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Objective: To systematically review the literature with respect to treatment-seeking rates for depression and associated mediating factors. This review focuses on adolescents and adults of all ages.Methods: A structured literature review using Medline and PsychInfo databases revealed 38 relevant papers. Two trained reviewers independently and blindly assessed each study according to 4 inclusion criteria. A total of 17 papers met all 4 criteria.Results: Between 17.0% and 77.8% of individuals with depressive episodes or disorders sought treatment in these studies. We could explain the range in rates by diverse measures of depression, mediating factors that influence treatment-seeking, varied years in which the studies were done, and different time periods over which treatment-seeking was assessed.Conclusions: Treatment-seeking rates for major depression appear to have increased over the years. Age, race, social supports, and clinical and psychiatric factors seem to influence treatment-seeking rates most. Public health initiatives can use this information to facilitate service access and delivery. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists can improve the quality of life of people receiving palliative care through the management of communication and swallowing difficulties (dysphagia). However, their role in this domain is poorly defined and little is understood about the current international professional practice in this field. Aims: To examine how speech and language therapists perceive their role in the delivery of palliative care to clients, to discover current international speech and language therapist practices and to explore the similarities and differences in speech and language therapists’ practice in palliative care internationally. This will inform professional clinical guidelines and practice in this area.Design:Anonymous, non-experimental, cross-sectional survey design.Participants:Speech and language therapists working with adult and paediatric palliative care populations in Republic of Ireland, United Kingdom, United States, Canada, Australia and New Zealand where the speech and language therapist profession is well established. Method: Purposive and snowball sampling were used to recruit participants internationally using gatekeepers. An online survey was disseminated using Survey Monkey (http://www.surveymonkey.com). Results: A total of 322 speech and language therapists responded to the survey. Speech and language therapist practices in palliative care were similar across continents. Current speech and language therapist practices along with barriers and facilitators to practice were identified. The need for a speech and language therapist professional position paper on this topic was emphasised by respondents. Conclusion: Internationally, speech and language therapists believe they have a role in palliative care. The speech and language therapist respondents highlighted that this area of practice is under-resourced, under-acknowledged and poorly developed. They highlighted the need for additional research as well as specialist training and education for speech and language therapists and other multidisciplinary team members in the area of palliative care. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite the key role that hospital and home care nurses have in supporting family carers in transitional care, there is limited comparative information on their attitudes toward supporting family carers during care transitions. As part of a larger research project, we conducted a descriptive comparative study using a cross-sectional survey. Canadian nurses (105 hospital, 34 home visiting) completed a demographic questionnaire and the Families' Importance in Nursing Care–Nurses' Attitudes (FINC-NA) measurement tool. There were no statistically significant differences between hospital and home visiting nurses' attitudes, which were positive about including families in care. Nurses who reported having a workplace philosophy or general approach to the care of family held more positive attitudes toward families than those who did not. This is important because positive attitudes are often linked to better communication with family carers and thus, better patient and carer outcomes. To our knowledge, only one Canadian master's thesis has used this tool. Thus, this research furthers understanding of nurse attitudes within a Canadian context. Furthermore, this article adds to the literature by including suggestions for future research that are based in social psychological theories. Interdisciplinary knowledge can help pre- and postlicensure clinicians in advanced family nursing to better lever barriers and facilitators within family nursing practice. [ABSTRACT FROM AUTHOR]

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them. [ABSTRACT FROM AUTHOR]

