搜索结果：Sante mentale au Quebec

ObjectiveGrowing efforts to transform youth mental health (YMH) services rest on the assumption that they will produce superior outcomes to those of traditional services. We therefore aimed to determine whether implementation of a broad YMH service model in Edmonton, Alberta (the largest site in the pan-Canadian ACCESS Open Minds [AOM] network) resulted in greater improvements in individual-level outcomes compared to a matched control group seen at non-AOM community mental health services.MethodThis retrospective cohort study used data on the Health of Nation Outcomes Scale (HoNOS) collected by trained clinicians, in youth aged 15-25 attending AOM or comparator services for any mental health problem between April 2016 and September 2019. A difference-in-differences approach compared HoNOS outcomes pre- versus post-exposure to the AOM service over a 1-year time horizon, in relation to youth attending a non-transformed service. Propensity score matching and sensitivity analyses were conducted to ensure bias reduction and robustness of observations, respectively.ResultsThe number of referrals to AOM Edmonton increased over time (36.3% [95%CI = 11.0%-68.0%] per month), and the site met benchmarks for rapid assessment (within 72 hours) and time to appropriate care (within 30 days). Of 1,078 youth (344 in the intervention [AOM] group and 734 in the control [non-AOM] group) aged 15-25 visiting community mental health centres, the intervention group had statistically greater improvements (7.4% absolute improvement or 1.2× relative improvement) in total HoNOS scores and its behavioural and symptom subscales.ConclusionsIn addition to improving the reach and timeliness of YMH services, AOM Edmonton produced greater improvements in HoNOS total scores (and two of four subscale scores) compared to a matched control group. Comparative evaluations such as these are essential to demonstrating the value of such services and generating continuous cycles of learning and improvement.Plain Language Summary TitleWhat are the outcomes of transforming youth mental health services in community settings? Recent years have seen multiple efforts to transform mental health services for young people. While some evaluations of these have been conducted, surprisingly few have actually used relevant comparison groups. This makes it more difficult to draw conclusions about which direction the field should head in. As a result, we attempted to examine individual outcomes in a major youth mental health service transformation organized around increased capacity and rapid access to appropriate care in Edmonton, Canada. We compared outcomes using the Health of Nation Outcomes Scale (HoNOS) in the transformed ACCESS Open Minds site with traditional community mental health clinics in Edmonton, and found that the numbers of referrals increased while the vast majority of youth received timely assessment and transfers of care within target times. Finally, individuals seen in the ACCESS Open Minds site once it opened had statistically greater improvements in HoNOS scores, suggesting that they received appropriate and effective care. Les efforts croissants visant à transformer les services de santé mentale pour les jeunes (SMJ) reposent sur l’hypothèse qu’ils produiront de meilleurs résultats que les services traditionnels. Nous avons donc cherché à déterminer si la mise en œuvre d’un modèle de services de SMJ élargi à Edmonton, en Alberta (le plus grand site du réseau pancanadien ACCESS Open Minds/Esprit ouverts [AOM]) a entraîné de plus grandes améliorations des résultats individuels comparativement à un groupe témoin apparié fréquentant des services de santé mentale communautaires non affiliés à AOM. Cette étude de cohorte rétrospective a utilisé les données de l’échelle HoNOS (Health of Nation Outcomes Scale) recueillies par des cliniciens formés auprès de jeunes de 15 à 25 ans fréquentant le service AOM ou des services de comparaison pour tout problème de santé mentale entre avril 2016 et septembre 2019. Une approche de différence-en-différences a comparé les résultats HoNOS avant et après l’exposition au service AOM sur un horizon temporel d’un an, par rapport aux jeunes qui fréquentent un service non transformé. Un appariement par score de propension et des analyses de sensibilité ont été effectués afin d’assurer respectivement la réduction des biais et la robustesse des observations. Le nombre d’orientations vers le service AOM d’Edmonton a augmenté au fil du temps (36,3 % [IC à 95 % : 11,0 % à 68,0 %] par mois), et le site a atteint les objectifs en matière d’évaluation rapide (dans les 72 heures) et de délai d’accès aux soins appropriés (dans les 30 jours). Parmi 1 078 jeunes (344 dans le groupe d’intervention [AOM] et 734 dans le groupe témoin [non-AOM]) âgés de 15 à 25 ans fréquentant des centres de santé mentale communautaires, le groupe d’intervention a présenté des améliorations statistiquement plus importantes (amélioration absolue de 7,4 % ou amélioration relative de 1,2 fois) au niveau du score total HoNOS et de ses sous-échelles comportementales et symptomatiques. En plus d’améliorer la portée et la rapidité d’accès aux services de santé mentale pour jeunes, le programme AOM d’Edmonton a permis d’obtenir de meilleures améliorations au niveau du score total HoNOS (et de deux des quatre sous-échelles) comparativement à un groupe témoin apparié. Les évaluations comparatives de ce type sont essentielles pour démontrer la valeur de ces services et favoriser un cycle continu d’apprentissage et d’amélioration.

