Mental health service use of young people in child welfare services in Quebec, Canada.

Background: Youth involved in child welfare have high rates of mental health problems and are known to receive mental health services from multiple settings. Still, gaps remain in our understanding of service use patterns across settings over the course of youth's involvement with child welfare. Objective: To examine the settings, reasons for contact, persons involved in initiating care, and timing of each mental health service contact for individuals over their involvement with the child welfare system, and to identify factors that predict multi-setting use. Methods: Data on mental health service contacts were collected retrospectively from charts for youth aged 11-18 (n=226) during their involvement with child welfare services in Montreal, Quebec. Logistic regression analysis was conducted to determine predictors of multi-setting mental health services use (defined as ≥3 settings). Results: 83% of youth had at least one mental health service contact over the course of their child welfare services follow-up, with 45% having multi-setting use. Emergency Departments were the top setting for mental health services. Youth with a higher number of placements and from neighborhoods with greater social and material deprivation were significantly likelier to use ≥3 mental health service settings over the course of their follow-up. Conclusion: These findings suggest a need for enhanced collaboration between youth-serving sectors to ensure that continuous and appropriate mental health care is being offered to youth followed by child welfare systems. The relationship between placement instability and multi-setting mental health service use calls for specific policies to ensure that young people do not experience multiple discontinuities of care.

Contexte: Les jeunes impliqués dans le système de la protection de la jeunesse ont des taux élevés de problèmes de santé mentale et il et ils reçoivent souvent des services de santé mentale dans plusieurs types d'établissements. Pourtant, des lacunes subsistent dans notre compréhension des trajectoires d'utilisation des services à travers divers contextes au cours du suivi d'un jeune dans le système de protection de la jeunesse. Objectif: Examiner les contextes, les raisons pour les contacts, les personnes impliquées dans l'initiation des soins, et le moment de chaque contact avec les services de santé mentale pour les personnes pendant la durée de leur suivi en protection de la jeunesse et identifier les facteurs qui prédisent une trajectoire impliquant de multiples établissements. Méthodes: Des données sur les contacts avec les services de santé mentale ont été recueillies rétrospectivement des dossiers de jeunes de 11 à 18 ans (n=226) leur suivi en protection de la jeunesse à Montréal, Québec. Une analyse de régression logistique a été menée pour déterminer les prédicteurs de l'utilisation des services de santé mentale multi-établissements (définie à ≥3 établissements). Résultats: Quatre-vingt-trois pour cent des jeunes avaient au moins un contact avec un service de santé mentale au cours de leur suivi en protection de la jeunesse, et 45 % avaient une trajectoire impliquant de multiples établissements. Les services d'urgence étaient l'établissement le plus fréquenté pour les services de santé mentale. Les jeunes ayant un nombre plus élevé de placements et provenant de quartiers d'une plus grande défavorisation sociale et matérielle étaient significativement plus susceptibles d'utiliser ≥3 établissements de services de santé mentale au cours de leur suivi. Conclusion: Ces résultats démontrent le besoin d'une collaboration améliorée entre les secteurs des services aux jeunes pour faire en sorte que les jeunes en protection de la jeunesse reçoivent des soins de santé mentale continus et appropriés. La relation entre l'instabilité de placement et les trajectoires complexes à travers les services de santé mentale exige de politiques spécifiques afin d'assurer que les jeunes ne connaissent pas de multiples discontinuités de soins.

Emergency Department Use for Mental Health Problems by Youth in Child Welfare Services.