Researchers are increasingly using complex population-based sample surveys to estimate the effects of treatments, exposures and interventions. In such analyses, statistical methods are essential to minimize the effect of confounding due to measured covariates, as treated subjects frequently differ from control subjects. Methods based on the propensity score are increasingly popular. Minimal research has been conducted on how to implement propensity score matching when using data from complex sample surveys. We used Monte Carlo simulations to examine two critical issues when implementing propensity score matching with such data. First, we examined how the propensity score model should be formulated. We considered three different formulations depending on whether or not a weighted regression model was used to estimate the propensity score and whether or not the survey weights were included in the propensity score model as an additional covariate. Second, we examined whether matched control subjects should retain their natural survey weight or whether they should inherit the survey weight of the treated subject to which they were matched. Our results were inconclusive with respect to which method of estimating the propensity score model was preferable. In general, greater balance in measured baseline covariates and decreased bias was observed when natural retained weights were used compared to when inherited weights were used. We also demonstrated that bootstrap-based methods performed well for estimating the variance of treatment effects when outcomes are binary. We illustrated the application of our methods by using the Canadian Community Health Survey to estimate the effect of educational attainment on lifetime prevalence of mood or anxiety disorders. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Psychiatric syndromes are complicated by comorbidity and other factors that burden patients, making guideline-informed psychiatric care challenging, and negatively affecting outcome. A comprehensive intake tool could improve the quality of care. Existing tools to quantify these characteristics do not identify specific complications and may not be sensitive to phenomena that are common in psychiatric outpatients. Objective: To develop a practical inventory to capture observations related to complex care in psychiatric outpatients and quantify the overall burden of complicating factors. Design: We developed a checklist inventory through literature review and clinical experience. The inventory was tested and compared with related measures in a cross-sectional study of 410 consenting outpatients at the time of initial assessment. Results: The summed score of inventory checklist items was significantly correlated with patient-assessed measures of distress (K10, r =0.36) and function (WHODAS 2.0, r =0.31), and physician-assessed measures of function (GAF, r =−0.42), number of psychiatric diagnoses [ F (df3)=33.6], and most complex diagnosis [ F (df3)=37.4]. In 53 patients whose assessment was observed by two clinicians, inter-rater reliability was acceptable for both total inventory score (intraclass correlation, single measures = 0.74) and agreement on specific items (mean agreement score = 90%). Conclusions: The Psychiatric C4 Inventory is a reliable instrument for psychiatrists that captures information that may be useful for quality improvement and resource planning. It demonstrates convergent validity with measures of patient distress, function, and complexity. Further tests of validity and replication in other settings are warranted. [ABSTRACT FROM AUTHOR]

The article discusses a study on the perception of nursing students/ educators on the contribution of ethics education to ethical competence of nursing students. It addresses questions including how they look at general contribution of ethics education, contribution of ethics education to ethical competence and features of ethics education needed to promote ethical competence. It suggests that ethics education adds to the ethical awareness and ethical reasoning competencies of nursing students.

The purpose of this study was to assess the frequency and types of negative behaviors directed toward gay men on university campuses and to understand heterosexual men's and women's motivations for engaging in antigay discrimination. Using a mixed methods approach, results from a quantitative survey (N = 286) indicated that students primarily engaged in covert antigay behaviors, such as telling antigay jokes and spreading gossip about gay men. Follow-up qualitative interviews with 8 highly homonegative individuals (4 men, 4 women) were then conducted to better understand their self-perceived motivations for perpetrating antigay discrimination. Results indicated that antigay behaviors were conducted to reinforce traditional male gender roles, alleviate feelings of discomfort, and convey heterosexual identity. Participants also expressed concern about being perceived as prejudiced and were motivated to control their prejudicial reactions to some degree. Implications regarding the contemporary nature of antigay violence on university campuses are discussed. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.Method: Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.Results: Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm.Conclusion: The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems. [ABSTRACT FROM AUTHOR]

Objective: To describe the rationale, methodology, and general sample characteristics of the Canadian Psychiatric Association (CPA) practice profile survey, a national survey of psychiatrists and psychiatric practice.Method: Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day.Results: There was a 45.5% response rate. Questionnaires completed by nonpsychiatrists or with a large percentage of missing or incorrect data were eliminated (107 surveys), resulting in a final sample size of 1570. CPA members and those from Western Canada responded at a higher rate to the survey. The results suggest some cause for concern about future manpower shortages. Most psychiatrists practise eclectically, seeing patients across the life-span, and working in both community and institutional settings. The old and the young appear to be underserviced, compared with adults.Conclusions: This study represents an important step forward in evaluating the profile and activities of the profession. [ABSTRACT FROM AUTHOR]

