Pub Date : 2016-11-01DOI: 10.1177/0706743716644147
S. Hatcher
This perspective article describes the problem of Canadian indigenous suicide from a non-Canadian viewpoint. In particular, the article compares both similarities and differences in suicide prevention between Māori in New Zealand and indigenous peoples in Canada. It emphasises that the problem of indigenous suicide is not being indigenous but coping with losses secondary to colonisation. A useful way to translate this into helpful clinical conversations and actions is to think about loss of belonging. Culture and belonging are key components of identity and as such should be considered in all psychiatric encounters, not just in those who are considered minorities or “other.” The article concludes by suggesting how some of the experiences of addressing health inequalities and suicide in Māori may be applied in Canada.
{"title":"Indigenous Suicide: A Global Perspective with a New Zealand Focus","authors":"S. Hatcher","doi":"10.1177/0706743716644147","DOIUrl":"https://doi.org/10.1177/0706743716644147","url":null,"abstract":"This perspective article describes the problem of Canadian indigenous suicide from a non-Canadian viewpoint. In particular, the article compares both similarities and differences in suicide prevention between Māori in New Zealand and indigenous peoples in Canada. It emphasises that the problem of indigenous suicide is not being indigenous but coping with losses secondary to colonisation. A useful way to translate this into helpful clinical conversations and actions is to think about loss of belonging. Culture and belonging are key components of identity and as such should be considered in all psychiatric encounters, not just in those who are considered minorities or “other.” The article concludes by suggesting how some of the experiences of addressing health inequalities and suicide in Māori may be applied in Canada.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"620 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114056963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-01DOI: 10.1177/0706743716664334
D. Kealy, Priyanka Halli, J. Ogrodniczuk, G. Hadjipavlou
Dear Editor: We thank Dr. Schonfeld and colleagues for their letter responding to our survey regarding burnout symptoms among Canadian psychiatry residents. Their correspondence raises the issue of the connection between burnout and depression, noting that our survey did not consider whether residents who indicated burnout symptoms may have indeed been depressed. We agree that clarifying the relationship between burnout and depression is important. Although a large body of research has established a link between these constructs, it is premature to conclude that burnout and depression are one and the same. Clinical depression is marked by considerable heterogeneity and is optimally assessed using interviews by trained clinicians. Unfortunately, these issues have been inadequately accounted for in burnout research. As Schonfeld and colleagues note in a recent review, this prevents definitive conclusions regarding the overlap between burnout and depression. Alarming rates of depressive symptoms have been reported among residents of various medical specialties. Further research is needed to tease apart the relationship between training-related burnout and other potential depressogenic factors. Our survey was not designed to accomplish this. Rather, we sought to investigate the incidence of emotional exhaustion—a prominent burnout symptom—among psychiatry trainees in Canadian residency programs. While we do not know whether the residents who endorsed burnout symptoms were struggling with clinical depression, our findings may nevertheless provide some stimulus for further work—including research using more comprehensive assessment methods. If unaddressed, burnout may progress to depression. Hopefully, residents’ use of personal psychotherapy—along with other resources—can mitigate this unfortunate trajectory. Whether linked with depression or not, burnout among residents is a significant concern. We thus reiterate our call for attention to this matter on the part of psychiatric educators, administrators, and residents—and we join Schonfeld and colleagues in arguing for further research in this area.