Autistic youth diagnosed with an associated intellectual disability (ID) represent nearly one third of the autistic population. However, the majority of studies on mental health and autism focus on autistic individuals without ID. Therefore, the mental health needs of autistic youth with an ID are still poorly understood. This case report focuses on the psychiatry follow-up of Nabil (fictitious name), an autistic adolescent with ID who has been treated for nearly 10 years for various symptoms, including ritualized behaviors that are part of a complex and rare diagnostic profile. In terms of neurodevelopmental disorders, in addition to symptoms associated with autism and ID, a diagnosis of attention deficit/hyperactivity disorder (ADHD) and Tourette syndrome was made, but the ADHD diagnosis was not maintained. Catatonia associated with autism has also emerged and is currently in remission. In terms of mental health, a diagnosis of obsessive-compulsive disorder (OCD) was made and behavioral problems were noted, without being attributed to the previous diagnoses. The presented case has three specific objectives: 1-to illustrate the challenges inherent in assessing the intellectual potential of autistic individuals with very low adaptive functioning and the impact on the treatment; 2- to provide avenues for the differential diagnosis of autistic rituals, compulsions, tics, stereotypies, and ADHD within this population and 3- to raise awareness about the underdiagnosis of catatonia in autistic youth.

Introduction Autistic people are particularly at risk of experiencing forms of violence, ostracism or discrimination, which lead to social exclusion in the course of their lives. However, very little research has addressed social exclusion from its subjective dimensions (e.g. attitudes, opinions, social representations and self-perception) and the relational contexts in which these experiences take shape and affect well-being and mental health. This article presents the results of qualitative research conducted with young autistic adults in Quebec who took part in asynchronous online discussion groups. It aims to identify the forms of social exclusion shared by the participants to better understand the relational contexts in which these experiences take place. Method Four asynchronous online focus groups were conducted with 23 autistic adults living in Quebec and aged 19 to 31 (average: 24). They all have received a professional diagnosis of autism. For nearly 3 weeks, open-ended questions were asked on a specific topic. A qualitative analysis using open coding was conducted. Results: The results show 4 main sources of exclusion mentioned by the participants: microaggressions, discrimination, victimization and constraints on self-determination. Social exclusion takes place in a variety of relational contexts, in which the entourage and formal services are sometimes seen as supports, sometimes as sources of vulnerability. Strategies of concealment, self-exclusion and camouflage appear to be ways of preventing exclusion, to the detriment of well-being. Discussion Five avenues for improvement in clinical and reception practices in general services are identified: 1. Develop service delivery practices in general and specialized services that are sensitive to the characteristics and needs of autistic people; 2. Adopt a trauma-informed approach and promote environments that support recovery; 3. Improve the flexibility of services and intervention methods in response to the needs expressed by autistic people; 4. Continue awareness-raising efforts to promote greater social acceptance of autism and neurodiversity in schools and the workplace; 5. Establish cross-sectoral collaborations between the education, employment, health, and social services sectors, involving user groups and advocacy organizations, to contribute to the development of truly inclusive practices.

