Jean Caron

Components of Social Support and Quality of Life in Severely Mentally Ill, Low Income Individuals and a General Population Group

Satisfaction with social support and quality oflife (QOL) were assessed for 60 psychiatric patients, 79welfare recipients and 266 people of the generalpopulation using the Social Provisions Scale (SPS) and the Satisfaction with Life Domains Scale(SLDS). Psychiatric patients reported less satisfactionthan the general population on all components of socialsupport. They have a comparable level of satisfaction with welfare recipients on most of thecomponents, with the exception of emotional integrationand opportunity for nurturance. However, patientssatisfaction with QOL was quite similar to the generalpopulation, although higher than welfare recipients on somedimensions. Their lower satisfaction with thepersonal-intimate dimension suggest deficiencies insocial support. All components of social support wereconsistently related to QOL in the general population.Attachment and reassurance of worth

Predictors of quality of life in schizophrenia.

The objective of this study was to clarify the relationships between socio-demographics, clinical characteristics, stressors, coping strategies, social support and quality of life (QOL) in 143 patients with a diagnosis of either schizophrenia or schizoaffective disorders. The research design is cross-sectional with repeated measures on the same subjects after a 6-month interval. A regression analysis generated a model that accounts for 50% of the variance in QOL at Time 1 and 43% at Time 2. The best predictors of QOL were two components of social support: attachment and reassurance of worth. Severity of daily hassles, the coping strategy of changing the situation, level of education and life-time hospitalization length were also related to QOL.

Socio-demographic and clinical predictors of quality of life in patients with schizophrenia or schizo-affective disorder

This article discusses the relationships between socio-demographic, clinical characteristics and Quality of Life (QOL) of individuals with schizophrenia. The client version of the Canadian version of the Wisconsin Quality of Life Index (CaW-QLI) was used with a population of 182 individuals with either schizophrenia or schizo-affective disorder. Multivariate analyses of variance with Tukey post hoc tests were used to assess differences between groups defined according to socio-demographic and clinical characteristics on all sub-scale scores in addition to the global score on the CaW-QLI. Relationships between socio-demographic characteristics and QOL were found for gender, age, education, employment status and living arrangement. Differences in QOL were found between groups with different clinical characteristics, such as diagnosis, hospitalization during the last 12 months and age at first hospitalization. Using socio-demographic and clinical variables in addition to psychosocial variables appears to be promising for understanding QOL in psychotic patients. Methodological considerations for future research are discussed.

Public attitudes towards intellectual disability: a multidimensional perspective

BACKGROUND Public attitudes towards persons with intellectual disabilities (IDs) have a significant effect on potential community integration. A better understanding of these can help target service provision and public awareness programmes. OBJECTIVE The objective of the present study is threefold: (1) describe public attitudes towards persons with ID along affective, cognitive and behavioural dimensions; (2) compare and contrast attitudes according to sex, age, education and income, as well as frequency and quality of contacts with persons with ID; and (3) ascertain whether the level of functioning has an effect on attitudes. METHODS The Attitudes Toward Intellectual Disability Questionnaire (ATTID) was administered by phone to 1605 randomly selected adult men and women, stratified by region in the province of Québec, Canada. The ATTID uses a multidimensional perspective of attitudes that reflect affective, cognitive and behavioural dimensions. RESULTS The results showed that public attitudes were generally positive regarding all three attitudinal dimensions. Public attitudes towards persons with ID are presented in terms of the five factors measured through the ATTID: (1) discomfort; (2) sensibility or tenderness; (3) knowledge of causes; (4) knowledge of capacity and rights; and (5) interaction. Attitude factor scores vary as a function of participant characteristics (sex, age, education and income) and the degree of knowledge about ID, the number of persons with ID known to the participants, as well as the frequency and quality of their contacts with these persons. Men had greater negative attitudes than women as regards the discomfort factor, while women had more negative attitudes regarding the knowledge of capacity and rights factor. More positive attitudes were revealed among younger and more educated participants. Attitudes were generally not associated with income. Public attitudes tended to be more negative towards people with lower functioning ID. CONCLUSION These results yield useful information to target public awareness and education.