{"title":"Unravelling the Relationship between Physician Burnout and Depression","authors":"D. Kealy, Priyanka Halli, J. Ogrodniczuk, G. Hadjipavlou","doi":"10.1177/0706743716664334","DOIUrl":"https://doi.org/10.1177/0706743716664334","url":null,"abstract":"Dear Editor: We thank Dr. Schonfeld and colleagues for their letter responding to our survey regarding burnout symptoms among Canadian psychiatry residents. Their correspondence raises the issue of the connection between burnout and depression, noting that our survey did not consider whether residents who indicated burnout symptoms may have indeed been depressed. We agree that clarifying the relationship between burnout and depression is important. Although a large body of research has established a link between these constructs, it is premature to conclude that burnout and depression are one and the same. Clinical depression is marked by considerable heterogeneity and is optimally assessed using interviews by trained clinicians. Unfortunately, these issues have been inadequately accounted for in burnout research. As Schonfeld and colleagues note in a recent review, this prevents definitive conclusions regarding the overlap between burnout and depression. Alarming rates of depressive symptoms have been reported among residents of various medical specialties. Further research is needed to tease apart the relationship between training-related burnout and other potential depressogenic factors. Our survey was not designed to accomplish this. Rather, we sought to investigate the incidence of emotional exhaustion—a prominent burnout symptom—among psychiatry trainees in Canadian residency programs. While we do not know whether the residents who endorsed burnout symptoms were struggling with clinical depression, our findings may nevertheless provide some stimulus for further work—including research using more comprehensive assessment methods. If unaddressed, burnout may progress to depression. Hopefully, residents’ use of personal psychotherapy—along with other resources—can mitigate this unfortunate trajectory. Whether linked with depression or not, burnout among residents is a significant concern. We thus reiterate our call for attention to this matter on the part of psychiatric educators, administrators, and residents—and we join Schonfeld and colleagues in arguing for further research in this area.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115344824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-13DOI: 10.1177/0706743716659062
J. Paris
{"title":"Book Review: Integrated Treatment for Personality Disorder: A Modular Approach","authors":"J. Paris","doi":"10.1177/0706743716659062","DOIUrl":"https://doi.org/10.1177/0706743716659062","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123571083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-13DOI: 10.1177/0706743716664333
I. Schonfeld, É. Laurent, P. Vandel, R. Bianchi
Dear Editor: A recent article in this journal described the results of a study of burnout in psychiatric residents. Using a 1-item scale to assess burnout, the investigators found that 21% of the residents were symptomatic. Aside from problems inherent in the absence of binding or consensual criteria to diagnose burnout, the article ignored research that connects burnout and depression. Mounting evidence, including evidence from research on health professionals, has linked burnout and depression and suggested that burnout is a depressive syndrome. Studies conducted in France and the United States found that teachers with high levels of burnout symptoms, compared to colleagues with few symptoms, were much more likely to experience the full array of depressive symptoms, including the most severe (e.g., suicidal ideation). In fact, in the French and US samples, burnout was assessed with the most commonly employed burnout instruments. In both studies, when measurement error was controlled, burnout and depressive symptoms correlated very highly (r .80). Moreover, burnout and depression have both been etiologically associated with unresolvable stress. Burnout is assumed to be a product of unresolvable job stress. Unresolvable job stress has been causally related to depression. Burnout and depression also share similar dispositional risk factors (e.g., neuroticism) and overlap in terms of allostatic load, an index of the cumulative biological cost of experienced psychosocial adversity. We therefore submit that in evaluating the distress experienced by overburdened psychiatric residents, investigators assess a problem with which psychiatry is already well familiar, namely, depression. Given the overlap of burnout with depression and the diagnostic blur surrounding burnout, we recommend that depression, rather than burnout, be assessed in occupational health research. In contrast to burnout, depression is nosologically well characterized and diagnosable using clinically validated instruments. To etiologically connect depression with work, the investigator can ask participants whether they mainly attribute their depressive symptoms to work-related problems. Irvin Sam Schonfeld, PhD, MPH Department of Psychology, The City College and the Graduate Center of the City University of New York, New York, NY, USA ischonfeld@ccny.cuny.edu