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Increasing concern about youth mental health has brought interest in service reform. Given the importance of positive care experiences, the authors aimed to study rates of satisfaction, as well as characteristics associated with satisfaction, in ACCESS Open Minds, a cocreated network of enhanced primary and community youth mental health services across Canada. A total of 482 youths receiving services at 10 ACCESS Open Minds sites (urban, rural, and Indigenous) completed the Client Satisfaction Questionnaire-4 and responded to additional demographic and service use questions. Ninety-one percent of youths were satisfied with their mental health services, substantially higher than the predefined goal of 75%. Youths who preferred virtual services (23%) were less satisfied than those who preferred in-person services. The findings are comparable with those from similar initiatives, highlighting the value of youth-friendly, holistic primary mental health care. High satisfaction across sociodemographic groups and sites suggests that such services are acceptable in diverse communities.

The Covid-19 pandemic has had well-established effects on mental health. However, few studies have examined its specific impact on people with hypertension. To address this gap, a study was conducted in the Beni Mellal province, Morocco, to assess the psychological repercussions of Covid-19 in hypertensive patients compared to normotensive controls. Symptoms of depression, anxiety, and stress were measured using the DASS-21 scale.

Objective Preventive relocations are used to limit the risks of weather hazards, such as flooding. While these practices are likely to increase in the context of climate change, their effects on the health and well-being of those who experience them remain poorly documented in Quebec. This lack of information could contribute to inadequate support practices for individuals experiencing these relocations. This article presents the results of a study that examined the measures taken by male homeowners affected by the major floods of 2019 in Quebec to adapt to the various stages leading up to the demolition of their homes and their relocation. Method Thirteen men from 2 neighboring municipalities in the Chaudière-Appalaches region were interviewed in semi-structured interviews and a group interview to validate the results, nearly 3 years after the major floods of 2019 that affected several regions of Quebec. They were asked to share their experiences of demolishing their homes after the floods and were questioned about the strategies they used to cope with the changes. Results The participants' adaptive process proved to be dynamic, characterized by the deployment of various strategies throughout their experience, which can be divided into 4 phases: 1) the moment of the flood; 2) the administrative procedures that followed; 3) demolition of their homes; 4) relocation. Preparing for the arrival of the flood, evacuating their homes to ensure their safety and that of their loved ones, or, conversely, staying put to limit damage, changing their eating habits, and seeking physical assistance from those around them were the main strategies used during the flood. Seeking information from government and municipal authorities, obtaining administrative support from their life partner, and rumination were predominant during the administrative process, while avoidance, identifying a temporary home, and using optimistic and forward-looking thoughts were predominant during the demolition phase. To facilitate their relocation, participants postponed their retirement or used savings set aside for it, reused goods and materials from their flooded homes in their new living environment, and established relationships with their new neighbors, although some preferred to avoid contact. Behavioral responses were adopted more than intra-individual responses, the latter being cognitive and emotional. Psychological processes, such as assessing the costs and benefits of a decision or action, also influenced participants' adaptation. Conclusion This study contributes to a better understanding of the adaptation of men affected by demolition.

Objectives Firefighters are repeatedly confronted with critical incidents (CIs) at work, which are events that significantly disrupt an individual's normal functioning (e.g. failed interventions, serious accidents, media criticism). Repeated exposure to such incidents increases their vulnerability to developing post-traumatic stress injuries (PTSIs). In Canada, approximately 30% of firefighters meet the clinical thresholds for at least one PTSI; the most commonly observed being depression, post-traumatic stress disorder (PTSD), anxiety, alcohol use, and suicidal ideations. The objectives of this study are to 1) describe the frequency of CIs that firefighters encounter at work and 2) identify the different types of CIs associated with PTSIs. Method This research is based on secondary use of cross-sectional data collected in 2018 as part of a partnership with a Quebec fire department. In this context, 690 firefighters responded to a survey designed to assess their overall psychological health. Participants reported on the CIs they had experienced during their careers. Standardized questionnaires were used to measure symptoms of depression, generalized anxiety, post-traumatic stress disorder, alcohol use disorder, substance use, and suicidal ideations. Results The results indicate that rare and serious incidents, particularly critical equipment failure, are strongly linked to various PTSI, while frequent incidents are associated with generalized anxiety and depression. Negative media criticism also appears to be a major stress factor associated with several PTSIs. Conclusion Given firefighters' increased vulnerability to PTSIs, this study highlights the importance of considering the diversity of CIs encountered at work as well as the influence of contextual factors such as media criticism. It also emphasizes the need for transdiagnostic approaches and intervention measures rooted in the professional reality of these workers to better support their mental health.

