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Copyright of Leisure/Loisir: Journal of the Canadian Association for Leisure Studies is the property of Routledge 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.)

This article critically examines the contemporary applicability of homonormativity in understanding LGBTQ experiences in outer suburban Australia. Representing a departure from urban-rural dichotomies in queer geographical research, this study enriches our understanding of LGBTQ life in suburban areas. Drawing on a comprehensive national survey encompassing 6835 LGBTQ adults in Australia, the research provides novel quantitative insights into the geographic distribution of LGBTQ mental health and wellbeing outcomes. Contrary to assumptions of suburban privilege, the article challenges the notion of homonormativity in the suburbs, shedding light on the unique challenges faced by LGBTQ people in these areas. Findings reveal that LGBTQ people in outer suburban Australia experience higher psychological distress and suicidal ideation compared to their inner suburban and rural counterparts. Additionally, they report lower levels of connection with LGBTQ communities, indicating a dearth of supportive resources in these areas. These insights have crucial policy implications, advocating for changes that foster diversity and inclusion in outer suburban areas. By emphasizing the distinct experiences of LGBTQ individuals in these settings, the research underscores the necessity for targeted interventions and support. This work extends beyond conventional urban-centric studies, offering valuable insights to inform policies, advocacy efforts, and community support initiatives for LGBTQ people in suburban environments. Cet article offre une approche critique sur l'applicabilité contemporaine de l'homonormativité pour comprendre les expériences des LGBTQ dans les grandes banlieues australiennes. Il s'écarte de la dichotomie ville-campagne qu'on trouve dans la recherche sur la géographie queer et enrichit nos connaissances sur la vie des LGBTQ dans les zones périurbaines. Reposant sur une enquête approfondie à l'échelle nationale concernant 6 835 adultes LGBTQ en Australie, il offre des données quantitatives inédites sur la distribution géographique des résultats en matière de bien-être et de santé mentale pour ce groupe social. Contrairement à la théorie du privilège urbain, cette recherche remet en question la notion d'homonormativité dans les banlieues et met en évidence les obstacles uniques auxquels se heurte la communauté LGBTQ dans ces environnements. Les résultats révèlent que les LGBTQ qui vivent dans la grande banlieue australienne éprouvent plus de détresse psychologique et plus de pensées suicidaires que ceux qui habitent en province ou en banlieue proche. En outre, ils font état de moins de liens avec les communautés LGBTQ, ce qui indique un manque de ressources de soutien dans ces parties du pays. Ces constatations ont des implications importantes au niveau stratégique, et préconisent des changements qui renforceraient la diversité et l'inclusion dans les zones de grande banlieue. En mettant en avant des expériences individuelles de LGBTQ dans ces environnements, l'étude souligne la nécessité d'interventions et de soutien ciblés. Cette recherche va au-delà des travaux conventionnels focalisés sur les villes et offre des perspectives utiles pour les politiques, les efforts de sensibilization et les initiatives de soutien communautaires pour les LGBTQ dans les grandes banlieues. [ABSTRACT FROM AUTHOR]

Residential location can significantly impact the mental health, wellbeing, and community involvement of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) young people. While research has explored geographical differences in LGBTQ adult wellbeing, limited knowledge exists regarding LGBTQ young people’s experiences. Using a large Australian cross-sectional survey of 6,620 LGBTQ individuals aged 14–21, this study examined the associations between residential location and wellbeing outcomes. Findings revealed that LGBTQ young people in rural and remote areas reported higher levels of psychological distress. Cisgender young people in rural areas experienced more verbal and physical harassment, while those in inner-suburban areas faced increased sexual harassment. Participants were also particularly vulnerable to experiencing homelessness when living in regional towns and rural and remote areas. Trans young people were more likely to attend LGBTQ events in inner-suburban areas. These results emphasize the need for policy changes to foster diversity and inclusion in rural areas, along with targeted support services to enhance the mental health and wellbeing of LGBTQ young people. Understanding the unique experiences of LGBTQ young people across different residential locations is vital, calling for tailored interventions and support in all settings. [ABSTRACT FROM AUTHOR]

Communimetric screening tools help clinicians identify and communicate their patient's areas of need and the corresponding level of action. However, few tools exist to identify mental health (MH) and developmental needs in young children. We aimed to implement and evaluate a new communimetric MH and developmental screening tool for children under 6 (HEADS‐ED Under 6) in a community MH agency in Ontario, Canada. Using a prospective cohort design, we explored how intake workers used the HEADS‐ED Under 6 screening tool from November 2019 to March 2021. 94.5% of children (n = 535/566) were screened with the HEADS‐ED at intake. Total HEADS‐ED scores and domains were used to inform the intensity of recommended services. Three clinical domains (Eating & sleeping, Development, speech/language/motor, and Emotions & behaviors) also independently predicted a priority recommendation. The tool showed good concordance with the InterRAI Early Years for children under 4 years old. The HEADS‐ED Under 6 was a brief, easy, and valid screening tool, and can be used to identify important MH and developmental domains early, rate level of action/impairment, communicate severity of needs, and help determine intensity of service required. [ABSTRACT FROM AUTHOR]