亲爱的编辑:本杂志最近的一篇文章描述了一项关于精神科住院病人倦怠的研究结果。采用1项量表评估倦怠，调查人员发现21%的居民有症状。除了缺乏有约束力或双方同意的诊断倦怠标准所固有的问题外，这篇文章还忽略了将倦怠和抑郁联系起来的研究。越来越多的证据，包括来自卫生专业人员的研究证据，已经将倦怠和抑郁联系起来，并表明倦怠是一种抑郁综合症。在法国和美国进行的研究发现，与症状较少的同事相比，有严重倦怠症状的教师更有可能经历各种抑郁症状，包括最严重的(例如，自杀念头)。事实上，在法国和美国的样本中，倦怠是用最常用的倦怠工具来评估的。在这两项研究中，当测量误差得到控制时，倦怠和抑郁症状的相关性非常高(r .80)。此外，倦怠和抑郁在病因上都与无法解决的压力有关。倦怠被认为是无法解决的工作压力的产物。无法解决的工作压力与抑郁症有因果关系。倦怠和抑郁也有相似的性格风险因素(例如，神经质)，在适应负荷方面也有重叠，适应负荷是经历心理社会逆境的累积生物成本指数。因此，我们认为，在评估负担过重的精神病住院患者所经历的痛苦时，调查人员评估的是精神病学已经非常熟悉的问题，即抑郁症。鉴于职业倦怠与抑郁症的重叠以及围绕职业倦怠的诊断模糊，我们建议在职业健康研究中评估抑郁症，而不是职业倦怠。与倦怠相反，抑郁症在病理学上有很好的特征，并且可以使用临床验证的工具进行诊断。为了从病因上将抑郁与工作联系起来，研究者可以询问参与者是否主要将抑郁症状归因于与工作有关的问题。Irvin Sam Schonfeld，博士，公共卫生硕士心理学系，纽约城市学院和纽约城市大学研究生中心，美国纽约ischonfeld@ccny.cuny.edu
{"title":"Burnout and Depression in Psychiatric Residents","authors":"I. Schonfeld, É. Laurent, P. Vandel, R. Bianchi","doi":"10.1177/0706743716664333","DOIUrl":"https://doi.org/10.1177/0706743716664333","url":null,"abstract":"Dear Editor: A recent article in this journal described the results of a study of burnout in psychiatric residents. Using a 1-item scale to assess burnout, the investigators found that 21% of the residents were symptomatic. Aside from problems inherent in the absence of binding or consensual criteria to diagnose burnout, the article ignored research that connects burnout and depression. Mounting evidence, including evidence from research on health professionals, has linked burnout and depression and suggested that burnout is a depressive syndrome. Studies conducted in France and the United States found that teachers with high levels of burnout symptoms, compared to colleagues with few symptoms, were much more likely to experience the full array of depressive symptoms, including the most severe (e.g., suicidal ideation). In fact, in the French and US samples, burnout was assessed with the most commonly employed burnout instruments. In both studies, when measurement error was controlled, burnout and depressive symptoms correlated very highly (r .80). Moreover, burnout and depression have both been etiologically associated with unresolvable stress. Burnout is assumed to be a product of unresolvable job stress. Unresolvable job stress has been causally related to depression. Burnout and depression also share similar dispositional risk factors (e.g., neuroticism) and overlap in terms of allostatic load, an index of the cumulative biological cost of experienced psychosocial adversity. We therefore submit that in evaluating the distress experienced by overburdened psychiatric residents, investigators assess a problem with which psychiatry is already well familiar, namely, depression. Given the overlap of burnout with depression and the diagnostic blur surrounding burnout, we recommend that depression, rather than burnout, be assessed in occupational health research. In contrast to burnout, depression is nosologically well characterized and diagnosable using clinically validated instruments. To etiologically connect depression with work, the investigator can ask participants whether they mainly attribute their depressive symptoms to work-related problems. Irvin Sam Schonfeld, PhD, MPH Department of Psychology, The City College and the Graduate Center of the City University of New York, New York, NY, USA ischonfeld@ccny.cuny.edu","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"164 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122177071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-13DOI: 10.1177/0706743716661329
M. Kral
Inuit in Canada have among the highest suicide rates in the world, and it is primarily among their youth. Risk factors include known ones such as depression, substance use, a history of abuse, and knowing others who have made attempts or have killed themselves, however of importance are the negative effects of colonialism. This took place for Inuit primarily during the government era starting in the 1950s, when Inuit were moved from their family-based land camps to crowded settlements run by white men, and children were removed from their parents and placed into residential or day schools. This caused more disorganization than reorganization. The most negative effect of this colonialism/imperialism for Inuit has been on their family and sexual relationships. Many Inuit youth feel alone and rejected. Suicide prevention has been taking place, the most successful being community-driven programs developed and run by Inuit. Mental health factors for Indigenous peoples are often cultural. It is recommended that practitioners work with the community and with Inuit organizations. Empowered communities can be healing.
