Prevalence of mental health problems among adolescents varies from 10 to 30%. Therefore, mental health promotion in school has risen as a very important developing area in public health services. The need is international. Despite the large number of projects and recommendations on the promotion of schoolchildren's mental health, the literature does not offer a comprehensive theoretical description of what mental health work with people of this particular age really is as a whole. The theory can be constructed by combining and comparing the viewpoints of the different parties--the employees, the schoolchildren and their families--as well as previous knowledge of the subject. The purpose of this research was to produce a description of the concepts used by employees when addressing the subject of promoting mental health in the upper level of comprehensive schools (grades 7-9). The description has been produced by analysing interviews with nine people who work with schoolchildren, as well as workgroup memos related to the development work. The respondents work in the fields of primary healthcare, specialised healthcare, the education authority and social services. The analysis was conducted by applying the grounded theory method. The research target was a Finnish upper-level comprehensive school with 446 pupils. Four key concepts were found: The concept of a school environment comprises the physical and social conditions in the school, the curricula and other instructions. Human resources comprise representatives of various organisations, their competencies and time-consumption opportunities. The schoolchildren and their families and also their friends are key operators and partners. The concept of work to promote mental health is related to enhancing the school's conditions, recognising problems and offering help, co-operation and joint agreement. The produced description clarifies the overall picture of mental health work in schools and facilitates the finding of key development areas.
This case study describes an ongoing demonstration project that engages nurses and nurse leaders in decision-making with respect to workload management issues at eight practice sites within British Columbia (two per healthcare sector: acute care, long-term care, community health and community mental health). The primary goal of this project is to promote high-quality practice environments by empowering front-line nurses and their leaders: giving them the means to systematically examine and act upon factors that influence their workloads. Examples from practice sites illustrate tangible benefits from the project.
High levels of anxiety during clinical practice in nursing education may interfere with learning and contribute to poor mental health. The relationship between undergraduate curriculum design and clinical practice anxiety is unknown.
A descriptive, comparative research design was used to compare levels of clinical practice anxiety in third year baccalaureate nursing students in a problem-based learning (PBLP) curriculum (n=53) with those in a traditional, lecture-based (TNP) curriculum (n=42). A secondary aim of this study was to explore relationships between some of the demographic characteristics of the student sample, students' predisposition to anxiety, clinical learning experiences, and clinical practice anxiety. Students anonymously completed three electronic questionnaires including: a demographic questionnaire, the Spielberger State-Trait Anxiety Inventory (STAI), and the Clinical Experience Assessment Form (CEAF).
The PBL and the traditional group did not significantly differ on clinical practice anxiety. The mean scores on the STAI for this sample of nursing students were higher than those previously reported for the general population of university students. Implications for nursing education: strategies aimed at reducing nursing students' clinical practice anxiety are explored.
Immigrants to Canada are less likely to report depression compared with the non-immigrant population. This healthy migrant effect has not so far been explained by demographic and socioeconomic determinants of health.
The present study examined whether the psychological health advantage of immigrants varied across Canadian health regions and investigated the hypothesis of immigrant density as a determinant of immigrant mental health advantage.
Data from the 2000-2001 Canadian Community Health Survey were used to build multi-level models estimating variation in depression within and between health regions by immigrant/visible minority status.
Immigrant and visible minority residents were less likely to experience depression compared with the general population. Depression varied across health regions and the extent of variation was greater for visible minorities. The likelihood of depression decreased with increasing percentage of immigrants in the region among visible minority participants but not among whites.
The protection against depression afforded by immigrant and visible minority status in Canada appears to depend on contextual factors, notably the percentage of immigrants in the region. Future work should seek to better characterize the experiences of visible minorities in different settings.
Military mental health research has rarely investigated social anxiety disorder, despite its known serious consequences in the general population, and what work has been conducted has used specialized samples (e.g., veterans) not representative of all military personnel.
Data were from the 2002 Canadian Community Health Survey-Canadian Forces Supplement, a representative survey of 8441 active regular and reserve military personnel.
Social anxiety disorder has a high lifetime (8.2%) and past-year (3.2%) prevalence in the military. It is associated with increased odds of depression, panic attacks/disorder, generalized anxiety disorder, and post-traumatic stress disorder (AOR range 4.16-16.29). Being female, ages 35-44, or separated/divorced/widowed increases the odds of having social anxiety disorder, while being an officer or a reservist decreases the odds. Treatment-seeking, as in the general population, is relatively rare. Overall, military personnel with social anxiety disorder experience significant rates of role impairment in all domains (53.1-88.3% report some impairment), with the rate of role impairment increasing with the number of social fears. Notably, many (70.6%) report at least some impairment at work (i.e., in their job with the military).
