8 ABSTRACT Title: Implementation of nursing practice standards in Nachod Regional Hospital Author: Kateřina Fialová Department: Charles University in Prague, Faculty of Humanities, Department of Management and Supervision in Social and Health Organisations Supervisor: Mgr. Petr Vrzáček, Department of Management and Supervision in Social and Health Organisations The focus of the thesis was development and especially implementation of nursing practice standards as well as exploration of non-medical health professionals' attitudes towards this process in Nachod Regional Hospital. The theoretical part clarified the concept of quality, standard, audit, accreditation, certification and also addressed the role of health and nursing care management in quality control. The practical part was divided into three research sections. The first one diagnosed nursing practice standards, their prototype version above all. The findings from this diagnosis provided two recommendations - to revise current version of methodology for standard process creation and to start changing health professionals' attitudes towards standards and standardization of nursing practice. The quantitative research in the second section analysed in detail attitudes and motivation of non-medical health professionals to make the development...

No description available.

Chez les personnes âgées, la dépression est un problème important en santé publique, à cause de sa prévalence élevée et de son association avec les incapacités fonctionnelles, la mortalité et l’utilisation des services. La plupart des études ont montré que le manque de relations sociales était associé à la dépression, mais les résultats ne sont pas clairs. Au Québec et au Canada, on possède peu de données sur la prévalence de la dépression chez les personnes âgées et de son association avec les relations sociales. Peu d’études ont examiné le rôle des relations sociales sur l’utilisation des services de santé par les personnes âgées déprimées. Le but de cette recherche était d’examiner le rôle des relations sociales dans la présence de la dépression et dans la consultation chez un professionnel de la santé des personnes âgées déprimées, au Québec. Plus spécifiquement, ce travail visait à : 1) examiner les associations entre les relations sociales et les troubles dépressifs selon la région de résidence; 2) examiner les associations différentielles des relations sociales sur la dépression des femmes et des hommes âgés; 3) examiner le rôle des relations sociales dans la consultation auprès d’un professionnel de la santé des personnes âgées déprimées. Pour répondre à ces objectifs, nous avons utilisé les données de l’enquête ESA (Enquête sur la Santé des Aînés), réalisée en 2005 -2006 auprès d’un échantillon de 2670 personnes âgées résidant à domicile au Québec, qui nous ont permis de rédiger trois articles. Les troubles dépressifs (incluant la dépression majeure et mineure) ont été mesurés, selon les critères du DSM-IV, en excluant le critère de l’altération du fonctionnement social, professionnel ou dans d’autres domaines importants, à l’aide du questionnaire ESA développé par l’équipe de recherche. Les relations sociales ont été mesurées à l’aide de cinq variables : (1) le réseau social; (2) l’intégration sociale; (3) le soutien social, (4) la perception d’utilité auprès des proches et (5) la présence de relations conflictuelles avec le conjoint, les enfants, les frères et sœurs et les amis. Des modèles de régression logistique multiple ont été ajustés aux données pour estimer les rapports de cote et leur intervalle de confiance à 95 %. Nos résultats ont montré des prévalences de dépression plus élevées chez les personnes qui résident dans les régions rurales et urbaines, comparées à celles qui résident dans la région métropolitaine de Montréal. La pratique du bénévolat, le soutien social et les relations non conflictuelles avec le conjoint sont associés à une faible prévalence de dépression, indépendamment du type de résidence. Comparés aux hommes, les femmes ont une prévalence de dépression plus élevée. L’absence de confident est associée à une prévalence de dépression élevée, tant chez les hommes que chez les femmes. La probabilité de dépression est plus élevée chez les hommes veufs et chez ceux qui ne pratiquent pas d’activités de bénévolat, comparativement à ceux qui sont mariés et font du bénévolat. Chez les femmes, aucune association significative n’a été observée entre le statut marital, le bénévolat et la dépression. Cependant, la présence de relations conflictuelles avec le conjoint est associée avec la dépression, seulement chez les femmes. Les relations avec les enfants, les frères et sœurs et les amis ne sont pas associées avec la dépression dans cette population de personnes âgées du Quebec. En ce qui concerne la consultation chez