Objectives: In Canada, little research has focused on emergency department (ED) use by youth involved with child welfare services, a vulnerable population. Our aims were therefore (1) to examine the characteristics of ED users among child welfare-involved youth, 2) to identify predictors of ED use and 3) to identify youth trajectories to EDs. Methods: Data were collected from child welfare charts from two agencies in Montreal, Canada. Logistic regression was conducted to determine the predictors of ED use. Latent class analysis was used to identify trajectories to the ED. Results: The sample included 226 youth aged 11-18 years. 33% of youth visited the ED at least once for mental health problems during child welfare involvement. ED users were more likely to be youth with a history of 1) sexual abuse, 2) parental mental illness, and 3) placements outside of the home, compared to youth with no ED visits. Mental health treatment was initiated in the 30 days following an ED presentation in 24% of cases. Three trajectories were found: 1) ED contact initiated by child welfare workers for suicidal ideation/attempts, 2) ED contact initiated by police for substance use and externalized behaviours and 3) ED contact initiated by parents for suicidal ideation/attempts. Discussion: Despite all youth being followed by child welfare and many already receiving mental health services, youth had high, often recurrent ED use. This highlights the need for stronger coordination between child welfare, youth mental health services and EDs.

Objectifs: Au Canada, peu de recherche s'est penchée sur l'utilisation du service d'urgence (SU) par les jeunes impliqués dans les services d'aide à l'enfance, une population vulnérable. Nous visions donc à (1) examiner les caractéristiques des utilisateurs de SU chez les jeunes impliqués dans l'aide à l'enfance, 2) identifier les prédicteurs de l'utilisation de SU et 3) identifier les trajectoires des jeunes au SU. Méthodes: Les données ont été recueillies des dossiers de l'aide à l'enfance dans deux agences de Montréal, Canada. La régression logistique a été menée pour déterminer les prédicteurs de l'utilisation du SU. L'analyse de classe latente a servi à identifier les trajectoires au SU. Résultats: L'échantillon comprenait 226 jeunes âgés de 11 à 18 ans, dont 33 % ont visité le SU au moins une fois pour des problèmes de santé mentale durant leur implication à l'aide à l'enfance. Les utilisateurs de SU étaient plus susceptibles d'être jeunes avec des antécédents de 1) abus sexuel, 2) maladie mentale parentale, et 3) placements hors du foyer, comparés aux jeunes sans visite au SU. Un traitement de santé mentale a été initié dans les 30 jours suivant une présentation au SU dans 24 % des cas. Trois trajectoires ont été distinguées: 1) un contact avec un SU initié par les travailleurs de l'aide à l'enfance pour des idéations/tentatives de suicide, 2) un contact avec un SU initié par la police pour utilisation de substances et comportements externalisés et 3) un contact avec un SU initié par les parents pour des idéations/tentatives de suicide. Discussion: Bien que tous les jeunes aient été suivis par l'aide à l'enfance et que nombre d'entre eux aient déjà reçu des services de santé mentale, les jeunes avaient une utilisation élevée souvent récurrente du SU. Ceci met en lumière le besoin d'une coordination plus forte entre l'aide à l'enfance, les services de santé mentale pour les jeunes et les SU.

[The Project TANGO Training: Supporting intervention with clients with borderline personality disorder in youth protection and CLSCs]. / La formation Projet TANGO : soutenir l'intervention auprès de la clientèle ayant un trouble de personnalité limite en protection de la jeunesse et en CLSC.