Objectives: There are few Canadian prevalence studies of mental retardation (MR); those that do exist were conducted prior to the era of community integration. We undertook a population-based study to explore mental health disturbances in young persons with MR. The first requirement was to identify a population with MR and to establish its prevalence. Here, we report data on the prevalence of MR in a population aged 14 to 20 years.Method: We conducted the study in the Niagara Region of Ontario, which has a population base of around 400,000. Researchers worked closely with schools and with agencies providing services to persons with MR to identify the study group. We confirmed the functioning level of participants through standard tests of nonverbal intelligence and receptive language; teachers and other service personnel provided information relevant to the estimation of nonparticipants' functioning level.Results: We identified 255 individuals as having MR (IQ < or = 75). Of these, 171 chose to participate (defined as "participants with MR"; the remaining 84 were "nonparticipants with MR"). Thus, the participation rate was 67% (171/255). Participants and nonparticipants with MR did not differ on age, sex, or IQ, although there were more nonparticipants in the lower social strata. Overall prevalence for MR was 7.18/1000. For mild mental retardation (MMR; that is, IQ = 50 to 75), prevalence was 3.54/1000, and for severe mental retardation (SMR; that is, IQ < 50), it was 3.64/1000.Conclusions: Our prevalence estimate for SMR is similar to rates from previous studies conducted worldwide. Our estimate for MMR parallels the lower rates found in Scandinavian countries and contrasts with the higher rates generally reported in the US. [ABSTRACT FROM AUTHOR]

Objective: Previous studies of veterans have linked posttraumatic stress disorder (PTSD) after combat-related trauma to increased reports of health problems. It is unclear whether this association between PTSD and increased health problems generalizes to civilians who are exposed to a broader array of traumatic events. We also do not know whether trauma exposure is associated with increased health problems in individuals who do not develop PTSD. Using a non-treatment-seeking civilian sample, we examined whether lifetime PTSD or trauma exposure by itself was associated with current health problems.Methods: Using a cross-sectional design and self-report measures, we evaluated urban Canadian bus drivers (n = 342) on trauma exposure, lifetime PTSD, and current health problems. Based on their responses, we divided our sample into individuals who had never experienced trauma (n = 91), trauma-exposed individuals who had never developed PTSD (n = 218), and persons who developed PTSD at some point after trauma (n = 33). We compared these groups on health problems, treatment service use, and health assessment measures.Results: The PTSD group reported increased health complaints, more frequent use of health treatments, and poorer health self-ratings compared with the exposed non-PTSD and nonexposed groups. Trauma-exposed drivers without PTSD did not differ from unexposed drivers on any health measure. Controlling for sex and trauma frequency did not alter our findings.Conclusions: Trauma exposure that leads to PTSD is associated with increased health problems, while trauma exposure alone is not. Our results extend previous findings to a broader civilian context and clarify associations between trauma exposure and health. [ABSTRACT FROM AUTHOR]

Objective: To examine changes in prevalence rates of treated schizophrenia over 10 years in a small urban teaching centre using data from the Kingston Psychiatric Record Linkage System (KPRLS).Method: The KPRLS, a psychiatric case register established in 1984, collects and links demographic, diagnostic, and service use information for all psychiatric inpatients, outpatients and emergency contacts at the 3 hospitals in Kingston, Ontario. A preliminary comparison of first admissions for schizophrenia used chart review (1976-1978) and KPRLS data (1996-1998). The KPRLS data were used to calculate population-based prevalence rates of treated schizophrenia in 3 census years (1986, 1991, 1996) for patients in the 2 counties closest to Kingston.Results: The preliminary comparison showed a 42% decrease in the number of first-admission schizophrenia cases over 20 years. In the main study, the annual inpatient prevalence rates decreased significantly (52%) from 1986 to 1996 with no corresponding change in outpatient rates, regardless of sex. Although total major affective disorders increased, this was due to an increase in major depression, not bipolar disorder.Conclusions: This is the first Canadian case-register study to support the widely reported falling rates of schizophrenia in other parts of the world over the last 40 years. Since this is a geographically limited prevalence study based on only 10 years of data, further research over longer periods of time in other regions of the country is required to support or refute these findings. [ABSTRACT FROM AUTHOR]

Objective: To construct an index that represents the general level of social problems among Canadian provinces and territories.Method: Factor weights were used to combine provincial and territorial rates for homicide, attempted murder, assault, sexual assault, robbery, divorce, suicide, and alcoholism into a single Social Problem Index.Results: The resulting index demonstrated strong positive intercorrelations among its factors across provinces. That is, provinces that showed high rates on one factor tended to show high rates on the others as well. The validity of the Social Problem Index is demonstrated by its positive correlation with an independent measure of the likelihood of having experienced personal trauma.Conclusions: The robust nature and apparent validity of the Social Problem Index suggest that it can be well used for needs assessments and theoretical studies and as a feedback mechanism to national, provincial, and community leaders on the social problem status of their particular jurisdictions. [ABSTRACT FROM AUTHOR]