Despite the societal impact of the COVID-19 pandemic, research assessing changes in symptoms of anxiety and depression following the sanitary crisis has reported heterogeneous evidence, especially among individuals with pre-existing mental health conditions. Most earlier studies used summary scores of depression or anxiety assessment surveys, which does not provide insights into changes in individual symptoms and symptom structure during the pandemic. This study used a network analysis to investigate the symptom structure of anxiety and depressive symptoms and temporal changes in symptoms across three timepoints before and during the COVID-19 pandemic in a sample primarily of persons with anxiety and depressive disorders. Data are retrieved from 675 participants of the Netherlands Study of Depression and Anxiety (NESDA) and Netherlands Study of Depression in Older Persons (NESDO) cohorts who completed all three timepoints. Anxiety and depressive symptoms were assessed using the Beck anxiety inventory (BAI) and the Quick Inventory of Depressive Symptomatology-Self-Rated (QIDS-SR). Symptom networks were estimated for three timepoints: pre-COVID, first COVID-peak (April 2020), second COVID-peak (January/February 2021), and compared. Symptom importance was quantified using centrality indices (strength, betweenness, and closeness), and temporal stability was assessed using the network comparison test (NCT). The symptom networks were largely consistent between the two COVID-19 peak timepoints but differed significantly from the pre-COVID network in terms of global strength. Fear-related anxiety symptoms, sleep-related symptoms, and thoughts of death or suicide demonstrated greater strength centrality at the pre-COVID timepoint compared to both COVID-19 peak timepoints. Our findings illustrate that a stressful situation, such as the COVID-19 pandemic, can result in changes in the complex associations of anxiety and depressive symptoms. Unexpectedly, anxiety symptom networks shifted from being driven by somatic fear responses before the pandemic, toward greater prominence of cognitive appraisal symptoms during the pandemic. Network insights could help focus intervention planning by targeting the key symptoms of anxiety and depression.

Objectives Few studies document the perceptions of climate change among teenagers who have been exposed to extreme weather events (EWE). This article aims to better understand, from the perspective of teenagers themselves, how the experience of such an event can transform the way they view climate change. Method Conducted in January 2023 in the Outaouais region (Quebec), this study gathered the views of 28 young Quebecers aged between 13 and 16 who had experienced flooding in a rural setting (2019) or a tornado in an urban setting (2018). Participants were recruited from 2 high schools located in disaster-affected communities and were expected to have experienced significant material impact or disruption as a result. Individual semi-structured interviews explored their journey since the event, particularly about their perceptions of climate change. Results Analysis of the data collected revealed 4 profiles of teenagers, according to their level of concern about climate change and their sense of control over it and the EWE it could cause: (1) the "engaged," the "powerless," the "confident" and the "disengaged." For many teenagers, the EWE was a turning point, sparking concerns about climate change. For the "engaged," these concerns translate into pro-environmental behaviors, while the "powerless," on the other hand, perceive EWE as inevitable and beyond their control. Although they make up a minority of the sample, some teenagers express little or no concern about climate change. They are sometimes "confident," because they have experienced several floods and feel better prepared to adapt to this type of disaster in the future. For their part, the "disengaged" show little interest and make little connection between the events they experienced and climate change. Conclusion The results highlight the diversity of teenagers' reactions to EWE. This observation suggests the importance of developing support tailored to different youth profiles, including awareness raising, education, and guidance, to develop coping strategies aimed at transforming anxiety into a driver for positive action in the face of climate change. These different forms of support are conducive to the development of individual and collective empowerment regarding current and future environmental issues.