Background: Generalized anxiety disorder (GAD) is a prevalent anxiety disorder characterized by uncontrollable worry, trouble sleeping, muscle tension, and irritability. Cognitive behavioural therapy (CBT) is one of the first-line treatments that has demonstrated high efficacy in reducing symptoms of anxiety. Electronically delivered CBT (e-CBT) has been a promising adaptation of in-person treatment, showing comparable efficacy with increased accessibility and scalability. Finding further scalable interventions that can offer benefits to patients requiring less intensive interventions can allow for better resource allocation. Some studies have indicated that weekly check-ins can also lead to improvements in GAD symptoms. However, there is a lack of research exploring the potential benefits of online check-ins for patients with GAD. Objective: This study aims to investigate the effects of weekly online asynchronous check-ins on patients diagnosed with GAD and compare it with a group receiving e-CBT. Methods: Participants (n e-CBT = 45; n check-in = 51) with GAD were randomized into either an e-CBT or a mental health check-in program for 12 weeks. Participants in the e-CBT program completed pre-designed modules and homework assignments through a secure online delivery platform where they received personalized feedback from a trained care provider. Participants in the mental health check-in condition had weekly asynchronous messaging communication with a care provider where they were asked structured questions with a different weekly theme to encourage conversation. Results: Both treatments demonstrated statistically significant reductions in GAD—7-item questionnaire (GAD-7) scores over time, but when comparing the groups there was no significant difference between the treatments. The number of participants who dropped out and baseline scores on all questionnaires were comparable for both groups. Conclusions: The findings support the effectiveness of e-CBT and mental health check-ins for the treatment of GAD. Plain Language Summary Title: Comparing the Effectiveness of Electronically Delivered Therapy (e-CBT) to Weekly Online Mental Health Check-ins for Generalized Anxiety Disorder—A Randomized Controlled Trial Plain Language Summary: Generalized anxiety disorder (GAD) is a prevalent psychiatric condition that leads to symptoms like uncontrollable worry, trouble sleeping, muscle tension, and irritability. Cognitive behavioural therapy (CBT) is a common psychotherapy used for GAD since it has been shown to reduce symptoms. However, traditional CBT that is in person can have barriers such as being inaccessible and costly, and therefore electronically delivered CBT (e-CBT) is a viable alternative since previous studies have shown its efficacy in reducing symptoms and being similar compared to face-to-face CBT. Previous studies have also shown reductions in GAD symptomology through the use of checking in on people and their mental health. Therefore, this study aimed to compare e-CBT to a check-in condition and had a total of 45 individuals in e-CBT and 51 participants in the check-in condition. Participants in the e-CBT condition completed 12 weeks of predesigned e-CBT modules, homework and received personalized feedback from a care provider. In contrast, individuals in the check-in condition completed 12 weeks of unstructured asynchronous messaging with a care provider. Results from the study showed that both the e-CBT and check-in condition demonstrated statistically significant improvements in GAD-7 across time, but when comparing the groups there was no significant difference. The results show the efficacy of e-CBT and checking in on people's mental health to reduce GAD and future research should examine the 2 conditions combined. [ABSTRACT FROM AUTHOR]

Objective: Existing studies, in mostly male samples such as veterans and athletes, show a strong association between traumatic brain injury (TBI) and mental illness. Yet, while an understanding of mental health before pregnancy is critical for informing preconception and perinatal supports, there are no data on the prevalence of active mental illness before pregnancy in females with TBI. We examined the prevalence of active mental illness ≤2 years before pregnancy (1) in a population with TBI, and (2) in subgroups defined by sociodemographic, health, and injury-related characteristics, all compared to those without TBI. Method: This population-based cross-sectional study was completed in Ontario, Canada, from 2012 to 2020. Modified Poisson regression generated adjusted prevalence ratios (aPRs) of active mental illness ≤2 years before pregnancy in 15,585 females with TBI versus 846,686 without TBI. We then used latent class analysis to identify subgroups with TBI according to sociodemographic, health, and injury-related characteristics and subsequently compared them to females without TBI on their outcome prevalence. Results: Females with TBI had a higher prevalence of active mental illness ≤2 years before pregnancy than those without TBI (44.1% vs. 25.9%; aPR 1.46, 95% confidence interval, 1.43 to 1.49). There were 3 TBI subgroups, with Class 1 (low-income, past assault, recent TBI described as intentional and due to being struck by/against) having the highest outcome prevalence. Conclusions: Females with TBI, and especially those with a recent intentional TBI, have a high prevalence of mental illness before pregnancy. They may benefit from mental health screening and support in the post-injury, preconception, and perinatal periods. Plain Language Title: Mental illness in the 2 years before pregnancy in a population with traumatic brain injury Plain Language Summary: Research has shown a strong association between traumatic brain injury (TBI) and mental illness. Most previous studies have been conducted in primarily male samples, like veterans and professional athletes. Understanding mental health before pregnancy is important for deciding what supports people need before and during pregnancy. However, there are no studies on the frequency of mental illness in females with TBI before a pregnancy. We examined the frequency of mental illness 2 years before pregnancy in a population with TBI, and in subgroups defined by different social, health, and injury-related characteristics, compared to those without TBI. We undertook a population-wide study of all females with and without TBI in Ontario, Canada, with a birth in 2012–2020. We used statistical models to compare these groups on the presence of mental illness in the 2 years before pregnancy, before and after accounting for social and health characteristics. We also identified subgroups with TBI according to their social (e.g., poverty), health (e.g., chronic conditions), and injury-related characteristics (e.g., cause of injury) and subsequently compared them to females without TBI on their frequency of mental illness in the 2 years before pregnancy. Forty-four percent of females with TBI had mental illness in the 2 years before pregnancy compared to 25% of those without TBI. There were 3 TBI subgroups. Females with low-income, past assault, and injuries that were described as being intentional had the highest frequency of mental illness in the 2 years before pregnancy. Females with TBI may benefit from mental health screening and support post-injury and around the time of pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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.)

Based on the results of an interventional research project involving professionals from schools and child psychiatry, this article examines what partnership work in mental health reveals about the different dimensions of the educational relationship. Thus, in what ways does the knowledge of education and care circulate within these partnerships to qualify the difficulties of the pupils? And how does a division of educational and health care work take place between these actors? In the first part of the article, the existence of a hierarchy of knowledge and professions in the field of mental health is underlined. In the second part, the negotiations of professionals to qualify and regulate children’s difficulties are questioned in this context. [ABSTRACT FROM AUTHOR]

In recent decades, two processes have been crucial for the development of psychotherapy regulation, which are interlinked and mutually reinforcing: efforts to legalise psychotherapy as an autonomous profession, and efforts to academise psychotherapy as an autonomous scientific discipline. While in Europe the European Association for Psychotherapy (EAP) plays a key role in efforts to legalise psychotherapy as an autonomous profession, the academisation of psychotherapy in the twentieth century started at postgraduate level, then, after the Bologna reform, at Masters and Doctoral level and, since 2005 also at undergraduate level, first in Austria and then in Slovenia and Germany. Based on brief descriptions of the regulation of psychotherapy in some European countries – Germany, Sweden, Finland, Austria, Malta and Croatia – it is pointed out that concern for equitable access to psychotherapy and its quality for those in need of such kind of help must be a key criterion and goal in efforts to regulate psychotherapy. The international comparison also shows that psychotherapy will survive but not flourish if it remains only in the hands of doctors and psychologists as a method or specialisation. [ABSTRACT FROM AUTHOR]