Objectives The relational mode and engagement difficulties of individuals with borderline personality disorder (BPD) can elicit a variety of emotions in the clinician. Emotional activation and compassion fatigue are thus common and can lead to counterproductive interventions. Working with this clientele requires the ability to regulate negative emotions and inhibit associated behaviors. However, the processes involved in this emotional work are rarely made explicit and even less taught. The Project TANGO training was developed to help clinicians modify their emotional and behavioral reactions in the context of common complex interventions. Strategies from dialectical behavioral therapy are taught so that they can use them to self-regulate during emotionally demanding interventions. The purpose of this study is to evaluate the effects of this training on intervention skills and readiness. Method The Project TANGO training was evaluated using a mixed-methods design with 184 practitioners working with adolescents and adults in youth protection (YP) and CLSC settings. Measures of emotion regulation, attitudes towards people with BPD, quality of professional life and self-esteem as a worker with this clientele were taken before, after and 3 months after the training. Pre- and post-training focus groups were used to document the challenges of working with this clientele and to assess the more difficult to quantify effects. Results All of the pre-test measures showed more favourable scores for PJ workers than for CLSC clinicians. Qualitative analyses suggest that they use emotional regulation strategies, such as masking the true emotion and simulating another emotion, which have been associated with burnout. Among PJ workers, the effects of Project TANGO were significant for variables associated with readiness to intervene, suggesting more positive Perceptions and Attitudes towards the clientele (p=0.011, ηp2= 0.160 and p=0.036, ηp2= 0.120), more Compassion Satisfaction and a decrease in Compassion Weariness (p=0.001, ηp2= 0.222 and p=0.002, ηp2= 0.212) three months after the training. CLSC clinicians achieved benefits on their Perceptions (p<0.001, ηp2= 0.168), Attitudes towards BPD (p<0.001, ηp2= 0.185) and Satisfaction with Compassion (p=0.042, ηp2= 0.065) upon completion of the training. Conclusion This study shows that the two groups benefit differently from the training. The results suggest that the training resulted in a more accurate reading of the challenges of intervention among YP practitioners. On the other hand, since these dispositions were more present among CLSC clinicians before the training, they seem to have benefited from the training to increase their intervention skills.

Nonsuicidal Self-Injury in Early Adolescence as a Predictor of Borderline Personality Disorder in Early Adulthood.

Borderline personality disorder (BPD) typically has an onset in adolescence. Nonsuicidal self-injury (NSSI) could be associated with its subsequent development. The aim of this study was to examine whether NSSI among adolescents in the community is associated with a risk for BPD in emerging adulthood. Sixty-nine adolescents (11-13 years old) with a history of NSSI and 61 matched controls were assessed for NSSI and then reassessed between ages 18 to 20 years. Findings showed that continuation of NSSI over time was associated with higher ratings of BPD symptomatology and greater impairment in psychosocial functioning. Both of these relations were mediated by deficits in emotion regulation. These results suggest that adolescents who engage in NSSI may need to be assessed for problems regulating emotions and to be provided with early interventions to help prevent continuation of NSSI.

Engagement complications of adolescents with borderline personality disorder: navigating through a zone of turbulence.

OBJECTIVE: Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Adolescents with borderline personality disorder (BPD) are heavy users of health care services and notoriously difficult to engage in treatment. However, there is hardly any data regarding this phenomenon with these youths. Considering that BPD treatment is associated with intense and chaotic therapeutic processes, exploring barriers emerging in the course of treatment could be relevant. Thus, conceptualizing treatment dropout as a process evolving from engagement to progressive disengagement, and ultimately to dropout, could highlight the mechanisms involved. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD. METHOD: A constructivist grounded theory method was used. This method has been favoured based on the assumption that the behaviours and decisions leading to disengagement may be better informed by the subjective experience of treatment. Thirty-three interviews were conducted to document 11 treatment trajectories with 3 groups of informants (9 adolescents with BPD 13-17 of age, 11 parents, and 13 clinicians). RESULTS: Well before dropout occurs, different phenomena identified as "engagement complications" characterize the disengagement process. These unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment. These emotions will then generate treatment interfering attitudes that eventually evolve into openly disengaged behaviours. These complications, which may sometimes go unnoticed, punctuate the progression from treatment engagement to disengagement leading the way towards the development of a "zone of turbulence" which creates a vulnerable and unstable therapeutic process presenting risk for late dropout. CONCLUSION: Engagement of adolescents with BPD is neither static nor certain, but on the contrary, subject to their fluctuating perceptions. Therefore, it can never be taken for granted. Clinicians must constantly pay attention to emergent signs of engagement complications. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.

Clinical outcomes of a stepped care program for borderline personality disorder.

