The relationship between sense of community belonging and self-rated mental health among Canadians with mental or substance use disorders

<p><i>Background</i>: One-third of Canadians meet the criteria for a mental or substance use disorder at some point in their lifetime. While prevention and treatment efforts have been focused on the individual, studies suggest the importance of incorporating social and community factors.</p> <p><i>Aims</i>: This study investigates the relationship between community belonging and self-rated mental health among Canadians with mental or substance use disorders.</p> <p><i>Methods</i>: The Canadian Community Health Survey-Mental Health (2012) is a nationally representative survey of Canadians aged 15 years and older (<i>n</i> = 25,113). The present analytic sample is comprised of respondents reporting a mental or substance use disorder in the previous 12 months (<i>n</i> = 2628). The relationship between community belonging and self-rated mental health is depicted with a multivariable multinomial logistic regression model.</p> <p><i>Results</i>: Self-rated mental health was reported as follows: poor or fair (38.1%); good (33.7%); and very good or excellent (28.2%). In the multivariable multinomial model, a positive relationship was observed. Those reporting very strong compared to very weak community belonging had an increased odds of better mental health.</p> <p><i>Conclusions</i>: Findings indicate the importance of social and community-based interventions to effectively engage and retain individuals in services for the prevention and treatment of mental and substance use disorders.</p

Additional file 1 of Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study

Additional file 1

Predictors of treatment allocation guesses in a randomized controlled trial testing double-blind injectable hydromorphone and diacetylmorphine for severe opioid use disorder

<p><b>Background:</b> SALOME (Study to Assess Longer-term Opioid Medication Effectiveness) tested in a double-blind non-inferiority clinical trial if hydromorphone could be as effective as diacetylmorphine for severe opioid use disorder. Although participants did not guess treatment correctly beyond what is expected by chance, perceived treatment assignment could affect patients’ response to treatment. This study tested if treatment allocation guess is associated with treatment outcomes and identified predictors of guess.</p> <p><b>Methods:</b> Data were obtained through questionnaires and clinical records. Participants were asked what medication they thought they were receiving (diacetylmorphine, hydromorphone or unsure) and their open-ended reasons. Multinomial logistic regression was used to assess the predictors of treatment guess. An inductive thematic analysis was used to code open-ended responses. This clinical trial was registered with U.S. National Institutes of Health (<a href="https://clinicaltrials.gov/ct2/show/NCT01447212" target="_blank">https://clinicaltrials.gov/ct2/show/NCT01447212</a>).</p> <p><b>Findings:</b> Participants referred to prior experiences with opioids and the presence or absence of specific drug effects as reasons for their guesses. There were no differences in illicit opioid use and retention by guess; however those who guessed diacetylmorphine had better physical and mental health scores. Participants with a treatment-related observed drowsiness event, and higher perceived drug-related high scores were more likely to guess diacetylmorphine compared to hydromorphone. Guessing hydromorphone was more likely among those who made negative comments as reasons for treatment guesses.</p> <p><b>Conclusions:</b> Understanding the clues participants use for treatment allocation guesses and relating them to treatment expectations could be integrated with accurate information about the treatment, providing an opportunity for patient–physician shared decision-making in opioid maintenance treatment.</p> <p><b>Clinical trial registration:</b> U.S. National Institutes of Health; ClinicalTrials.gov Identifier: NCT01447212; <a href="https://clinicaltrials.gov/ct2/show/NCT01447212" target="_blank">https://clinicaltrials.gov/ct2/show/NCT01447212</a></p