un professionnel de la santé, nos résultats ont révélé que presque la moitié des personnes âgées dépressives n’ont pas consulté un professionnel de la santé, pour leurs symptômes de dépression, au cours des 12 derniers mois. Par ailleurs, notre étude a montré que les personnes âgées qui disposent de tous les types de soutien (confident, émotionnel et instrumental) consultent plus pour leurs symptômes de dépression que ceux qui ont moins de soutien. Comparativement aux hommes mariés, les femmes mariées consultent plus les professionnels de la santé, ce qui laisse supposer que le réseau de proches (épouse et enfants) semble agir comme un substitut en réduisant la fréquence de consultation chez les hommes. Vu la rareté des études canadiennes sur la prévalence de la dépression chez les personnes âgées et les facteurs psychosociaux qui y sont associés, les résultats de ce travail seront utiles pour les cliniciens et pour les responsables des politiques à l’échelle nationale, provinciale et locale. Ils pourront guider des interventions spécifiques, selon la région de résidence et pour les hommes et les femmes âgées, dans le domaine de la santé mentale. / Depression is an important public health problem among the elderly population due to its high prevalence and its association with disability, mortality and use of health services. Most studies have shown that lack of social networks is associated with depression but results are not clear. In Quebec and in Canada, little evidence exists on the prevalence of depression in the elderly population and on its associations with social relationships. Few studies have examined the associations between social relationships and health services utilisation among the depressed elderly patients. The aim of this work was to examine the role of social relationships on the presence of depression and on the consultation with a health professional by the elderly patient with depression, in Québec. More specifically, this work aimed at examining if: 1) the associations between social relationships and depression varied in rural and urban areas; 2) the associations between social relationships and depression were different in men and in women and 3) assessing the role of social relationships in the consultation of a health professional by the elderly patients with depression. To attain these objectives we have written three articles using data from the ESA survey, conducted in 2005-2006 on a representative sample of 2670 community dwelling people over 65 in Quebec. Depressive disorders (including major and minor depression) were measured by the DSM-IV criteria using the ESA questionnaire developed by the research team which excludes the criteria on limitations of social functioning. Social relationships were measured by aspects of social networks (marital status and diversity of ties), engagement in community social activities (religious attendance, frequenting social centers, and volunteerism), social support and perception of usefulness and presence of conflict in the relationships with spouse, children, siblings and friends. Multiple logistic regressions were adjusted to estimate odds ratios and their 95 % confidence intervals. Prevalence of depression was higher among those living in urban and rural areas of Quebec compared with metropolitan Montreal. Volunteerism, social support and not having conflict with the spouse were associated with lower frequency of depression independently of the area of residence. Women had higher prevalence of depression compared with men. Lack of a confident was associated with higher frequency of depression both in men and in women. Men who were widows and those who were not involved in volunteer work had higher odds of depression than men in other marital situations and men who were volunteering. Marital status and volunteer work were not associated with depression in women. However, conflict in marriage was associated with depression in women. Relationships with children, siblings and friends are not associated with depression in this population of elderly people from Quebec. Concerning consultation with a health professional for symptoms of depression, we have shown that approximately half of those depressed elderly, both among men and among women, have not consulted for their symptoms in the last 12 months. Consultation is associated with high levels of support, but the immediate network (spouse and siblings) seems to act as a substitute for depressed elderly men, reducing their frequency of consultation. Given the scarcity of Canadian studies on depression prevalence among the elderly population, these results on depression and its associated factors provide important information for clinicians and decision makers for planning and targeting of services by area of residence and for both men and women.

