Guy Grenier

Predictors of quality of life in a longitudinal study of users with severe mental disorders.

BackgroundSince the end of the 20th century, quality of life has become a key outcome indicator in planning and evaluation of health services. From a sample of 297 users with severe mental disorders from Montreal (Canada), this study aimed to identify the key predictors of subjective quality of life (SQOL).MethodsUsers were recruited and interviewed from December 2008 to September 2010 and re-interviewed approximately 18xa0months later. A comprehensive framework including socio-demographic data, clinical, needs and functionality variables, negative life events, social support and healthcare service use, and appreciation data were considered as predictors. Clinical records and eight standardized instruments were used.ResultsLower severity of needs, schizophrenia, better social integration, better reassurance of worth, fewer drug abuse problems, and living in supervised housing are predictors of SQOL. With regard to needs, absence or lower severity of needs in the areas of company, daytime activities, social exclusion, safety to self, and benefits are linked to SQOL.ConclusionReducing the severity of needs is especially beneficial to ensure a higher SQOL for users with severe mental disorders. To improve SQOL, priority must be given to programs and interventions that promote the development of a stimulating and supportive social network, and maintain a plurality of residential services matching the functional abilities of users.

Predictors of Healthcare Service Utilization for Mental Health Reasons

This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.

Determinants and patterns of service utilization and recourse to professionals for mental health reasons

BackgroundThis study has a dual purpose: 1) identify determinants of healthcare service utilization for mental health reasons (MHR) in a Canadian (Montreal) catchment area; 2) determine the patterns of recourse to healthcare professionals in terms of frequency of visits and type of professionals consulted, and as it relates to the most prevalent mental disorders (MD) and psychological distress.MethodsData was collected from a random sample of 1,823 individuals interviewed after a two-year follow-up period. A regression analysis was performed to identify variables associated with service utilization and complementary analyses were carried out to better understand participants’ patterns of healthcare service utilization in relation to the most prevalent MD.ResultsAmong 243 individuals diagnosed with a MD in the 12xa0months preceding an interview, 113 (46.5%) reported having used healthcare services for MHR. Determinants of service utilization were emotional and legal problems, number of MD, higher personal income, lower quality of life, inability of individuals to influence events occurring in their neighborhood, female gender and, marginally, lack of alcohol dependence in the past 12xa0months. Emotional problems were the most significant determinant of healthcare service utilization. Frequent visits with healthcare professionals were more likely associated with major depression and number of MD with or without dependence to alcohol or drugs. People suffering from major depression, psychological distress and social phobia were more likely to consult different professionals, while individuals with panic disorders relied on their family physician only. Concerning social phobia, panic disorders and psychological distress, more frequent visits with professionals did not translate into involvement of a higher number of professionals or vice-versa.ConclusionsThis study demonstrates the impact of emotional problems, neighborhood characteristics and legal problems in healthcare service utilization for MHR. Interventions based on inter-professional collaboration could be prioritized to increase the ability of healthcare services to take care especially of individuals suffering from social phobia, panic disorders and psychological distress. Others actions that could be prioritized are training of family physicians in the treatment of MD, use of psychiatric consultants, internet outreach, and reimbursement of psychological consultations for individuals with low income.

Patients’ Report of Help Provided by Relatives and Services to Meet Their Needs

This article analyzes help provided by relatives and/or services to the needs of individuals with severe mental illness who have, versus do not have, regular contact with family. Factors that influence help are also examined. Data collection is based on a random sample of 186 Quebec outpatients. Patients’ needs were assessed using the Camberwell Assessment of Need. Relatives provided adequate help for social and functioning needs, adequately complementing services in other needs categories. Six sociodemographic variables influence help from relatives, only one affects help from services. The role of relatives is identified as important in meeting patients’ needs, either solely or jointly with services.

Predictors of alcohol and drug dependence.

Objective: Our study sought to identify sociodemographic, clinical, life perception, and service use characteristics that distinguish new cases of people dependent on substances from the general population; and to determine predictors of substance dependence over a 2-year period. Variables that differentiate people dependent on substances according to sex and age were also assessed. Methods: Among 2434 people who took part in an epidemiologic catchment area health survey at baseline, 2.2% were identified with substance dependence at the second measurement time only. Using a comprehensive framework, various aspects were considered as predictors for multivariate statistics. Results: Participants with substance dependence at time 2 only showed worse clinical conditions, life events, life and health perception, and neighbourhood characteristics than other participants, but only 2.5% used health care services. Male sex, younger age, stigmatization, and impulsiveness were predictors of substance dependence. Regarding sex, females with dependence were only more likely to suffer from social phobia than males. In terms of age categories, participants over 50 with substance dependence were more likely to have a lower household income and less social support than younger people. Conclusion: Stigmatization was the strongest predictor of substance dependence. Our study also confirmed that males and younger people were more likely to have substance dependence. Anti-stigmatization, prevention, and outreach programs are needed to overcome the reluctance of this clientele to use health care services. Health professionals should also pay more attention to life and health perception and neighbourhood characteristics of newly identified drug users.