Background: There is an urgent need for culturally and contextually relevant mental health support for First Nations, Inuit and Métis youth. Objective: Our aim was to identify mental health and wellness services that are currently available to Indigenous youth across Canada. Methodology: As a first step, we conducted a web-based environmental scan of services tailored to Indigenous youth. Specific factors were examined for each program, including organization type and mission, types of services, and who provides services. Results: One hundred and seventeen programs were found, with 54% being non-profits and 34% being on-reserve. Four core features were identified. The first was a strengths-based focus, rather than a pathology/deficit-focus, in programs' vision and mission statements, reflected in words like wellness and resilience. The second (87% of included programs) was the integration of mental health services with a range of other services and supports (e.g., health, employment, housing). The third was the provision of land-based programming (in 34% of programs) such as camps or hunting. Such programs were framed as promoting wellness and healing and strengthening identity. The fourth was the role of community members without formal mental health professional training (in 42% of programs), for example, as youth workers or knowledge keepers. This stems not only from the dearth of specialists in many Indigenous settings, but also a valuing of Indigenous knowledge. Conclusion: These core features in mental health services for Indigenous youth may be promising avenues for communities seeking to strengthen the services they offer to First Nations, Inuit and Métis youth. [ABSTRACT FROM AUTHOR]

Background: While a small number of scholars explore how contemporary American soldiers consume music "in theatre" (in a war zone) to motivate themselves and protect their mental health, little research addresses how music functions for Canadian combatants. Analysis: Case studies of two Canadian veterans illuminate the varied ways they used music to protect their mental health during their deployments in Afghanistan. Conclusion and implications: This article demonstrates that Canadian soldiers listened to a wide range of music to cope while on tour and argues for music as a unique portal through which to understand soldiers' deployment experiences. [ABSTRACT FROM AUTHOR]

Objective: Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of concurrent disorders have been developed; however, there exists little guidance outlining their structure and activities. Our objective was to synthesize available information on outpatient child and youth concurrent disorders programs and produce a comprehensive framework detailing the components of such programs. Methods: We used a four-stage critical interpretive synthesis design: (1) systematic review of published and grey literature, (2) data abstraction to identify program components and purposive sampling to fill identified gaps, (3) organization of components into a structured framework, (4) feedback from programs. We employed an iterative process by which programs reviewed data abstraction and framework development and provided feedback. Results: Through systematic review (yielding 1,408 records total and 7 records eligible for inclusion) and outreach strategies (yielding an additional 7 eligible records), we identified 11 programs (4 American, 7 Canadian) and 2 theoretical models from which data could be abstracted. Program activities were categorized into 12 overarching constructs that make up the components of the framework: accessibility, engagement, family involvement, integrated assessment, psychotherapy for patients, psychotherapy for families, medication management, health promotion, case management, vocational support, recreation and social support, and transition services. Program components are informed by the philosophical orientation of the program and models of care. This framework considers health system factors, clinical service factors, program development, and community partnership that impact program structure and activities. Multidisciplinary teams provide care and include addiction medicine, psychiatry, psychology, nursing, social work, occupational therapy, recreation therapy, peer support, and program evaluation. Conclusion: We developed a comprehensive framework describing components of child and youth outpatient concurrent disorders programs. This framework may assist programs currently operating, and those in development, to reflect on their structure and activities. [ABSTRACT FROM AUTHOR]

We use linked individual-level data on school enrollment, physician services received, and prescription medications from September 2016 to March 2022 to measure the effect of the COVID-19 pandemic and associated disruptions on the monthly frequency of mental health treatments received by adolescents in British Columbia. The results suggest substantial increases for non-Indigenous girls whose home language was English in treatment for depression and anxiety, attention deficit hyperactivity disorder (ADHD), eating disorders, and other mental health conditions. Girls whose home language was not English also show increases in treatment for depression and anxiety, and Indigenous girls show increases in treatment for ADHD. In contrast, boys show no change or even reductions in treatment for most mental health conditions. The exception is conduct disorders, which increase among boys whose home language was English. Treatment for substance use disorders declines among these boys, Indigenous boys, and Indigenous girls. Effects vary somewhat by socio-economic status, but we find no evidence that they vary substantially by schooling mode. [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.)

Adverse childhood experiences (ACEs) are well-known risk factors for poor physical and mental health outcomes. The purpose of this study was to explore the relationship between ACEs and self-report measures of emotional regulation and interpersonal functioning among a sample of individuals provincially incarcerated for sexual offending. In total, 112 males participating in an in-custody sexual offender treatment program completed the study measures. Two-stage hierarchical linear regression was used to examine the association between cumulative ACE scores and each self-report measure. Individual ACE item impacts were also explored using two-stage hierarchical regression. Higher cumulative ACE scores were associated with greater emotional dysregulation and multiple indices of interpersonal dysfunction. Several ACE items were consistently associated with greater emotional and interpersonal difficulties. The findings have clinical implications for sexual offender assessment, treatment, and prevention. Specifically, the findings support a growing movement towards trauma-informed practice, incorporating attachment theory and intimacy-based interventions, and promoting empirically supported interventions for cultivating emotional self-regulation. [ABSTRACT FROM AUTHOR]

We assessed prevalence and correlates of differential maternal‐infant bonding (i.e., experiencing a stronger bond with one baby vs. the other) in mothers of twins, focusing on aspects of maternal mental health, well‐being, and pregnancy/birth that have been previously linked with maternal‐infant bonding. Participants (N = 108 American women, 88.89% White, 82.41% non‐Hispanic, aged 18–45, who gave birth to twins in the past 6–24 weeks) were recruited from postpartum support websites. Participants completed a Qualtrics survey assessing pregnancy/birth history, symptoms of depression and anxiety, sleep, stress, romantic relationship satisfaction, and postpartum bonding. Twenty‐six participants (24.07%) reported a bonding discrepancy. These participants endorsed higher symptoms of depression and anxiety, lower relationship satisfaction, lower average postpartum bonding, higher general and parenting stress, and longer pregnancy (all ps >.05). Greater degree of bonding discrepancy correlated with more depression, higher parenting stress, longer pregnancy, and lower relationship satisfaction (all ps >.05). Mothers of twins may benefit from postpartum mental health support, stress management strategies, and interventions to improve bonding. Future work should assess the role of breastfeeding difficulties, delivery method, birth‐related trauma, infant regulatory capacity, and temperament. Longitudinal studies will help test cause and effect and potential long‐term repercussions of maternal‐infant bonding discrepancies. [ABSTRACT FROM AUTHOR]

