Une validation québécoise du Satisfaction with Life Domains Scale

La version québécoise de l'Échelle de satisfaction avec les domaines de la vie (ESDV), développée aux Etats-Unis auprès de la population générale et adaptée pour des personnes avec des problèmes sévères et persistants de santé mentale a été validée auprèsI d'un échantillon de 266 personnes de la population générale, et de 245 personnes avec des troubles mentaux sévères. Les analyses factorielles ont permis d'identifier quatre sous-échelles dans la population clinique et cinq dans la population générale. La consistance interne de l'échelle globale (alpha = 0,90) et des sous-échelles (alpha entre 0,60 et 0,84) s'est avérée excellente et la stabilité temporelle de l'instrument s'est avérée bonne (r = 0,73). De plus, des analyses de la variance et l'analyse discriminante permettent de constater que les sous-échelles ont un pouvoir discriminant élevé ; elles permettent de distinguer la population générale, les bénéficiaires d'aide sociale et les personnes psychotiques. Les résultats obtenus suggèrent que l'ESDV possède de très bonnes qualités psychométriques et constitue une mesure valide de qualité de vie subjective pour desI études descriptives ou évaluatives.This article presents the results of the Quebec validation of the Sa-tisfaction With Life Domains Scale. This scale was développée in theUnited States for the general population and adapted for severely men-tally ill individuals. Two hundred and sixty six individuals from the ge-neral population and 245 severely mentally ill persons participated inthis study. Factor anlysis allowed the identification of four sub-scalesfor the clinical population and five for the general population. The scale(alpha=0,90) and the sub-scales (alpha between 0,60 et 0,84) show ex-cellent internal consistencies and the test-retest reliability was good (r=0,73). Moreover, analysis of the variance and the discriminant analysisallow to acknowledge that the sub-scales have a high discriminatingpower; they allow to distinguish the general population from welfare re-cipient and people suffering from psychosis. The overall results suggestthat l'Échelle de satisfaction des domaines de vie have good psychome-tric properties and can be considered as a valid instrument for assessingsubjective quality of life in descriptive or evaluative studies

Perspective d’usagers suivis en clinique externe d’établissements de première, deuxième et troisième lignes

L'étude regroupe les résultats de quatre enquêtes majeures sur la satisfaction de la clientèle de services de consultation externe en santé mentale de Montréal. Elle implique des milieux offrant des services de base, des services spécialisés et des services ultra-spécialisés. Effectuée à l'aide d'entrevues individuelles auprès d'un total de 856 patients, elle a permis de documenter la perspective de ces usagers. Les principales tendances observées indiquent que les patients sont généralement très satisfaits de la façon d'être des intervenants et de l'alliance thérapeutique établie avec eux. L'organisation et le fonctionnement des services génèrent toutefois des taux de satisfaction nettement inférieurs. Ces résultats semblent refléter l'impact des transformations récentes dans le système de services en santé mentale.This study is based on results of four major surveys on the satisfaction of the clientele regarding external consultation of mental health services in Montréal. It covers milieux offering primary care, specialized and ultra-specialized services. Conducted with 856 patients through personal interviews, this study has allowed to document consumers' perspectives. The major tendencies observed indicate that patient are generally highly satisfied with the work of mental health professionals and the therapeutic alliance they establish with them. Organization as well as functioning of services however, generate less satisfaction. These results appear to reflect the impact of recent transformation of the mental health system.El estudio reagrupa los resultados de cuatro grandes encuestas sobre la satisfacción de la clientela de los servicios de consulta externa en salud mental de Montreal. Esta implica los medios que ofrecen servicios de base, servicios especializados y servicios ultra especializados. Efectuada por medio de entrevistas individuales a 856 pacientes, la misma ha permitido documentar la perspectiva de estos usuarios. Las principales tendencias observadas indican que en general los pacientes se encuentran satisfechos de la manera de ser de los trabajadores y de la alianza terapéutica que se ha establecido con ellos. La organización y el funcionamiento de los servicios generan sin embargo algunos porcentajes de satisfacción, netamente inferiores. Estos resultados parecen reflejar el impacto de las recientes transformaciones en el sistema de servicios en salud mental

Clinical utility of combinatorial pharmacogenomic testing in depression: A Canadian patient- and rater-blinded, randomized, controlled trial

The pharmacological treatment of depression consists of stages of trial and error, with less than 40% of patients achieving remission during first medication trial. However, in a large, randomized-controlled trial (RCT) in the U.S. (“GUIDED”), significant improvements in response and remission rates were observed in patients who received treatment guided by combinatorial pharmacogenomic testing, compared to treatment-as-usual (TAU). Here we present results from the Canadian “GAPP-MDD” RCT. This 52-week, 3-arm, multi-center, participant- and rater-blinded RCT evaluated clinical outcomes among patients with depression whose treatment was guided by combinatorial pharmacogenomic testing compared to TAU. The primary outcome was symptom improvement (change in 17-item Hamilton Depression Rating Scale, HAM-D17) at week 8. Secondary outcomes included response (≥50% decrease in HAM-D17) and remission (HAM-D17 ≤ 7) at week 8. Numerically, patients in the guided-care arm had greater symptom improvement (27.6% versus 22.7%), response (30.3% versus 22.7%), and remission rates (15.7% versus 8.3%) compared to TAU, although these differences were not statistically significant. Given that the GAPP-MDD trial was ultimately underpowered to detect statistically significant differences in patient outcomes, it was assessed in parallel with the larger GUIDED RCT. We observed that relative improvements in response and remission rates were consistent between the GAPP-MDD (33.0% response, 89.0% remission) and GUIDED (31.0% response, 51.0% remission) trials. Together with GUIDED, the results from the GAPP-MDD trial indicate that combinatorial pharmacogenomic testing can be an effective tool to help guide depression treatment in the context of the Canadian healthcare setting (ClinicalTrials.gov NCT02466477)