Refondation sociale, « sécurisation » des parcours professionnels, assouplissement des cas de recours au contrat à durée déterminée, « flexisécurité »… Tous les regards sont tournés vers le droit du travail. Sa rigidité prétendue est dénoncée comme un frein à l’emploi. En comparaison, le droit de la sécurité sociale attire peu l’attention. Il est pourtant d’une importance considérable. De meilleures relations entre les caisses de sécurité sociale et les entreprises seraient profitables à tous. Les entreprises se mueraient en partenaires des organismes sociaux. Des contrats conclus, pourrait naître une plus grande souplesse, gage de compétitivité. Longtemps repoussée, aujourd’hui inévitable, une refondation du système de protection sociale est envisagée. Le seuil des trois millions de chômeurs a été franchi tandis que les plans sociaux se multiplient. Les réflexions menées par le groupe de travail sur la compétitivité de l’économie française devront être croisées avec celles confiées au Haut conseil pour le financement de la protection sociale. La proposition de scenarii « pesant moins sur le travail » conditionne la pérennité de notre modèle social. / Social reorganisation, the « securing » of career paths, easing recourse toward fixed-term contracts, « flexisecurity »... All eyes are on labour law. Its supposed rigidity is denounced as a brake upon employment whereas social security law is paid little attention despite it being of considerable importance. Better relations between social security offices and employers would benefit everyone. Businesses would become partners of varying social organisations. Such agreements could give rise to greater flexibility and competitiveness. A reorganisation of the social security system, although postponed for a long time is now inevitable and is currently being considered. The threshold of three million unemployed has been reached while restructuring plans multiply. The reflections of the working group on the competitiveness of the French economy should be intersected with those entrusted to the High Council for the financing of social security. Proposing scenarios which «pose less risk to work » will determine the sustainability of our social security model.

A presente dissertação, inserida na área temática da Saúde Pública de Regulação e Fiscalização em Saúde (categoria SP1.011.127), destacou aspectos relacionados à política nacional de regulação em saúde. Com base na revisão da literatura relacionada com o tema, o estudo teve como objetivo principal apresentar e discutir os desdobramentos da realização de intervenção no sistema de regulação do acesso à assistência às especialidades médicas de um município de 250 mil habitantes no período de 2009 a 2011. Teve também, como objetivo secundário, analisar estratégias de desenvolvimento e operacionalização de protocolos de regulação do acesso à assistência ambulatorial em perspectiva municipal. Como referencial metodológico foi adotado o estudo de caso com abordagem descritiva predominantemente qualitativa. O capítulo de introdução versou sobre o cenário relacionado com a regulação do acesso à assistência e as intervenções aplicadas. Como resultados foram apresentadas as ações desenvolvidas no município no campo de infraestrutura e tecnologia da informação, aperfeiçoamento logístico e de processos, educação permanente e o desenvolvimento de protocolos de regulação do acesso. Na discussão, foram analisados os processos desenvolvidos, escolhas e ferramentas adotadas para o aperfeiçoamento do acesso à atenção ambulatorial, suas características e vulnerabilidades, discutindo-se as potencialidades desta implementação e o impacto no acesso aos serviços de saúde municipal / This dissertation, inserted in the thematic area of Health Care Coordination and Monitoring (SP1.011.127 category), emphasized issues related to national policy health regulation in Brazil. Based on a review of literature related to the topic, the study had, as main objective, present and discuss the unfolding of intervention performed in the medical specialties accessibility settled in a city of 250 000 inhabitants in the period from 2009 to 2011. Also sought, as a secondary objective, examine strategies to develop and manage regulatory access protocols in that city. The methodological framework was a case study with predominantly qualitative descriptive approach. The introductory chapter was about the scenario related to the regulation of access to care and interventions applied. Results presented the actions developed in the field of municipal infrastructure and information technology, logistics and process improvement, Public Health Professional Education and the development of regulatory access protocols. In the discussion were analyzed the processes developed, choices and tools used for the improvement of Health Services Accessibility, their characteristics and vulnerabilities, discussing the potential of this implementation and the impact on local health services