Objectives: Emergency departments (EDs) are a vital part of healthcare systems, at times acting as a gateway to community-based mental health (MH) services. This may be particularly true for veterans of the Royal Canadian Mounted Police who were released prior to 2013 and the Canadian Armed Forces, as these individuals transition from federal to provincial healthcare coverage on release and may use EDs because of delays in obtaining a primary care provider. We aimed to estimate the hazard ratio (HR) of MH-related ED visits between veterans and non-veterans residing in Ontario, Canada: (1) overall; and by (2) sex; and (3) length of service. Methods: This retrospective cohort study used administrative healthcare data from 18,837 veterans and 75,348 age-, sex-, geography-, and income-matched non-veterans residing in Ontario, Canada between April 1, 2002, and March 31, 2020. Anderson–Gill regression models were used to estimate the HR of recurrent MH-related ED visits during the period of follow-up. Sex and length of service were used as stratification variables in the models. Results: Veterans had a higher adjusted HR (aHR) of MH-related ED visits than non-veterans (aHR, 1.97, 95% CI, 1.70 to 2.29). A stronger effect was observed among females (aHR, 3.29; 95% CI, 1.96 to 5.53) than males (aHR, 1.78; 95% CI, 1.57 to 2.01). Veterans who served for 5–9 years had a higher rate of use than non-veterans (aHR, 3.76; 95% CI, 2.34 to 6.02) while veterans who served for 30+ years had a lower rate compared to non-veterans (aHR, 0.60; 95% CI, 0.42 à 0.84). Conclusions: Rates of MH-related ED visits are higher among veterans overall compared to members of the Ontario general population, but usage is influenced by sex and length of service. These findings indicate that certain subpopulations of veterans, including females and those with fewer years of service, may have greater acute mental healthcare needs and/or reduced access to primary mental healthcare. [ABSTRACT FROM AUTHOR]

Les situations de crise sont fréquentes à l'adolescence. Le Dispositif Départemental Réactif pour Adolescents (DDRA31) a été implanté en 2017, en Haute-Garonne, pour offrir rapidement, aux adolescents en crise, une consultation spécialisée de psychiatrie avec un accompagnement de trois mois. Notre objectif était de mesurer l'effet de l'implantation de ce dispositif sur l'évolution de l'incidence annuelle des consultations aux urgences et hospitalisations des adolescents pour motif psychiatrique au CHU de Toulouse, guichet hospitalier unique de leur prise en charge en Haute-Garonne. Nous avons conduit une étude quasi expérimentale mesurant l'évolution avant-après l'implantation du DDRA31, l'incidence annuelle des passages aux urgences (pédiatriques et adultes) et d'hospitalisation pour motif psychiatrique au CHU de Toulouse parmi la file active annuelle de tous les adolescents âgés de 12 à 17 ans révolus, résidant en Haute-Garonne, de 2014 à 2019. Les facteurs associés au risque d'hospitalisation ont été analysés par régression logistique à effet mixte pour mesurer l'effet du dispositif au cours du temps, avec l'année comme variable explicative principale, ajusté sur le sexe et l'âge. De 2014 à 2019, 6686 passages aux urgences, réalisés par 4245 adolescents ont été observés. Le taux annuel d'incidence de passage aux urgences pour motif psychiatrique était stable, passant de 14,0 (IC 95 % : 13,2–14,9) pour 100 adolescents en 2014, à 13,9 (IC 95 % : 13,2–14,7) pour 100 adolescents en 2019. L'incidence annuelle des hospitalisations a diminué significativement de 38,3 (IC 95 % : 34,1–42,8) pour 100 adolescents en 2014 à 24,2 (IC 95 % : 21,2–27,4) pour 100 adolescents en 2019. La modélisation du risque d'hospitalisation montrait une réduction significative à partir de 2017, avec un rapport de cotes passant de 0,63 (IC 95 % : 0,49–0,80) en 2017 à 0,52 (IC 95 % : 0,41–0,67) en 2019. Nous n'avons pas montré d'effet du dispositif sur l'incidence annuelle du passage aux urgences pour motif psychiatrique mais un effet possible sur la réduction du risque d'hospitalisation en psychiatrie, suite à un passage aux urgences. La mise en place de structures ambulatoires réactives pourrait diminuer la sollicitation de services d'hospitalisation sous tension. Crisis situations are common during adolescence. Current data show that adolescents in crisis are either directly referred to hospital psychiatric emergency rooms, or they make an appointment for a specialized consultation, in a medical-psychological center (CMP), in a medical-psychological-pedagogical center (CMPP), or with a private practitioner. The Departmental Reactive System for Adolescents was implemented in 2017 in the French department of Haute-Garonne to provide adolescents in crisis an immediate specialized psychiatric consultation including on-going support for three months. Our objective was to measure the effect of the implementation of this health system organization (HSO) on the evolution of the annual incidence of emergency room visits and hospitalizations of adolescents for psychiatric reasons at the Toulouse University Hospital, the sole facility for such care in Haute-Garonne. We conducted a quasi-experimental study comparing the evolution, before and after the implementation of the DDRA31, the annual incidence rates of emergency room visits (pediatric and adult) and hospitalizations related to mental health at the Toulouse University Hospital for adolescents aged 12 to 17 years of age, residing in Haute-Garonne, from 2014 to 2019. Factors associated with the risk of hospitalization were analyzed using mixed-effects logistic regression to measure the effect of the system, over time, with the specific year as the primary explanatory variable, adjusted for sex and age. From 2014 to 2019, 6 686 emergency room visits by 4 245 adolescents took placefor psychiatric motives or diagnostics. The annual incidence rate of emergency department visits related to mental health was stable from 14.0 (95 % CI: 13.2–14.9), per 100 adolescents in 2014 to 13.9 (95 % CI: 13.2–14.7) in 2019, with a higher incidence rate for girls and adolescents aged from 15 to 17 years old. The main reasons for emergency room visits were behavioral problems or agitation, drug intoxications or suicide attempts, and drug or alcohol use or abuse. The annual incidence of hospitalizations decreased significantly since 2017, from 38.3 (95 % CI: 34.1–42.8) per 100 adolescents in 2014 to 24.2 (95 % CI: 21.2–27.4) per 100 adolescents in 2019. This decrease was shown for both males and females but only for adolescents aged from 15 to 17 years old, from 21.8 (CI 95 %: 17.9–26.1) in 2014 to 2.6 (CI 95 %: 1.5–4.1) in 2019. Modeling of the hospitalization risk showed a significant reduction from 2017 onward inclusive with an odds ratio ranging from 0.63 (95 % CI: 0.49–0.80) in 2017 to 0.52 (95 % CI: 0.41–0.67) in 2019. The fact that an impact of the HSO was found only for adolescents aged 15 to 17 years of age could indicate a selective effectiveness depending on age possibly caused by differences in physician attitudes depending on the age of the patient. The chronology of changes in hospitalization rates after a visit to the emergency room corresponded to the period when the HSO was implemented, whereas hospitalization rates were stable over the three years prior to its implementation. The main limitations of our study were the absence of data regarding emergency department diagnoses and discharge modes for the year 2019 and the lack of a temporal perspective. Our study did not show any significant effect of the HSO on the annual incidence of emergency room visits related to mental health, but there was a possible effect on reducing the yearly incidence rate and the risk of hospitalization of adolescents in psychiatric services following an emergency room visit. The implementation of reactive ambulatory structures could therefore reduce the demand on hospitalization services that are under pressure. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies 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.)

