Background Several studies have shown that the Individual Placement and Support (IPS) model of supported employment is an effective approach to help many people with severe mental illness to find and maintain competitive employment. These studies include a randomized trial conducted in Montreal, Canada. Very few studies, however, have evaluated the cost-effectiveness of IPS compared to traditional services. Objective To evaluate the cost-effectiveness of IPS model compared to usual vocational services, using data from the Montreal trial. Methods A total of 149 unemployed adult with severe mental illness were randomly assigned to receive either IPS or usual vocational services and were followed for 12 months. Costs were estimated from the perspectives of the health and social care system, the government, and the society. Competitive employment hours and wages were taken as measures of effectiveness. A cost-effectiveness analysis was conducted, using the net benefit framework. A sensitivity analysis was carried out to take into account baseline differences of inpatient days between the two groups. Results IPS dominated usual services with significantly better competitive employment outcomes and less average costs, regardless of the economic perspective. IPS is likely to be more cost-effective than usual services even if the decision maker is only willing to pay a small amount of money per unit improvement in employment outcomes. If only clients without inpatient days during the year before the baseline are considered, IPS costs more than usual services but still with significantly better competitive employment outcomes: $155.73 per additional competitive employment hour and $20.12 per additional dollar of competitive employment earnings from the health and social care services perspective. Conclusions In this study, IPS proved cost-effective compared to usual services, although the baseline difference in inpatient days attenuates the strength of this finding. / IntroductionPlusieurs études ont démontré que le modèle de soutien à l'emploi « Individual Placement and Support » (IPS - Placement et soutien individuels) constitue une méthode efficace pour aider un grand nombre de personnes qui ont des troubles graves de santé mentale à obtenir et conserver un emploi régulier. Ces études incluent une étude expérimentale menée à Montréal, Canada. Très peu d'études, toutefois, ont évalué la coût-efficacité de IPS en comparaison avec des services traditionnels. Objectif Évaluer la coût-efficacité du modèle IPS en comparaison avec des services d'insertion socio-professionnelle habituels, en utilisant des données de l'étude montréalaise. Méthodes Au total, 149 adultes sans emploi et ayant des troubles mentaux graves furent répartis de façon aléatoire entre un programme IPS et des services habituels, et suivis pendant 12 mois. Les coûts furent estimés à partir des perspectives du système de santé et de services sociaux, du gouvernement et de la société. L'efficacité a été évaluée au moyen de deux variables: les heures en emploi régulier et les revenus de ces emplois. Une analyse coût-efficacité fut menée, en utilisant le cadre bénéfice net (net benefit framework). Une analyse de sensibilité fut effectuée pour tenir compte de la différence entre les deux groupes entre leurs jours d'hospitalisation au cours de l'année précédant leur entrée dans l'étude. Résultats IPS domine les services habituels avec de bien meilleurs résultats au niveau de l'emploi compétifi et des coûts moyens moindres, qu'importe la perspective économique. IPS semble plus coût-efficace que les services habituels même si le décideur n'est prêt qu'à payer un faible montant pour une amélioration dans les résultats au niveau de l'emploi. Si on ne retient que les clients qui n'avaient aucun jour d'hospitalisation pendant l'année précédant l'entrée dans l'étude, les sujets du groupe IPS coûtent nettement plus cher en moyenne que ceux des services habituels, mais toujours avec des résultats meilleurs au niveau de l'emploi compétitif. Du point de vue du systèeme de santé et services sociaux, les ratios coût-efficacité incrémentaux qui en résultent sont de 155,73 $ par heure d'emploi compétitif additionnelle et 20,12 $ par dollar additionnel de revenus compétitifs. Conclusions Dans cette étude, IPS s'est révélé coût-efficace en comparaison avec les services habituels, quoique la différences entre les groupes au niveau des jours d'hospitalisation à l'entrée atténue la force de cette conclusion.

No description available.

Self-esteem is an important construct in psychiatric disorders. We hypothesize that in patients with first onset of a psychotic disorder, self-esteem will be associated with outcome and it will, in turn, be influenced by early life experiences. Methods: The Self-Esteem Rating Scale, The Parental Bonding Instrument (PBI), the Measure of Parental Style (MOPS) and The Childhood Trauma Questionnaire (CTQ) were administered to individuals with first-episode psychosis. Symptoms and the GAF were assessed at entry to the program and at six months. Results: Self-esteem was positively correlated with the GAF, but not with remission status at six months. Self-esteem was negatively correlated with the PBI Overprotection, MOPS Overcontrol and Abuse subscales, in relation to mothers and also negatively with Emotional Neglect, Emotional Abuse and Sexual Abuse subscales of the CTQ. Conclusion: Self-esteem influences outcome in early psychosis and is in turn, influenced by early life experiences. This may have implications for designing special interventions to improve outcome. / L'estime de soi est un élément important dans le développement de troubles psychiatriques. Nous posons l'hypothèse que chez les patients présentant des signes avant-coureurs de trouble psychotique, l'estime de soi sera associée avec le pronostic et elle sera en retour influencée par les expériences en début de vie.Méthode: L'échelle de mesure de l'estime de soi (The Self-Esteem Rating Scale), la mesure sur l'attachement parental (PBI), l'instrument de mesure sur le style d'attachement (MOPS) et le questionnaire des traumatismes de l'enfance (CTQ) ont été administrés aux individus confrontés à un premier épisode psychotique. Les symptômes et le niveau de fonctionnement global (GAF) ont été évalués à l'entrée du programme et six mois plus tard.Résultats: L'estime de soi était corrélée positivement avec le GAF, mais elle n'était pas corrélée avec le statut de rémission à six mois. L'estime de soi était négativement corrélée avec la surprotection du PBI, les échelles de surcontrôle et d'abus du MOPS, en relation avec les mères. L'estime de soi était aussi négativement corrélée avec les échelles de négligence émotionnelle, d'abus émotionnel et sexuel du CTQ.Conclusion: L'estime de soi influence le pronostic de psychoses précoces et, en retour, elle est influencée par les premières expériences de vie. Ceci pourrait avoir des implications afin de développer des interventions spécialisées améliorant le pronostic.

