Psychological, Physical and Behavioral Health of Adults, 3 Years After Exposure to a Train Derailment.

In July 2013, a train derailment profoundly disrupted the tranquility of the population of Lac-Mégantic for months and even years. In 2016, we conducted a representative population-based survey among 387 people from Lac-Mégantic and 413 from other municipalities with the aim to document psychological and physical health of adults exposed to the disaster. This article examines differences between 3 groups of respondents: those who were highly, moderately or not exposed to the train accident. Khi Square analyses, odds ratios and logistic regressions were used to examine differences between the 3 groups of respondents (high, moderate and no exposure). Results show that the level of exposure to this technological disaster is strongly associated with psychological suffering, post-traumatic growth, physical heath, drinking patterns, and use of prescribed and non-prescribed drugs. We can explain these results by the nature and cause of the event as well as its consequences.

An online peer support program to improve mental health among university students: A randomized controlled trial.

Despite recent calls for more peer support initiatives aimed at promoting mental health in postsecondary institutions, those initiatives remain scarce. In this study, a multisite randomized controlled trial was designed to assess the effect of an online peer support intervention based on acceptance and commitment therapy using mental health and school indicators. Undergraduate students were recruited in three Canadian universities and randomly assigned to an intervention (n = 54) or a wait-list control group (n = 53). Compared to control participants, those who took part in the program self-reported reduced psychological inflexibility, stress, anxiety and depression, and increased psychological flexibility and well-being. The intervention had no effect on academic satisfaction and engagement. These results were found both in completer and intent-to-treat samples. The findings provide evidence that peer support may be a beneficial adjunct to mental health interventions offered to college and university students.

An Interpersonal Approach to the Treatment of Social Anxiety Disorder (Social Phobia): A Component Analysis.

Background: Most treatments of social anxiety disorder aim at anxiety reduction. To what extent this leads to improved social functioning remains unclear. An effective alternative aiming primarily at social functioning- the Interpersonal Approach- is available. The present study sought to identify its active ingredients. Methods: This is a randomized controlled study; 102 social anxiety disorder individuals were randomly assigned to 3 versions of the Interpersonal Approach. A total of 76 patients completed treatment and 67, a 1-year follow-up. The patients met Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for social anxiety disorder. The study was carried out in an experimental clinic for the treatment of social anxiety disorder at the Research Center of Louis-H. Lafontaine Hospital in Montreal, Canada. Results: No clinically meaningful change occurred during the waiting list. A significant and equivalent improvement was obtained in all treatment conditions in social functioning, anxiousness, and general psychopathology, maintaining over a 12-month follow-up. Remission rates improved progressively with 54% remission at 1-year follow-up. All variants of the Interpersonal Approach resulted in similar improvements. Conclusion: The Interpersonal Approach in all its versions has proved to be effective in reducing anxiety complaints and improving social functioning. The combined improvement in these 2 outcomes accounts for the significant remission rates seen at 1-year follow-up. Two active features were common to all: (1) targeting and ultimately dissolving long-standing habits of self-protection across various spheres of life and (2) fostering participatory interpersonal patterns of behavior, enacted by patients systematically and repeatedly between sessions.

Processes of change within acceptance and commitment therapy for university students: Preliminary evidence from a randomized controlled trial.

OBJECTIVE: This randomized controlled trial examined whether KORSA workshops indirectly influence anxiety, depression and stress symptoms among university students through their effect on two second-order psychological flexibility processes: 1) mindfulness and acceptance, and 2) commitment and behavior change. Participants: During the fall 2014 and the winter 2015 semesters, 124 students participated in the study. Methods: They were randomized to either a 4-week intervention group (n = 61) or a wait-list control group (n = 63). They completed measures of anxiety, depression, stress and psychological flexibility before and immediately after the intervention. Results: Bootstrapping-based mediation analyses showed that the intervention indirectly influenced symptoms reduction through its effect on acceptance and mindfulness processes, but not through commitment and behavior change processes. Conclusions: These initial findings suggest that contact with the present moment, acceptance, cognitive defusion and self as context are important processes of change through which KORSA workshops affect the students mental health.

The Use of Acceptance and Commitment Therapy to Promote Mental Health and School Engagement in University Students: A Multisite Randomized Controlled Trial.

The aim of this multisite randomized controlled trial was to determine whether an intervention based on Acceptance and Commitment Therapy (ACT) was efficacious in improving university students' psychological flexibility, mental health, and school engagement. Students were recruited in four Canadian universities and randomly assigned to an intervention (n = 72) or a wait-list control group (n = 72). Students in the intervention group took part in four 2.5-hour workshops during a 4-week period and were asked to do exercises at home (e.g., meditation, observation grids). Wait-list students received the intervention soon after the post measurements. MANCOVAs and ANCOVAs revealed that students in the intervention group showed greater psychological flexibility at postintervention than those in the control group. They also reported greater well-being and school engagement, and lower stress, anxiety, and depression symptoms. Taken together, results of this study suggest that an ACT-based intervention offers a valuable way to promote mental health and school engagement in postsecondary settings.

