L’aide apportée par des tiers et les réactions des aidantes naturelles à la prise en charge de personnes âgées en perte d’autonomie

Cet article s'intéresse à la relation entre, d'une part, l'aide apportée par des tiers et, d'autre part, le fardeau ressenti et la dépression pour les aidantes principales de personnes âgées souffrant de problèmes physiques ou cognitifs. Les auteurs avancent l'hypothèse que le soutien social ne constitue pas une entité homogène et que les différents types d'aide apportée sont susceptibles d'avoir des effets différents sur les réactions adverses à la prise en charge. Les données proviennent d'une étude menée en 1990, dans la région de Montréal, auprès de 159 aidantes co-résidant avec la personne aidée et demandeurs de services de la part du réseau formel et le réseau informel. Les analyses de régression hiérarchique montrent le rôle restreint des variables d'aide apportée par le réseau dans l'explication des niveaux de dépression et de fardeau et confirment l'hypothèse d'un spectre d'action étroit de ces variables.This article is about the relation between, on the one hand, support provided by third parties and, on the other, the burden and the depression experienced by the main female supporters who care for the elderly suffering from physical or cognitive problems. The authors examine the hypothesis that social support is not homogeneous accross the board and that the different types of support are likely to have different effects on elders with adverse reactions to the caring process. Data originates from a study that was conducted in the Montréal area in 1990 with 159 female supporters living with an elder requiring care who requested support services from formal and informal networks. Hierarchical regression analyses show that the variables in connection with care dispensed by the network play a limited role in attempting to explain the depression and burden levels. Furthermore, these analyses confirm the hypothesis of the variables' narrow range of influence

Discrepancies between survey and administrative data on the use of mental health services in the general population: findings from a study conducted in Québec

<p>Abstract</p> <p>Background</p> <p>Population surveys and health services registers are the main source of data for the management of public health. Yet, the validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness and to the risk of recall bias. The main objectives of this study were to compare data on the use of mental health services from a large scale population survey and a national health services register and to identify the factors associated with the discrepancies observed between these two sources of data.</p> <p>Methods</p> <p>This study was based on the individual linkage of data from the cycle 1.2 of the Canadian Community Health Survey (CCHS-1.2) and from the health services register of the Régie de l'assurance maladie du Québec (RAMQ). The RAMQ is the governmental agency managing the Quebec national health insurance program. The analyses mostly focused on the 637 Quebecer respondents who were recorded as users of mental health services in the RAMQ and who were self-reported users or non users of these services in the CCHS-1.2.</p> <p>Results</p> <p>Roughly 75%, of those recorded as users of mental health services users in the RAMQ's register did not report using mental health services in the CCHS-1.2. The odds of disagreement between survey and administrative data were higher in seniors, individuals with a lower level of education, legal or de facto spouses and mothers of young children. They were lower in individuals with a psychiatric disorder and in frequent and more recent users of mental health services according to the RAMQ's register.</p> <p>Conclusions</p> <p>These findings support the hypotheses that social desirability and recall bias are likely to affect the self-reported use of mental health services in a population survey. They stress the need to refine the investigation of mental health services in population surveys and to combine survey and administrative data, whenever possible, to obtain an optimal estimation of the population need for mental health care.</p

Latent variables and structural equation models for longitudinal relationships: an illustration in nutritional epidemiology

<p>Abstract</p> <p>Background</p> <p>The use of structural equation modeling and latent variables remains uncommon in epidemiology despite its potential usefulness. The latter was illustrated by studying cross-sectional and longitudinal relationships between eating behavior and adiposity, using four different indicators of fat mass.</p> <p>Methods</p> <p>Using data from a longitudinal community-based study, we fitted structural equation models including two latent variables (respectively baseline adiposity and adiposity change after 2 years of follow-up), each being defined, by the four following anthropometric measurement (respectively by their changes): body mass index, waist circumference, skinfold thickness and percent body fat. Latent adiposity variables were hypothesized to depend on a cognitive restraint score, calculated from answers to an eating-behavior questionnaire (TFEQ-18), either cross-sectionally or longitudinally.</p> <p>Results</p> <p>We found that high baseline adiposity was associated with a 2-year increase of the cognitive restraint score and no convincing relationship between baseline cognitive restraint and 2-year adiposity change could be established.</p> <p>Conclusions</p> <p>The latent variable modeling approach enabled presentation of synthetic results rather than separate regression models and detailed analysis of the causal effects of interest. In the general population, restrained eating appears to be an adaptive response of subjects prone to gaining weight more than as a risk factor for fat-mass increase.</p

