[Progress and living situations among the elderly with severe mental illness: perspectives of psychosocial services]. / Cheminements et situations de vie des personnes âgées présentant des troubles mentaux graves : perspectives d'intervenants psychosociaux.

Services for elders with severe mental illness (SMI) have major deficiencies, among them a lack of adequate psychosocial services. Some analysts have attributed this situation to "double stigmatization" targeting both ageing and mental illness in our societies. Using qualitative methods (23 semi-directed interviews, theme-based content analysis), our exploratory research aims to understand better the perceptions of psychosocial practitioners working in community and institutional settings about the elderly with SMI and their living situations. Our informants evoke living situations marked by a lack of support (isolation), of resources (financial precariousness/poverty) and of power (learned passivity), traits that are related not only to mental illness per se, but also to long term psychiatric institutionalization. For them, the current situation of elders with SMI is the end product of biographies in which life-course, illness-course and life in services and/or institutions join and, sometimes, become indistinguishable. Implications for psychosocial practices are discussed.

Immigration, lack of control and psychological distress: findings from the Oslo Health Study.

The aims of this study are to compare the level of psychological distress between Norwegian born and immigrants from countries with different income levels and culture, and to investigate the explanatory effect of socioeconomic and psychosocial factors, with special emphasis on lack of control (powerlessness and self-efficacy). A cross-sectional survey with self-administered questionnaire was conducted in 2000-2001 in a sample of 15,723 adults living in Oslo. Psychological distress was measured by a ten-item shortened version of Hopkins Symptom Checklist-25 items, whereas psychosocial variables were measured by various instruments. The results show that the level of psychological distress is significantly higher in immigrants from low- and middle-income countries than in the Norwegian born and the immigrants from high-income countries. They also report more powerlessness, more negative life events, less social support, less income and less paid work. It is concluded that negative life events, mainly related to social network, somatic health and economic situations, as well as lack of social support, are important mediators between immigration from low- and middle-income countries to Norway and psychological distress. Powerlessness also plays a role, but this is mainly because of a concept overlap between psychological distress and powerlessness.

Unconventional indicators of drug dependence among elderly long-term users of benzodiazepines.

A quarter of the elderly population is prescribed benzodiazepines (BZD). This has led to growing concerns about drug dependence and the validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for dependence to a substance. This study aimed to understand how dependence was experienced by long-term BZD users. Interviews were conducted with 45 elderly persons who had been using BZDs for an average of nine years. These users' comments suggest six indicators of dependence: self-identifying as a dependent user, invoking multiple stressors to justify BZD use, using BZD to cope with anticipated stressors, trivializing the dangers of BZDs, keeping a supply in reserve, having previously tried and failed to stop, and reducing the dosage. Our results stress the need to take a more elaborate, person-centered view of dependence.

Biomedical cooptation of the psychological care and support continuum for severely distressed persons.

In this issue of Ethical Human Sciences and Services, Lehrman describes his vision, focusing on continuity of care, of a mental health care system for psychosis. His main argument is that the same psychiatrist should treat an individual patient whatever the settings (hospital, community) that the patient shifts through, and that the psychiatrist is the key treating professional and as such should manage and direct care over the continuum. While continuity of psychiatric care is desirable and indeed noncontroversial and feasible, psychiatric services are not central to the care continuum, and its psychiatric control will lead to even more biomedical orientation in patient care. This would undermine another key aspect of Lehrman's vision: a mental health system focused upon the whole person in interaction with the environment. The history of psychiatry shows that, as a medical specialty, psychiatry will inevitably focus upon the brain rather than the person. Psychiatric care could serve as adjunct to appropriate supports, services, and treatment, but if it determines them, they will merely become a downplayed accessory of biomedical (i.e., psychotropic drug) treatment.

Factors in duration of anxiolytic, sedative, and hypnotic drug use in the elderly.

At least 2 decades of descriptive research on factors associated with psychotropic drug use by the elderly in the community has failed to yield convergent results. The authors posited that duration of use may have been confounding results of previous studies, since variables influencing initial use may not be those influencing long-term use. They conducted a secondary analysis of the elderly respondents in the cross-sectional 1998 Quebec Health Survey (n = 3,012). Results clearly show that factors associated with ASH use vary with duration of use. Apart from depression, medical and mental health factors significant for short-term use are not associated with long-term use. The only factors found that explain long-term but not short-term use were gender (female) and health perception (less than positive). These findings suggest that over the long term it is unlikely that mental health therapeutic benefits explain ASH use. The authors hypothesize that drug dependency could play a role in long-term use. They therefore encourage community health nurses to implement withdrawal programs in order to reduce harmful long-term consumption.

An integrated exploration into the social and environmental determinants of health: the Saskatchewan Population Health and Evaluation Research Unit (SPHERU).

The Saskatchewan Population Health and Evaluation Research Unit (SPHERU) is a new interdisciplinary research institute established by the Universities of Saskatchewan and Regina. SPHERU developed four of its research programs using a hierarchic model of health determining conditions and contexts. In descending order these programs include: Economic and Environmental Globalization, Governance and Health Community/Environment as a Health Determinant Multiple Roles, Gender and Health Determinants of Healthy Childhood Development A fifth program researching the determinants of health of indigenous peoples spans all four levels. Two research projects, one on power, control and health, and another on community capacity building approaches to human service programs, assist SPHERU in developing the theoretical linkages between its programs. This article describes SPHERU's research model and the Unit's approach to research and summarizes each of its current research programs and projects.