Sante Mentale au Quebec最新文献

Objective Meeting the mental health needs of the population is a priority of the Quebec government. To do so, it is important to evaluate and improve the quality of mental health care in primary and community care settings, particularly with respect to person-centred and recovery-oriented care. The purpose of this study is to identify existing quality indicators that measure these dimensions, and to report on their strengths and weaknesses. Method A review of systematic reviews was conducted in MEDLINE, EMBASE, PsycINFO and CINAHL, using combinations of search terms related to the concepts of "mental disorders," "primary care," "health care quality," and "review." The review of titles and abstracts review was completed by single reviewers and full-text review by pairs of reviewers working independently. Consultation with an expert in mental health care quality and a hand search of the references of identified articles finalized the search. A review of the grey literature, including the reports and websites of Canadian or international organizations, was also conducted. Results From 2837 initial references, the review of systematic reviews led to the inclusion of 6 systematic reviews. For the grey literature, relevant indicators were found on the websites of 13 organizations, including 7 international and 6 Canadian ones, from 25 organizations consulted. A total of 106 indicators were retrieved, including 91 for person-centred care approaches and 15 for recovery-oriented approaches. Among the indicators for person-centred care, two levels emerged: the organizational level, focusing mainly on continuity issues, and the practice level, focusing on processes related to the care providers or the individual. For recovery-oriented approaches to care, four categories emerged: community connections, discrimination and stigma, social roles, and social support. Conclusion Evaluating person-centered, recovery-oriented care for people with mental disorders based on robust quality indicators poses a major challenge and our review revealed several limitations related to the current set of indicators that exist to measure these approaches. Further efforts must be made to improve the measurement of quality of mental health care in terms of person-centred and recovery-oriented care, so that the governmental and clinical strategies currently in place, such as the Programme Québécois pour les Troubles Mentaux (PQPTM), can achieve their goals.

Objectives Daytime sleepiness in adolescents has negative impacts on physical, cognitive, and emotional health, with direct or indirect consequences on their mental health. This review aims to describe specialized tools assessing daytime sleepiness in adolescents so that mental health professionals can screen for a variety of sleep disorders, from the rarest ones, such as narcolepsy, to the most common ones, such as sleep-wake cycle delay in adolescents. Method Articles were selected in Medline (https://pubmed.ncbi.nlm.nih.gov/) and targeted adolescents aged between 13 and 18 or the keyword "adolescent*". The keywords used were: "sleepiness test" AND "questionnaire*". Only articles in French or English and published until January 9, 2023 were included. A total of 277 scientific articles were screened. Final sample included a total of 35 articles describing sleepiness measurement tools in adolescents. Results Among the 35 articles, a total of seven daytime sleepiness measurement tools in adolescents were identified. Four of them were subjective: 1) the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), 2) the Pediatric Daytime Sleepiness Scale (PDSS), 3) the Cleveland Adolescent Sleepiness Questionnaire (CASQ) and 4) the French Sleepiness Scale for Adolescents (FSSA). These self-reported questionnaires are less expensive and they can be used easily by mental health professionals as opposed to objective tools. Three objective tools have been identified: 1) the multiple sleep latency test (MSLT), 2) the maintenance of wakefulness test or called the "Maintenance Wakefulness Test" (MWT) and 3) the pupillographic sleepiness test (PST). Conclusion Given that adolescents end-of the-day sleep pressure, often resulting in a greater opportunity to light exposure, they are more at risk for daytime sleepiness and consequently to mental health challenges. Mental health professionals should therefore systematically screen for daytime sleepiness in adolescents using subjective tools. There are reliable and validated tools that are translated into French, such as the FSSA and the ESS-CHAD to measure daytime sleepiness in adolescents and lifestyles problems associated with sleep loss When daytime sleepiness suggests the presence of medical-based sleep disorders, such as narcolepsy, restless sleep disorders or sleep apnea, it is important to pursue an investigation with objective tools (nocturnal polysomnography, MLST and MWT) in collaboration with the adolescent's physician.