Daily management of type 1 diabetes (T1D) can trigger various psychological and physiological responses, including depressive symptoms and hyperglycemia. Substantial evidence shows that emotion regulation modulates psychological and physiological experiences in the general population; yet, its role among individuals with T1D has yet to be systematically investigated. In 2024-2025, a comprehensive literature search for psychological and physiological correlates of emotion regulation among individuals with T1D was conducted using PRISMA guidelines. Eight studies (with cohorts ranging from 60 to 301 patients; 69.3% women), consisting of 5 cross-sectional and 3 longitudinal studies, met the inclusion criteria. Emotion regulation was measured using either the Difficulties in Emotion Regulation Scale (n=3); the Emotion Regulation Questionnaire (n=2); or subscales from the coping, executive function, and mindfulness questionnaires deemed to capture emotion regulation (n=3). Among psychological correlates, most studies assessed diabetes distress (n=5), whereas 2 assessed depressive symptoms. Overall, results indicate that greater difficulties in emotion regulation correlated with higher diabetes distress levels, whereas greater use of certain emotion regulation strategies, such as cognitive reappraisal, correlated with lower diabetes distress levels. As for physiological correlates, most studies evaluated glycated hemoglobin (A1C) (n=7) and insulin restriction (n=1). The included studies show that greater difficulties in emotion regulation correlated with higher A1C and insulin restriction levels. Taken together, we introduced a conceptual model connecting emotion regulation and psychophysiological correlates with broader sociocontextual factors. Although emotion regulation relates to psychophysiological functioning among individuals with T1D, further longitudinal research considering sociocontextual factors is warranted to confirm the directionality of effects.

We describe the trajectory of a 24-year-old woman with a history of borderline personality disorder (BPD) and complex trauma who presented with significant dissociative episodes. The initial assessment-including a psychiatric interview, the use of standardized measures (PCL-5, CAPS-5), and collateral information gathering-identified complex post-traumatic-stress disorder (PTSD) comorbid with dissociative identity disorder (DIID) and incomplete diagnostic criteria for BPD. Treatment consisted of an integrated psychiatric and psychotherapeutic approach based on the DBT-PTSD model. After just over one year of follow-up and 45 therapy sessions, the patient was in clinical remission from PTSD, while dissociative episodes attributable to DID persisted at a lower intensity. This case illustrates that response to DBT-PTSD may be favorable in patients with comorbid DID. The one-year follow-up highlights the persistence of dissociative episodes alongside sustained clinical remission of PTSD. The patient also shares her perspective on her therapeutic experience. This is, to our knowledge, the first reported case of the results of DBT-PTSD on a person with both complex PTSD and DID, at one year of follow-up after finishing therapy.

The growing awareness of the risks associated with climate change poses a significant challenge to both psychological and collective well-being. Many individuals, particularly young adults, experience psychological distress, recognized as eco-anxiety. Although this reaction is considered a normal response to a real threat, it can nevertheless have harmful effects on those who experience it. Despite a growing body of research on eco-anxiety, few studies have examined its social dimension. This paper draws on a set of focus groups conducted as part of a broader project on the experience of eco-anxiety among young adults aged 18 to 34 in Quebec. Although the initial aim of the research did not focus on the social dimension, it emerged as a recurrent and structuring theme throughout the qualitative analysis. Anchored in a social psychology and public health perspective, this article aims to characterize this dimension by examining how interpersonal, normative, and societal dynamics shape the experience of eco-anxiety among young adults. Eight focus groups were conducted with 32 young adults living in Quebec who identified as experiencing eco-anxiety. Thematic analyses reveal social dynamics shaping the experience of eco-anxiety, such as tensions within family and friendship networks and experiences of stigmatization, but also the search for emotional support among peers who share similar concerns. These interactions influence how eco-anxiety is experienced, expressed, and regulated, sometimes amplifying distress and at other times serving as sources of comfort and legitimacy. The study underscores the central role of the social dimension, both as a factor that can exacerbate distress and as a source of support. Although eco-anxiety is often presented as an individual response to climatic and environmental threats, our findings suggest that it is also deeply shaped by the social fabric, particularly by the interpersonal relationships within which it emerges. Recognizing this dimension opens the way to a more nuanced understanding of eco-anxiety and interventions that emphasize spaces for dialogue, support, and collective action as resources for emotional regulation and resilience.