A Comparative Descriptive Study of Characteristics of Early- and Late-Onset Dementia Family Caregivers.

Characteristics of early- and late-onset dementia family caregivers were described and compared. Based on a theoretical model of role transition, data were collected through structured interviews from 48 caregivers of adults with Alzheimer's disease or a related dementia older than the age of 70 and 48 caregivers of similarly diagnosed adults younger than the age of 60. A significantly higher proportion of caregivers of younger adults were spouses and gainfully employed compared with those of older adults; they had more years of schooling, took care of a person with more severe impairments, received more help, perceived themselves as better prepared to deal with future needs, and better informed about services. They did not differ from caregivers of older adults in terms of psychological distress, role confidence, self-efficacy, and social support. This study highlights differences and similarities to be considered in the development of services tailored to the specific needs of each group.

Maintaining the potential of a psycho-educational program: efficacy of a booster session after an intervention offered family caregivers at disclosure of a relative's dementia diagnosis.

BACKGROUND: Booster sessions as a means of maintaining the benefits of psycho-educational programs have received little attention in caregiving research. Caregivers were offered a booster session following participation in a program entitled Learning to Become a Family Caregiver (LBFC) intended to facilitate transition to the caregiver role after diagnostic disclosure of dementia in a relative. The 90-minute booster session served to review program content and afforded the opportunity to discuss and practice learned skills. This study sought to test the efficacy of the booster session in maintaining or recovering program effects at six months post-program. METHOD: Participants in the program were randomly assigned to a group that received the booster session (n = 31) or a group that did not (n = 29). A third control group was also formed, which continued to receive only the usual care provided in memory clinics. Eligible participants - French-speaking primary caregivers of a relative diagnosed with Alzheimer's in the past nine months - were recruited in memory clinics in Quebec (Canada). Participants were blindly assessed before randomization and six months after the booster session on outcomes associated with a healthy role transition. RESULTS: Prediction analyses revealed one significant positive effect of the booster session: emergence of preparedness to provide care. Moreover, with or without the booster session, the program continued to have a positive effect on psychological distress and contributed to the emergence of self-efficacy in dealing with caregiving situations. The booster session had no significant effect on knowledge of services, planning for future care needs, use of reframing as a coping strategy, perceived informal support, and family conflicts. CONCLUSION: The limited effect observed is discussed in terms of the booster session's content and intensity. Recommendations are made for designing future research on the effect of booster sessions, including the importance of including a placebo booster group.

"Learning to become a family caregiver" efficacy of an intervention program for caregivers following diagnosis of dementia in a relative.

PURPOSE: The purpose of this experimental study was to test the efficacy of a psychoeducational individual program conceived to facilitate transition to the caregiver role following diagnosis of Alzheimer disease in a relative. DESIGN AND METHODS: Caregivers were recruited in memory clinics and randomized to an experimental group (n = 62) or a control group (n = 49) receiving usual care. Eligible participants-primary caregivers of a relative diagnosed with Alzheimer in the past 9 months-were assessed blindly before randomization, at the end of the program (post-test), and 3 months later (follow-up) on different outcomes associated with healthy role transition. RESULTS: The analyses indicated that at post-test and follow-up, caregivers in the experimental group were more confident in dealing with caregiving situations, perceived themselves to be better prepared to provide care and more efficacious in their caregiver role, were better able to plan for the future care needs of their relative, had better knowledge of available services, and made more frequent use of the coping strategies of problem solving and reframing. The program had no significant effect on use of stress-management strategies, perceived informal support and family conflicts. IMPLICATIONS: This program underscores that a proactive intervention approach from the onset of the care trajectory is key to fostering caregiver adaptation to the new challenges they must meet.

Challenges associated with transition to caregiver role following diagnostic disclosure of Alzheimer disease: a descriptive study.