OBJECTIVE: This study examines the clinical outcomes of two clinics for borderline personality disorder (BPD) in a naturalistic setting, offering a stepped care model with both short-term (ST) treatment lasting 12 weeks and extended care (EC) up to 24 months. METHODS: A total of 479 patients attending the ST clinic and 145 attending the EC clinic were assessed on depression, impulsivity, self-esteem, emotion dysregulation, substance abuse, self-harm and suicidality. RESULTS: There were significant reductions in all symptoms in both clinics with the exception that substance abuse was only reduced in the EC clinic. On all symptoms, no significant differences in magnitude of changes were observed between patients who stayed in EC clinic for 6-12 months in comparison to those who stayed for 18-24 months. CONCLUSIONS: These results support the concept that for the majority of patients with BPD, brief treatment can be effective. While some patients still need longer treatment, the results are encouraging for brief treatment as a first step for the majority of patients with BPD. While this study adds to the weight of evidence to support ST interventions for patients with BPD, further research using a control group is needed. Copyright © 2018 John Wiley & Sons, Ltd.

High Prevalence of Physical Pain Among Treatment-Seeking Individuals With Borderline Personality Disorder.

Research has demonstrated that about 30% of chronic pain patients suffer from borderline personality disorder (BPD), yet pain is not often discussed in research on the treatment of BPD. Sixty-five patients entering outpatient treatment for BPD were assessed at baseline for the prevalence of DSM-IV lifetime pain disorder, current medical problems, and the experience of current pain as measured by the McGill Pain Questionnaire. DSM-IV lifetime pain disorder diagnosis was present in 65% of patients. Current pain was experienced by 89% of participants, with intensity ranging from mild (19%) to excruciating (2%). Some individuals (21.5%) also reported experiencing daily medical problems in the past month prior to entering treatment. Physical pain is highly prevalent among treatment-seeking individuals with BPD. This pain phenomenon should be considered during treatment to help prevent a lifetime of functional impairment, including the possibility of abusing substances as a maladaptive coping mechanism.

Estimating the prevalence of borderline personality disorder in mothers involved in youth protection services.

Characteristics of borderline personality disorder (BPD) can undermine maternal capacity and in some cases lead to involvement with youth protection services (YPS). Yet, few studies exist on the prevalence of maternal BPD in this context and on the comparison of these families with families with other maternal psychiatric disorders or families with no mental illness within YPS. The current study surveyed 291 caseworkers working with mothers whose children and adolescents are followed by YPS. After reported prevalence was adjusted with validation procedures, the prevalence of maternal BPD in a sample of 1875 mothers was 34.3%. Comparison of three groups of families suggest that some risk factors, including substance abuse and severe conjugal conflicts, were more frequent in mothers with BPD than in mothers with other psychiatric illness or none. Furthermore, results revealed that 48.9% of mothers with BPD had a history of being followed by YPS in their childhood. Finally, children of mothers with BPD were placed at a younger age than the other children and were less often reported for conduct disorder. These results call for more attention to these highly vulnerable parents and children in both research and in adult and child mental health services. Copyright © 2017 John Wiley & Sons, Ltd.

Substance Misuse Is Associated With Increased Psychiatric Severity Among Treatment-Seeking Individuals With Borderline Personality Disorder.

Despite high prevalence rates of concurrent borderline personality disorder (BPD) and substance use disorders (SUDs), little is known about the impact of substance misuse on the presentation of BPD. Sixty-five individuals with BPD were assessed at intake and at 3- and 6-month follow-up. Assessment included validated instruments such as the Addiction Severity Index and the Revised Symptom Checklist (SCL-90-R). Over half (58.5%) of individuals entering treatment were currently misusing substances. Substance misuse was associated with more legal and employment problems, greater mood disturbance, impulsivity, and psychiatric severity, including almost all SCL-90-R subscales. For the majority of patients (58%), there was little change in substance misuse post-treatment. The high prevalence of substance misuse and its association with psychiatric severity among individuals with BPD suggest that substance misuse should be a targeted behavior during treatment, and further specialized interventions are needed for individuals with comorbid BPD and SUD.

Prevalence, Mortality, and Health Care Use among Patients with Cluster B Personality Disorders Clinically Diagnosed in Quebec: A Provincial Cohort Study, 2001-2012.