Implementation of the Quebec mental health reform (2005–2015)

BackgroundThis study evaluates implementation of the Quebec Mental Health (MH) Reform (2005–2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined.MethodsEleven Quebec MH service networks provided the study setting. Networks were identified in consultation with 20 key MH decision makers and selected based on variation in services offered, integration strategies, best practices, and geographic criteria. Data collection included: primary documents, structured questionnaires completed by 25 managers from MH primary care teams and 16 respondent-psychiatrists working in shared-care, and semi-structured interviews with 102 network stakeholders involved in the reform. The study employed a mixed method approach, triangulating the three data sources across networks.ResultsWhile implementation was not fully achieved in most networks, the Quebec reform succeeded in improving primary care services with the creation of adult primary care teams, and one-stop services which increased access to care, mainly for clients with common MH disorders. In terms of clinical strategies implemented, the functions provided by respondent-psychiatrists had a greater impact on the MH primary care teams than on general practitioners (GPs) in medical clinics; whereas the implementation of best practices were indirect outcomes of another reform developed simultaneously by the Quebec substance use disorders program. The main integration strategies used for increasing continuity of care and collaboration between primary care and specialized services were those involving fewer formal procedures such as referrals between teams and organizations. The lack of operational mechanisms and protocols governing new services and structures were important barriers to primary care consolidation and service integration, as was the lack of interest and involvement of most GPs in MH.ConclusionsSuccessful and sustained healthcare reform requires attention to process and outcomes as well as structural change or service reorganization. Six recommendations for more successful implementation of the Quebec MH Reform are provided, with implications for healthcare reform internationally.

Utility of the Montreal assessment of need questionnaire for community mental health planning.

Abstract Needs assessment facilitates mental health services planning, provision, and evaluation. This study aimed to a) validate a new instrument, the Montreal Assessment of Needs Questionnaire (MANQ), and b) use this to assess variations and predictors of need (number and seriousness) in 297 individuals with severe mental disorders for 18 months, during implementation of the Quebec Mental Health Action Plan. MANQ internal and external validations were adequate. Variables significantly associated with need number and seriousness variations were used to build multiple linear regression models. Autonomous housing, not receiving welfare, not having consulted a health educator, higher level of help from services, Alcohol Use Disorders Identification Test total score, and social support were associated with decreasing need number and seriousness over time. Having a higher education was also associated with decreasing need number. In a reform context, the MANQ’s unique ability to detect rapid improvement in patient needs has usefulness for Quebec mental health planning.

Adequacy of Help Received Among Individuals With Severe Mental Disorders

Using multiple linear regression analyses and a new assessment measure, this exploratory study identifies variables associated with help adequacy of 352 individuals with severe mental disorder. Help adequacy is higher with tobacco use, psychological distress domain, having a caregiver, help form services, being older, and lower with number of needs; accommodation, food, childcare and involvement in treatment decisions domains; number of suicide attempts, legal problems in previous year, and drugs problem. Results confirm the importance of a better collaboration with relatives, healthcare and social service providers to provide more adequate and satisfactory services for severe mental disorders individuals.

Predictive typology of subjective quality of life among participants with severe mental disorders after a five-year follow-up: a longitudinal two-step cluster analysis

BackgroundThis study aims to create a predictive typology of quality of life at five-year follow-up of 204 individuals with severe mental disorders, according to clinical, socio-demographic, and health service use variables.MethodsParticipant typology was carried out by means of two-step cluster analysis. Independent variables were measured at T0 and subjective quality of life (SQOL) at T2.ResultsAnalysis yielded four classes. SQOL at T2 was higher than the mean in Class 4 (“Older, poorly educated single men living in supervised housing, with psychotic disorders but with few serious needs, receiving substantial help from services”) and lower than the mean in Class 2 (“Young females with serious needs and co-occurring mental and addiction disorders living in independent apartments”).ConclusionGiven that predictive SQOL varies in relation to combinations of associated variables, it would be useful for treatments or service programs to target specific predictors to the different profiles.

Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme.

Background: Fragmentation and lack of coordination often occur among organisations offering treatment for individuals with substance-use disorders. Better integration from a system perspective within a network of organisations offering substance-use disorder services can be developed using various integration strategies at the administrative and clinical levels. This study aims to identify integration strategies implemented in Quebec substance-use disorder networks and to assess their strengths and limitations. Methods: A total of 105 stakeholders representing two regions and four local substance-use disorder networks participated in focus groups or individual interviews. Thematic qualitative and descriptive quantitative analyses were conducted. Results: Six types of service integration strategies have been implemented to varying degrees in substance-use disorder networks. They are: 1) coordination activities-governance, 2) primary-care consolidation models, 3) information and monitoring management tools, 4) service coordination strategies, 5) clinical evaluation tools and 6) training activities. Conclusion: Important investments have been made in Quebec for the training and assessment of individuals with substance-use disorders, particularly in terms of support for emergency room liaison teams and the introduction of standardised clinical evaluation tools. However, the development of integration strategies was insufficient to ensure the implementation of successful networks. Planning, consolidation of primary care for substance-use disorders and systematic implementation of various clinical and administrative integration strategies are needed in order to ensure a better continuum of care for individuals with substance-use disorders.