The enhancement of mental health is becoming an increasingly important public health issue. Anxiety disorders are the most common mental problems. In light of the scope of the problem, public health has the mandate to continuously monitor the evolution of these disorders and to ensure that the health care system serves the population appropriately, in terms of service availability, accessibility, continuity and effectiveness. Moreover, public health ensures that prevention and promotion programs are put in place to contend with risk factors and encourage individuals to adopt habits that promote good mental health. This article describes public health interventions in relation to anxiety disorders in Montreal.
To verify the validity of self-reported data on service use from clients with mental or substance abuse disorders in Montreal and Quebec services for homeless individuals.
To compare the self-reported data from the Enquête chez les personnes itinérantes (Fournier, 2001) on health service use with official data from Quebec health services (MEDECHO and RAMQ).
The analysis shows a moderate-to-high level of concordance between the self-reported and the official data. Almost every item analyzed presents moderate but significant intraclass correlation coefficients for general and psychiatric hospitalization and use of psychiatric medication, but lower and nonsignificant coefficients for medical hospitalization. Participant characteristics such as mental disorders, homeless status, and substance abuse problems do not seem to have an impact on data validity.
The answers on health service use from individuals with mental health problems, homeless status, or substance abuse problems are generally valid in the results presented. Thus the self-reported data from these individiuals seems to be a generally valid source of data and an affordable one for research on service use or other domains.
Changing Directions, Changing Lives, the Mental Health Strategy for Canada, prioritizes the development of coordinated continuums of care in mental health that will bridge the gap in services for Inuit populations.
In order to target ways of improving the services provided in these contexts to individuals in Nunavik with depression or anxiety disorders, this research examines delays and disruptions in the continuum of care and clinical, individual and organizational characteristics possibly associated with their occurrences.
A total of 155 episodes of care involving a common mental disorder (CMD), incident or recurring, were documented using the clinical records of 79 frontline health and social services (FHSSs) users, aged 14 years and older, living in a community in Nunavik. Each episode of care was divided into 7 stages: (a) detection; (b) assessment; (c) intervention; (d) planning the first follow-up visit; (e) implementation of the first follow-up visit; (f) planning a second follow-up visit; (g) implementation of the second follow-up visit. Sequential analysis of these stages established delays for each one and helped identify when breaks occurred in the continuum of care. Logistic and linear regression analysis determined whether clinical, individual or organizational characteristics influenced the breaks and delays.
More than half (62%) the episodes of care were interrupted before the second follow-up. These breaks mostly occurred when planning and completing the first follow-up visit. Episodes of care were more likely to end early when they involved anxiety disorders or symptoms, limited FHSS teams and individuals over 21 years of age. The median delay for the first follow-up visit (30 days) exceeded guideline recommendations significantly (1-2 weeks).
Clinical primary care approaches for CMDs in Nunavik are currently more reactive than preventive. This suggests that recovery services for those affected are suboptimal.
The current study presents data on the prevalence of depressive and anxiety disorders in the Canadian population aged between 15 and 24 years and examines their potential correlates.
The study is based on the 2002 Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). This survey was administered to a representative sample of 36,984 Canadians. A subsample of 5673 Canadians aged between 15 and 24 years was available for the analyses. We used descriptive analyses to calculate lifetime and 12-month prevalence of depressive and anxiety disorders, and we used logistic regressions to measure odds ratios.
Among Canadian youths, 10.2% had suffered from depressive disorders during their lifetime, whereas 12.1% had suffered from anxiety disorders. For 12-month prevalence, the rates were 6.4% and 6.5% for depressive and anxiety disorders, respectively. Depressive disorders were more frequent among youth aged 20 to 24 years and among those no longer in school. Both disorders were more common among women and people under extreme stress.
The prevalence rates found are comparable with other studies, and most of the correlates are concordant with the literature. Results indicate that there is a turning point for depression between late adolescence and adulthood that could be crucial for intervention planning.
The purpose of this study was to compare potential risk factors of depressive disorders among young Canadians (aged 15-24) to those of older age groups (25-34 and 35-44) and examine the contribution of individual and contextual factors in the continuity and discontinuity of depression.
Data from the Canadian Community Health Survey--Cycle 1.2 were analyzed to examine the associations between individual, familial, social and environmental factors and the continuity or discontinuity of depressive disorders among young Canadians. The sample consisted of 5,673 Canadians aged 15-24, 5,830 aged 25-34 and 7,830 aged 35-44. Youths were also categorized according to the type of cases: non-case, new case, case in remission or long-lasting case.
Among Canadian youth, 10.2% had suffered from depression during their lifetime. Social support was the only factor distinguishing the youngest age group from the others regarding depression. Compared to older age groups, stress levels were notably higher for young people. The combination of social network, social support and stress levels strongly distinguished between the long-term cases and the non-cases among youths. Weak feeling of community cohesion was also related to new cases of depression and could contribute to their beginnings.
Potential targets for preventive measures lie in the contextual and social influences of youth; particularly what impacts stress levels, social support and social networks. Studying processes of continuity and discontinuity contribute to identifying distinct profiles of onset, recurrence or remission of depression that may point to avenues for prevention and early intervention.