This research has two objectives. First, mental health problems among refugee children were studied in terms of the intensity and the form of the symptomatology, and in terms of school performance. Second, the characteristics of the refugee process which influence the manifestation of these problems were identified as specific stressors stemming from the pre-migratory and post-migratory experiences of the refugees. / The research was conducted among 156 refugee children, born in Southeast Asia and Central America. The methodology was based on both quantitative and qualitative approaches. / Results indicate that the manifestation of emotional problems and the principal risk and protection factors vary greatly as a function of the ethnic origin of the subjects; this seems to be secondary to the interaction of specific cultural and contextual variables. / This heterogeneity of the refugee children population put into question the strategies put forward by the schools and the health services for the detection and prevention of mental health problems in these children.

Thesis (Ph. D.)--University OF MICHIGAN.

DISSERTATION (PH.D.)--THE UNIVERSITY OF MICHIGAN

Children with chronic physical illness have twice the risk of psychosocial maladjustment as healthy children. One specific aspect of mental functioning is abnormal eating attitudes, hypothesized to be an early stage of an eating disorder. To date, there has been no study of the association of a variety of physical chronic illnesses with a specific psychiatric syndrome in a diagnostically heterogeneous population, comparing chronically ill children with healthy children. This study examined the association between chronic illness and eating attitudes in a population of school children from Western Quebec. A checklist of chronic medical conditions was added to the parent questionnaire in order to determine presence of chronic illness. There were two objectives of this thesis. The first objective was to determine whether chronic illness was associated with eating attitudes in children as measured by the Eating Attitudes Test. The second study objective was to determine whether there was a meaningful group difference in othcr psychometric scores of depression, family functioning and stress between children with a chronic illness and children without a chronic illness. (Abstract shortened by UMI.)

The purpose of the present study was to predict children's posthospitalization behavioural difficulties consequent to day surgery. Temperament characteristics and characteristics of the mother-child relationship were used to predict children's behavioural difficulties at three days, three weeks and two months posthospitalization. The mothers of the 57 subjects rated their child's pre- and posthospitalization behaviour on the Vernon Hospital Questionnaire. The Behavioural Style Questionnaire was used as the temperament measure and the Parenting Stress Index was used to assess the degree of stress within the mother-child relationship. Repeated measures analysis of variance on the Vernon Hospitalization Questionnaire indicated that there were significant differences among children's scores at the pre- and posthospitalization periods. Subsequent analyses indicated significant differences on four of the six subscales of this questionnaire. HMRs were conducted on children's behavioural difficulties with three temperament variables and the total stress variable entered as predictors. The results of these HMRs indicated that mood and total stress predicted behavioural difficulties at pre- and two month posthospitalization, whereas adapt and total stress predicted behavioural difficulties at three days and three weeks posthospitalization. Assessment of the predictive accuracy of the sample regression equations by the jackknife procedure indicated that the regression equations provide accurate predictors. Recommendations are proposed concerning how to identify children at risk for posthospitalization behavioural difficulties.

Il s'agit d'une étude ayant pour but d'examiner les besoins perçus et le niveau de détresse mentale d'aidants naturels primaires (ANP) de patients en attente de pontages aortocoronariens (PAC). Le devis de recherche consiste en un pré-post-test auprès d'un échantillon aléatoire de 19 ANP. L'Inventaire des Besoins des Familles (IBF) et le Brief Symptom Inventory (BSI) ont servi à mesurer respectivement les besoins et la détresse mentale auprès de la clientèle cible, les ANP, avant (T1 ) et suivant (T2 ) une session d'information. Les résultats révèlent qu'il existe une différence significative (p = 0,015) à la dimension besoins physiques entre les deux intervalles de temps visés. La corrélation entre les besoins et la santé mentale s'accroît avec le temps. L'âge est corrélée positivement (r = 0,51) avec l'indice de détresse mentale au T1 . Les ANP ayant une scolarité post-secondaire présentent un score plus élevé (p = 0,02) au nombre total de besoins comparativement aux autres.

Caregiver burden has been studied at length in caregivers of many populations of chronically ill people. The other side of the informal caregiving relationship is the recipient's response to aid, especially their perceptions of the burden they pose to their caregiver. This is referred to as self-perceived burden, and has rarely been studied from the patient's point of view. Strong feelings of being a burden may be an important emotional factor influencing adjustment to illness, compliance with physician's orders, utilization of health-care resources and end-of-life decision-making. The current study advances the current understanding of self-perceived burden through the development and preliminary validation of the Self-Perceived Burden Scale. Through the course of this study, we have developed a valuable screening instrument for feelings of being a burden. It is brief, easily self-administered, and reliably identifies individuals in emotional distress due to feelings of being a burden on others. (Abstract shortened by UMI.)