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies 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.)

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies 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.)

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies 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.)

The author proposes that the experiences we designate as disturbing are those in which we are unable to distinguish healthy from unhealthy aspects, as the absence of a scientifically based theory of mental health leaves us too exposed to social pressures. The author also proposes that we should consider the theoretical contribution that could come from putting order in our conceptions of sanity through an evolutionary approach. In particular, he proposes a revision of the concept of psychological defense focusing the existence of ancient defense strategies in the form of paroxysmal metabolic savings (freezing) which in the course of evolution have become partly maladaptive, coming into conflict with the defense strategies which push in the direction of greater metabolic expenditure through hunting and aggression. The two defensive strategies can conflict if they are not regulated through cortical mediation. Some reasons for the failure of this mediation are examined, a failure that leaves individuals at the mercy of the oscillations of their basic nuclei. [ABSTRACT FROM AUTHOR]

This monograph analyzes online coverage and social media posts from five professional athletes—Simone Biles, Serena Williama, Naomi Osaka, Chloe Kim, and Gracie Gold—to sheds light on the journalistic and individual narratives around athletes, performance, goals as these intersect with mental health. Online news and entertainment media's general representation of athletes frequently emphasizes victory with a focus on outcomes, often overshadowing the athletes' well-being. Using social identity and framing theories, the study identifies narratives in social and online media, emphasizing the storytelling components related to mental health, as well as what athletes express as potential causes of the mental health issues they are experiencing, especially intense competition, physical condition, media pressure, and a general lack of mental health awareness in sports. The study's examination of how athletes use their social media platforms to help journalists craft their stories offers a deeper understanding of their mental health stories beyond the basic win-or-lose narrative. We advocate for a paradigm shift, urging recognition of athletes as individuals with vulnerabilities who deserve supportive environments. [ABSTRACT FROM AUTHOR]

Background: Early substance use is associated with increased risks for mental health and substance use problems which are compounded when using several substances (i.e., polysubstance use). A notable increase in substance use occurs when adolescents transition from elementary to secondary schooling. Objective: This study seeks to characterize student and school classes of substance use. Methods: A cross-sectional multilevel latent class analysis and regression was conducted on a representative sample of 19,130 grade 6-8 students from 180 elementary schools in Ontario, Canada to: 1) identify distinct classes of student substance use; 2) identify classes of schools based on student classes; and 3) explore correlates of these classes, including mental health, school climate, belonging, safety, and extracurricular participation. Results: Two student and two school classes were identified. 4.1% of students were assigned to the high probability of early polysubstance use class while the remaining 95.9% were in the low probability class. Students experiencing depressive and externalizing symptoms had higher odds of being in the early polysubstance use class (Odds Ratio [OR]s=1.1-1.25). At the school level, 19% of schools had higher proportions of students endorsing polysubstance use. Perceptions of positive school climate, belonging, and safety increased the odds of students being in the low probability of early polysubstance use student-level class (ORs=0.85-0.93) and lower probability of early polysubstance use school-level class. Associations related to extracurricular participation were largely not statistically significant. Conclusions: Student and school substance use classes may serve as targets for tailored prevention and early interventions. Results support examining school-based interventions targeting school climate, belonging, and safety. [ABSTRACT FROM AUTHOR]

Plusieurs études ont démontré l'existence de pathologies psychiques et de risques psychosociaux chez les marins, notamment les officiers de la marine marchande. Les principaux facteurs de risque notifiés sont la fonction d'officier, l'accroissement de la durée de travail et en corollaire la diminution du temps de sommeil, la solitude, l'éloignement familial et plus récemment l'impact de la pandémie de COVID-19 (peur pour sa santé, celle de sa famille, allongement des durées d'embarquement). La faible latitude décisionnelle des membres d'équipage comparativement aux officiers a également été mis en exergue. À ce jour, il n'existe pas d'étude chez les élèves officiers de la marine marchande. Un groupe de travail comprenant des membres des écoles supérieurs de la marine marchande et du CHU de Brest a été constitué. Un questionnaire comprenant des données démographiques et des navigations auquel nous avons adjoint le questionnaire GHQ-12, HAD et le questionnaire de Karasek a été élaboré. L'ensemble des élèves a été sollicité et a rempli le questionnaire de manière anonyme par voie électronique. Les résultats des différents questionnaires ont ensuite été analysés en utilisant les modalités de cotation reconnues au niveau international. Une phase d'analyse descriptive puis une analyse selon les catégories du score de Karasek a été menée. Cent soixante-dix questionnaires ont pu être inclus. La population est majoritairement masculine (76,4 %), et l'âge moyen des élèves est de 21,7 ans. Près de 20 % des élèves déclarent avoir vécu un événement traumatisant au cours d'un stage embarqué. Nous observons que la moyenne du GHQ-12 est à 13,3 et donc supérieure à 12. Les moyennes du HAD anxiété et HAD dépression sont respectivement 6,9 et 5,37, avec respectivement 18,2 % et 7,6 % des élèves inclus présentant des signes d'anxiété et de dépression. Selon la classification de Karasek, nous notons que la classe « actif » est la plus représentée avec 29,4 % des élèves, puis viennent à égalité les classes « tendu » et « détendu » avec 27,6 %. La classe « passif » est la moins représentée avec 15,3 %. Cette étude montre que les élèves de l'école officiers de la marine marchande française ont une évaluation moyenne de leur santé globale et que nous retrouvons une prédominance de troubles anxieux mais peu de signes de dépression. Des signes de « work strain » selon Karasek sont retrouvés pour 1/4 de la population de ces jeunes officiers. La proportion d'élèves officiers présentant des signes d'anxiété et dépression selon le questionnaire HAD est similaire aux études chez les officiers français et européens. Par contre, la proposition d'élèves classés comme « tendus » est plus importante. Concernant les événements traumatisants, dans une analyse semi-dirigée sur les premiers embarquements des étudiants, les principaux facteurs de stress déclarés étaient la conduite du navire, les avaries, la piraterie puis les conditions météorologiques. La période des études au sein des ENSM est une période d'apprentissage théorique mais également de mise en situation lors des stages. Dans ce milieu très spécifique de la marine marchande, l'impact des contraintes psychosociales semble important. Ces données nous interrogent également sur l'impact de la profession mais également celui de la période de pandémie de SARS CoV-2. Cela soulève aussi la problématique de l'aptitude à la navigation de certains élèves présentant des signes anxieux et dépressifs lors de l'enquête, et d'autres à risque de développer ce type de pathologies entrant dans la liste des inaptitudes à la navigation. Several studies have demonstrated the existence of mental disorders and psychosocial risks among sailors, particularly merchant navy officers. The main risk factors reported are assuming the status of an officer, longer working hours and the consequent reduction in sleep time, loneliness, separation from family, and, more recently, the impact of the COVID-19 pandemic (fear for one's own health and that of one's family, and longer embarkation times). The low decision latitude of crew members compared to that of officers has also been highlighted. To date, no studies have been carried out among merchant navy officer cadets. A working group including members of the Merchant Navy school and the hospital of the University of Brest was set up. A questionnaire was devised that included demographic and navigational data to which we added the GHQ-12, HAD and Karasek questionnaires. All the students were asked to complete the questionnaire anonymously and submit it electronically. The results of the questionnaires were then analyzed using internationally recognized scoring procedures. A descriptive analysis phase was conducted which was followed by an analysis according to the Karasek scoring categories. In all, 170 questionnaires were submitted. The participant population was predominantly male (76.4%), and the average age of the students was 21.7 years. Nearly 20% of the students stated that they had experienced a traumatic event during an on-board training course. We note that the average GHQ-12 is 13.3 and therefore higher than 12. The HAD anxiety and HAD depression averages are 6.9 and 5.37 respectively, with 18.2% and 7.6% of the students included showing signs of anxiety and depression. According to Karasek's classification, we note that the "active" class is the most represented with 29.4% of students, followed by the "tense" and "relaxed" classes with 27.6%. The "passive" class is the least represented with 15.3%. This study demonstrates that the students of the French Merchant Navy Officer Training School evaluated their overall health as average, with a predominance of anxiety disorders but few signs of depression. Signs of "work strain" according to the Karasek questionnaire were found in 1/4 of these young officers. The proportion of cadets showing signs of anxiety and depression according to the HAD questionnaire is similar to that shown in studies among French and European officers. On the other hand, the proportion of cadets classified as "tense" is higher. Concerning traumatic events, in a semi-structured analysis of the students' first deployments at sea, the main stress factors reported were how the ship was managed, damaged, piracy and then weather conditions. The period of study within the ENSM involves both a period of theoretical learning but also one of practical training. In the highly specific environment of the merchant navy, the impact of psychosocial constraints seems to be significant. These data also raise questions about the impact of the profession as well as that of the SARS CoV-2 pandemic period. This also raises the issue of the fitness of certain students to sail where they showed signs of anxiety and depression at the time of the survey, and of others who are at risk of developing this type of pathology, which is included in the list of criteria for unfitness for sea duty. [ABSTRACT FROM AUTHOR]