To identify the determinants of service use by young Canadians with mental health problems.
Data were drawn from a recent large Canadian mental health survey. The analyses were conducted on a subsample of 1092 Canadians aged 15 to 24 years and identified as presenting a mood disorder, an anxiety disorder, or a substance-related disorder in the 12 months preceding the survey. We classified variables potentially associated with any type of service use for a mental health problem over a 12-month period according to predisposing, enabling, and need factors. We conducted weighted multivariate logistic regressions to determine the association of each factor with service use.
In the final model, being female and living alone were the predisposing factors associated with service use. None of the enabling factors predicted help seeking. In regard to the perceived need factors, those who had difficulties with social situations were more likely to use services. Having a mood disorder and (or) having a diagnosed chronic illness were the evaluated need factors associated with service use.
Certain groups of young Canadians are less likely to seek help for mental health problems and could be the target of interventions aimed at increasing service use.
There are two factors that limit our knowledge of the risk factors associated with homelessness among runaway adolescents, namely (1) the samples used are often composed of youth homeless service users and/or youths living on the streets (visible homelessness), whereas most adolescents in fact use "private" resources (hidden homelessness), and (2) failure to use an adequate control group to identify risk factors associated specifically with homelessness. Our study compares the characteristics of two groups of youths under the supervision of the youth protection system, according to the presence or absence of periods of homelessness. The results throw light on the factors underlying the shift from "at risk" to "homeless", showing that youths with experience of homelessness are more likely to have been placed in substitute home environments, have experienced significant relationship difficulties with one of their parents (deterioration of the parent/youth relationship and parental abuse) and to have been diagnosed with behavioural disorders. The findings suggest that the decision to place young people under supervision is based more on the dynamic between risk factors rather than on the existence of behavioural problems.
Mental health is one of the leading causes of morbidity worldwide. Its impact in terms of cost and loss of productivity is considerable. Improving the efficiency of mental health care system has thus been a high priority for decision makers. In the context of current reforms that privilege the reinforcement of primary mental health care and integration of services, this article brings new lights on the role of general practitioners (GPs) in managing mental health, and shared-care initiatives developed to deal with more complex cases. The study presents a typology of GPs providing mental health care, by identifying clusters of GP profiles associated with the management of patients with common or serious mental disorders (CMD or SMD).
GPs in Quebec (n = 398) were surveyed on their practice, and socio-demographic data were collected.
Cluster analysis generated five GP profiles, including three that were closely tied to mental health care (labelled, respectively: group practice GPs, traditional pro-active GPs and collaborative-minded GPs), and two not very implicated in mental health (named: diversified and low-implicated GPs, and money-making GPs).
The study confirmed the central role played by GPs in the treatment of patients with CMD and their relative lack of involvement in the care of patients with SMD. Study results support current efforts to strengthen collaboration among primary care providers and mental health specialists, reinforce GP training, and favour multi-modal clinical and collaborative strategies in mental health care.
Depression is one of the most prevalent mental health problems worldwide with considerable social and economic burdens. While practice guidelines exist, their adherence is inconsistent in clinical practice.
To provide up-to-date national estimates of the adequacy of treatment received by Canadians having suffered a major depressive disorder (MDD) and examine factors associated with this adequacy. To evaluate the impact of different definitions of guideline-concordant treatment on the results.
Data were drawn from the Canadian Community Health Survey, cycle 1.2: Mental Health and Well-Being (CCHS 1.2), a nationally representative survey conducted in 2002 and targetting persons aged 15 years or older living in private dwellings. In order to calculate the prevalence of treatment adequacy, we used a sample of 1,563 individuals meeting the criteria for MDD in the 12 months preceding the survey. A subset of 831 subjects who reported having used health services for mental health purposes at least once during that time served to identify the factors associated with treatment adequacy.
Four definitions of minimally adequate treatment were considered and covariates were selected according to a well-known behavioral model. The analyses consisted of prevalence estimates and logistic regression models.
Among selected subjects, 55% received guideline-concordant treatment according to the Canadian guidelines. Inadequacy was more prevalent in rural settings, for less complex cases, and in the general medical sector. Depending on the definition, prevalence of guideline-concordant treatment ranged between 48 and 71%, and factors associated with guideline-concordant treatment were mainly need factors and sector of care.
A large proportion of people with a depressive disorder do not receive minimally adequate treatment. Improved access to and quality of treatment is required, especially in primary care settings.
The objective of this cohort study is to describe the service utilization by clients of homeless resources in Quebec and Montreal (Canada) over a 5-year period. Participants (N = 426) were recruited from a survey conducted in 1999 about clients' utilization of resources intended for homeless people in Montreal and Quebec. Data analyzed in this study were also drawn from three administrative databanks managed by the Quebec health care system. Results revealed that: (1) in general, mental health services are less used than physical health services; (2) generally, women, older persons, nonhomeless persons, and persons with mental health problems utilized proportionately more health services; and (3) participants involved in this study tend to continue using services over years in a system where health services are free. These findings are discussed in terms of long-term service utilization by clients of homeless resources.