specific prevention programs for this population.
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Affiliation(s)
- C Poulin
- Centre de santé publique de Québec
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Abstract
In 1993, the University of Montreal Medical School changed from an old teaching curriculum to a new one with Problem-Based-Learning as its major component. The first group of problems covers growth and development at all ages. The authors present this new learning method and discuss their experience and that of students with problems involving physiologic, psychologic and environmental learning objectives.
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Affiliation(s)
- B Boileau
- Psychiatre, hôpital Sainte-Justine, Montréal, Canada
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48
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Abstract
In clinical practice, non-compliance is an often unrecognised or frustrating reality, which physicians find difficult to accept or deal with. Possible determinants of adolescents' level of compliance may be divided into demographic factors, patient and family characteristics, aspects of the illness and treatment regimen, and quality of the patient-doctor relationship. Compliance should be viewed as a reflexion of the experience of chronic illness as well as the expression of specific adolescent developmental issues. Practical guidelines are proposed.
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Affiliation(s)
- P Alvin
- Département de pédiatrie, CHU Bicêtre, Le Kremlin-Bicêtre, France
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Michaud PA, Frappier JY, Pless IB. [Compliance in adolescents with chronic disease]. Arch Fr Pediatr 1991; 48:329-36. [PMID: 1859234] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study was undertaken with the aim of improving the understanding of the phenomenon of compliance in adolescents presenting with chronic diseases. In 192 subjects aged 12 to 20 years presenting with diabetes, asthma, cystic fibrosis, systemic lupus erythematosus or juvenile rheumatoid arthritis, appointment keeping, compliance with prescribed medical regimens or general instructions and the filling up of a calendar describing the daily levels of fatigue were studied. Correlations (Pearson) between these various types of measurements were weak: from 0.04 to 0.26. Appointment keeping was about 90%. Overall compliance either with treatments or with general instructions was 50% only (without clearcut changes according to diseases); however only 11% of subjects presented with a good compliance with all the treatment components. Various factors (familial environment, perception of the disease and of the patient-physician relationships) were significantly associated with compliance (p less than 0.005). These results emphasize the necessity of taking care of all aspects of compliance, which is difficult to predict at this age, due to the multiple factors involved.
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Affiliation(s)
- P A Michaud
- Département de pédiatrie de l'Université de Montréal, Hôpital Sainte-Justine, Montréal, Canada
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50
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Abstract
We report the incidence of traffic injuries to children in Montreal: 33.4 per 10,000, 57 per cent pedestrians, 24.5 per cent passengers, and 18.4 per cent bicyclists. Nearly 20 per cent were hospitalized and 1.2 per cent died. One-third had MAIS scores of 2 or more with the highest rate of severe injuries found among pedestrians. Pedestrian and bicycle (but not passenger) injuries in low income areas were four to nine times greater than those in more affluent areas.
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