Sante Mentale au Quebec最新文献

Objectives Shame is a painful feeling that one feels when under the impression of having committed an offence or contravened to a personal or moral standard. Shame experiences are often intense and entail a global, negative self-evaluation; persons then feel like they are bad, weak, worthless, or deserving others' contempt. Some people are more prone to shame feelings. Although shame is not listed as a diagnostic criterion of borderline personality disorder (BPD) in the DSM-5, studies suggest that shame is an important feature in individuals with BPD. The aim of this study is to garner additional data to document shame proneness in individuals presenting with borderline symptomatology in the population from the Province of Quebec. Method Overall, 646 community adults from the Province of Quebec completed online the brief version of the Borderline Symptom List (BSL-23), measuring the severity of symptoms associated with BPD from a dimensional perspective, and to the Experience of Shame Scale (ESS), measuring shame proneness in various areas of a person's life. Participants were then compared on their shame scores after they were assigned to one of the four groups based on Kleindienst et al. (2020) classification of severity of borderline symptoms: (a) none or low symptoms (n = 173), (b) mild symptoms (n = 316), (c) moderate symptoms (n = 103), or (d) high, very high or extremely high symptoms (n = 54). Results Between-group differences were found with large effect sizes in all shame areas measured by the ESS, suggesting that shame feelings tend to be greater in persons presenting more borderline traits. Conclusion Results are discussed in a clinical perspective of BPD, emphasizing the importance of having shame as a clinical target in psychotherapy with these clients. Furthermore, our results raise conceptual questions regarding how to integrate shame in the assessment and treatment of BPD.

Anxiety disorders are among the most prevalent psychopathologies in children and adolescents around the world. They affect their personal, family, school and social functioning. Although symptoms of generalized anxiety disorder (GAD) are among the most commonly observed symptoms in adolescence, relatively little is known about the most important risk factors. Objectives The purpose of the present study was therefore 1) to document the prevalence of the central feature of GAD, excessive worrying, in high school students aged 12 to 17 years, by identifying the percentage of students reporting low, medium, and high levels of symptoms, 2) to identify key sociodemographic characteristics associated with high symptom level, and 3) to identify individual and family risk factors associated with high symptom level and estimate their relative contribution. Method A total of 8689 Quebec high school students (55.9% girls) participated in the study. The average age of these students was 14.34 years (SD=1.52). A k-means cluster analysis was first performed to create three categories based on the symptoms of generalized anxiety presented by the participants (low, medium, high). Multinomial logistic regression analyzes were then performed to identify the variables that best predict membership in these different categories. Results The results showed that 35.1% of the students reported a low level of symptoms, 40.2% reported an average level of symptoms, while 24.7% reported a high level of symptoms. Girls and adolescents in higher grades were more likely to report high levels of symptoms. Several factors were also identified as increasing the risk of being in the high generalized anxiety symptoms category compared to the average generalized anxiety symptoms and low generalized anxiety symptoms categories. These include fear of negative evaluation by others, perfectionism, depressed feelings, negative problem orientation and cognitive avoidance. Conclusion This study supports previous research showing that girls are at greater risk of developing generalized anxiety disorder. It also highlights the multidimensional aspect of the problem, by identifying the most important risk factors. Ultimately, this better understanding of the factors involved will allow us to better identify the targets to prioritize in the prevention of generalized anxiety disorders in adolescence.

Objective The objective of this paper is to provide an overview of the provision and organization of forensic mental health services around the world. In particular, we attempt to address the following question: What system-level characteristics are important to consider in relation to the organization and structure of forensic mental health services? Methods To do so, we synthesize publicly accessible information, identified through Academic Search Complete (EBSCO), ProQuest Central, Scopus, PsycInfo, Google Scholar and Google, to describe how forensic systems are organized throughout the world. We examine the fundamental principles in the organization of services and examine potential quality indicators. Results This review is a steppingstone for the identification of best practices. Based on these fundamental principles, an efficient forensic mental health system would include the following elements: providing a comprehensive and balanced continuum of services; integrating services within and between systems; matching services to individual need; adhering to human rights; responding to population diversity; and using the best available evidence to make system-wide improvements. Conclusion Though all of these system-level principles are important, we focus on how the first three (service continuum, system integration, and service matching) may be applied to the organization of forensic mental health services.

Objectives The objective of this study is to develop the logic model and the content of the Borderline Intervention for Work Integration (BIWI). Methods The creation of BIWI was based on Chen's (2015) recommendations for establishing the change model and the action model. Individual interviews with four women with a borderline personality disorder (BPD) and focused groups with occupational therapists and service providers in community organizations from three Quebec regions (n=16) were conducted. The group and individual interviews began with a presentation of data from studies in the field. This was followed by a discussion of the challenges of people with BPD in relation to job choice, performance, tenure, and the essential components to be included in an ideal intervention. Transcripts of the individual and group interviews were examined using content analysis. The components of the change and action models were validated by these same participants. Results The change model of the BIWI intervention addresses six themes, which seem appropriate to focus on for a population with BPD in the process of reintegration into the workplace: 1) meaning given to work; 2) self-awareness and sense of competence as a worker; 3) management of internal and external factors that affect mental workload; 4) interpersonal relationships in the work context; 5) disclosure of the mental disorder in the work context; and 6) more satisfying routines outside of work. The action model of BIWI reveals that this intervention is deployed in collaboration with health professionals from the public and private sectors and service providers from community or government agencies. It combines group (n=10 sessions) and individual meetings (n=2), in face-to-face and online modes. The prioritized outcomes are to reduce the number of perceived barriers to work reintegration and to improve mobilization towards a sustainable employment reintegration project. Conclusion Work participation is a pivotal target in the interventions for people with BPD. With the support of a logic model, it was possible to identify the key components to be considered in the schema of such an intervention. These components relate to central issues for this clientele, such as: their representations of work, self-knowledge as a worker, maintenance of performance and well-being at work, relations with the work group and external partners, and work embedded in one's occupational repertoire. These components are now included in the BIWI intervention. The next step will be to test this intervention with unemployed persons with BPD who are motivated to reintegrate the workforce.