Raymond Tempier

General Practice and Mental Health Care: Determinants of Outpatient Service Use:

Objective: To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types. Method: Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35 236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants. Result: Three types of variables were examined: need, enabling, and predisposing factors. Among need, the most common predictors of service use for mental health reasons were self-rated mental health, the presence of chronic conditions, depression and panic attacks, unmet mental health needs, psychological well-being, and the ability to handle daily demands. Among enabling factors, emotional and informational support and income were important predictors. Among predisposing factors, men were less likely to consult with a family physician and other resources but not with psychiatrists; and people with less education were less likely to consult psychologists and other health providers. Conclusion: Need factors were the most important predictors of both psychiatrist and combined family physician and psychiatrist consultation in the previous year. However, sex barriers remain and promotion campaigns in seeking mental health care should be aimed toward men. Further, education and income barriers exist in the use of specialty providers of psychotherapy and policies should thus focus on rendering these services more accessible to disadvantaged people.

Mental disorders and mental health care in Canada and Australia: comparative epidemiological findings

BackgroundCanada and Australia although geographically distant have similarities in human geography and history. Each has had a national mental health policy for some years, but Australia has driven policy implementation in this area harder than has Canada. Comparable epidemiological surveys from Australia in 1997 and Canada in 2002 allow us to explore relative rates of mental disorders and compare estimates of access to care from mental health services.MethodsWe compare findings from the Australian National Survey of Mental Health and Wellbeing (1997) with those from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (2002).ResultsDifferences in prevalence rates and in service utilisation emerge between the two countries: Anxiety Disorders are estimated as almost 2% higher in Canada than in Australia while there is suggestion that Major Depressive Disorder, Alcohol Dependence and Drug Dependence may be more prevalent in Australia. More of the people with co-morbid disorders in Australia than in Canada make use of mental health services and a finding of marginal significance suggests that this may be true across all disorders.ConclusionsCausation cannot be determined from this study but possible explanations for differences in prevalence include changes in global economic, political and security contexts and concerns between 1997 and 2002 and the possible role of greater availability of alcohol in Australia. The findings also provide encouragement that strenuously implementing a national mental health policy may have been of benefit to people with mental health problems in Australia.

From benzos to berries: treatment offered at an Aboriginal youth solvent abuse treatment centre relays the importance of culture.

First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatrys individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder–based and Aboriginal culture–based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation—storytelling—experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatrys approach to treating mental disorders within the etiology for Aboriginal Peoples.

Does Assertive Community Outreach Improve Social Support? Results From the Lambeth Study of Early-Episode Psychosis

OBJECTIVESnSpecialized early intervention by a team providing assertive community treatment (ACT) is beneficial to the recovery, housing, and employment of individuals with schizophrenia, but few studies have examined its effect on social support. This study assessed whether the ACT model of care was related to clinical and social outcomes among patients who had experienced a first episode of psychosis.nnnMETHODSnThe sample was drawn from the Lambeth Early Onset Trial, a study of 144 patients in the United Kingdom who sought treatment for a first episode of psychosis between January 2000 and October 2001 and who were randomly assigned to a specialized early intervention modeled on ACT or standard care. The Positive and Negative Syndrome Scale, the Global Assessment of Functioning, and the Significant Others Scale were administered at six-month and 18-month follow-ups.nnnRESULTSnData on social support were available at both follow-ups for 57 patients assigned to specialized care and 50 patients assigned to standard care. The two groups were similar in personal characteristics, relationship status, and living arrangements at baseline and at six-month follow-up, but by 18 months, patients in specialized care reported having a higher mean±SD number of significant others in their social networks than did standard care patients (2.40±1.20 and 1.71±1.06, respectively; p=.01). They also achieved superior clinical outcomes at 18 months, and these outcomes were associated with network size.nnnCONCLUSIONnEarly intervention by using an ACT model of care may improve clinical results by reestablishing or maintaining bonds between patients and family, friends, and acquaintances.

Prevalence of mental disorders and service utilization in seniors: results from the Canadian community health survey cycle 1.2.

This paper examined the 12‐month rate of mental disorders and subsequent service use among Canadian seniors aged 65–79 and 80 and over and adults aged 20–49 and 50–64.

Long-term trend in pediatric antidepressant use, 1983-2007: a population-based study.