BACKGROUND: Cluster B personality disorders (PDs) are prevalent mental health conditions in the general population (1%-6% depending on the subtype and study). Affected patients are known to be heavier users of both mental and medical health care systems than patients with other clinical conditions such as depression. METHODS: Several rates were estimated using data from the integrated monitoring system for chronic diseases in the province of Quebec, Canada. It provides a profile of annual and period prevalence rates, mortality rates, and years of lost life as well as health care utilisation rates for Quebec residents. All Quebec residents are covered by a universal publicly managed care health plan. It is estimated that the monitoring system includes 99% of Quebec's 8 million inhabitants. RESULTS: Quebec residents aged 14 years and older were included in the study. The lifetime prevalence of cluster B PDs was 2.6%. The mean years of lost life expectancy were 13 for men and 9 for women compared to the provincial population. The 3 most important causes of death are suicide (20.4%), cardiovascular diseases (19.1%), and cancers (18.6%). In 2011 to 2012, 78% had consulted a general practitioner and 62% a psychiatrist, 44% were admitted to an emergency department, and 22% were hospitalised. CONCLUSIONS: Considering mortality, cluster B personality disorder is a severe condition, is highly prevalent in the population, and is associated with heavy health care services utilisation, especially in emergency settings.

[Model of Engagement and Dropout for Adolescents with Borderline Personality Disorder]. / Modèle de l'engagement et de l'abandon de traitement de l'adolescent avec trouble de personnalité limite.

Objectives More than half of suicidal adolescents, a large proportion of which manifest borderline personality disorder (BPD), drop out from treatment. The consequences of their premature termination are cause for concern given the recurrence of their suicidal attempts and that they present elevated risk for major mental disorders during adulthood. The study sought to gain a broader appreciation of processes involved in the treatment dropout among adolescents with BPD.Method A constructivist grounded theory was chosen using a multiple-case research design. Twelve cases were examined. Three groups of informants were recruited (adolescents, parents, and therapists involved in the treatment) and 34 interviews were conducted to document the cases. Theoretical sampling and the different stages of analysis specific to grounded theory were performed according to the iterative process of constant comparative analysis.Results Various dropout vulnerabilities specific to adolescents with BPD and their parents, including psychological characteristics, help-seeking context and perception of mental illness and mental healthcare were identified. Care-setting response including management of accessibility problems, adaptation of services to needs of adolescents with BPD, preparation for treatment, and consideration for the health professional's disposition to treat were also found to be determinant to their engagement to treatment. The processes of disengagement from treatment have also been specified. Negative perceptions regarding treatment, clinicians and receiving treatment have been shown to generate emotional activation. The aforementioned lead to counterproductive attitudes that evolve into outright disengagement behaviours. In this context, responses from the care-setting, such as an insufficient regulation of the engagement, therapeutic faux pas and paradoxical demands, precipitate premature treatment termination. Finally, the processes involved in the abandonment of treatment were formalized in the Model of engagement and treatment dropout for adolescent with BPD. This theoretical model highlights two key milestones that may lead to treatment completion or to dropout during care. It illustrates that distinct processes characterize the premature and late dropouts of adolescents with BPD. The early terminations result from the failure of the care-setting to take advantage of the impetus for help seeking to engage the adolescent and the parent at that first critical moment in the care trajectory. On the other hand, the late dropouts translate failures of the care-setting to adopt corrective measures to maintain the patient in treatment at a second critical moment indicated by their disengagement.Conclusion The termination rate of those adolescent treatments could be diminished by a system of care-setting that recognizes the inherent difficulties related to the treatment of those specific patients, is proactive to solve problems of disengagement, integrates support systems for clinicians and promotes a reflexive practice.

Exploring resilience and borderline personality disorder: a qualitative study of pairs of sisters.