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Introduction. Parmi les répercussions généralisées de la pandémie de COVID-19, l'aggravation marquée des symptômes d'anxiété et de dépression est devenue une préoccupation urgente. Dans cette étude, les auteurs ont analysé la prévalence des symptômes d'anxiété et de dépression au Canada de septembre à décembre 2020, en évaluant les influences démographiques et socio-économiques ainsi que le rôle potentiel des diagnostics de COVID-19 et des expériences négatives liées à la maladie. Méthodologie. Les données ont été tirées de l'Enquête sur la COVID-19 et la santé mentale réalisée par Statistique Canada, qui a utilisé un plan d'échantillonnage à deux degrés pour recueillir les réponses de 14 689 adultes dans les dix provinces et les trois capitales territoriales, en excluant moins de 2 % de la population. Ces données ont été recueillies au moyen de questionnaires électroniques auto-administrés ou d'entrevues téléphoniques. Nous avons utilsé des techniques d'analyse comme les fréquences, les tableaux croisés et la régression logistique pour évaluer la prévalence des symptômes d'anxiété et de dépression, les caractéristiques sociodémographiques des Canadiens présentant des symptômes accrus d'anxiété et de dépression et l'association de ces symptômes avec les diagnostics de COVID-19 et les expériences négatives vécues pendant la pandémie. Résultats. L'étude a révélé que 14,62 % (intervalle de confiance [IC] à 95 % : 13,72 % à 15,51 %) des répondants présentaient des symptômes de dépression et que 12,89 % (IC à 95 % : 12,04 % à 13,74 %) ont fait état de symptômes d'anxiété. Aucune différence nette n'a été observée quant à la prévalence des symptômes entre les personnes infectées par la COVID-19 ou les proches d'une personne infectée et les personnes n'ayant pas vécu ces situations. Toutefois, il y avait de fortes associations entre les fac-teurs de risque classiques de symptômes de dépression et d'anxiété et les expériences négatives vécues pendant la pandémie, comme des problèmes de santé physique, la solitude et des difficultés dans les relations personnelles au sein du ménage. Conclusion. L'étude fournit un aperçu du lien entre COVID-19 et santé mentale au sein de la population canadienne en révélant une prévalence accrue des symptômes d'anxiété et de dépression associés aux épreuves liées à la COVID-19 et aux déterminants courants de ces symptômes avant la pandémie. D'après nos résultats, la santé mentale en période de pandémie a été principalement façonnée par les déterminants classiques des symptômes de dépression et d'anxiété ainsi que par les expériences négatives vécues au cours de la pandémie. [ABSTRACT FROM AUTHOR]