{"title":"Suicide and Suicide Prevention among Inuit in Canada","authors":"M. Kral","doi":"10.1177/0706743716661329","DOIUrl":"https://doi.org/10.1177/0706743716661329","url":null,"abstract":"Inuit in Canada have among the highest suicide rates in the world, and it is primarily among their youth. Risk factors include known ones such as depression, substance use, a history of abuse, and knowing others who have made attempts or have killed themselves, however of importance are the negative effects of colonialism. This took place for Inuit primarily during the government era starting in the 1950s, when Inuit were moved from their family-based land camps to crowded settlements run by white men, and children were removed from their parents and placed into residential or day schools. This caused more disorganization than reorganization. The most negative effect of this colonialism/imperialism for Inuit has been on their family and sexual relationships. Many Inuit youth feel alone and rejected. Suicide prevention has been taking place, the most successful being community-driven programs developed and run by Inuit. Mental health factors for Indigenous peoples are often cultural. It is recommended that practitioners work with the community and with Inuit organizations. Empowered communities can be healing.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116938156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-13DOI: 10.1177/0706743716659247
L. Mehl‐Madrona
Introduction: Suicide is disproportionately common among Aboriginal people in Canada. Methods: Life stories were collected from 54 Aboriginal suicide attempters in northern Saskatchewan. Constant comparison techniques and modified grounded theory identified common themes expressed. Results: Three common plots/themes preceded suicide attempts: 1) relationship breakup, usually sudden, unanticipated, involving a third person; 2) being publicly humiliated by another person(s), accompanied by high levels of shame; and 3) high levels of unremitting, chronic life stress (including poverty) with relative isolation. We found 5 common purposes for suicide attempts: 1) to “show” someone how badly they had hurt the attempter, 2) to stop the pain, 3) to save face in a difficult social situation, 4) to get revenge, and 5) don’t know/don’t remember/made sense at the time, all stated by people who were under the influence of alcohol and/or drugs at the time of their suicide attempt. We found 5 common beliefs about death: 1) you just cease to exist, and everything just disappears; 2) you go into the spirit world and can see and hear everything that is happening in this world; 3) you go to heaven or hell; 4) you go to a better place; and 5) don’t know/didn’t think about it. Discussion: The idea of personal and cultural continuity is essential to understanding suicide among First Nations youth. Interventions targeted to the individual’s beliefs about death, purpose for suicide, and consistent with the life story (plot) in which they find themselves may be more successful than one-size-fits-all programs developed outside of aboriginal communities.
{"title":"Indigenous Knowledge Approach to Successful Psychotherapies with Aboriginal Suicide Attempters","authors":"L. Mehl‐Madrona","doi":"10.1177/0706743716659247","DOIUrl":"https://doi.org/10.1177/0706743716659247","url":null,"abstract":"Introduction: Suicide is disproportionately common among Aboriginal people in Canada. Methods: Life stories were collected from 54 Aboriginal suicide attempters in northern Saskatchewan. Constant comparison techniques and modified grounded theory identified common themes expressed. Results: Three common plots/themes preceded suicide attempts: 1) relationship breakup, usually sudden, unanticipated, involving a third person; 2) being publicly humiliated by another person(s), accompanied by high levels of shame; and 3) high levels of unremitting, chronic life stress (including poverty) with relative isolation. We found 5 common purposes for suicide attempts: 1) to “show” someone how badly they had hurt the attempter, 2) to stop the pain, 3) to save face in a difficult social situation, 4) to get revenge, and 5) don’t know/don’t remember/made sense at the time, all stated by people who were under the influence of alcohol and/or drugs at the time of their suicide attempt. We found 5 common beliefs about death: 1) you just cease to exist, and everything just disappears; 2) you go into the spirit world and can see and hear everything that is happening in this world; 3) you go to heaven or hell; 4) you go to a better place; and 5) don’t know/didn’t think about it. Discussion: The idea of personal and cultural continuity is essential to understanding suicide among First Nations youth. Interventions targeted to the individual’s beliefs about death, purpose for suicide, and consistent with the life story (plot) in which they find themselves may be more successful than one-size-fits-all programs developed outside of aboriginal communities.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116953588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-22DOI: 10.1177/0706743716658455