Objective: Research is needed to clarify and improve our understanding of appropriateness and safety issues concerning antidepressant (AD) treatment. We explored the long-term trend in the dispensing of pediatric ADs using provincial, population-based data from Canada. Methods: Data covering 22 ADs were drawn from the Saskatchewan Ministry of Health administrative data files in outpatient settings. The data were for 9 triennial years from 1983 to 2007, a 24-year period, for those aged 0 to 19 in the general population. Descriptive analyses were used. Results: In 1983, 5.9 per 1000 population aged 0 to 19 were dispensed at least 1 AD; this decreased to 5.1 per 1000 population in 1989, and then increased to 15.4 per 1000 population in 2007, with a slower increase after 2004. Both sexes were dispensed more ADs from 1989 onwards, with females being the heavier users. The rate of AD use increased significantly with age, and this trend became more pronounced after 1998. Family physicians were the major prescribers and their prescriptions significantly increased from 1989 to 2004 and decreased in 2007. The use of selective serotonin reuptake inhibitors (SSRIs) was the major reason for the increase. The number of AD scripts per patient also increased. Conclusions: The growth in the prevalence of AD use among children and youth was largely caused by the use of SSRIs. The possibility of safety issues induced by AD use among children and adolescents, and different patterns of medication practice, suggest continuing education is warranted.

Trends in psychotropic use in Saskatchewan from 1983 to 2007.

Objective: There has been little research reported on trends in the use of a full spectrum of psychotropics in a general population. We provide an overview of trends in psychotropic use over a 24-year period for Saskatchewan. Methods: Data were drawn from the Saskatchewan Ministry of Health administrative data files. It covers antidepressants (ADs), antipsychotics, mood stabilizers, anxiolytics, stimulants, and cholinesterase inhibitors in outpatient settings. We analyzed data from 9 triennial years from 1983 to 2007. Descriptive statistics were used. Results: Among the Saskatchewan population in our study, 8.38% were prescribed at least 1 psychotropic in 1983. The prevalence decreased to 7.44% in 1989, then gradually increased to 12.90% in 2007. We found a continuous increase in the number of psychotropic prescriptions for both males and females. The trend became more marked during the 1990s. Females used more psychotropics. Family physicians were the major prescribers, and their prescriptions dramatically increased over the period. There was an increase in the prescribing of all psychotropics except for anxiolytics. AD prescriptions dramatically increased, especially from 1995 onward. The proportion of patients with 8 to 11 and 12 or more prescriptions per year also gradually increased, whereas the proportion of patients with less than 3 prescriptions per year decreased. Conclusions: AD prescriptions are the major reason for the increasing trend of psychotropic use. Given the major role of family physicians in the use of psychotropics, the need for appropriate training and continuing education is reinforced.

Survival of patients with incident dementia who had a pre-existing psychiatric disorder: a population-based 7-year follow-up study

Although it is widely accepted that psychiatric disorders and dementia coexist and survival data for dementia patients have been published, there is a paucity of information regarding the survival of patients with a psychiatric disorder who develop dementia. This study fills this information gap providing survival data on patients with such comorbidity and identifies mortality risk factors.

Comparing mental health of francophone populations in Canada, france, and belgium: 12-month prevalence rates of common mental disorders (part 1).

Objective: To compare the 12-month prevalence of common mental disorders among francophones in Canada, France, and Belgium. This is the first article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations. Methods: This is a secondary analysis of data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) in 2002 and the European Study of Epidemiology of Mental Disorders-Mental Health Disability (ESEMeD) from 2001 to 2003, where comparable questionnaires were administered to representative samples of adults in Canada, France, and Belgium. In Canada, francophone respondents living in Quebec (n = 7571) and outside Quebec (n = 500) completed the French version of the CCHS 1.2 questionnaire. Francophone respondents in Belgium (n = 389) and in France (n = 1436) completed the French version of the ESEMeD population survey questionnaire. Major depressive episodes (MDEs), specific anxiety disorders (ADs), and alcohol abuse and (or) dependence disorders rates were assessed. Results: The overall prevalence rate for the presence of any MDE, AD, or alcohol abuse and (or) dependence was similar in all francophone populations studied in Canada and Europe and averaged 8.5%. Conclusions: Mental disorders were equally distributed in all francophone populations studied. Cross-national comparisons continue to be instrumental in providing information useful for the creation of appropriate policies and programs for specific subsets of populations.

Patient-centered care in affective, non-affective, and schizoaffective groups: patients' opinions and attitudes.

An outcome evaluation was conducted to obtain psychiatric inpatients’ perspectives on acute care mental health treatment and services. The applicability of diagnostic categories based on affective, non-affective, and schizoaffective disorder were considered in the predictability of responses to treatment regimens and the related services provided in an inpatient psychiatric unit. A multidimensional approach was used to survey patients, which included the DAI-30, the BMQ, the SERVQUAL, and the CSQ-8. Overall, findings indicate that inpatient satisfaction could be improved with tailoring treatment to suit their respective symptoms. Furthermore, this exploratory study demonstrates some preliminary support for the inclusion of patients with a diagnosis of schizoaffective disorder as a separate group toward improving acute mental health care while hospitalized.