The category of Registered Counsellors was created to provide psychological service at primary level to previously disadvantaged communities, yet there is lack of public and professional knowledge concerning this category. This study aimed at finding reasons why people choose to become registered counsellors and what their relevance and future is in South Africa. Social constructionism is the epistemological framework for this qualitative investigation. Three registered counsellors aged between 27 and 31 were chosen for this study using a combination of purposive and snowball sample technique. Rich data were collected through open ended interviews. This approach was chosen as the most relevant because it helped in giving a voice to the three ‘registered counsellors’ which in turn helped in getting a holistic understanding of the participants’ point of view. Thematic analysis technique was used to identify key themes. The main themes identified in comparative analysis were the following: the need to help, feeling of fulfillment, working in a multidisciplinary team, registered counsellors as first point of entry, experiencing barriers in terms of lack of recognition, confusion between registered counsellors and other healthcare professionals; and the role of HPCSA. The results showed that the participants became registered counsellors because of the need to help others. The results also showed that registered counsellors are relevant in South Africa because their services are needed for the well-being of society. There is a future for registered counsellors in South Africa to close the gap in terms of mental health workforce shortage. / Psychology / M.A. (Psychology)

Os objetivos desta pesquisa foram: compreender a perspectiva do profissional de saúde e do usuário hipertenso sobre a interação que ocorre entre eles no contexto da atenção em unidades públicas de saúde e analisar de que forma essa interação contribui para a não-adesão ao regime terapêutico. A metodologia aplicada para o desenvolvimento do estudo foi a Teoria Fundamentada nos Dados e o referencial teórico utilizado para a análise dos dados e interpretação dos resultados foi o Interacionismo Simbólico, além da literatura existente sobre o assunto. Ao todo, quinze profissionais de saúde e dez usuários fizeram parte da pesquisa. Ao final, foram encontradas seis categorias (duas delas, centrais) e outras subcategorias as quais, depois de um processo elaborado de comparações, relações e integração compuseram a proposição teórica que a autora fez sobre a interação entre o usuário e o profissional de saúde e da qual extraiu elementos para analisar a contribuição que essa interação tem para a não-adesão ao regime terapêutico. A autora concluiu que a interação, por ser pautada no modelo biomédico, centralizada no profissional de saúde, desigual, assimétrica e distanciada, tem elementos que podem estar contribuindo para a não- adesão do usuário ao regime terapêutico. Concluiu também que a principal ação que o profissional de saúde utiliza para promover a adesão do usuário ao regime terapêutico – a conscientização – tem sido ineficaz uma vez que se baseia no modelo tradicional de educação em saúde e no qual o usuário não é considerado como sujeito. Outra conclusão é a de que o usuário, por estar administrando o regime terapêutico à sua maneira, tem feito indicações ao profissional de saúde sobre sua forma de ver, entender e conviver com a hipertensão arterial e o regime terapêutico que nem sempre é congruente com o que o profissional de saúde quer e espera dele. Esta pesquisa aponta para a necessidade do profissional de saúde e outras instâncias políticas de decisão repensarem a interação profissional / usuário nos moldes que tem acontecido atualmente e para a necessidade de mudanças no modo de pensar e agir em relação ao usuário e com ele. / The aims of this research were to understand the perspective of the health professional and the hypertensive user about the interaction that occurs between them in the context of the service in health units and to analyze how this interaction contributes to the non-adherence to the therapeutic regime. The methodology applied for the development of the study was the Grounded Theory and the theoretical reference used for the analysis of the data and interpretation of the results was the Symbolic Interacionism, as well as existing literature on the subject. In all, fifteen health professionals and ten users were involved in the research. At the end, six categories were found (two of which were central) and other subcategories which, after an elaborated process of comparisons, relations and integration composed the theoretical proposal that the author made about the interaction between the user and the health professional and from which some elements were extracted in order to analyze the contribution that this interaction makes to the nonadherence to the therapeutic regime. The author concluded that the interaction, being based in the biomedical model, was centered in the health professional, was unequal, asymmetric and distant, and has elements that could be contributing to the user non-adherence to the therapeutic regime. It was also concluded that the main action that the health professional uses to make the user adhere to thetherapeutic regime – making the user aware of it – has been ineffective because it is based on the traditional model of health education in which the user is not considered individually. Another conclusion is that the user since he is managing the therapeutic regime in his own way has made indications to the health professional of his way of seeing, understanding and dealing with the arterial hypertension and the therapeutic regime that is not always congruent with what the health professional wants and expects of him. This research points to the necessity of the health professional and other policy-making forums to rethink the health professional/user interaction in the molds that have happened currently, and for the necessity of change in the way of thinking and of acting in relation to and with the user.