The provision of services that improve the functioning, social participation and quality of life of individuals with behavioral or mental health problems is a common denominator amongst psychosocial professionals in Quebec, including social workers, psychologists and psychoeducators. One intervention that has gained empirical support as an intervention tool is physical activity. In fact, numerous studies have demonstrated the benefits of physical activity for many populations with whom psychosocial professionals work. Objectives Thus, the primary objective of this study was to understand the role physical activity plays in psychosocial intervention, specifically in the field of psychoeducation. The specific objectives of this study are (1) to assess how physical activity spans out in the academic and continuing education of psychoeducators, (2) establish the use of physical activity, and (3) to explore whether certain variables influence the use of physical activity by psychoeducators. Method A total of 150 psychoeducators across Quebec (years of experience: M = 11.2; SD = 9.1) completed an online survey. Descriptive statistics, conditional probability, chi-square, analyses, and logistic regression were performed. Results The results suggest that physical activity is an intervention tool used by psychoeducators, with just over 75% of professionals reporting having used physical activity in their practice. However, very few psychoeducators have received academic or continuing education pertaining to this intervention tool. The use of physical activity was not found to differ across clienteles with whom psychoeducators worked, but was positively and significantly predicted by the number of years of experience of the professionals. Conclusion Considering the numerous benefits associated with physical activity, the results of the present study emphasize the need to reflect on physical activity in psychosocial intervention and on the training offered to professionals in relation to the use of this tool. Taken together, the results of the scientific literature and our study highlight that physical activity can be used as an intervention tool by psychosocial professionals. However, in order to avoid iatrogenic outcomes resulting from inappropriate use of physical activity, further research is needed to ensure that professionals have the necessary training and supervision for safe and effective implementation.

Background Remote psychosocial intervention has been used by most health care organizations since the beginning of COVID-19 pandemic. However, the rapid introduction of this type of practice generates new methods of intervention that raise many questions, particularly about men who, in general, use face-to-face psychosocial intervention less than women. This documentary research aims to report on current knowledge on remote psychosocial intervention with men. Methods PICO technique was used to find relevant documents to achieve the objective of this research. In accord with our criteria, 62 documents were selected in several databases and search engines. The selected texts were subject to an analysis process consisting of two stages: the creation of reading sheets followed by a content analysis. Results The results underline the lack of scientific data on the men's experience when they initiate a request for help, the commitment process, and the effectiveness of the remote intervention. Several elements seem potentially promising, including patients' perceptions of having more power and freedom which could favorize engagement of men who have a traditional vision of masculinity. Conclusions It appears that gender-related variables are not commonly used when it comes to analyze the effects of distance psychosocial intervention. Other studies will be needed to have a holistic vision of the realities experienced by men towards the offer of remote psychosocial intervention.

Objectives Residential and long-term care facilities struggle to support older residents who experience a loss of autonomy, use psychoactive substances and face issues related to their consumption. Substance use can interact negatively with other physical, mental health or social conditions (e.g., homelessness) to create particularly complex profiles. In Quebec, as in many other countries around the world, there are often no clear guidelines for the care of elderly residents using psychoactive substances. The purpose of this study is to document the characteristics of existing interventions and practices towards older people who use psychoactive substances in residential and long-term care facilities in order to support decision makers with improvement of services and quality of care. Methods We carried out a scoping review of the scientific literature. We consulted 7 scientific databases (MEDLINE, EmBASE, PsychINFO, CINAHL, SocIndex, Ageline, Érudit). To identify the relevant grey literature, we explored the websites of governmental, non-governmental organizations and professional associations in the fields of addiction and aging in a selection of OECD countries. In addition, 31 experts were solicited to enhance the documentary research process. We conducted a thematic analysis on 65 documents. Results The philosophies underlying practices related to substance use reflect a hard balance to strike between priorities to be given to health, safety, and respect for human rights in residential and long-term-care settings. These philosophies, and the practices that stem from them, are distributed along a continuum ranging from the demand for abstinence to a total "laissez-faire" approach to substance use. Services offered are varied and involve complementary expertise in the health and social fields to meet the complex needs of this population. Finally, a diversity of organizational dynamics is observed: proposed interventions regarding substance use can be structured programs, informal interventions, internal substance use management policies, or specific settings for older adults who use substances, such as wet eldercare facilities. Conclusion This portrait of the interventions that target the use of psychoactive substances in residential and long-term care settings may assist care workers and service managers in Quebec and internationally, with clinical practice improvements. This may ultimately support both seniors-dedicated and addiction services. In view of population aging and the complex needs of older populations, clear guidelines are crucial to ensure the quality of care and services in these settings.