BACKGROUND: The prevalence of Alzheimer's disease is rising. The large number of new cases identified each year means that many new families will set upon a long trajectory of caring for a relative with dementia. Diagnostic disclosure of Alzheimer's disease marks the official transition to the caregiver role, yet this early period of the caregiver career have rarely been studied. OBJECTIVES: Based on Meleis's theoretical framework for role transition, the objectives of this study were to document the characteristics of the caregiving context during the transition to the caregiver role following diagnostic disclosure of Alzheimer's disease and to compare these characteristics by caregiver gender and kinship tie to the relative. DESIGN SETTINGS AND PARTICIPANTS: A descriptive design was used. Data were collected using standardized measures selected in accordance with the role transition theoretical framework. The sample recruited in Quebec (Canada) cognition clinics comprised 122 caregivers of an elderly relative diagnosed with Alzheimer's disease in the past nine months. RESULTS: Findings reveal the context of care to be marked by several challenges for caregivers. The majority of caregivers receives little informal support, has poor knowledge of available formal services, and has difficulty planning ahead for the relative's future care needs. Caregivers themselves report a lack of preparedness to provide care. Compared with men caregivers, women seem to have more problems controlling disturbing thoughts about their new caregiver role and to experience more family conflicts and psychological distress. Compared with offspring caregivers, spouse caregivers are less able to respond to the relative's disruptive behaviors, make less use of problem-solving strategies, and report fewer family conflicts. CONCLUSIONS: The challenges faced by caregivers during the transition to the caregiver role are sensitive to nursing interventions. Pro-active interventions from the outset of the caregiving career, such as early assessment of caregiver needs for support and of caregiver preparedness to provide care as well as early psycho-educational interventions, are essential to foster positive caregiver responses to the challenges of their new role.

Psychopathological manifestations of children with intellectual disabilities according to their cognitive and adaptive behavior profile.

Children with intellectual disabilities show deficits in cognitive abilities and adaptive behavior which increase the risk of psychopathological disorders. This exploratory study aims at delineating profiles of children based on their cognitive functioning and adaptive behaviors, and to compare them on psychopathological manifestations. A cognitive assessment and an evaluation of adaptive behaviors are conducted with 52 school-age children receiving services from a rehabilitation center for people with intellectual disabilities. Adaptive behaviors are evaluated by a special educator and a questionnaire concerning psychopathology is filled out by a parent and a teacher. Cluster analyses highlight three profiles among children: Performing, Uncooperative and Non-performing. They differ on cognitive functions, collaboration and in terms of practical abilities of adaptive behaviors. Chi-square tests show significant differences in social competences, but not in problematic behaviors, according to the viewpoint of parents and teachers. Potential explanations are provided to understand the absence of significant differences in problematic behaviors between the three profiles.

Burnout, psychological distress, and overwork: the case of Quebec's ophthalmologists.

BACKGROUND: Studies have shown that physicians are subject to high stress levels that can lead to mental health problems. Ophthalmologists are facing particularly high pressures because of shortages in their number and lack of resources. This study describes the state of mental health of Quebec's ophthalmologists and identifies certain elements of their work environment and personal lives that may contribute to problems. METHODS: This cross-sectional study uses self-report questionnaires, including validated instruments, as well as instruments created for the study. A total of 133 out of 266 Quebec's ophthalmologists participated in the study. RESULTS: More than 35% of ophthalmologists reported high levels of burnout and psychological distress. The 5 main occupational stressors were growth in demand for services (49.2%), shortage of ophthalmologists (48.1%), amount of work to be done (45.4%), budgetary pressures (44.6%), and repeated training of new work teams (41.9%). Self-acceleration is the defensive strategy used most often to deal with work overload. Nearly half (47.4%) reported having problems reconciling work and personal life. The mean scores indicate that ophthalmologists received little recognition from administration. INTERPRETATION: Work overload and systemic organizational deficiencies are burdening ophthalmologists in Quebec. They constantly work harder to preserve their professional ideals, but they receive little recognition from the administration. The levels of distress observed in this context point to the need for the authorities to take action to improve practice conditions. The situation is urgent because population aging has already begun to cause a sharp increase in demand, and younger physicians appear to be suffering most from work overload and burnout.

Predicting longitudinal patterns of psychological distress in older husband caregivers: further analysis of existing data.

Further analysis of existing data from a previous longitudinal study of older husband caregivers sought to determine whether primary objective and subjective stressors drawn from Pearlin's model of caregiving could predict three patterns of psychological distress observed in the sample over 1 year: (a) stable high (n=115), (b) stable low (n=44), and (c) rising (n=46). Results of discriminant function analyses show that subjective stressors (level of role overload, role captivity and relational deprivation) at baseline, distinguish the stable low group of husbands from the stable-high. The results suggest that there is considerable stability over time. Many husband caregivers report high-psychological distress and need help, whereas there is a need of preventive interventions to keep psychological distress low. Implications for singular interventions that target specific factors according to group membership are discussed.

Changes in health outcomes among older husband caregivers: a one-year longitudinal study.

This one-year longitudinal study carried out on a sample of 232 older husband caregivers sought to describe changes in psychological distress and self-perceived health, and to examine relationships between factors drawn primarily from Pearlin's model of caregiving and changes in these two health outcomes. Prediction analyses shows that nearly two thirds of the husbands have unsuccessful outcomes with respect to these two dimensions, that is, most husbands obtain either steadily poor scores at both times of the study or worse scores on one or both outcomes. Higher levels of education and informal instrumental support at time 1, as well as an increase in role overload, are predictive of unsuccessful outcome for psychological distress, whereas an increase in self-efficacy predicts successful outcome for self-perceived health. Overall, husband caregivers vary in their response to caregiving over time. The findings support previous study results showing subjective stressors, rather than objective stressors, and caregiver resources to be significant predictors of caregiving outcomes.