This case report describes the clinical course of an adult man followed in forensic and community psychiatry, presenting a complex history of a psychotic disorder, developmental trauma, severe polysubstance use, and prolonged social marginalization. The originality of this case lies in the progressive emergence of atypical obsessive-compulsive phenomena during phases of structured psychosocial reintegration. These phenomena intensify in contexts of multiple relational and institutional demands and attenuate when the patient withdraws from certain commitments or imposed frameworks. Predominant symptoms include persistent intrusive ruminations, ritualized somatic self-soothing behaviors, and repetitive actions that are poorly modifiable through reasoning. The differential diagnosis, therapeutic interventions, and clinical evolution are discussed in light of contemporary models of obsessive-compulsive disorders, complex post-traumatic stress disorder, and reintegration trajectories among justice-involved patients with psychotic disorders. This case highlights the importance of considering the psychosocial environment as a dynamic factor that may exacerbate or mitigate obsessive-compulsive symptoms, independently of apparent psychotic stability.

Imagine a treatment improving physical AND mental health is identified by an important number of studies. Scientists continuously work on this treatment to analyze, improve, and understand it better. Imagine that this treatment is not only cheap but makes people save money when used. Imagine now that a large number of professionals are especially trained each year to administer this treatment but next to none are working in any health service centre nor pharmacy. This absurd situation is currently happening in Quebec. Despite the vast literature supporting the benefits of physical activity for mental health, kinesiologists are seldom involved in mental health care settings. Paradoxically, Quebec's and Canada's researchers have made important strides on this subject over the last decade. Indeed, teams worked to analyze physical activity's effect on mental well-being, mental illness symptoms and comorbid metabolic disorders. But kinesiologists (physical activity and behaviour change specialists) are still chronically underemployed in mental health settings nonetheless. Today, fewer than 1 in 3 kinesiology graduates is fully employed in a position linked to their training (including a variety of fields outside of health services). Financing the implantation of kinesiologists in public health services would, therefore, be among the best use of public funds.

Late-onset auditory verbal hallucinations (AVH) present diagnostic and therapeutic challenges, particularly when antipsychotic treatment is limited by poor tolerability. We report a case of a 75-year-old woman with de novo AVH temporally related to hemp oil use, in the general context of longstanding hearing impairment. Symptoms persisted and progressively worsened over 12 months despite discontinuation and antipsychotic treatment, resulting in marked distress and functional impairment. Adjunctive repetitive transcranial magnetic stimulation (rTMS) targeting the left temporoparietal cortex was administered in 2 separate treatment courses. Each course was associated with a marked reduction in AVH severity and enabled substantial tapering of antipsychotic medication. In both instances, symptom relapse occurred within 2-3 months after rTMS discontinuation. This case highlights the multifactorial nature of late-onset AVH and suggests that rTMS may serve as a time-limited, adjunctive intervention in selected older patients when pharmacological strategies are constrained, with potential implications for maintenance-based approaches.

Atypical neuropsychiatric presentations in older adults pose significant diagnostic challenges, particularly when psychiatric symptoms predominate early in the clinical course. We report the case of a 68-year-old woman referred to geriatric psychiatry for depressive symptoms associated with fluctuating cognitive complaints, brief paroxysmal episodes of confusion and language disturbance, and atypical somatic and motor manifestations. Initial investigations, including brain imaging and laboratory testing, were unremarkable, leading to preliminary consideration of primary psychiatric or functional etiologies. However, the longitudinal evolution, stereotyped episodic phenomena, and some clinical findings prompted further neurological assessment. Video-EEG monitoring ultimately documented epileptic activity consistent with temporal lobe seizure, providing a unifying explanation for the patient's symptoms. Introduction of anticonvulsant therapy resulted in marked improvement in mood, anxiety, somatic complaints, and motor manifestations, supporting an underlying neurological cause. This case highlights the diagnostic complexity of conditions at the interface of psychiatry and neurology and illustrates the risk of premature psychogenic attribution when standard investigations are normal. It underscores the importance of longitudinal diagnostic reasoning, vigilance for atypical features, and close interdisciplinary collaboration to minimize diagnostic delay and inappropriate treatment. Improved characterization of diagnostic trajectories in complex neuropsychiatric presentations among older adults may enhance diagnostic accuracy, optimize care pathways, and ultimately improve clinical outcomes.