Social anxiety disorder is an important disorder to take into account when considering military mental health. Observing low rates of treatment-seeking for social anxiety disorder among military personnel highlights the importance of initiatives to allow its identification and treatment.
To describe and validate the 'DAWBA bands'. These are novel ordered-categorical measures of child mental health, based on the structured sections of the Development and Well-Being Assessment (DAWBA).
We developed computer algorithms to generate parent, teacher, child and multi-informant DAWBA bands for individual disorders and for groups of disorder (e.g. 'any emotional disorder'). The top two (out of 6) levels of the DAWBA bands were used as computer-generated DAWBA diagnoses. We validated these DAWBA bands in 7,912 British children (7-19 years) and 1,364 Norwegian children (11-13 years), using clinician-rated DAWBA diagnoses as a gold standard.
In general, the prevalence of clinician-rated diagnosis increased monotonically across all levels of the DAWBA bands, and also showed a dose-response association with service use and risk factors. The prevalence estimates of the computer-generated DAWBA diagnoses were of roughly comparable magnitude to the prevalence estimates from the clinician-generated diagnoses, but the estimates were not always very close. In contrast, the estimated effect sizes, significance levels and substantive conclusions regarding risk factor associations were very similar or identical. The multi-informant and parent DAWBA bands performed especially well in these regards.
Computer-generated DAWBA bands avoid the cost and delay occasioned by clinical rating. They may, therefore, sometimes provide a useful alternative to clinician-rated diagnoses, when studying associations with risk factors, generating rough prevalence estimates or implementing routine mental health screening.
Studies of urban-rural differences in rates of non-psychotic psychiatric disorders have produced contradictory results, with some finding higher urban rates and others no difference.
This study aimed to compare geographic variability of rates of depression and three anxiety disorders in a large, random community sample of Canadian residents.
Data from the 2002 Canadian Community Health Survey 1.2 were analyzed, using a four-category classification of urban-rurality.
Significant bivariate urban-rural differences were found for age, marital status, country of birth, ethnicity, education, household income, income adequacy, employment, home ownership, physical activity, perceived stress, and physical health. In addition, participants in the urban core and urban fringe had a weaker sense of belonging to their community and reported lower social support. There was a modest urban excess of depression in the previous 12 months but no difference in rates of agoraphobia, panic disorder or social phobia across the geographical areas. The multivariate modeling showed a lower prevalence of depression for people living in the most rural environment only (odds ratio = 0.76, 95% confidence interval = 0.59, 0.98). Factors associated with an increased rate of depression in the model were female gender, younger age, being not married, being born in Canada, white ethnicity, higher education, unemployment, not owning one's home, and poor physical health. Also, participants with a stronger sense of belonging to their community and higher social support reported lower rates of depression.
These results confirmed a lower risk of depression amongst rural dwellers, which was associated with a stronger sense of community belonging. Further research on this topic could usefully include community-level variables, usually subsumed under the rubric of social capital.
This study examined the effects of cannabis use and driving after cannabis use on self-reported collision involvement within the previous 12 months while controlling for demographics, driving exposure, binge drinking, and driving after drinking based on a large representative sample of adults in Ontario.
Data are based on the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults aged 18 and older, conducted by the Centre for Addiction and Mental Health. Data on drivers who reported driving at least one kilometer per week and who responded to the collision item from 2002 to 2007 were merged into one data set (n = 8481). Logistic regression analysis of self-reported collision risk posed by cannabis use (lifetime and past 12 months), driving after cannabis use (past 12 months), and driving after drinking among drinkers (past 12 months) was implemented, controlling for the effects of gender, age, region, income, education, marital status, kilometers driven in a typical week, and consuming five or more drinks of alcohol on one occasion (past 12 months). Due to list-wise deletion of cases the logistic regression sample was reduced (n = 6907).
Several demographic factors were found to be significantly associated with self-reported collision involvement. The logistic regression model revealed that age, region, income, marital status, and number of kilometers driven in a typical week, were all significantly related to collision involvement, after adjusting for other factors. Respondents who reported having driven after cannabis use within the past 12 months had increased risk of collision involvement (odds ratio [OR] = 1.84) compared to those who never drove after using cannabis, a greater risk than that associated with having reported driving after drinking within the past 12 months (OR = 1.34).
Further investigation of the impact of driving after cannabis use on collision risk and factors that may modify that relationship is warranted.
This study investigated the association between the work ability index (WAI) and the single-item question on work ability among women working in human service organizations (HSO) currently on long-term sick leave. It also examined the association between the WAI and the single-item question in relation to sick leave, symptoms, and health. Predictive values of the WAI, the changed WAI, the single-item question and the changed single-item question were investigated for degree of sick leave, symptoms, and health.