Implementation and effects of an individual stress management intervention for family caregivers of an elderly relative living at home: a mixed research design.

The purpose of this project was to evaluate the implementation and effects of a stress management intervention for family caregivers of elderly persons. The intervention was implemented through an action research design with the collaboration of case managers working in community health centers. A total of 81 caregivers participated in the study. The quasi-experimental design used to test the effects of the intervention showed significant effects on perceived challenge associated with caregiver role, control by self, use of social support, and use of problem solving. Qualitative data demonstrate caregiver empowerment with respect to the caregiving role. This study illustrates the relevance of using a mixed research design in order to provide evidence for changes in practice.

Older husbands as caregivers of their wives: a descriptive study of the context and relational aspects of care.

The purpose of this study was to describe the context and relational aspects that characterize male caregiving. The sample comprised 323 older husbands caring for their wives in Quebec (Canada). Nearly 60% of them spent at least 84 h/week caregiving and about 40% regularly performed personal care and instrumental tasks. Family provided emotional support above all and service utilization was limited for certain services. Husbands perceived relational deprivation but also personal gain relative to their role. Conflicts seldom occurred with family members. Comparisons between husbands of wives with and without memory problems revealed selected differences on context and relational variables. This study contributes to knowledge on male caregivers and provides directions for nursing practice and research.

Follow-up of an intervention program for caregivers of a relative with dementia living in a long-term care setting: Are there any persistent and delayed effects?

The purpose of this randomized study was to test the persistent and delayed effects of an intervention program entitled "Taking Care of Myself " on selected mental health outcomes of daughter caregivers of a relative with dementia living in a long-term care setting. One group of caregivers took part in the experimental program (EG, n = 45), one in a comparison program offered by an Alzheimer Society (AG, n = 51), and another constituted a control group (CG, n = 41). Effects were verified at the end of the program and 3 months later. Results from prediction analyses reveal that competence dealing with healthcare staff and use of the coping strategy of reframing were persistent effects unique to the EG condition, whereas perceived availability of informal and formal support was a persistent effect in the EG and in the AG. A delayed effect was observed in the AG regarding competence dealing with healthcare staff. These results underline the importance of follow-up assessments of intervention programs and suggest avenues to support caregivers of institutionalized seniors.

Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: a replication.

The aim of this study was to replicate and extend the findings of O'Connor, Bélanger, Marchand, Dupuis, Elie, and Boyer [Addict. Behav. 24 (1999) 537], which had established a psychosocial profile associated with psychological distress in benzodiazepine (BZD) use. Forty-one participants with anxiety or insomnia, receiving maintenance therapy of BZD for at least 8 weeks, participated in a 20-week, tapered discontinuation protocol with physician counselling. Drug type and use was monitored throughout. Questionnaire measures of anxiety, behavioural inhibition, neuroticism, withdrawal complaints, social support, psychological distress, self-efficacy in coping without BZD, quality of life, positive and negative life events, were completed at baseline, postdiscontinuation, and at 3-month follow-up. Measures of baseline psychological distress and anxiety inhibition were consistently associated with both discontinuation and the emergence of withdrawal complaints. Successful withdrawal was characterized by low baseline neuroticism, low behavioural inhibition, higher number of positive events, and higher level of social support satisfaction. Higher dosage (in diazepam equivalent dose) was associated with both poorer outcome and the emergence of withdrawal symptoms. Self-efficacy in coping was negatively associated with relapse but not with outcome. Psychosocial factors play a role at different stages of the BZD withdrawal process and could be targeted in treatment.

Locus of control and academic efficacy in the thoughts of life and death of young Quebec university students.

This study evaluated the role of control and efficacy expectations in the thoughts of life and death of 50 male and 50 female university students and investigated sex differences in this regard. It followed a correlational design and employed measures of tridimensional locus of control, expectations of academic efficacy, thoughts of life and death. A comparison of means revealed that male students did not differ from their female counterparts on any of the variables under study. Stepwise regression coefficients indicated that the two cognitive factors accounted more for thoughts of death than for thoughts of life; expectations of academic efficacy were the single variable that most explained variance. Regression equations by sex showed that thoughts of life were associated with internality and expectations of academic efficacy in females, and that thoughts of death were associated with expectations of academic inefficacy in males. The university counseling personnel should be especially sensitive to youths presenting with expectations of externality and of academic inefficacy. The latter variable seems to be particularly important, regardless of sex.