Research indicates that a proportion of children exposed to childhood abuse develop psychological symptoms and are at risk for borderline personality disorder (BPD). However, not all maltreated children develop BPD as adults. This qualitative study explores some of the protective factors that contribute to resilient outcomes. The methods involved interviewing pairs of sisters who both experienced childhood abuse and family dysfunction but only one of whom developed BPD. The themes that emerged included individual, family, external and novel factors (acceptance of the past and the meaning of children). These findings could be helpful for understanding mechanisms of resilience in populations at risk.

Using a sibling design to compare childhood adversities in female patients with BPD and their sisters.

Abuse and neglect are well-established risk correlates of borderline personality disorder (BPD). The goal of this study was to examine whether BPD probands can be differentiated from their sisters with respect to a range of developmental adversity and maltreatment indicators, including retrospective self-reports of past experiences of childhood abuse and neglect, dysfunctional parent-child relationships and peer victimization and dysfunctional peer relationships. A total of 53 patients with BPD were compared to 53 sisters who were currently free of psychopathology on measures assessing childhood adversities. Both probands and sisters reported similar prevalence of intrafamilial abuse, although BPD patients reported more severe physical and emotional abuse. BPD patients reported higher prevalence of physical abuse by peers. These findings generally support the principle of multifinality, in which similar histories of adversities can be associated with a variety of outcomes, ranging from psychopathology to resilience.

Response inhibition deficits in unaffected first-degree relatives of patients with borderline personality disorder.

OBJECTIVE: Impulsiveness is a heritable feature of borderline personality disorder (BPD) which aggregates in families affected with the illness. Whereas BPD patients show deficits on neuropsychological tests of response inhibition, it is unknown whether these deficits are also present in their first-degree biological relatives who are at an increased genetic risk for this illness. The purpose of the current study was to identify and characterize a subgroup of BPD patients with pronounced response inhibition deficits, and secondarily, to estimate the relative recurrence risk of these deficits among affected families. METHOD: Thirty-nine pairs of female BPD probands and their unaffected first-degree biological sisters were recruited from hospital outpatient clinics. Participants completed the Conners' Continuous Performance Test (CPT) and the Barratt Impulsiveness Scale-11. RESULTS: BPD relatives made a similar number of commission errors on the CPT compared to healthy controls with no personal or family history of psychiatric illness; however, cluster analysis revealed a subgroup of BPD relatives who displayed clinically elevated commission errors and atypically fast RTs to target stimuli, indicating a genuine response inhibition deficit. The estimated relative recurrence risk for response inhibition deficits for all sibling pairs on the CPT was moderate at λ = 4.55. CONCLUSIONS: These findings suggest that response inhibition deficits are pronounced in some BPD relatives, may be heritable between siblings, are nonredundant with diagnostic status, and show promise as candidate neuropsychological endophenotypes for BPD.

Psychopathology, childhood trauma, and personality traits in patients with borderline personality disorder and their sisters.

The aim of this study was to document and compare adverse childhood experiences, and personality profiles in women with borderline personality disorder (BPD) and their sisters, and to determine how these factors impact current psychopathology. Fifty-six patients with BPD and their sisters were compared on measures assessing psychopathology, personality traits, and childhood adversities. Most sisters showed little evidence of psychopathology. Both groups reported dysfunctional parent-child relationships and a high prevalence of childhood trauma. Subjects with BPD reported experiencing more emotional abuse and intrafamilial sexual abuse, but more similarities than differences between probands and sisters were found. In multilevel analyses, personality traits of affective instability and impulsivity predicted DIB-R scores and SCL-90-R scores, above and beyond trauma. There were few relationships between childhood adversities and other measures of psychopathology. Sensitivity to adverse experiences, as reflected in the development of psychopathology, appears to be influenced by personality trait profiles.

Platelet [³H] paroxetine binding in female patients with borderline personality disorder and their sisters.