A Febre Maculosa Brasileira (FMB) é uma doença aguda, transmitida por carrapatos, com curso variável, que pode ocorrer com formas leves e atípicas, até formas graves, com alta taxa de letalidade. A dificuldade no diagnóstico oportuno por deficiência no envolvimento dos profissionais de saúde e ausência de esclarecimentos da população, em áreas de transmissão, é uma das causas desta alta letalidade. Este estudo foi desenvolvido em uma Unidade Básica de Saúde (UBS) situada em área de relevância epidemiológica para FMB, com incidências recorrentes de casos e óbitos no município de São Bernardo do Campo na Região Metropolitana de São Paulo. O objetivo principal do estudo foi implantar e analisar uma proposta de intervenção educativa participativa em saúde e ambiente envolvendo a equipe de agentes comunitários de saúde com a temática de vigilância da FMB em uma área de transmissão visando a produção de novos saberes para o enfrentamento da doença na região. O método de pesquisa qualitativa utilizado seguiu a linha da pesquisa participante, a pesquisa-ação, com uso de instrumentos como entrevistas, rodas de conversa, oficinas de planejamento, mapas falantes, painéis, fotos, filmagens e observação participante. O processo saúde doença da FMB na região serviu de tema norteador além de outros como educação em saúde e ambiente, e o planejamento educativo. O processo de aprendizagem vivenciado pelos profissionais de saúde foi avaliado positivamente, demonstrando que houve sensibilização, diálogo, reflexão e decisão conjunta nos vários momentos proporcionados pelas oficinas pedagógicas. As atividades realizadas promoveram oportunidades para os agentes conduzirem e organizarem suas próprias tarefas e os momentos de planejamento das ações foram relevantes, e inovadores; além de outras demonstrações de envolvimento como a recomendação de ampliação para outros temas e para outras localidades, evidenciando satisfação e acolhimento da proposta, embora também aponte para a preocupação com a temática na região e a necessidade em ampliar as discussões. A pesquisa participante mostrou-se extremamente adequada para a interação do grupo estimulando o interesse por buscar soluções aos problemas levantados gerando nos profissionais um sentimento de empoderamento. Estes resultados indicam que estas metodologias podem ser incorporadas aos programas de vigilância de outras doenças com o objetivo de melhorar o envolvimento dos agentes comunitários de saúde nos planos de ações educativas nas localidades onde atuam. / Brazilian Spotted Fever (BSF) is an acute disease, transmitted by ticks, with a variable course, which can occur with mild and atypical forms, to severe forms, with a high lethality rate. The difficulty in the opportune diagnosis due to the deficiency in involvement of health professionals and the lack of clarification of the population in transmission areas is one of the causes of this high lethality. This study was developed in a Basic Health Unit located in an area of epidemiological relevance for FMB, with recurrent incidence of cases and deaths in the municipality of São Bernardo do Campo in the Metropolitan Region of São Paulo. The main objective of the study was to establish and analyze a proposal for participatory educational intervention in health and environment involving the team of community health professionals with the theme of FMB surveillance in a transmission area aiming at the production of new knowledge for coping with the disease in the region. The qualitative research method used was participatory research or action research, with use of planning workshops, wheels of conversation, interviews, talking maps, panels, photos, filming and participant observation. The disease health process of the BSF in the region served as a guiding theme besides others such as education in health and environment, and educational planning. The learning process experienced by health professionals was evaluated positively, demonstrating that there was awareness, dialogue, reflection and joint decision in the various moments provided by the pedagogical workshops. The activities carried out provided opportunities for the agents to conduct and organize their own tasks and the moments of action planning were relevant and innovative; as well as other demonstrations of involvement such as the recommendation for extension to other themes and other locations, showing satisfaction and acceptance of the proposal, although it also points to the concern with the theme in the region and the need to broaden the discussions. The participant research method proved to be extremely suitable for the group\'s interaction, stimulating interest in seeking solutions to the problems raised, generating a feeling of empowerment for these professionals. These results indicate that these methodologies can be incorporated into surveillance programs for other diseases with the aim of improving the involvement of community health professionals in educational plans in the places where they operate.