Awakening: 'Spontaneous recovery’ from substance abuse among Aboriginal peoples in Canada

There is a paucity of research on spontaneous recovery (SR) from substance abuse in general, and specific to Aboriginal peoples. There is also limited understanding of the healing process associated with SR. In this study, SR was examined among a group of Aboriginal peoples in Canada. Employing a decolonizing methodology, thematic analysis of traditional talking circle narratives identified an association between a traumatic life event and an ‘awakening.’ This ‘awakening’ was embedded in primary (i.e., consider impact on personal well-being) and secondary (i.e., implement alternative coping mechanism) cognitive appraisal processes and intrinsic and extrinsic motivation rooted in increased traditional Aboriginal cultural awareness and understanding. This contributed to both abstinence (i.e., recovery) and sustained well-being (i.e., continued abstinence). Three key interrelated ‘themes’ specific to the role of culture in SR and recovery maintenance were identified: Aboriginal identity, cultural practices, and traditional values. These findings, combined with the limited literature, were developed into a prospective model of SR from substance abuse in Aboriginal peoples. This model highlights the potential need for substance abuse treatment and intervention policy to consider culture as a determinant of health and well-being

Awakening: \u27Spontaneous recovery’ from substance abuse among Aboriginal peoples in Canada

There is a paucity of research on spontaneous recovery (SR) from substance abuse in general, and specific to Aboriginal peoples. There is also limited understanding of the healing process associated with SR. In this study, SR was examined among a group of Aboriginal peoples in Canada. Employing a decolonizing methodology, thematic analysis of traditional talking circle narratives identified an association between a traumatic life event and an ‘awakening.’ This ‘awakening’ was embedded in primary (i.e., consider impact on personal well-being) and secondary (i.e., implement alternative coping mechanism) cognitive appraisal processes and intrinsic and extrinsic motivation rooted in increased traditional Aboriginal cultural awareness and understanding. This contributed to both abstinence (i.e., recovery) and sustained well-being (i.e., continued abstinence). Three key interrelated ‘themes’ specific to the role of culture in SR and recovery maintenance were identified: Aboriginal identity, cultural practices, and traditional values. These findings, combined with the limited literature, were developed into a prospective model of SR from substance abuse in Aboriginal peoples. This model highlights the potential need for substance abuse treatment and intervention policy to consider culture as a determinant of health and well-being

Mental Health Symptoms in Post-earthquake Miami Haitians: Cumulative Effect of Disaster-related Stressful Events

Purpose: This study evaluated correlates of mental health symptoms among Haitians living in Miami-Dade County, 2-3 years following the 2010 Haiti earthquake, using 3 types of exposure variables: (1) basic exposure status (direct/indirect/no), (2) total of earthquake-related stressful events, (3) a combination of the two former variables. The novelty of the design was that it allowed studying disaster-related accumulated stress among people indirectly exposed to a disaster, which had not been done previously to the investigators’ knowledge. Methods: A random-sample household survey was conducted from October 2011 through December 2012, in Miami-Dade County, Florida. Haitian participants (N=421) were assessed for their earthquake exposure and related stressful events, and for symptoms of posttraumatic stress disorder (PTSD), of generalized anxiety, and of major depression, using standardized screening scales and thresholds. Results: We found a dose-response association for each type of exposure variable with 5 outcomes: percentage of respondents exceeding threshold for PTSD (PCL-C ≥ 44), for anxiety (BAI ≥ 26), and for depression (CES-D ≥ 16); at least one scale exceeds its threshold; and number of scales exceeding their respective threshold. Stepwise logistic or linear regressions produced stronger associations for the combined exposure variable with all outcomes, except for anxiety which was more strongly associated with basic exposure status. Conclusions: The number of disaster-related stressful events is an important correlate of mental health symptoms, including among people indirectly exposed to the disaster. Those indirectly exposed represent a population much larger than those directly exposed, deserving equal mental mental-health attention. Evaluation of accumulated stress and emergence of psychopathology among persons indirectly exposed to disaster should be the focus of further research and of public health interventions

Expérience d’immigration de Francophones en contexte linguistique minoritaire au Canada : défis et répercussions sur la santé mentale

Cet article explore les défis rencontrés par de nouveaux arrivants francophones à leur arrivée dans une communauté francophone en situation minoritaire au Canada, les répercussions qui en découlent et les facteurs modérateurs ayant une incidence sur leur intégration. Une recherche qualitative par entrevues semi-dirigées a été menée dans trois villes canadiennes auprès de soixante adultes immigrants ou réfugiés. Le défi principal auquel sont confrontées ces personnes est la barrière linguistique ; elle vient amplifier les défis liés à l’intégration sociale et la recherche de l’emploi. L’expérience migratoire a aussi une répercussion sur la santé mentale, sur les relations avec les proches et sur la santé physique. Le soutien social et la résilience personnelle favorisent l’adaptation dans la communauté d’accueil.This article explores challenges that Francophone newcomers face at their arrival in a francophone community in a minority context in Canada, as well as the impact of these obstacles on, and moderating factors associated to, the integration process. A qualitative research was conducted, using semi-structured interviews with sixty immigrants or refugees in three Canadian cities. The most challenging obstacle is the language barrier, as it has a direct impact on social integration and employment-seeking. The migration experience also has an impact on mental health, interpersonal relationships and physical health. Social support and personal resilience foster adaptation into the host community