R. Tempier
{"title":"Book Review: Cinquante ans de psychiatrie à l’Université de Montréal (1965-2015)","authors":"R. Tempier","doi":"10.1177/0706743716658455","DOIUrl":"https://doi.org/10.1177/0706743716658455","url":null,"abstract":"","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130351209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-12DOI: 10.1177/0706743716670130
G. Gariépy, F. Elgar
Objective: To describe trends in psychological health symptoms in Canadian youth from 2002 to 2014 and examine gender and socioeconomic differences in these trends. Method: We used data from the Canadian Health Behaviour in School-aged Children (HBSC) study. We assessed psychological symptoms from a validated symptom checklist and calculated a symptom score (range, 0-16). We stratified our analyses by gender and affluence tertile based on an index of material assets. We then plotted trends in symptom score and calculated the probability of experiencing specific symptoms over time. Results: Between 2002 and 2014, psychological symptom score increased by 1.01 (95% confidence interval [CI], 0.73 to 1.41), 1.08 (95% CI, 0.79 to 1.37), and 0.84 (95% CI, 0.55 to 1.13) points in girls in the low-, middle-, and high-affluence tertiles, respectively. In boys, psychological symptoms decreased by –0.39 (95% CI, –0.66 to –0.12) and –0.12 (95% CI, –0.43 to 0.19) points in the high- and middle-affluence tertiles, respectively, and increased by 0.30 (95% CI, –0.04 to 0.63) points in the low-affluence tertile. The probability of feeling anxious and having sleep problems at least once a week notably increased in girls from all affluence groups, while the probability of feeling depressed and irritable decreased among boys from the high-affluence tertile. Conclusion: Psychological symptoms increased in Canadian adolescent girls across all affluence groups while they remained stable in boys from low and middle affluence and decreased in boys from high affluence. Specific psychological symptoms followed distinct trends. Further research is needed to uncover the mechanisms driving these trends.
{"title":"Trends in Psychological Symptoms among Canadian Adolescents from 2002 to 2014: Gender and Socioeconomic Differences","authors":"G. Gariépy, F. Elgar","doi":"10.1177/0706743716670130","DOIUrl":"https://doi.org/10.1177/0706743716670130","url":null,"abstract":"Objective: To describe trends in psychological health symptoms in Canadian youth from 2002 to 2014 and examine gender and socioeconomic differences in these trends. Method: We used data from the Canadian Health Behaviour in School-aged Children (HBSC) study. We assessed psychological symptoms from a validated symptom checklist and calculated a symptom score (range, 0-16). We stratified our analyses by gender and affluence tertile based on an index of material assets. We then plotted trends in symptom score and calculated the probability of experiencing specific symptoms over time. Results: Between 2002 and 2014, psychological symptom score increased by 1.01 (95% confidence interval [CI], 0.73 to 1.41), 1.08 (95% CI, 0.79 to 1.37), and 0.84 (95% CI, 0.55 to 1.13) points in girls in the low-, middle-, and high-affluence tertiles, respectively. In boys, psychological symptoms decreased by –0.39 (95% CI, –0.66 to –0.12) and –0.12 (95% CI, –0.43 to 0.19) points in the high- and middle-affluence tertiles, respectively, and increased by 0.30 (95% CI, –0.04 to 0.63) points in the low-affluence tertile. The probability of feeling anxious and having sleep problems at least once a week notably increased in girls from all affluence groups, while the probability of feeling depressed and irritable decreased among boys from the high-affluence tertile. Conclusion: Psychological symptoms increased in Canadian adolescent girls across all affluence groups while they remained stable in boys from low and middle affluence and decreased in boys from high affluence. Specific psychological symptoms followed distinct trends. Further research is needed to uncover the mechanisms driving these trends.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114280021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/0706743716645305
J. Karagianis