A Febre Maculosa Brasileira (FMB) é uma doença aguda, transmitida por carrapatos, com curso variável, que pode ocorrer com formas leves e atípicas, até formas graves, com alta taxa de letalidade. A dificuldade no diagnóstico oportuno por deficiência no envolvimento dos profissionais de saúde e ausência de esclarecimentos da população, em áreas de transmissão, é uma das causas desta alta letalidade. Este estudo foi desenvolvido em uma Unidade Básica de Saúde (UBS) situada em área de relevância epidemiológica para FMB, com incidências recorrentes de casos e óbitos no município de São Bernardo do Campo na Região Metropolitana de São Paulo. O objetivo principal do estudo foi implantar e analisar uma proposta de intervenção educativa participativa em saúde e ambiente envolvendo a equipe de agentes comunitários de saúde com a temática de vigilância da FMB em uma área de transmissão visando a produção de novos saberes para o enfrentamento da doença na região. O método de pesquisa qualitativa utilizado seguiu a linha da pesquisa participante, a pesquisa-ação, com uso de instrumentos como entrevistas, rodas de conversa, oficinas de planejamento, mapas falantes, painéis, fotos, filmagens e observação participante. O processo saúde doença da FMB na região serviu de tema norteador além de outros como educação em saúde e ambiente, e o planejamento educativo. O processo de aprendizagem vivenciado pelos profissionais de saúde foi avaliado positivamente, demonstrando que houve sensibilização, diálogo, reflexão e decisão conjunta nos vários momentos proporcionados pelas oficinas pedagógicas. As atividades realizadas promoveram oportunidades para os agentes conduzirem e organizarem suas próprias tarefas e os momentos de planejamento das ações foram relevantes, e inovadores; além de outras demonstrações de envolvimento como a recomendação de ampliação para outros temas e para outras localidades, evidenciando satisfação e acolhimento da proposta, embora também aponte para a preocupação com a temática na região e a necessidade em ampliar as discussões. A pesquisa participante mostrou-se extremamente adequada para a interação do grupo estimulando o interesse por buscar soluções aos problemas levantados gerando nos profissionais um sentimento de empoderamento. Estes resultados indicam que estas metodologias podem ser incorporadas aos programas de vigilância de outras doenças com o objetivo de melhorar o envolvimento dos agentes comunitários de saúde nos planos de ações educativas nas localidades onde atuam. / Brazilian Spotted Fever (BSF) is an acute disease, transmitted by ticks, with a variable course, which can occur with mild and atypical forms, to severe forms, with a high lethality rate. The difficulty in the opportune diagnosis due to the deficiency in involvement of health professionals and the lack of clarification of the population in transmission areas is one of the causes of this high lethality. This study was developed in a Basic Health Unit located in an area of epidemiological relevance for FMB, with recurrent incidence of cases and deaths in the municipality of São Bernardo do Campo in the Metropolitan Region of São Paulo. The main objective of the study was to establish and analyze a proposal for participatory educational intervention in health and environment involving the team of community health professionals with the theme of FMB surveillance in a transmission area aiming at the production of new knowledge for coping with the disease in the region. The qualitative research method used was participatory research or action research, with use of planning workshops, wheels of conversation, interviews, talking maps, panels, photos, filming and participant observation. The disease health process of the BSF in the region served as a guiding theme besides others such as education in health and environment, and educational planning. The learning process experienced by health professionals was evaluated positively, demonstrating that there was awareness, dialogue, reflection and joint decision in the various moments provided by the pedagogical workshops. The activities carried out provided opportunities for the agents to conduct and organize their own tasks and the moments of action planning were relevant and innovative; as well as other demonstrations of involvement such as the recommendation for extension to other themes and other locations, showing satisfaction and acceptance of the proposal, although it also points to the concern with the theme in the region and the need to broaden the discussions. The participant research method proved to be extremely suitable for the group\'s interaction, stimulating interest in seeking solutions to the problems raised, generating a feeling of empowerment for these professionals. These results indicate that these methodologies can be incorporated into surveillance programs for other diseases with the aim of improving the involvement of community health professionals in educational plans in the places where they operate.