Paroxetine binding could be a vulnerability marker for traits associated with borderline personality disorder (BPD). To study this relationship, we examined [³H] paroxetine binding in female patients with BPD and their sisters. The sample consisted of 54 sibling pairs in which a proband met criteria for BPD. All subjects were given the Diagnostic Interview for Borderlines, revised (DIB-R), the Diagnostic Assessment for Personality Pathology: Brief Questionnaire (DAPP-BQ), the Barratt Impulsivity Scale (BIS), the Affective Lability Scale (ALS), the Hamilton Rating Scale for Anxiety (HAM-A), the Hamilton Rating Scale for Depression (HAM-D), and the Symptom Checklist-90, revised (SCL-90-R). All subjects had platelets assayed for [³H] paroxetine binding. There were no significant differences between probands and sisters, but both groups scored significantly lower than a previously studied control group on B(max). There were no differences on Kd. Neither B(max) nor K(d) was related to most trait or symptomatic measures. Paroxetine binding could reflect endophenotypes common to BPD probands and their first-degree relatives.

Risk models of dating aggression across different adolescent relationships: a developmental psychopathology approach.

The present study examined physical dating aggression in different adolescent relationships and assessed linear, threshold, and moderator risk models for recurrent aggressive relationships. The 621 participants (59% girls, 41% boys) were drawn from a 1-year longitudinal survey of Canadian high school youths ranging from Grade 9 through Grade 12. Approximately 13% of participants reported recurrent dating aggression across 2 different relationships. Using peer and dyadic risk factors from Time 1 of the study, the authors confirmed a linear risk model, such that adolescents in 2 different violent relationships had significantly more contextual risk factors than did adolescents in 1 or no violent relationship. Further, structural equation modeling assessing moderation of contextual risk factors indicated that, for adolescents with high acceptance of dating aggression, peer aggression and delinquency significantly predicted recurrent aggression in a new relationship. In comparison, for adolescents with low acceptance of dating aggression, negative relationship characteristics significantly predicted recurrent aggression. Acceptance did not moderate concurrent associations between risk factors and aggression in 1 relationship. Results support a developmental psychopathological approach to the understanding of recurrent aggression and its associated risk factors.

Men's recognition of violence against women and spousal abuse: comparison of three groups of men.

Our goal was to assess whether men in the following three groups differ in their ability to recognize and judge the severity of diverse forms of aggressive behavior: (a) men who reported being physically aggressive toward their spouses and who were entering treatment for domestic violence; (b) men who, after participating in a treatment program, were no longer physically violent; and (c) men who reported never having been physically violent towards their spouses (NPV group-non-physically violent). All 81 men in the study reported being verbally aggressive toward their spouses. Men who had been in treatment for spousal abuse and who had not been physically violent toward their spouses since finishing the program were better able than the other two groups to recognize emotionally abusive behaviors.

[A serious challenge for youth protection services: intervening with parents suffering from borderline personality disorder (BPD)]. / Un défi de taille pour les centres jeunesse. Intervenir auprès des parents ayant un trouble de personnalité limite.

An exploratory survey of 68 youth protection services' workers in Montréal, who followed 1,030 children reveals that 39 % of these children have at least one parent who suffer from mental health problems. Among these parents, 48 % of mothers and 30 % of fathers have a personality disorder, and for the majority, a borderline personality disorder. This mental health problem is preoccupying for youth protection workers because of its high prevalence, its impact on children and case workers and the difficulties brought forth by having to intervene in a context of authority and within an organization not adapted to the management of this mental health problem. Some intervention's guidelines to work with these parents are presented as well as some challenges and future perspectives.

[Validation of the French version of the CTQ and prevalence of the history of maltreatment]. / Validation de la version française du CTQ et prévalence de l'histoire de maltraitance.

This study demonstrates that the five maltreatment scales in the long and short versions of the CTQ are valid and usable with French-speaking populations. It also shows emotional neglect to be the most common form of maltreatment in its general population sample, and physical neglect to be the least common. Physical, emotional and sexual abuse prevalences in the convenience sample roughly correspond to the rates generally obtained in non-clinical samples. Finally, women in the sample display greater co-occurrence of different forms of maltreatment, especially involving sexual abuse, than men.