Aline Drapeau

The relationship between work stress and mental disorders in men and women: findings from a population-based study

Objectives: This analysis estimated the gender-specific associations between work stress, major depression, anxiety disorders and any mental disorder, adjusting for the effects of demographic, socioeconomic, psychological and clinical variables. Methods: Data from the Canadian national mental health survey were used to examine the gender-specific relationships between work stress dimensions and mental disorders in the working population (n  =  24 277). Mental disorders were assessed using a modified version of the World Mental Health—Composite International Diagnostic Interview. Results: In multivariate analysis, male workers who reported high demand and low control in the workplace were more likely to have had major depression (OR 1.74, 95% CI 1.12 to 2.69) and any depressive or anxiety disorders (OR 1.47, 95% CI 1.05 to 2.04) in the past 12 months. In women, high demand and low control was only associated with having any depressive or anxiety disorder (OR 1.39, 95% CI 1.05 to 1.84). Job insecurity was positively associated with major depression in men but not in women. Imbalance between work and family life was the strongest factor associated with having mental disorders, regardless of gender. Conclusions: Policies improving the work environment may have positive effects on workers’ mental health status. Imbalance between work and family life may be a stronger risk factor than work stress for mental disorders. Longitudinal studies incorporating important workplace health research models are needed to delineate causal relationships between work characteristics and mental disorders.

Epidemiology of Psychological Distress

Aline Drapeau1,2,3, Alain Marchand4,5 and Dominic Beaulieu-Prevost6 1Departement de psychiatrie – Universite de Montreal 2Centre de recherche Fernand-Seguin – Hopital Louis. H. Lafontaine 3Departement de medecine sociale et preventive – Universite de Montreal 4Ecole de relations industrielles – Universite de Montreal 5Institut de recherche en sante publique – Universite de Montreal 6Departement de sexologie – Universite du Quebec a Montreal Canada

Family trauma and its association with emotional and behavioral problems and social adjustment in adolescent Cambodian refugees

OBJECTIVE The main aim of this study was to investigate the effect of war-related trauma on the subsequent social adjustment and functioning of young Cambodian refugees. METHOD This longitudinal study of 67 young Cambodian refugees in Montreal interviewed in the first year of high school and then 2 years later examines a familys exposure to war related premigration trauma and its association with an adolescents emotional and behavioral problems and social adjustment. Emotional and behavioral problems were assessed using the Youth Self-Report and an inventory of risk behavior. Social adjustment was assessed in terms of academic achievement, peer relations, and feeling of competence. RESULTS The trauma a family suffered before leaving their homeland and prior to the teenagers birth seems to play a protective role at various times in adolescence with regard to externalized symptoms, risk behavior, and school failure in boys, and foster positive social adjustment in girls. CONCLUSIONS These reactions may be understood as overcompensation by the children of the survivors of a massacre, to whom the implicit duty to succeed has been passed on. They suggest that a broader range of posttraumatic responses to war situations should be investigated and that traumas dual nature as both burden and source of strength should be examined more closely.

A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender

BackgroundPsychological distress is a widespread indicator of mental health and mental illness in research and clinical settings. A recurrent finding from epidemiological studies and population surveys is that women report a higher mean level and a higher prevalence of psychological distress than men. These differences may reflect, to some extent, cultural norms associated with the expression of distress in women and men. Assuming that these norms differ across age groups and that they evolve over time, one would expect gender differences in psychological distress to vary over the life-course and over time. The objective of this study was to investigate the construct validity of a psychological distress scale, the K6, across gender in different age groups and over a twelve-year period.MethodsThis study is based on data from the Canadian National Population Health Survey (C-NPHS). Psychological distress was assessed with the K6, a scale developed by Kessler and his colleagues. Data were examined through multi-group confirmatory factor analyses. Increasing levels of measurement and structural invariance across gender were assessed cross-sectionally with data from cycle 1 (n = 13019) of the C-NPHS and longitudinally with cycles 1 (1994-1995), 4 (2000-2001) and 7 (2006-2007).ResultsHigher levels of measurement and structural invariance across gender were reached only after the constraint of equivalence was relaxed for various parameters of a few items of the K6. Some items had a different pattern of gender non invariance across age groups and over the course of the study. Gender differences in the expression of psychological distress may vary over the lifespan and over a 12-year period without markedly affecting the construct validity of the K6.ConclusionsThis study confirms the cross-gender construct validity of psychological distress as assessed with the K6 despite differences in the expression of some symptoms in women and in men over the life-course and over time. Findings suggest that the higher mean level of psychological distress observed in women reflects a true difference in distress and is unlikely to be gender-biased. Gender differences in psychological distress are an important public health and clinical issue and further researches are needed to decipher the factors underlying these differences.

Premigration exposure to political violence among independent immigrants and its association with emotional distress.

Although the distinction between independent immigrants and refugees has an impact on policy, services, and public opinion because it implies differences in resettlement needs, few recent studies have documented the validity of this assumption. In this population-based survey of recent migrants in Quebec (N = 1871), immigration status (refugee, independent, or sponsored immigrant) is examined in relation to premigration exposure to political violence and refugees’ emotional distress, assessed with the SCL-25. A higher percentage of refugees reported exposure to political violence in their homeland, but the percentages of exposed independent (48%) and sponsored (42%) immigrants were unexpectedly high. Emotional distress was significantly higher among Chinese respondents who had witnessed acts of violence and in subjects from Arab countries who reported persecution. These results suggest that service providers and policy makers should not assume that independent immigrants have not been exposed to political violence before their migration.

