Catherine Lamoureux-Lamarche

Gender and age group differences in suicide risk associated with co-morbid physical and psychiatric disorders in older adults.

BACKGROUND It is unclear whether health service use influences the association between psychiatric and physical co-morbidity and suicide risk in older adults. METHODS Controls were older adults (n = 2,494) participating in a longitudinal study on the health of the elderly carried out between 2004 and 2007, in Quebec. The cases were all suicide decedents (n = 493) between 2004 and 2007, confirmed by the Quebec Coroners office. Multivariate analyses were carried out to test the association between suicide and the presence of psychiatric and physical illnesses controlling for health service use and socio-demographic factors by gender and age group. Interaction terms were also tested between suicide and co-morbidity on outpatient service use. RESULTS The presence of physical illnesses only, was associated with a reduced risk of suicide across all sex and age groups. The presence of a mental disorder only was associated with an increased risk of suicide overall and specifically in females and those aged 70 to 84 years of age. Suicide risk was lower in those with a psychiatric and physical co-morbidity and consulting mental health services. CONCLUSIONS Increased mental health follow-up in older adults with psychiatric illnesses is needed for the detection of suicidal behavior and reducing suicide risk in males. Further research should focus on the mitigating effect of the presence of physical illnesses on stigma and health service use and the presence of social support in the elderly.

Post-traumatic stress syndrome in a large sample of older adults: determinants and quality of life

Objectives: The aims of this study are to assess in a sample of older adults consulting in primary care practices the determinants and quality of life associated with post-traumatic stress syndrome (PTSS). Method: Data used came from a large sample of 1765 community-dwelling older adults who were waiting to receive health services in primary care clinics in the province of Quebec. PTSS was measured with the PTSS scale. Socio-demographic and clinical characteristics were used as potential determinants of PTSS. Quality of life was measured with the EuroQol-5D-3L (EQ-5D-3L) EQ-Visual Analog Scale and the Satisfaction With Your Life Scale. Multivariate logistic and linear regression models were used to study the presence of PTSS and different measures of health-related quality of life and quality of life as a function of study variables. Results: The six-month prevalence of PTSS was 11.0%. PTSS was associated with age, marital status, number of chronic disorders and the presence of an anxiety disorder. PTSS was also associated with the EQ-5D-3L and the Satisfaction with Your Life Scale. Conclusion: PTSS is prevalent in patients consulting in primary care practices. Primary care physicians should be aware that PTSS is also associated with a decrease in quality of life, which can further negatively impact health status.

Association between perceived social stigma against mental disorders and use of health services for psychological distress symptoms in the older adult population: validity of the STIG scale

Objectives: To document the reliability, construct and nomological validity of the perceived Social Stigmatisation (STIG) scale in the older adult population. Design: Cross-sectional survey. Setting: Primary medical health services clinics. Participants: Probabilistic sample of older adults aged 65 years and over waiting for medical services in the general medical sector (n = 1765). Measurements: Perceived social stigma against people with a mental health problem was measured using the STIG scale composed of seven indicators. Results: A second-order measurement model of perceived social stigma fitted adequately the observed data. The reliability of the STIG scale was 0.83. According to our results, 39.6% of older adults had a significant level of perceived social stigma against people with a mental health problem. Results showed that the perception of social stigma against mental health problems was not significantly associated with a respondent gender and age. Results also showed that the perception of social stigma against the mental health problems was directly associated with the respondents’ need for improved mental health (b = −0.10) and indirectly associated with their use of primary medical health services for psychological distress symptoms (b = −0.07). Conclusion: Results lead us to conclude that social stigma against mental disorders perceived by older adults may limit help-seeking behaviours and warrants greater public health and public policy attention. Also, results lead us to conclude that physicians should pay greater attention to their patients’ attitudes against mental disorders in order to identify possible hidden mental health problems.

Healthcare use and costs associated with post-traumatic stress syndrome in a community sample of older adults: results from the ESA-Services study.

BACKGROUND Studies have shown higher healthcare utilization and costs associated with post-traumatic stress syndrome (PTSS) in veterans and community adult populations. Given the aging population and the impact on health system resources, it is important to understand the economic consequences of PTSS. METHODS The data retained came from 1,456 older adults aged 65 years and over recruited in primary medical clinics in the province of Quebec. PTSS was measured with the PTSS scale. Healthcare services (outpatient, emergency department (ED) visits, and inpatient stay) and medication use were captured separately from provincial administrative databases. Healthcare costs incurred in the past year included costs related to outpatient and ED visits, physician fees, inpatient stay, and medication use. Costs were calculated using a healthcare system perspective. χ 2 and Mann-Whitney analyses were used to assess healthcare use. Generalized linear models (GLM) with a gamma distribution (Log Link) were used to evaluate the healthcare costs associated with PTSS. RESULTS Results showed a significant difference in the number mental health outpatient visits, the number of total prescriptions and the use (presence of at least one prescription) of antidepressants (ADs) and benzodiazepines (BZDs). The multivariate analyses showed that costs associated with outpatient visits, ED visits, mental health inpatient stays, physician fees, and medication use were significantly associated with the presence of PTSS. The total adjusted healthcare cost difference between groups was significant and reached

Early career researchers’ perspectives and roles in patient-oriented research

838 CAN. CONCLUSIONS Respondents with PTSS were more likely to be prescribed psychotropic medications and to have higher ambulatory costs but not inpatient services related costs, more research is required to better understand whether the mental health needs of individuals with a probable PTSS are being met.

