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Journal Cover Canadian Journal of Psychiatry
  [SJR: 1.244]   [H-I: 79]   [16 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0706-7437 - ISSN (Online) 1497-0015
   Published by Sage Publications Homepage  [842 journals]
  • Suicide
    • Authors: Patten; S. B.
      Pages: 380 - 381
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716654628
      Issue No: Vol. 61, No. 7 (2016)
  • Correlates of Attempted Suicide from the Emergency Room of 2 General
           Hospitals in Montreal, Canada
    • Authors: Rahme, E; Low, N. C. P, Lamarre, S, Daneau, D, Habel, Y, Turecki, G, Bonin, J.-P, Morin, S, Szkrumelak, N, Singh, S, Lesage, A.
      Pages: 382 - 393
      Abstract: Introduction: The epidemiology of attempted suicide has not been well characterized because of lack of national data or an International Classification of Diseases (ICD) code for suicide attempts. We conducted a retrospective chart review in 2 adult general hospitals (tertiary and community) in Montreal, Canada, in 2009-2010 to 1) describe the characteristics of men and women who presented to the emergency department (ED) and/or were hospitalized following a suicide attempt, 2) identify factors associated with attempts requiring hospitalizations, and 3) validate the use of International Classification of Diseases, 10th Revision (ICD-10) codes for "intentional self-harm" as a method to detect suicide attempts from hospital abstract summary records. Method: All potential suicide attempts were identified from hospital abstract summary records and ED nursing triage file using ICD-10 codes and keywords suggestive of suicide attempts. All identified charts were examined, and those with confirmed suicide attempts were fully reviewed. Results: Of the 5746 identified charts, 369 were fully reviewed. Of these, 176 were for suicide attempters treated in the ED and 193 for hospitalized attempters, of whom 46% had an ICD-10 code for intentional self-harm. Poisoning (46%) was the most frequent method of suicide used. Half of attempters were younger than 34 years, 53% were female, and 75% had a history of mental disorders. Conclusion: About half of individuals who seek medical care for attempted suicide are admitted to hospital. About half of attempters use poisoning as a method of suicide, and a quarter do not have a history of mental disorders. Intentional self-harm codes capture only about half of hospitalized attempters.
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716639054
      Issue No: Vol. 61, No. 7 (2016)
  • How Often Do Individuals with Major Depression Receive Minimally Adequate
           Treatment' A Population-Based, Data Linkage Study
    • Authors: Puyat, J. H; Kazanjian, A, Goldner, E. M, Wong, H.
      Pages: 394 - 404
      Abstract: Objective: Depression is usually treated with antidepressants, psychotherapy, or both. In this study, we examined the extent to which individuals with depression receive minimally adequate treatment with regard to the use of antidepressants and psychotherapy. Method: Using population-based administrative data, we identified individuals with inpatient or outpatient diagnoses of depression and tracked their use of publicly funded mental health services within a 12-month period. We used mixed-effects logistic regression to assess the influence of patient-level characteristics and physician-level variations on the receipt of minimally adequate treatment. Results: A total of 108 101 individuals, predominantly women (65%) and urban residents (89%), were diagnosed with depression in 2010–2011. Of these, 13% received minimally adequate counseling/psychotherapy with higher proportions observed among men, younger individuals, and urban residents. In contrast, there were more who received minimally adequate antidepressant therapy (48%), with women, older individuals, and rural residents having the highest proportions. Overall, about 53% received either type of treatment, and the pattern of use was similar to that of antidepressant therapy. Mixed-effects logistic regression results indicate that these factors remain independent predictors of the receipt of minimally adequate depression care. Significant practice variations also exist, which determine patients’ receipt of minimally adequate care, particularly with respect to counseling or psychotherapy. Conclusions: Only about half of those with depression receive either minimally adequate counseling/psychotherapy or minimally adequate antidepressant therapy. Disparities also persist, affecting mostly men and younger individuals. A multifactorial approach is needed to improve access to and reduce variations in receipt of minimally adequate depression care.
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716640288
      Issue No: Vol. 61, No. 7 (2016)
  • Suicide in Canada: Is Poisoning Misclassification an Issue'
    • Authors: Skinner, R; McFaull, S, Rhodes, A. E, Bowes, M, Rockett, I. R. H.
      Pages: 405 - 412
      Abstract: Objective: The aim of this study is to compare Canadian suicide rates with other external causes of death to examine potential poisoning misclassifications as a contributor to suicide underreporting. Method: The study used Statistics Canada mortality data from 2000 to 2011 to calculate sex-and age-specific ratios by external cause of injury codes. Results: The overall Canadian suicide rate, as well as the poisoning suicide rate, declined over the study timeframe by an average annual percentage change (AAPC) of 1.0% each year. However, unintentional and undetermined poisonings increased significantly during the timeframe. Unintentional poisoning mortality (primarily narcotics and hallucinogens, including opioids) increased in proportion to suicides for both sexes, although females were consistently higher. The undetermined death to suicide ratio was higher and increasing for females. Poisonings of undetermined intent increased over time to comprise 47% to 80% of the undetermined death category for males and females combined. Conclusions: Canadian poisoning suicide rates declined, in contrast to rising unintentional and undetermined poisoning mortality rates. This trend is similar to that of the United States, supporting the hypothesis that misclassification of poisoning deaths may also be an issue in Canada.