Prevalence of psychological distress and mental disorders, and use of mental health services in the epidemiological catchment area of Montreal South-West

BackgroundThis report presents the initial results of the first Epidemiological Catchment Area Study in mental health in Canada. Five neighbourhoods in the South-West sector of Montreal, with a population of 258,000, were under study. The objectives of the research program were: 1) to assess the prevalence and incidence of psychological distress, mental disorders, substance abuse, parasuicide, risky behaviour and quality of life; 2) to examine the links and interactions between individual determinants, neighbourhood ecology and mental health in each neighbourhood; 3) to identify the conditions facilitating the integration of individuals with mental health problems; 4) to analyse the impact of the social, economic and physical aspects of the neighbourhoods using a geographic information system. 5) to verify the adequacy of mental health services.MethodA longitudinal study in the form of a community survey was used, complemented by focused qualitative sub-studies. The longitudinal study included a randomly selected sample of 2,433 individuals between the ages of 15 and 65 in the first wave of data collection, and three other waves are projected. An overview of the methods is presented.ResultsThe prevalence of psychological distress, mental disorders and use of mental health services and their correlates are described for the first wave of data collection.ConclusionSeveral vulnerable groups and risk factors related to socio-demographic variables have been identified such as: gender, age, marital status, income, immigration and language. These results can be used to improve treatment services, prevention of mental disorders, and mental health promotion.

Comprehensive determinants of health service utilisation for mental health reasons in a canadian catchment area

IntroductionThis study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area.MethodsTo be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersens behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out.ResultsAmong 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females.ConclusionsOur study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.

Validation of the attitudes toward intellectual disability – ATTID questionnaire

BACKGROUND Individuals with an intellectual disability (ID) continue to experience major obstacles towards social, educational and vocational integration. Negative attitudes toward persons with ID has remained relevant over time and has led to discrimination and stigma. OBJECTIVE The present study describes the development of a new questionnaire for tapping into the general populations attitudes toward individuals with ID and addresses its psychometric properties. METHODS Adopting a multidimensional perspective, the Attitudes Toward Intellectual Disability Questionnaire (ATTID) was developed from a series of previously validated instruments and principles from the Montreal Declaration on Intellectual Disability (2004). The ATTID was administered by phone to 1605 randomly selected adult men and women, stratified by region in the Province of Quebec, Canada. RESULTS The ATTID yielded a five-factor structure overlapping the tri-partite model of attitudes. The cognitive component was represented by two factors: knowledge of capacity and rights and knowledge of causes of ID. The affective component tapped into two factors: discomfort and sensitivity/compassion. Finally, the behavioural component emerged as a single factor. The ATTID had good internal consistency with Cronbachs alpha coefficients ranging from 0.59 to 0.89 for the five factors and of 0.92 for the overall questionnaire. Test-retest reliability yielded correlations from 0.62 to 0.83 for the five factors. CONCLUSION The ATTID can be used to measure attitudes among different populations and allows comparisons over time within the same population as a function of various intervention strategies for de-stigmatising ID.

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.

A multi-level study of the determinants of mental health service utilization.

BACKGROUND Until now, research has focused on neighbourhood variations in mental health services and their relationships with local attributes, such as healthcare supply and socio-economic deprivation, without controlling for individual characteristics (age, sex, income, or education, for instance). Hence, this study is a major attempt to clarify the role played by individual and local attributes in the utilization of mental health services. The aim of this study was to disentangle individual and neighbourhood effects on mental health service use. METHODS In this cross-sectional study, individual-level data on 423 participants with a frequent mental health disorder was recruited from the general population and linked to neighbourhood-level data at the census tract level from the 2006 Canadian Census. Neighbourhood variables included socio-economic deprivation, mean income, residential stability and the proportion of recent immigrants. Individual characteristics included gender, age, marital status, self-rated mental health and the number of diagnoses. Multi-level logistic regression was used to assess the effects of individual and neighbourhood characteristics simultaneously on mental health service use. RESULTS The intraclass correlation coefficient indicated that 12.26% of the variance of mental health service utilization is at the neighbourhood level. Final analysis showed that at the individual level, being female, married, or self-rating mental health less than excellent increased healthcare use. At the neighbourhood level, deprived socio-economic neighbourhood decreased health service use (OR=0.71, P<0.05), while residential stability increased use (OR=1.24, P<0.05). CONCLUSIONS Individual and neighbourhood characteristics determine mental health service utilization. Taking both into consideration allows better targeting of health service policy and planning and enables more accurate needs-based resource allocation. However, future research should continue to investigate the pathway through which neighbourhood affects health service utilization.

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.