Objective The aim of this text is to describe the challenges and issues associated with family caregivers during the experience of caring for a person at the end of life at home, in the context of a pandemic. This support situation, already normally demanding, turned out to be more difficult and complicated than usual due to the many challenges and issues associated, in particular, with the health restrictions imposed at the time. Here, we present an analysis of comments gathered from family caregivers during the pandemic. Method Testimonials from caregivers were drawn from a research study entitled COVIDEUIL. The qualitative component of this study included many rich comments drawn from the voices of PPA and collected by questionnaire. For the present article, the focus was on qualitative data relating to the end-of-life situation at home of a loved one. This theme was documented by analyzing the responses of 71 caregivers. These people described, sometimes in detail, the particular circumstances surrounding their loved one's final days and death. Results PPAs report various issues in end-of-life care at home during the pandemic. Some results are similar to studies already carried out, including fatigue and the benefits of outside help, while others are perhaps more amplified, including the lack of support from caregivers, isolation, and the absence of continuity in services, due to the pandemic context. Testimonies show that home care requires physical and mental availability on the part of PPAs; the burden is imposing. In some cases, financial resources have been invested to pay for home care services. Moreover, formal and informal help remains an important element in maintaining home care until the end, otherwise it is compromised and institutional care becomes necessary. Conclusion For PPAs who were able to provide end-of-life care at home for their loved one at the end of life, various challenges were reported. In short, if end-of-life care at home is to be a safe and satisfying experience, PPAs must receive adequate support, and care must be tailored to the needs of the person being cared for. Support at the end of life at home is part of a long process of assistance and care provided by PPAs. The formal assistance offered should follow the evolution of the dyad's journey-PPA and cared-for person. End-of-life care at home is likely to increase as the population ages. As such, care and services must be orchestrated and adapted from the moment the diagnosis is announced. The Observatoire québécois de la proche aidance will certainly be able to assess the impact of the national policy on PPAs and measure the effects on their health, well-being and quality of life (art. 40) (ministère de la Santé et des Services sociaux, 2021a).

Major neurocognitive disorders (MND) affect more than 100,000 Quebecers and this number is expected to increase by 66% by 2030. The World Health Organization (WHO) considers MND as a public health priority in its "Closing the Gaps in Mental Health" program (WHO, 2011). Behavioral and psychological symptoms related to dementia (BPSD) are highly prevalent and are associated with cognitive and functional deterioration, caregiver burnout, early admission to hospital and additional costs. As part of the ministerial initiative stemming from the Plan Alzheimer du Québec (PAQ) promoted by le ministère de la Santé et des Services sociaux (MSSS) du Québec, innovative clinical practices have been implemented for the optimal management of this clientele, particularly through the creation or enhancement of teams dedicated to BPSD. With a view to continuous quality improvement, the MSSS has mandated a team of clinicians, researchers and deciders to paint a picture of current practices in the context of BPSD and to issue recommendations. This study offers a unique and innovative look at the development of quality care for BPSD in Quebec. Objectives 1. Review organizational and clinical practices, as well as care pathways for BPSD; 2. Propose an interprofessional management process based on best practices; 3. Advise the MSSS on the implementation of measures necessary to ensure access to safe, quality clinical services. Method A review of recent international literature and practice guides was conducted. Semi-structured interviews with professionals from BPSD teams were also conducted in order to paint a picture of the situation in Quebec. An outline of a logic model was proposed based on this information. A group of experts was formed to review clinical and organizational BPSD practices in light of the results. Results The ministerial initiative resulting from the PAQ has had an important structuring effect on the development, consolidation and prioritization of services for people with BPSD. Facilitating elements as well as barriers to the implementation of these services were identified and recommendations were issued to advise the ministry on the actions to be taken. Conclusion The essential conditions and strategies to be adopted to consolidate the trajectory of care for BPSD were transmitted to the MSSS. The main impact is to improve the accessibility and quality of BPSD care for the benefit of users and their families.