Chez les personnes âgées, la dépression est un problème important en santé publique, à cause de sa prévalence élevée et de son association avec les incapacités fonctionnelles, la mortalité et l’utilisation des services. La plupart des études ont montré que le manque de relations sociales était associé à la dépression, mais les résultats ne sont pas clairs. Au Québec et au Canada, on possède peu de données sur la prévalence de la dépression chez les personnes âgées et de son association avec les relations sociales. Peu d’études ont examiné le rôle des relations sociales sur l’utilisation des services de santé par les personnes âgées déprimées. Le but de cette recherche était d’examiner le rôle des relations sociales dans la présence de la dépression et dans la consultation chez un professionnel de la santé des personnes âgées déprimées, au Québec. Plus spécifiquement, ce travail visait à : 1) examiner les associations entre les relations sociales et les troubles dépressifs selon la région de résidence; 2) examiner les associations différentielles des relations sociales sur la dépression des femmes et des hommes âgés; 3) examiner le rôle des relations sociales dans la consultation auprès d’un professionnel de la santé des personnes âgées déprimées. Pour répondre à ces objectifs, nous avons utilisé les données de l’enquête ESA (Enquête sur la Santé des Aînés), réalisée en 2005 -2006 auprès d’un échantillon de 2670 personnes âgées résidant à domicile au Québec, qui nous ont permis de rédiger trois articles. Les troubles dépressifs (incluant la dépression majeure et mineure) ont été mesurés, selon les critères du DSM-IV, en excluant le critère de l’altération du fonctionnement social, professionnel ou dans d’autres domaines importants, à l’aide du questionnaire ESA développé par l’équipe de recherche. Les relations sociales ont été mesurées à l’aide de cinq variables : (1) le réseau social; (2) l’intégration sociale; (3) le soutien social, (4) la perception d’utilité auprès des proches et (5) la présence de relations conflictuelles avec le conjoint, les enfants, les frères et sœurs et les amis. Des modèles de régression logistique multiple ont été ajustés aux données pour estimer les rapports de cote et leur intervalle de confiance à 95 %. Nos résultats ont montré des prévalences de dépression plus élevées chez les personnes qui résident dans les régions rurales et urbaines, comparées à celles qui résident dans la région métropolitaine de Montréal. La pratique du bénévolat, le soutien social et les relations non conflictuelles avec le conjoint sont associés à une faible prévalence de dépression, indépendamment du type de résidence. Comparés aux hommes, les femmes ont une prévalence de dépression plus élevée. L’absence de confident est associée à une prévalence de dépression élevée, tant chez les hommes que chez les femmes. La probabilité de dépression est plus élevée chez les hommes veufs et chez ceux qui ne pratiquent pas d’activités de bénévolat, comparativement à ceux qui sont mariés et font du bénévolat. Chez les femmes, aucune association significative n’a été observée entre le statut marital, le bénévolat et la dépression. Cependant, la présence de relations conflictuelles avec le conjoint est associée avec la dépression, seulement chez les femmes. Les relations avec les enfants, les frères et sœurs et les amis ne sont pas associées avec la dépression dans cette population de personnes âgées du Quebec. En ce qui concerne la consultation chez un professionnel de la santé, nos résultats ont révélé que presque la moitié des personnes âgées dépressives n’ont pas consulté un professionnel de la santé, pour leurs symptômes de dépression, au cours des 12 derniers mois. Par ailleurs, notre étude a montré que les personnes âgées qui disposent de tous les types de soutien (confident, émotionnel et instrumental) consultent plus pour leurs symptômes de dépression que ceux qui ont moins de soutien. Comparativement aux hommes mariés, les femmes mariées consultent plus les professionnels de la santé, ce qui laisse supposer que le réseau de proches (épouse et enfants) semble agir comme un substitut en réduisant la