The influence of culture and context on the pre- and post-migration experience of school-aged refugees from Central America and Southeast Asia in Canada

Pre- and post-migration contexts of refugee children from Central America and Southeast Asia were compared. The results suggest that the culture of origin radically modulates the relationship between the pre-migration experience and the developing post-migration universe. In the case of the Central American children, the state-sponsored violence suffered in the country of origin is strongly associated with subsequent family conflicts, whereas in the case of the Southeast Asians, conflict is associated with an active social network in the community of origin, suggesting that there is a delicate balance between the support provided and the burden imposed by the extended family.

Prevalence and correlates of seclusion with or without restraint in a Canadian psychiatric hospital: a 2‐year retrospective audit

Seclusion with or without restraint is a measure used to manage patients with challenging behaviours. Although controversial, the intervention remains poorly documented, especially in Canadian psychiatric hospitals. The purpose of this study is to assess the prevalence of the measure and identify any correlated demographic characteristics and psychiatric disorders. Episodes of seclusion with or without restraint were extracted from a computerized, hospital-based system introduced specifically to track such interventions. Of 2721 patients hospitalized during that time, 23.2% (n = 632) were secluded with or without restraint, and 17.5% (n = 476) were secluded with restraint. Younger age, schizophrenia or other psychosis, bipolar and personality disorder, and longer stay in hospital are predictors of an episode of seclusion with or without restraint. Younger age, bipolar and personality disorders and a longer stay in hospital are predictors of an episode of seclusion with restraint. For patients who spent longer in seclusion and under restraint, there is a positive association with longer stay in hospital. In this inpatient psychiatric facility, seclusion with or without restraint thus appears to be common. More research is warranted to better identify the principal factors associated with seclusion and restraint and help reduce resort to these measures.

The Influence of Social Anchorage on the Gender Difference in the Use of Mental Health Services

Overall, women are more likely than men to seek professional care when they face light or moderate mental health problems. This difference is usually attributed to culture-related factors, but neither women nor men form a homogeneous cultural group. The help-seeking behavior may reflect not only the cultural values and expectations associated with a specific gender but also those associated with specific social roles endorsed by women and men. In addition, the influence of these culture-related factors on the help-seeking behavior is constrained by barriers to care, which apply similarly to women and men. In consequence, the gender difference in the use of mental health services should vary across social roles and types of service. This hypothesis was tested on data from the cycle 1.2 of the Canadian Community Health Survey. Logistic regression analyses show that, although women are more likely than men to use mental health services, this gender difference is larger for general services than for psychiatric and psychological services whose access in Canada is constrained, respectively, by systemic and financial barriers to care. They also suggest that holding the role of worker tends to foster the use of psychological services in women, especially in married women, and to a lesser degree in men, whereas it tends to hinder the use of general and psychiatric services in men but to exert no or less influence in women. Thus, professional anchorage seems to be an important source of the societal norms that influence the decision of women and men to seek or not to seek medical care for mental health problemsOverall, women are more likely than men to seek professional care when they face light or moderate mental health problems. This difference is usually attributed to culture-related factors, but neither women nor men form a homogeneous cultural group. The help-seeking behavior may reflect not only the cultural values and expectations associated with a specific gender but also those associated with specific social roles endorsed by women and men. In addition, the influence of these culture-related factors on the help-seeking behavior is constrained by barriers to care, which apply similarly to women and men. In consequence, the gender difference in the use of mental health services should vary across social roles and types of service. This hypothesis was tested on data from the cycle 1.2 of the Canadian Community Health Survey. Logistic regression analyses show that, although women are more likely than men to use mental health services, this gender difference is larger for general services than for psychiatric and psychological services whose access in Canada is constrained, respectively, by systemic and financial barriers to care. They also suggest that holding the role of worker tends to foster the use of psychological services in women, especially in married women, and to a lesser degree in men, whereas it tends to hinder the use of general and psychiatric services in men but to exert no or less influence in women. Thus, professional anchorage seems to be an important source of the societal norms that influence the decision of women and men to seek or not to seek medical care for mental health problems

The Impact of Culture on the Transmission of Trauma

Studies of intergenerational transmission of trauma have reported complex, even contradictory, findings (Kaufman & Zigler, 1989; Solkoff, 1992) and have taken many different views of what can be transmitted from one generation to the next, independent of context. Moreover, the wide variety of traumatic settings observed introduces the concept of specificity of transmission, which may fragment our understanding of the phenomena of transmission to such an extent that generalization becomes totally impossible. This attention to context usually tends to focus on the characteristics of the traumatic settings, paying scant heed to those of the groups that experience the traumatic events.

Psychological distress in Canada: The role of employment and reasons of non-employment

Background: This study investigated variations in psychological distress in a large sample of the Canadian population according to employment status, occupation, work organization conditions, reasons for non-employment, stress and support outside the work environment, family situation and individual characteristics. Methods: Data came from cycle 4 (2000–1) of the Canadian National Population Health Survey conducted by Statistics Canada. Multiple regression analyses, adjusted for the family situation, the level of support from the social network and the individual characteristics, were carried out on a sample of 7258 individuals aged from 18 to 65 years. Results: Occupation, social support at work, age, self-esteem, presence of children aged five and under and social support outside of the workplace were associated with lower levels of psychological distress, while permanent and temporary disability, psychological demands in the workplace, job insecurity, female gender, and stressful financial, marital and parental situations were related to higher levels of psychological distress. Conclusions: Findings from this study suggest that, in terms of psychological distress, having a job is not always better than non-employment, and that specific non-employment situations associate differently with psychological distress.