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716639918
      Issue No: Vol. 61, No. 7 (2016)
  • Management of Current Psychiatric Disorders: A French Family Physician
           Experience. A Qualitative Study
    • Authors: Oude Engberink, A; Carbonnel, F, David, M, Norton, J, Bourrel, G, Boulenger, J.-P, Capdevielle, D.
      Pages: 413 - 421
      Abstract: Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716639922
      Issue No: Vol. 61, No. 7 (2016)
  • Time Trends in Emergency Department Visits for Suicide-Related Behaviours
           by Girls and Boys in Alberta: A Population-Based Retrospective Cohort
    • Authors: Newton, A. S; Rosychuk, R. J, Carlisle, C. E, Zhang, X, Bethell, J, Rhodes, A. E.
      Pages: 422 - 427
      Abstract: Objective: In Canada, emergency departments (EDs) are a frontline setting for treating suicide-related behaviours (SRBs) among adolescents, yet description of national trends in ED SRB visits is lacking. We determined whether the SRB incidence rate and method patterns between 2002 and 2010 previously shown for Ontario adolescents were also experienced in Alberta. Method: A retrospective, population-based study of ED visits for SRBs (self-poisoning or self-injury, irrespective of suicidal intent) by 12- to 17-year-olds was conducted using administrative health care data from 104 EDs across Alberta, Canada. Incidence rates and 95% confidence intervals (CIs) were calculated and graphed. Rate ratios (RRs) comparing rates between time periods (2002-2005 and 2006-2010) and corresponding 95% CIs were estimated. Changes in SRB methods were also described. The time periods chosen were based on published Ontario trends. Results: Decreases in yearly incidence rates levelled off after 2005. Crude RRs indicated a rate decrease in 2006 to 2010 for boys (RR, 0.77; 95% CI, 0.65 to 0.90) and girls (RR, 0.80; 95% CI, 0.67 to 0.95). From 2002 to 2010, the proportion of SRB visits for self-poisoning decreased (girls, –13%; boys, –10%) while visits for self-cutting increased (girls, +13%; boys, +14%). Conclusions: Alberta trends were similar to those previously published for Ontario. Determining if the trends and observed changes are associated with mental health care access or availability and/or provincial suicide prevention strategies would contextualize these findings and could shape future prevention efforts. Lack of identification of suicidal intent and exclusion of fatal SRB are limitations of the current study.
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716633430
      Issue No: Vol. 61, No. 7 (2016)
  • Clinician Prediction of Future Suicide Attempts: A Longitudinal Study
    • Authors: Wang, Y; Bhaskaran, J, Sareen, J, Bolton, S.-L, Chateau, D, Bolton, J. M.
      Pages: 428 - 432
      Abstract: Objective: Established risk assessment tools are often inaccurate at predicting future suicide risk. We therefore investigated whether clinicians are able to predict individuals’ suicide risk with greater accuracy. Method: We used the SAFE Database, which included consecutive adult (age ≥18 years) presentations (N = 3818) over a 22-month period to the 2 tertiary care hospitals in Manitoba, Canada. Medical professionals assessed each individual and recorded his or her predicted risk for future suicide attempt (SA) on a 0-10 scale—the clinician prediction scale. The SAD PERSONS scale was completed as a comparison. SAs within 6 months, assessed using the Columbia Classification Algorithm for Suicide Assessment, were the primary outcome measure. Receiver operating characteristic curve and logistic regression analyses were conducted to determine the accuracy of both scales to predict SAs, and the scales were compared with z scores. Clinician prediction scale performance was stratified based on level of training. Results: Clinicians were able to predict future SAs with significantly greater accuracy (area under the curve [AUC] = 0.73; 95% CI, 0.68 to 0.77; P < 0.001) compared with the SAD PERSONS scale (z = 3.79, P < 0.001). Both scales nonetheless showed positive predictive value of less than 7%. Analyses by level of training showed that junior psychiatric residents and non–psychiatric residents did not accurately predict SAs, whereas senior psychiatric residents and staff psychiatrists demonstrated greater accuracy (AUC = 0.76 and 0.78, respectively). Conclusions: Clinicians are able to predict future attempts with fewer false positives than a conventional risk assessment scale, and this skill appears related to training level. Predicting future suicidal behaviour remains very challenging.
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716645287
      Issue No: Vol. 61, No. 7 (2016)
  • Doubting the Doubts About the Clinical Effectiveness of Community
           Treatment Orders
    • Authors: Karagianis; J.
      Pages: 433 - 434
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716645305
      Issue No: Vol. 61, No. 7 (2016)
  • Community Treatment Orders Disconnect
    • Authors: Hastings, T. J; Gray, J. E.
      Pages: 435 - 436
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716645306
      Issue No: Vol. 61, No. 7 (2016)
  • Evidence-Based Practice in Use of CTOs: Authors Reply
    • Authors: Dawson, J; Kisely, S, Rugkasa, J.
      Pages: 437 - 438
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716645307
      Issue No: Vol. 61, No. 7 (2016)
  • In Memoriam: Dr. Quentin Rae-Grant
    • Pages: 439 - 439
      PubDate: 2016-06-14T12:46:59-07:00
      DOI: 10.1177/0706743716651050
      Issue No: Vol. 61, No. 7 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
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