This cohort study comprised 324 HSO female workers on long-term (>60 days) sick leave, with follow-ups at 6 and 12 months. Participants responded to questionnaires. Data on work ability, sick leave, health, and symptoms were analyzed with regard to associations and predictability. Spearman correlation and mixed-model analysis were performed for repeated measurements over time.
The study showed a very strong association between the WAI and the single-item question among all participants. Both the WAI and the single-item question showed similar patterns of associations with sick leave, health, and symptoms. The predictive value for the degree of sick leave and health-related quality of life (HRQoL) was strong for both the WAI and the single-item question, and slightly less strong for vitality, neck pain, both self-rated general and mental health, and behavioral and current stress.
This study suggests that the single-item question on work ability could be used as a simple indicator for assessing the status and progress of work ability among women on long-term sick leave.
The aim was to study the prevalence of mental disorders among homeless men and women admitted for inpatient treatment in hospitals.
Hospital care utilization of homeless people, 1364 men and 340 women, was compared with a control group consisting of 3750 men and 1250 women from the general population, 1996-2002.
Homeless women ran a higher risk for mental disorders than women in the population [risk ratio (RR) 20.88]; their risk was also higher than the risk for homeless men (RR 1.20). Younger homeless women had the highest risk (RR 2.17). Alcohol use disorders were equally common among homeless men and women, but women had more drug use disorders (RR 1.32). Women had higher risk of schizophrenia (RR 2.79), and personality disorders (RR 2.73). When adjustment was made for substance use disorders, no increased risk for mental disorder was found in the homeless group.
The elevated risk for mental disorders among the homeless was mainly related to substance use problems. Younger homeless women had the highest risk of mental disorder.
To estimate the proportion of older adults who have used mental health services in the past 12 months among those who meet the criteria for one or more Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, 12-month psychiatric disorders. We also examine the factors associated with mental health care use in this population.
We used secondary data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). We first estimated the proportion of adults aged 55 years and older who used a range of mental health services. Next, using logistic regression, we examined the relative contribution of predisposing, enabling, and need characteristics in predicting any service use in this population.
Among the 12 792 adults aged 55 years and older in the CCHS 1.2, 513 (4.23%, 95% CI 3.89% to 4.95%) met the criteria for at least one 12-month DSM-IV disorder. Among these respondents, 37% (95% CI 31% to 43%) saw at least one type of mental health care provider in the past 12 months. Visits to a general health care provider for mental health reasons were most common, followed by specialist care. Only psychological distress was significantly and positively associated with using mental health care services.
Over 60% of the older adults who met the criteria for a DSM-IV disorder were not using mental health care services. Social and demographic factors did not predict service use in this population.
Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards.
Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization.
The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint.
The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.
The objective of this study was to investigate predictors of emergency department (ED) return visits for pediatric mental health care. The authors hypothesized that through the identification of clinical and health system variables that predict return ED visits, which children and adolescents would benefit from targeted interventions for persistent mental health needs could be determined.
Data on 16,154 presentations by 12,589 pediatric patients (
Circadian clocks guide the metabolic, cell-division, sleep-wake, circadian and seasonal cycles. Abnormalities in these clocks may be a health hazard. Circadian clock gene polymorphisms have been linked to sleep, mood and metabolic disorders. Our study aimed to examine polymorphisms in four key circadian clock genes in relation to seasonal variation, reproduction and well-being in a sample that was representative of the general population, aged 30 and over, living in Finland.
Single-nucleotide polymorphisms in the ARNTL, ARNTL2, CLOCK and NPAS2 genes were genotyped in 511 individuals. 19 variants were analyzed in relation to 31 phenotypes that were assessed in a health interview and examination study. With respect to reproduction, women with ARNTL rs2278749 TT genotype had more miscarriages and pregnancies, while NPAS2 rs11673746 T carriers had fewer miscarriages. NPAS2 rs2305160 A allele carriers had lower Global Seasonality Scores, a sum score of six items i.e. seasonal variation of sleep length, social activity, mood, weight, appetite and energy level. Furthermore, carriers of A allele at NPAS2 rs6725296 had greater loadings on the metabolic factor (weight and appetite) of the global seasonality score, whereas individuals with ARNTL rs6290035 TT genotype experienced less seasonal variation of energy level.
ARNTL and NPAS2 gene variants were associated with reproduction and with seasonal variation. Earlier findings have linked ARNTL to infertility in mice, but this is the first time when any polymorphism of these genes is linked to fertility in humans.