La fonction de juré d'assises n'est pas sans conséquence sur la santé mentale. En effet, l'exposition à divers types de preuves, ou encore la responsabilité qui leur est conférée, peut faire émerger de grandes difficultés d'ordre psychique chez les jurés. L'objectif de cet article est ainsi d'effectuer un état des lieux des conséquences du rôle de jurés d'assises sur la santé mentale et de ce qui est actuellement proposé en termes d'accompagnement en France. Une revue de la littérature française et internationale a ainsi été effectuée, permettant de mettre en lumière les principales conséquences du rôle de jurés d'assises sur la santé mentale ; mais également les méthodes de prises en charge actuellement proposées. Plusieurs études ont mis en évidence l'impact de cette fonction sur la santé mentale, notamment en matière de stress, trouble anxieux et/ou symptomatologie post-traumatique. Bien que des dispositifs se déploient au fur et à mesure en France, cette possibilité de prise en charge n'est pas présente sur tout le territoire et n'est pas systématique. De plus, le type d'intervention proposé (prévention, intervention post-procès) diffère selon le département. Au regard des données disponibles dans la littérature, une piste de proposition d'accompagnement généralisée des jurés d'assises sera proposée. Enfin, sera discutée la nécessité de systématiser l'évaluation des effets produits par les dispositifs d'accompagnement, autrement que par la seule satisfaction des participants. Jury duty, as exceptional as it is, is not without consequences for mental health. Indeed, during this assignment, randomly selected citizens are called on to judge people accused of criminal acts, to decide on their guilt and, if necessary, on their sentence. Thus, in court trials, the juror's voice will count just as that of the professional judges who sit with them. However, this enormous responsibility and the imperative aspect of jury duty can cause significant stress, especially when we consider that very often, jurors only have a limited knowledge of the judicial system. Also, being exposed to various types of evidence and to serious facts can be trying. Finally, the various obligations jurors have to meet can accentuate the difficulty of this duty, for example, the fact that, because the procedure is subject to sanctions, the jurors cannot discuss the case with others and must respect the secrecy of deliberations, even after the judgment has been rendered. For all these reasons, and also sometimes because of pre-existing individual vulnerabilities, the jury duty experience can lead to a variety of psychological difficulties, difficulties that are still not sufficiently taken into account. Although several forms of care are emerging today, such treatments remain varied and unequally available throughout the country. This article has multiple purposes. First, it aims to enumerate the possible consequences of jury duty on mental health, then, to present an inventory of what is actually available in terms of care in France. Finally, this inventory leads us to the possible intervention in several stages which could be made available to jurors, thereby offering a comprehensive and generalized support. A review of French and international literature was carried out, highlighting the main consequences of jury duty on mental health and the emergence of care systems, particularly in North America and France. Several studies stress the impact of jury duty on mental health, particularly in terms of stress, anxiety disorder and/or post-traumatic symptomatology. While support systems have emerged particularly in Canada, some have also gradually begun to be put in place in France, but they differ from one area to another, and they are not systematically made available. Some of them focus exclusively on post-trial support, while others also offer an upstream prevention phase. Finally, in terms of evaluation, the effectiveness of those interventions is estimated only by the participant's satisfaction, without any systematization or assurance of the real effectiveness of these interventions. Considering the available data in the literature and the various existing support systems, a proposal for a system of generalized support to jurors has been put forth in order to argue in favor of the adoption of this type of care. Indeed, in addition to a post-trial intervention, it seems important to plan for a phase of pre-trial prevention and the presentation of a treatment protocol, before the actual trial begins. Particularly, this should encourage jurors to more willingly take part in the post-trial intervention should signs of stress and anxiety emerge. Finally, it appears necessary to systematize the evaluation of the effectiveness of those support systems other than simply in terms of the satisfaction of the participants. [ABSTRACT FROM AUTHOR]

A recent review of the literature has shown that one of the reasons for excess mortality among people with mental disorders is less access to somatic care (Gandré et al., 2022). This article explores the testimonial injustices by people living with mental health problems and their repercussions on their somatic care, through analyzing the accounts of people affected by mental disorders, psychiatric caregivers and nursing students. It also proposes a device to bring (future) caregivers to question their own practices regarding the testimonial injustices experienced by people with mental disorders. Finally, it is an opportunity to think about addressing this theme in pre- and post-graduate healthcare training to improve the cares of people concerned by this issue. [ABSTRACT FROM AUTHOR]

Context: This study followed a quantitative study that showed the positive effects of a 15-hour psychoeducational intervention aimed at the wellbeing of 3rd year pre-clinical medical students. Aim: To explore what students believe to be the source of these observed positive effects on their wellbeing. Methods: A thematic qualitative analysis was conducted on 192 texts sent by 192 students. Results: The qualitative content of the texts is consistent with and clarifies the positive effects observed in the quantitative study. Different processes could be identified as potentially causing these effects. The factors influencing the students' wellbeing can be grouped into three areas: at an intrapersonal level, the discovery of the self-regulation process and the content and tools learned through the intervention; at an interpersonal level, the development of a culture of sharing vulnerabilities among students; at the environmental level, the trainer's attitudes and the pace and safe space of the intervention seem to explain the positive effects observed on the students. Conclusion: The qualitative study allowed us to go one step further by identifying, within the students' texts, processes that may be responsible for the benefits identified quantitatively on their wellbeing. Further quantitative studies would allow us to meaningfully test these identified processes in order to help health educators identify the levers to ensure the wellbeing of their students. [ABSTRACT FROM AUTHOR]

Introduction. La santé mentale perçue des personnes au Canada ayant rencontré des obstacles en matière de soins de santé pendant la pandémie de COVID-19 est sous-explorée. Méthodologie. Nous avons analysé les données collectées entre mars et juin 2021 sur les adultes ayant déclaré avoir eu besoin de services de santé au cours des 12 derniers mois dans le cadre de l'Enquête sur l'accès aux soins de santé et aux produits pharmaceutiques pendant la pandémie. Des analyses de régression logistique non ajustées et ajustées ont été menées pour explorer les associations entre les obstacles en matière de soins de santé (problèmes liés à la prise de rendez-vous, report de la communication avec un professionnel de la santé) et un niveau élevé de santé mentale autoévaluée ainsi que la perception d'une détérioration de la santé mentale par rapport à la période précédant la pandémie, de façon globale et avec stratification en fonction du sexe, du groupe d'âge, du nombre de problèmes de santé chroniques et du tertile de revenu du ménage. Résultats. Les personnes ayant subi des changements de rendez-vous en raison de la pandémie ou dont le rendez-vous n'avait pas encore été fixé étaient moins susceptibles d'avoir un niveau élevé de santé mentale autoévaluée (RCa = 0,81 et 0,64 respectivement) et plus susceptibles de percevoir une détérioration de leur santé mentale (RCa = 1,50 et 1,94 respectivement) que les personnes sans problème lié aux rendez-vous. Les personnes ayant tardé à communiquer avec un professionnel de la santé en raison de la pandémie (par exemple parce qu'elles craignaient d'être infectées) ou pour d'autres raisons étaient moins susceptibles d'avoir un niveau élevé de santé mentale autoévaluée (RCa = 0,52 et 0,45 respectivement) et plus susceptibles de percevoir une détérioration de leur santé mentale (RCa = 2,31 et 2,43 respectivement) que les personnes qui n'avaient pas tardé à communiquer avec un professionnel de la santé. Le report de la communication avec un professionnel de la santé pour des raisons liées à la pandémie était associé à une perception moins favorable de la santé mentale dans tous les sousgroupes, tandis que l'association entre la santé mentale perçue et les changements de rendez-vous liés à la pandémie était importante dans certains groupes seulement. Conclusion. Les obstacles en matière de soins de santé pendant la pandémie ont été associés à une perception moins favorable de la santé mentale. Ces résultats pourraient orienter l'affectation des ressources en soins de santé et les messages de santé publique. [ABSTRACT FROM AUTHOR]