Dear Editor: Dawson’s conclusion that ‘‘there is no robust evidence that the mandatory element in a CTO . . . produces greater clinical benefits for patients than simply offering them the same package of services on a voluntary basis’’ contrasts substantial evidence to the contrary. Further, absence of evidence is not evidence of absence. Appropriately used, community treatment orders (CTOs) are a critical tool to help prevent patient disengagement from mental health care. Otherwise, these patients would become unable to consistently and longitudinally access evidence-based treatments and the supports necessary for relapse prevention and optimization of recovery. A CTO helps ensure recovery-focused, patient and service provider participation in a comprehensive plan of treatment, care, and supervision. Disengagement from mental health services occurs in a large minority of patients with both schizophrenia and bipolar disorder. Various studies demonstrate disengagement rates of 25% to 30%. The National Comorbidity Survey showed that 53% of individuals with serious mental illnesses hadn’t received any mental health treatment in the prior year. When asked for reasons, more than half of respondents reported that they didn’t believe they had a problem requiring treatment (that is, anosognosia). In a 5-year follow-up study, Fischer et al found that among patients with schizophrenia and bipolar disorder, 25% had 1 or more gaps in care lasting at least 12 months and 9% had gaps of 2 years or more. O’Brien et al observed 30% disengagement from services in a follow-up period of 9 years. Similar rates of disengagement occur in patients served by even intensive multidisciplinary assertive outreach teams (for example, early psychosis programs and assertive community treatment teams). While there are many potential strategies to enhance engagement, it seems highly unlikely that these strategies will ever be sufficient to ensure care to a core group of treatment refusers. Where the alternatives to care include involuntary hospital admission, legal involvement, and violence to self and others with resulting coercive consequences, CTOs represent a coercion reduction tool. They also help save scarce beds for other patients with severe mental illnesses. As a separate issue, another large group of patients may be engaged in services but remain inadequately adherent to medication that is also necessary for their long-term recovery and avoidance of the consequences of relapse. While questions remain about what factors are most critical to the success of CTOs, there is little doubt in the minds of most clinicians and families with experience with CTOs that they remain an indispensable tool for some patients who would otherwise not avail themselves of the care they need. The strength of the effect of CTOs will likely always be determined by appropriate patient selection, the strength of the treatment plan, and the many variables involved in its implementation. Patients m
{"title":"Doubting the Doubts About the Clinical Effectiveness of Community Treatment Orders","authors":"J. Karagianis","doi":"10.1177/0706743716645305","DOIUrl":"https://doi.org/10.1177/0706743716645305","url":null,"abstract":"Dear Editor: Dawson’s conclusion that ‘‘there is no robust evidence that the mandatory element in a CTO . . . produces greater clinical benefits for patients than simply offering them the same package of services on a voluntary basis’’ contrasts substantial evidence to the contrary. Further, absence of evidence is not evidence of absence. Appropriately used, community treatment orders (CTOs) are a critical tool to help prevent patient disengagement from mental health care. Otherwise, these patients would become unable to consistently and longitudinally access evidence-based treatments and the supports necessary for relapse prevention and optimization of recovery. A CTO helps ensure recovery-focused, patient and service provider participation in a comprehensive plan of treatment, care, and supervision. Disengagement from mental health services occurs in a large minority of patients with both schizophrenia and bipolar disorder. Various studies demonstrate disengagement rates of 25% to 30%. The National Comorbidity Survey showed that 53% of individuals with serious mental illnesses hadn’t received any mental health treatment in the prior year. When asked for reasons, more than half of respondents reported that they didn’t believe they had a problem requiring treatment (that is, anosognosia). In a 5-year follow-up study, Fischer et al found that among patients with schizophrenia and bipolar disorder, 25% had 1 or more gaps in care lasting at least 12 months and 9% had gaps of 2 years or more. O’Brien et al observed 30% disengagement from services in a follow-up period of 9 years. Similar rates of disengagement occur in patients served by even intensive multidisciplinary assertive outreach teams (for example, early psychosis programs and assertive community treatment teams). While there are many potential strategies to enhance engagement, it seems highly unlikely that these strategies will ever be sufficient to ensure care to a core group of treatment refusers. Where the alternatives to care include involuntary hospital admission, legal involvement, and violence to self and others with resulting coercive consequences, CTOs represent a coercion reduction tool. They also help save scarce beds for other patients with severe mental illnesses. As a separate issue, another large group of patients may