fréquence de consultation chez les hommes. Vu la rareté des études canadiennes sur la prévalence de la dépression chez les personnes âgées et les facteurs psychosociaux qui y sont associés, les résultats de ce travail seront utiles pour les cliniciens et pour les responsables des politiques à l’échelle nationale, provinciale et locale. Ils pourront guider des interventions spécifiques, selon la région de résidence et pour les hommes et les femmes âgées, dans le domaine de la santé mentale. / Depression is an important public health problem among the elderly population due to its high prevalence and its association with disability, mortality and use of health services. Most studies have shown that lack of social networks is associated with depression but results are not clear. In Quebec and in Canada, little evidence exists on the prevalence of depression in the elderly population and on its associations with social relationships. Few studies have examined the associations between social relationships and health services utilisation among the depressed elderly patients. The aim of this work was to examine the role of social relationships on the presence of depression and on the consultation with a health professional by the elderly patient with depression, in Québec. More specifically, this work aimed at examining if: 1) the associations between social relationships and depression varied in rural and urban areas; 2) the associations between social relationships and depression were different in men and in women and 3) assessing the role of social relationships in the consultation of a health professional by the elderly patients with depression. To attain these objectives we have written three articles using data from the ESA survey, conducted in 2005-2006 on a representative sample of 2670 community dwelling people over 65 in Quebec. Depressive disorders (including major and minor depression) were measured by the DSM-IV criteria using the ESA questionnaire developed by the research team which excludes the criteria on limitations of social functioning. Social relationships were measured by aspects of social networks (marital status and diversity of ties), engagement in community social activities (religious attendance, frequenting social centers, and volunteerism), social support and perception of usefulness and presence of conflict in the relationships with spouse, children, siblings and friends. Multiple logistic regressions were adjusted to estimate odds ratios and their 95 % confidence intervals. Prevalence of depression was higher among those living in urban and rural areas of Quebec compared with metropolitan Montreal. Volunteerism, social support and not having conflict with the spouse were associated with lower frequency of depression independently of the area of residence. Women had higher prevalence of depression compared with men. Lack of a confident was associated with higher frequency of depression both in men and in women. Men who were widows and those who were not involved in volunteer work had higher odds of depression than men in other marital situations and men who were volunteering. Marital status and volunteer work were not associated with depression in women. However, conflict in marriage was associated with depression in women. Relationships with children, siblings and friends are not associated with depression in this population of elderly people from Quebec. Concerning consultation with a health professional for symptoms of depression, we have shown that approximately half of those depressed elderly, both among men and among women, have not consulted for their symptoms in the last 12 months. Consultation is associated with high levels of support, but the immediate network (spouse and siblings) seems to act as a substitute for depressed elderly men, reducing their frequency of consultation. Given the scarcity of Canadian studies on depression prevalence among the elderly population, these results on depression and its associated factors provide important information for clinicians and decision makers for planning and targeting of services by area of residence and for both men and women.