Les policiers en Franc sont souvent amenés à intervenir auprès de patients souffrant de troubles psychiatriques, lorsqu'ils présentent des troubles à l'ordre public. L'objectif de notre étude était d'explorer la perception de différentes dimensions de la psychiatrie (symptômes, traitements, prévalence, dangerosité...) par la police parisienne à travers une étude exploratoire. Un auto-questionnaire a été envoyé aux policiers parisiens, comprenant 25 questions réparties en cinq sous-parties évaluant notamment leur exposition personnelle et professionnelle, la perception de différentes dimensions de la psychiatrie et leurs attentes concernant des formations spécifiques à la psychiatrie. Au total, 191 policiers parisiens ont répondu au questionnaire, et rapportent une exposition fréquente à la psychiatrie (deux tiers disent intervenir au moins une fois par mois auprès de patients souffrant de troubles psychiatriques). On retrouve des attitudes globalement bienveillantes des policiers qui rapportent néanmoins un risque accru d'usage de la force ou de violences physiques lors des interventions impliquant des personnes présentant des troubles psychiatriques. De plus, la majorité des participants rapportent se sentir insuffisamment formés à la psychiatrie et se montraient favorables à la mise en place de formations spécifiques, au cours de leurs études ou de leur carrière professionnelle. Cette première étude réalisée en France montre des résultats concordants avec ceux de la littérature scientifique internationale et pourrait mener à la mise en place de formations spécifiques auprès des effectifs de police. Psychiatric pathologies are widespread in the general population and rank third among the most frequent pathologies in the world, according to the World Health Organization, affecting nearly one in four people over their lifetime. Police officers in France are often required to intervene with people suffering from psychiatric disorders when they are involved in disturbances to public order. However, despite the frequency of these interventions in France, only a few specific training courses in psychiatry are made available to police officers. There has not been any research conducted in France on this subject. The objective of our study was to explore the perception of different dimensions of psychiatry (symptoms, treatments, prevalence, and dangerousness) by the Parisian police through an exploratory study. A self-administered questionnaire was sent to Parisian police officers through an internal mailing list. The questionnaire was comprised of 25 questions divided into five sub-sections. The first section of the questionnaire concerned the demographic and professional characteristics of the participants (age, gender, rank, and years of experience). The second section explored the exposure (personal and professional) of police officers to psychiatry. The third and fourth sections were devoted to questions about training in psychiatry and their perception of the different dimensions of psychiatry. The last section of the questionnaire was dedicated to any comments regarding the questionnaire. One hundred and ninety-one Parisian police officers – 106 men (56%) and 83 women (43%) – responded to the questionnaire and many of them reported frequent exposure to psychiatry (two-thirds say they are involved at least once a month with patients suffering from psychiatric disorders). The most frequently encountered problems were delusional ideas, agitation, suicide attempts or suicides, behavioral problems related to substance abuse, and hallucinations. We generally found benevolent attitudes on the part of the police. The police officers questioned evoked: mistrust (94.7%), empathy (46.8%), fear (37.4%), incomprehension (32.9%), and a negative judgment (8.4%), and 84% of the police officers reported an increased risk of using force during interventions involving people with psychiatric disorders. These results can be partly explained by the impairment of discernment found in people with decompensated psychiatric disorders, communication difficulties between police and patients, and the lack of training in the management or recognition of such symptoms. In addition, the majority of the participants reported feeling insufficiently trained in psychiatry and were in favor of the implementation of specific training courses either during their studies or as an element in their professional career: three-quarters of the police officers questioned never had any training in psychiatry during their studies or since taking up their post, and 80% of the police officers said they were inadequately trained to evaluate and deal with situations involving psychiatric disorders. The police officers largely favored specific training: 82.7% of them would like to be more trained in psychiatry during their studies or on the job, thus underlining a desire to be better prepared for these interventions. This study is, to our knowledge, the first of its kind in France on this subject. Several results are consistent with those of international scientific literature and highlight the frequent exposure of Parisian police officers to people with psychiatric disorders and the officers' mostly benevolent, understanding, and non-stigmatizing attitudes. Nevertheless, police officers remain insufficiently trained in psychiatry, and this lack of training can be the source of communication difficulties, mistrust, or fear and thus increase the risk of the use of force. The majority of the study participants favor implementing these training courses, particularly with respect to the management of agitation and behavioral disorders, which are the symptoms most frequently encountered during these interventions. This study remains exploratory but could inform future work, mainly in implementing and evaluating specific psychiatric training for police officers. [ABSTRACT FROM AUTHOR]

Peut-on raisonnablement défendre la suppression de l'évaluation du discernement dans l'appréciation de la responsabilité pénale des infracteurs ? Si une telle question peut à première vue sembler purement rhétorique, de récentes propositions de réforme de l'article 122-1 du Code pénal suggèrent qu'il n'en est rien. Une recommandation, publiée dans les Annales Médico-Psychologiques (Bouchard, 2018), de réécriture dudit article s'appuie même explicitement sur une argumentation en faveur de l'abandon des concepts – légitimement jugés insuffisamment précis – d' abolition et d' altération du discernement, auxquels devrait se substituer l'idée, supposément moins équivoque, d'un lien de causalité nouant (de façon « exclusive » ou non) la présence d'un trouble mental et la commission des faits. Nous nous proposons ici de démontrer en quoi le raisonnement censé justifier l'évacuation de l'examen de la qualité du discernement – remplacé par une estimation de type causal particulièrement ambitieuse – repose sur des prémisses éminemment controversables et nous achemine en outre vers d'insurmontables difficultés évitées par le texte actuel. Can one reasonably defend the suppression of the investigation of discernment in the assessment of the criminal responsibility of offenders? While such a question may at first glance seem purely rhetorical, recent proposals for reform of article 122-1 of the Penal Code suggest that this is not the case. A recommendation, published in the Annales Médico-Psychologiques (Bouchard, 2018), to rewrite this article is in fact explicitly based on an argument insisting on the desirable removal of the concepts – legitimately judged insufficiently precise – of abolition and alteration of discernment , which should be replaced by the idea, supposedly less equivocal, of a causal link ("exclusive" or not) between the presence of a mental disorder and the commission of the offence. In this paper, we propose to demonstrate how such an evacuation of the examination of the quality of discernment – intended to be replaced by a particularly ambitious causal type analysis – is incoherent and moreover produces insurmountable difficulties avoided by the current text. [ABSTRACT FROM AUTHOR]

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