Paula Goering

One-Year Prevalence of Psychiatric Disorder in Ontarians 15 to 64 Years of Age

Objective: To present the one-year prevalence of 14 psychiatric disorders in a community sample of Ontarians aged 15 to 64 years. Method: Data on psychiatric disorders were collected on 9953 respondents using the University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI). DSM-III-R criteria were used to define the psychiatric disorders. Results: Almost 1 in 5 Ontarians (18.6%) had one or more of the disorders measured in the survey. Among 15- to 24-year-olds, 1 in 4 was affected. The distribution of individual disorders varied by sex and age. Conclusion: Because of the immense burden of suffering associated with psychiatric disorders, clinical and research efforts in this area should receive high priority within the health budget.

The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities

Introduction Housing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city,

The Use of Mental Health Services in Ontario: Epidemiologic Findings

110 million demonstration project and provides the rationale for key scientific decisions. Methods A pragmatic, mixed methods, multi-site field trial of the effectiveness of Housing First in Vancouver, Winnipeg, Toronto, Montreal and Moncton, is randomising approximately 2500 participants, stratified by high and moderate need levels, into intervention and treatment as usual groups. Quantitative outcome measures are being collected over a 2-year period and a qualitative process evaluation is being completed. Primary outcomes are housing stability, social functioning and, for the economic analyses, quality of life. Hierarchical linear modelling is the primary data analytic strategy. Ethics and dissemination Research ethics board approval has been obtained from 11 institutions and a safety and adverse events committee is in place. The results of the multi-site analyses of outcomes at 12 months and 2 years will be reported in a series of core scientific journal papers. Extensive knowledge exchange activities with non-academic audiences will occur throughout the duration of the project. Trial registration number This study has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.

Narratives of Identity: Re-presentation of Self in People Who Are Homeless

Objective: To describe the distribution and predictors of mental health service use for a survey of Ontario household residents aged 15 to 64 years. Method: Service use was defined as any past-year contact with formal or informal health care providers for mental health reasons. Data from the Mental Health Supplement (the Supplement) to the Ontario Mental Health Survey were used to compare the sociodemographic, geographic, and diagnostic status characteristics of service users with these characteristics among nonusers. Results: Mental health services were used by 7.8% of respondents in the past year. The majority (57.8%) had a past-year University of Michigan Composite International Diagnostic Interview (UM-CIDI) diagnosis, although 27.1% had never met diagnostic criteria. Other significant predictors were marital status, household public assistance, gender, age, and urban/rural residence. Conclusion: Although diagnosis is the strongest predictor of use, the fit between “need” and “care” in Ontario is not perfect. Help seeking differs within specific sociodemographic and geographic groups. Furthermore, the association of marital disruption and economic disadvantage with utilization indicates that prevention and intervention should address needs beyond the medical or psychological.

Organizational Factors that Influence University-Based Researchers’ Engagement in Knowledge Transfer Activities

The problem of homelessness is a pressing social and health concern ascribed to the interaction between personal, social, economic, and service system resources. This article is based on a qualitative study of the experiences of 29 homeless individuals. In-depth interviews were conducted with single adult shelter users. Analysis revealed the self to be a process that was continually developing. Participants tacitly locate their self-concepts in the past, present, and future. These time frames reflect the form and content of self. They also reveal hopes, dreams, beliefs, and understandings about self. The ways in which homelessness discredits notions of self and personal identity, and the hierarchy of identity with which homeless individuals use to cope are also examined.

BECOMING AND REMAINING HOMELESS: A QUALITATIVE INVESTIGATION

Knowledge transfer has become a priority for universities and other publicly funded research institutions. However, researchers working in these settings report certain structural barriers to engaging in knowledge translation activities. This article describes these barriers, situating them in the disjunction between current expectations and the historical tradition of disciplinary authority in academia. The authors review some of the organizational solutions that have been proposed to address this disjunction. This analysis of barriers and solutions suggests that five domains of organizational policy and practice—promotion and tenure, resources and funding, structures, knowledge transfer orientation, and documentation—may be critical to promoting researchers’engagement in knowledge transfer.

The mental health of informal caregivers in Ontario: an epidemiological survey.

This article reports the qualitative findings of a multimethod study of the homeless population in Toronto, Canada. The qualitative component sought to identify how people become homeless and why some individuals remain homeless for an extended period of time or cycle in and out of homelessness (the chronically homeless). In-depth, semistructured interviews were conducted with 29 homeless adults. The findings suggest that people both become and remain homeless due to a combination of macro level factors (poverty, lack of employment, low welfare wages, lack of affordable housing) and personal vulnerability (childhood abuse or neglect, mental health symptoms, impoverished support networks, substance abuse). Chronically homeless individuals often reported experiences of severe childhood trauma and tended to attribute their continued homelessness to a substance abuse problem. It is concluded that both macro and individual level factors must be considered in planning programs and services to address the issue of homelessness in Canada.

The economic burden of schizophrenia in Canada.

OBJECTIVES This study describes the mental health status, disability, physical health, and mental health service utilization of informal care-givers under the age of 65 in the province of Ontario. METHODS The study analyzed data collected in the 1991 province-wide, population-based mental health supplement to the Ontario Health Survey. Diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised, were generated on the basis of a structured diagnostic interview. Caregivers and noncaregivers are compared here on past-year prevalence of psychiatric disorder, physical illness, disability, and utilization of mental health services. The possible confounding effects of age, sex, employment status, and economic disadvantage are explored. RESULTS Informal caregivers (n = 1219) constituted 15.0% of the sample. Caregivers had higher rates of affective (6.3% vs 4.2%) and anxiety (17.5% vs 10.9%) disorders than noncaregivers and used health services for mental health problems at nearly twice the rate. CONCLUSIONS Documentation of the prevalence of caregiving and the increased prevalence of psychiatric disorders, disability, and service utilization among caregivers is of critical importance as governments continue to move toward community-based care. To accomplish this goal, the needs of caregivers must be acknowledged and met by the establishment of appropriate and readily accessible support services.

Mood disorders: rural/urban differences in prevalence, health care utilization, and disability in Ontario

Objective: To estimate the financial burden of schizophrenia in Canada in 1996. Method: Using a prevalence-based approach, all direct health care costs, administrative costs of income assistance plans, and costs of incarceration attributable to schizophrenia were determined. Also included was the value of lost productivity associated with premature mortality and morbidity. In addition to using published papers and documents, direct contact was made with representatives from various provincial and federal programs for estimates of the direct health care and non-health care costs. Results: The estimated number of persons with schizophrenia in Canada in 1996 was 221 000, with equal distribution between males and females. The direct health care and non-health care cost was estimated to be

Mental Health Supplement to the Ontario Health Survey : Methodology

1.12 billion in 1996. In addition, another