A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender

<p>Abstract</p> <p>Background</p> <p>Psychological distress is a widespread indicator of mental health and mental illness in research and clinical settings. A recurrent finding from epidemiological studies and population surveys is that women report a higher mean level and a higher prevalence of psychological distress than men. These differences may reflect, to some extent, cultural norms associated with the expression of distress in women and men. Assuming that these norms differ across age groups and that they evolve over time, one would expect gender differences in psychological distress to vary over the life-course and over time. The objective of this study was to investigate the construct validity of a psychological distress scale, the K6, across gender in different age groups and over a twelve-year period.</p> <p>Methods</p> <p>This study is based on data from the Canadian National Population Health Survey (C-NPHS). Psychological distress was assessed with the K6, a scale developed by Kessler and his colleagues. Data were examined through multi-group confirmatory factor analyses. Increasing levels of measurement and structural invariance across gender were assessed cross-sectionally with data from cycle 1 (n = 13019) of the C-NPHS and longitudinally with cycles 1 (1994-1995), 4 (2000-2001) and 7 (2006-2007).</p> <p>Results</p> <p>Higher levels of measurement and structural invariance across gender were reached only after the constraint of equivalence was relaxed for various parameters of a few items of the K6. Some items had a different pattern of gender non invariance across age groups and over the course of the study. Gender differences in the expression of psychological distress may vary over the lifespan and over a 12-year period without markedly affecting the construct validity of the K6.</p> <p>Conclusions</p> <p>This study confirms the cross-gender construct validity of psychological distress as assessed with the K6 despite differences in the expression of some symptoms in women and in men over the life-course and over time. Findings suggest that the higher mean level of psychological distress observed in women reflects a true difference in distress and is unlikely to be gender-biased. Gender differences in psychological distress are an important public health and clinical issue and further researches are needed to decipher the factors underlying these differences.</p

Effect of premigratory exposure to political violence on the social anchorage of refugees in Montreal

This thesis introduces a conceptual framework centered around the idea of social anchorage, which is viewed as a component of the psychosocial adjustment of refugees as it enables them to recapture or redefine their social identity and, thus, to regain some control over their life. The main objective of this thesis is to estimate the effect of premigratory exposure to political violence on the social anchorage of refugees in the host country.The sample is made up of 270 Southeast Asian and Central American refugees with school-aged children who had been living in Canada for a mean of 7 years at the time of interview. Social anchorage is measured by five types of social anchor (i.e., political, professional, religious, academic and community) and by two indices of the diversity of social anchorage. Three measures of exposure to political violence are investigated personal acute (i.e., threat and torture), personal chronic (i.e., imprisonment, reeducation camp, forced labor), and family exposure (i.e., acute and chronic). In addition to the analyses focusing on the estimation of the effect of exposure to political violence, exploratory analyses are also carried out to identify other factors such as transferable skills and socio-demographic characteristics that may affect social anchorage once exposure to political violence and ethnicity are taken into account. Approximated risk ratios are calculated from the odds ratios obtained by binary and ordinal regression analyses.Data analysis shows that specific forms of political violence may act differently on the social anchorage of refugees from Southeast Asia and Central America and across ethnic groups. Overall, personal acute exposure tends to foster their social anchorage whereas personal chronic exposure tends to prevent it. Personal acute exposure appears to foster the probability of a wider range of social anchors in Southeast Asian refugees but to inhibit it in Central Americans whereas personal chronic exposure tends to have the opposite effect as it may be a driving force for Central Americans and a brake for Southeast Asians. Finally, when controlling for exposure to political violence and ethnicity, transferable skills (such as premigratory work experience compatible with an urban setting and level of schooling) and socio-demographic characteristics (in particular number of years spent in Canada, income category and age) contribute to the social anchorage of Southeast Asian and Central American refugees. (Abstract shortened by UMI.

The influence of culture and context on the pre- and post-migration experience of school-aged refugees from Central America and Southeast Asia in Canada

Pre- and post-migration contexts of refugee children from Central America and Southeast Asia were compared. The results suggest that the culture of origin radically modulates the relationship between the pre-migration experience and the developing post-migration universe. In the case of the Central American children, the state-sponsored violence suffered in the country of origin is strongly associated with subsequent family conflicts, whereas in the case of the Southeast Asians, conflict is associated with an active social network in the community of origin, suggesting that there is a delicate balance between the support provided and the burden imposed by the extended family.refugee children context culture