Cites: Biochem Biophys Res Commun. 1997 Apr 7;233(1):258-649144434
Cites: Am J Med Genet B Neuropsychiatr Genet. 2010 Mar 5;153B(2):570-8119693801
Cites: Lancet. 1998 Oct 24;352(9137):1369-749802288
Canadian recommendations exist for energy intake (EI), physical activity (PA) and gestational weight gain (GWG) to help pregnant women avoid excessive GWG and attain "fit pregnancies". Our objectives were: 1) to measure daily EI, PA and GWG to observe whether pregnant women were meeting recommendations, 2) to explore the impact of health care provider advice on PA and GWG, and 3) to determine behaviours associated with recommended weekly GWG.
Women (n = 81) were recruited from prenatal classes. Current weight and self-reported pre-pregnancy weight were documented. Current PA levels and provider advice for PA and GWG were surveyed using questionnaires. Dietary recalls and pedometer steps were recorded for three and seven days respectively.
The majority of our women were classified as having average pre-pregnancy body mass indices (BMI) of 23.3 +/- 4 kg/m2, average EI of 2237 kcal/d and energy expenditure (EE) of 2328 kcal/d, but with weekly rates of GWG in excess of current recommendations despite having received advice about GWG (74%) and PA (73%). Most were classified as sedentary ( 8.5 MET-hr/wk.
Health care providers need to provide appropriate PA and GWG guidelines to pregnant women. Development of pregnancy step and MET-hr/wk recommendations are warranted in order to promote greater PA during pregnancy.
The present study aimed (1) to determine the proportion of patients treated with persistent antipsychotic polypharmacy in an outpatient population and (2) to determine if persistent antipsychotic polypharmacy is associated with excessive dosing.
Using a province-wide network that links all pharmacies in British Columbia, Canada, to a central set of data systems, we identified community mental health outpatients who had been treated with the same pharmacologic regimen for at least 90 days. Apart from antipsychotics, data collection included anticholinergics, antidepressants, mood stabilizers, benzodiazepines, lipid-lowering agents, and antidiabetic agents. Demographic data including sex, age, and diagnosis were obtained from the patient's chart. In order to compare dosages of the various antipsychotics we used a fixed unit of measurement based on dividing the prescribed daily dose (PDD) by the defined daily dose (DDD). A PDD/DDD ratio greater than 1.5 was defined as excessive dosing.
Four hundred thirty-five patients met the inclusion criteria and were included in the analysis. Overall, the prevalence of persistent antipsychotic polypharmacy was 25.7% for the entire cohort. The prevalence of persistent antipsychotic polypharmacy was highest for patients with schizoaffective disorder (33.7%), followed by schizophrenia (31.7%), psychosis not otherwise specified (20.0%), bipolar disorder (16.9%), and major depression (14.3%). The mean +/- SD PDD/DDD ratio for all patients prescribed persistent antipsychotic polypharmacy was not only excessive, it was significantly greater compared to that of patients receiving antipsychotic monotherapy (1.94 +/- 0.12 vs 0.94 +/- 0.04, P
Approximately fifty percent of older adults with a mental health problem do not receive services. A proactive outreach strategy, Project PIE (Prevention-Intervention-Education) relies upon the assistance of non-traditional referral sources, namely community liaisons, to identify and refer to the CSSS vulnerable or isolated elders with a mental health problem. An evaluation of this project reveals encouraging results. The project appears useful, relevant and efficient to detect elders with a mental health problem and offer the required assistance. This project also appears to be a means to foster social solidarity.
In this article, some hopeful outlooks on the evolution of the law are identified and ways of assessing the state and progress of legislation are advanced, drawing from international organizations and some inspiring efforts in other countries. Potential contributors to the evolution of Canadian mental health law are surveyed. The author concludes that there are coherent ways of changing tack, although in this fraught legislative field, no one can make confident predictions about the future.
This article explores several conundrums and attempts to identify ways of redirecting the Canadian ship of state. It first presents an overview of some of the salient features of the array of mainly coercive provincial and territorial mental health statutes. The failure in the main of the Charter to deliver on its early ostensible promises for people with mental health problems is assessed. Next, the author argues that extant legislation remains anchored in the medical model, when other human rights promoting paradigms transforms the statutory agenda.
In this article, the author examines the impact of judicial intervention of individuals with mental illness on family members. The author subunits the hypothesis that an offer of more diversified services could reduce legal intervention of these individuals and consequently attenuate the devastating effects on family members. According to the families' equation, the more services will be developed and adapted, the less frequent family will have to call upon the legal system to intervene and fewer individuals with mental illness will find themselves behind bars.