Context In Quebec, adult mental health (AMH) first-line teams are mandated to provide psychosocial services to people living with mental health difficulties, including anxiety and mood disorders. Following the establishment of new clinical guidelines in 2017, the duration of interventions was not to exceed 15 sessions, with some exceptions. Objectives The overall aim of the longitudinal component of the Shared Knowledge study was to evaluate the care experience of individuals with an anxiety or depressive disorder receiving a short-term intervention (<15 sessions) by first-line AMH teams, and the evolution of recovery over time. Specifically, the objectives were to: 1) determine the appreciation of short-term interventions by service users; and 2) assess the evolution over time of the symptomatology, functioning and quality of life and recovery of individuals receiving short-term interventions. Method A mixed method longitudinal design was used. Telephone interviews were conducted with participants, in which the following variables were quantitatively and qualitatively assessed: appreciation of services received, quality of relationship with the provider (INSPIRE), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), global functioning (WHODAS), quality of life (ReQOL), and personal recovery (ERTAD). Linear mixed model analyses were performed to examine changes over time on quantitative measures. Content analysis was performed on the qualitative data. Results A total of 63 individuals participated in an interview before the start of their intervention and 22 of them participated after the end of this intervention. Statistical analyses showed a significant improvement in anxiety symptoms, quality of life, and personal recovery, but no difference was observed in depressive symptoms and level of functioning. Nearly half (47.4%) of participants reported that the intervention they received had "completely" met the need that had led them to seek help, and 33.3% felt "completely" equipped or empowered in their recovery. The quality of the relationship with the caregiver, the opportunity to take part in decision-making, and the personalization of the intervention according to their needs and preferences were some of the elements that were particularly appreciated. Conclusion Short-term interventions seem to be appreciated and produce positive effects in many people suffering from anxiety or depressive disorders. However, they remain insufficient for a number of them. A personal recovery measure should be used in conjunction with symptomatology and functioning scales to monitor the progress of people using first-line mental health services.

Objective In this study, we present the results of a comparative research carried out on three cohorts of university students in the context of a pandemic. Several research indicate that the anxiety level of populations has increased significantly. Method In this article, we present the results of a comparative study of three cohorts study conducted on 1674 Quebec students. Participants were recruited at three separate time points, in the summer of 2020 (cohort 1; N = 398), in the fall of 2020 (cohort 2; N = 621) and in the winter of 2021 (cohort 3; N = 655). Anxiety was measured using Beck's anxiety inventory and several sociodemographic variables were tested. Results Results from cohort 1 indicate that being younger and having a mental health diagnosis may be vulnerability factors for anxiety. For cohort 2, the interaction of gender x diagnosis x program of study had a significant effect. Age and family income were predictive of significant anxiety in cohort 3. Limitations and perspectives of the study are explored. Conclusion The study recommends that the results be considered in developing preventive and intervention programs in the post-pandemic period.

Objectives To describe the different issues surrounding the integration of peer support workers (PSW) and family peer support workers (FPSW) into early intervention for psychosis services (EIS): their roles, the impacts of these interventions for patients, their families, and treatment teams, as well as the challenges and facilitators of this process. Method This article, co-authored with PSW and FPSW, presents a description and discussion of the experience of implementing peer support and family peer support in EIS in Québec, supported by a perspective of a review of the scientific and grey literature published in French or English in the last twenty years. Results Eight of the 36 scientific articles and two of the 14 grey literature publications selected were specific to early intervention for psychosis; the remainder were on mental health intervention. These publications put into context the experience described by clinicians, PSW and FPSW, and illustrated by clinical vignettes. Different modalities of peer support have demonstrated a positive impact on young people with early psychosis: it contributes to the improvement of self-esteem, quality of life, emotional well-being and can facilitate the rehabilitation process and reduce hospitalizations. Family peer support can reduce the stigma surrounding mental health problems, foster hope and a sense of belonging, increase knowledge of the illness and its treatment, and promote better coping strategies by family members. Nevertheless, many challenges have been identified during the integration of peer support and family peer support within clinical teams: planning and funding the implementation of services, defining their roles in EIS, training, clinical supervision, etc. These challenges need to be identified and addressed quickly in order to optimize care for youth and their families. Various strategies have been proposed for the successful implementation of peer support in EIS, which remains limited in Quebec and in the French-speaking world. It requires the participation and support of all stakeholders, including health professionals, managers and decision makers. Conclusion Peer support and family peer support emphasizes lived experience as expertise, recognizing the contribution of people with psychosis and their families as sources of support and models for recovery. This perspective fits well with the philosophy advocated by EIS. This promising intervention, which has been put forward by various national policies or guides, would benefit from being rapidly implemented on a larger scale in Quebec EIS and in the French-speaking world. This would make it possible to study the positive impacts described for service users and their families with more rigorous research designs and larger samples.