Family Physicians Attaching New Patients From Centralized Waiting Lists: A Cross-Sectional Study

Plain English summaryPatient-oriented research (POR) has received increasing attention in recent years. In this approach, patients’ experiential knowledge, derived from their experiences of living with a condition or illness and of interacting with the healthcare system, is recognized, valued, and seen as complementary to scientific knowledge. Early career researchers (ECRs) are the next generation of researchers, but little is known about how they perceive POR. In this study, ECRs were invited to reflect on what POR is, how patients can best contribute to research, and ECRs’ own role in developing POR. Using a technique designed to collect expert opinions and find consensus—the Delphi method—a panel of 16 ECRs responded, in three rounds, to three questionnaires, with the second and third being built on responses to the preceding ones. Based on their understanding, the panelists agreed that the most important element in defining POR would be valuing, mobilizing, and legitimizing the experiential knowledge of patients who live with a particular health condition. Panelists considered patients to be integral members of the research team, but were less convinced that they should be considered co-researchers. The panelists saw themselves as taking part in developing POR by sharing information, teaching, and encouraging POR among their peers, as well as by participating actively in organizations interested in POR. This is the first study to examine the perspectives of ECRs, who, along with many others, have an important role in supporting the on-going development of POR so that it becomes more widely adopted.AbstractBackground Literature on patient-oriented research (POR) is growing rapidly. This field is increasingly encouraged by funders and structured by new research networks. POR involves moving away from considering patients as ‘subjects’, towards perceiving them as experts with experience-based knowledge. However, little is known about how early-career researchers (ECRs) perceive POR and their roles in developing it. This study examined how ECRs perceive POR, patients’ roles, the future of POR, and their own role in developing this approach. Methods A three-round Delphi study was conducted with Quebec’s Strategy for People and Patient-Oriented Research and Trials (SUPPORT) Unit awardees, composed of graduate students and clinicians, all ECRs. Of the 25 invited, 18 agreed to participate (72%), with a three-round retention rate of 89% (n = 16 on 18). Panelists answered open-ended questions, selected the most salient statements, and rated their (dis)agreement with proposals using a 7-point scale. Results Five main themes emerged: 1) ECRs’ knowledge of and experience with POR; 2) the POR definition; 3) patients’ roles and contributions; 4) the future of POR; and 5) ECRs’ roles in POR development. This study revealed that the ECRs were not so familiar with POR, even given their opportunities for networking within a scholarship program. Panelists agreed on the main components of a POR definition: valuing, mobilizing, and legitimizing the experiential knowledge of patients living with a health condition; conducting research that focuses on patients’ concerns, participation, and outcomes; and integrating active partnership among a variety of actors. Panelists considered patients to be integral members of the research team (M = 5.31 ± 1.66), but were less convinced they should be considered co-researchers (M = 4.50 ± 1.75). Panelists saw themselves as playing many roles in developing POR, such as becoming well-informed about it and acting as knowledge brokers, motivators, doers, delegators, and activists. Conclusion The ECRs’ perspectives are informative on how the next generation of researchers envision POR, its future and how they might contribute to developing this approach. There is a clear need for a coherent and concerted strategy for POR capacity development, in which ECRs’ perspectives and their specific needs are taken into account.

The 6-month prevalence of posttraumatic stress syndrome (PTSS) among older adults: validity and reliability of the PTSS scale.

Purpose: In response to more than 15% of Canadians not having a family physician, 7 provinces have implemented centralized waiting lists for unattached patients. The aim of this study is to analyze the association between family physicians’ characteristics and their participation in centralized waiting lists. Methods: Cross-sectional observational study using administrative data in 5 local health networks in Quebec, between 2013 and 2015. All physicians who had attached at least 1 patient were included (n = 580). Multivariate linear regressions for the number of patients and proportion of vulnerable patients attached per physician were performed. Results: Physicians with more than 20 years of experience represented more than half of those who had participated in the centralized waiting lists and physicians in traditional primary care models represented more than 40%. Physicians’ number of years of practice, primary care model, local health network, and the number of physicians participating in the centralized waiting lists per clinic influenced physicians’ participation. Physicians with 0 to 4 years of experience and those practicing in network clinics were found to attach more patients. Practicing in a Centre Locaux de Services Communautaires (local community service center) was associated with attaching 19% more vulnerable patients compared with practicing in a Family Medicine Unit (teaching unit). Conclusion: Centralized waiting lists seem to be used by early career physicians to build up their patient panels. However, because of the large number of them participating in the centralized waiting lists, physicians with more experience and those practicing in traditional models of primary care might be of interest for future measures to decrease the number of patients waiting for attachment in centralized waiting lists.