Objective: To estimate the 12-month period prevalence of major depression in Calgary.Methods: Subjects (n = 2542) were selected using random digit dialing (RDD) and interviewed by telephone using the Composite International Diagnostic Interview-Short Form for Major Depression (CIDI-SFMD). A subset of this sample was recontacted and administered the full mood disorders section of the CIDI.Results: The weighted proportion of the sample scoring in the positive range on the major depression predictor was 14.7%. Validation data determined that approximately three-quarters of these subjects would be expected to have major depression according to the CIDI. Hence, the estimated 12-month period prevalence of major depression was approximately 11.0%.Conclusions: This prevalence estimate is higher than most, but not all, previous Canadian estimates and resembles that of the American National Comorbidity Survey (NCS). Calgary may have a high prevalence of major depression; however, because methodologically comparable studies are not available, to conclude this would be premature. Selection bias due to the RDD sampling (and the associated relatively high rate of nonresponse) may have led to an inflated prevalence estimate. Alternatively, because it allows increased anonymity and emotional "distance" from the nonprofessional interviewers, telephone-based data collection may be more sensitive to psychopathology than face-to-face interviewing. [ABSTRACT FROM AUTHOR]

Objective: To investigate the nature and extent of gambling problems in a region of Canada in which legalized gambling activities were expanded during the 1990s.Method: A standardized telephone interview was conducted with a random sample of 738 community-dwelling adults (response rate 74%) in Winnipeg, Manitoba.Results: According to traditional classification criteria, the lifetime prevalence of "probable pathological gambling" was 2.6%. A further 3.0% of the sample met criteria for traditionally defined "problem gambling," and evidence suggests that both types of gamblers share several characteristics. Social or recreational gamblers significantly differed on several variables from individuals who reported gambling problems.Conclusions: The 2.6% prevalence figure is the highest yet reported in a Canadian epidemiological survey and was obtained in a region that developed a more liberal attitude toward gambling in the 1990s. Further, a continuum of severity was demonstrated by scores on the South Oaks Gambling Screen (SOGS), and a clear and consistent distinction between problem and probable pathological gambling was not apparent. Frequenting casinos and using video poker and slot machines, rather than buying lottery tickets, distinguishes problem or pathological gamblers from recreational gamblers. [ABSTRACT FROM AUTHOR]

Objective: To describe the psychiatric symptomatology and mental health service needs of homeless shelter users in Calgary, Alberta. Data were collected as part of a broad-based community action initiative designed to reduce the problem of homelessness.Methods: A semistructured interview was conducted with a representative sample of 250 emergency shelter users. Mental health problems were measured through self-reports of 9 psychiatric symptoms known to be related to illnesses prevalent among homeless populations (depression, anxiety, and psychoses). The CAGE alcohol screen was also used.Results: Three-quarters of the sample expressed some symptomatology. About one-third were estimated to have a significant mental health problem. The lifetime prevalence of alcohol abuse was 33.6%. Higher levels of psychiatric symptomatology appeared to relate to a wide range of hardships, personal and public health risks, addictive behaviours, victimization, economic and interpersonal life events, dissatisfaction, and stress. Also, those with significant symptomatology frequently needed mental health care services but often did not know where to access them.Conclusions: The prevalence of mental health and substance abuse problems within homeless populations is significant and associated with considerable hardship as well as personal and public health risks. [ABSTRACT FROM AUTHOR]

Objective: To determine differences by gender among elderly persons who commit suicide on demographic characteristics, place of suicide, suicide method, previous suicide behaviour, and precipitant stressor.Method: This study included completed suicides of individuals aged 55 years and over during 1984-1995 in Alberta (n = 920). Information was abstracted from suicide records of medical examiners.Results: Relative to elderly female suicides, elderly males who commit suicide characteristically use guns to commit suicide (43.8%), are single (12.5%), live in rural areas (46.7%), and have a lower frequency of previous suicide attempts (16.5%). Physical illness and financial difficulty as precipitant stressors of suicide are significantly more frequent among males (40.3% and 8.7% respectively) than females (29.9% and 1.8% respectively). Mental illness as a precipitant stressor is more common among females, 35.8% for women and 15.3% for men.Conclusions: Lethal methods of suicide and physical illness and financial difficulty as precipitant stressors of suicide are more common among elderly males than females who commit suicide. [ABSTRACT FROM AUTHOR]