be engaged in services but remain inadequately adherent to medication that is also necessary for their long-term recovery and avoidance of the consequences of relapse. While questions remain about what factors are most critical to the success of CTOs, there is little doubt in the minds of most clinicians and families with experience with CTOs that they remain an indispensable tool for some patients who would otherwise not avail themselves of the care they need. The strength of the effect of CTOs will likely always be determined by appropriate patient selection, the strength of the treatment plan, and the many variables involved in its implementation. Patients m","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"C-20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126772285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-01DOI: 10.1177/0706743716633430
A. Newton, R. Rosychuk, Corine E. Carlisle, Xuechen Zhang, Jennifer Bethell, A. Rhodes
Objective: In Canada, emergency departments (EDs) are a frontline setting for treating suicide-related behaviours (SRBs) among adolescents, yet description of national trends in ED SRB visits is lacking. We determined whether the SRB incidence rate and method patterns between 2002 and 2010 previously shown for Ontario adolescents were also experienced in Alberta. Method: A retrospective, population-based study of ED visits for SRBs (self-poisoning or self-injury, irrespective of suicidal intent) by 12- to 17-year-olds was conducted using administrative health care data from 104 EDs across Alberta, Canada. Incidence rates and 95% confidence intervals (CIs) were calculated and graphed. Rate ratios (RRs) comparing rates between time periods (2002-2005 and 2006-2010) and corresponding 95% CIs were estimated. Changes in SRB methods were also described. The time periods chosen were based on published Ontario trends. Results: Decreases in yearly incidence rates levelled off after 2005. Crude RRs indicated a rate decrease in 2006 to 2010 for boys (RR, 0.77; 95% CI, 0.65 to 0.90) and girls (RR, 0.80; 95% CI, 0.67 to 0.95). From 2002 to 2010, the proportion of SRB visits for self-poisoning decreased (girls, –13%; boys, –10%) while visits for self-cutting increased (girls, +13%; boys, +14%). Conclusions: Alberta trends were similar to those previously published for Ontario. Determining if the trends and observed changes are associated with mental health care access or availability and/or provincial suicide prevention strategies would contextualize these findings and could shape future prevention efforts. Lack of identification of suicidal intent and exclusion of fatal SRB are limitations of the current study.
{"title":"Time Trends in Emergency Department Visits for Suicide-Related Behaviours by Girls and Boys in Alberta","authors":"A. Newton, R. Rosychuk, Corine E. Carlisle, Xuechen Zhang, Jennifer Bethell, A. Rhodes","doi":"10.1177/0706743716633430","DOIUrl":"https://doi.org/10.1177/0706743716633430","url":null,"abstract":"Objective: In Canada, emergency departments (EDs) are a frontline setting for treating suicide-related behaviours (SRBs) among adolescents, yet description of national trends in ED SRB visits is lacking. We determined whether the SRB incidence rate and method patterns between 2002 and 2010 previously shown for Ontario adolescents were also experienced in Alberta. Method: A retrospective, population-based study of ED visits for SRBs (self-poisoning or self-injury, irrespective of suicidal intent) by 12- to 17-year-olds was conducted using administrative health care data from 104 EDs across Alberta, Canada. Incidence rates and 95% confidence intervals (CIs) were calculated and graphed. Rate ratios (RRs) comparing rates between time periods (2002-2005 and 2006-2010) and corresponding 95% CIs were estimated. Changes in SRB methods were also described. The time periods chosen were based on published Ontario trends. Results: Decreases in yearly incidence rates levelled off after 2005. Crude RRs indicated a rate decrease in 2006 to 2010 for boys (RR, 0.77; 95% CI, 0.65 to 0.90) and girls (RR, 0.80; 95% CI, 0.67 to 0.95). From 2002 to 2010, the proportion of SRB visits for self-poisoning decreased (girls, –13%; boys, –10%) while visits for self-cutting increased (girls, +13%; boys, +14%). Conclusions: Alberta trends were similar to those previously published for Ontario. Determining if the trends and observed changes are associated with mental health care access or availability and/or provincial suicide prevention strategies would contextualize these findings and could shape future prevention efforts. Lack of identification of suicidal intent and exclusion of fatal SRB are limitations of the current study.","PeriodicalId":309115,"journal":{"name":"The Canadian Journal of Psychiatry","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128452560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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