Background: The Tennessee veterans represents 8.3 percent of state’s adult population, these includes the service members from World War II to Iraq and Afghanistan conflicts. Some of the research done on veterans shows that approximately 14% to 16% of U.S. service members deployed suffer from mental health challenges like PTSD or depression and substance abuse. The issue of mental health and substance abuse worsen among veterans populations while transitioning to civil life. The mental health symptoms among 1,239 American veterans assessed online one month prior to the COVID-19 outbreak in the United States through next year shows slight increase in mental health symptoms over time. The proposed study examines the association between veteran status and depression, alcohol use, and smoking in Tennessee. Methods: We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults aged 18 years and extracted data for Tennessee (n=4,788). Logistic regression analyses were conducted to test the association between coronary artery disease and depression. We controlled for past month income, race/ethnicity, educational status, gender, and age. Results: Overall, among U.S. military veterans 23.7% (n=145) were diagnosed with depression, 46.6% consumed alcohol in the last 30 days, while 15.2% (n=93) smoked cigarettes within the last 30 days. U.S military veterans status (OR=1.40, 95% CI, 1.12, 1.74) along with low income (OR=2.21, 95% CI, 1.91, 2.55) and female gender (OR=2.07, 95% CI, 1.78, 2.41) was significantly associated with depression. U.S military veteran status was not associated with alcohol use or smoking. Conclusion: The results implicate that the veterans in Tennessee are on higher risks of depression and alcohol consumption than non-veterans. Findings highlight the need of ongoing treatment and social support for the veterans population in Tennessee. Additional research is needed to understand the type of treatment and social support for this population. Keywords: Coronary Heart Disease, Mental Health Disorders, Health disparities in Tennessee

Digitalization has posed challenges for individuals with mental health disorders, creating a digital divide that hinders their integration into the digital society. This case study delved into the experiences of members at the Fountain House in Lund, a group of people diagnosed with mental health disorders. The study aimed to uncover the digital barriers they faced, thus contributing to the discussion on digital inclusion and the divide. Through extensive research, the study examined the digital divide comprehensively, emphasizing the role of social sustainability in achieving digital inclusion. Barriers such as missing skills, technical, external, and individual were meticulously analyzed. Based on these findings, a prototype was developed to bridge the digital divide and foster digital inclusion. The study's efforts in addressing digital barriers at the intersection of digitalization and mental health disorders offer insights into the digital divide and practical strategies for achieving social sustainability in the digital age.

Adolescents with health disorders experience an increased risk of psychological functioning problems. However, the lack of availability of psychological help and research on methods’ effectiveness in this group is still being extensively discussed worldwide. Theoretical assumptions of the Solution-Focused Brief Therapy (SFBT), closely related to the ideas of constructivism and systems theory, indicate that therapeutic effect of the model can be viewed as not limited to changes in the problem presented for the therapy, but as having potential of spreading into other areas of psychological functioning. Thus the aim of the dissertation is to estimate the changes in the severity of psychological functioning problems during SFBT among in-patient and out-patient adolescents experiencing mental or physical health disorders. Participants were 12-18 year old out-patients of two primary mental health care centers and in-patients of a rehabilitation hospital (N=131). Treatment group consisted of 23 out-patients and 21 in-patients (control groups accordingly 23 and 28 adolescents). Changes in the severity of problems presented for the therapy were assessed by The Therapist’s Evaluation of Improvement and The Client’s Evaluation of Progress, while the severity of psychological functioning problems and its changes were assessed by Standardized Interview for the Evaluation of Adolescents’ Problems and Checklist of Adolescent Behavior Changes. Results of the study revealed that mental... [to full text] / Sveikatos sutrikimų turintys paaugliai susiduria su padidėjusia psichologinio funkcionavimo problemų rizika. Tačiau dažnai diskutuojama psichologinės pagalbos prieinamumo ir metodų efektyvumo tyrimų šioje grupėje trūkumo problema. Darbe tyrinėjamo į sprendimus sutelkto trumpalaikio konsultavimo (SSTK) prielaidos, kurios glaudžiai siejasi su konstruktyvizmo ir bendrosios sistemų teorijos idėjomis, leidžia galvoti, kad SSTK terapinis poveikis neapsiriboja tik konkrečios problemos sprendimu, bet turi galimybę išsiplėsti į kitas psichologinio funkcionavimo sritis. Tad šio tyrimo tikslas – nustatyti dėl psichikos ir somatinės sveikatos sutrikimų gydomų paauglių psichologinio funkcionavimo problemų laipsnio kitimą SSTK metu. Tyrime dalyvavo 131 vienoje reabilitacijos ligoninėje ir dviejuose pirminės psichikos sveikatos priežiūros centruose gydomas 12 – 18 m. paauglys. Poveikio grupę sudarė 23 PPSPC ir 21 reabilitacinės ligoninės pacientas (kontrolines grupes – atitinkamai 23 ir 28). Konsultavime sprendžiamų problemų sunkumo pokyčiams vertinti taikyti Kliento vertinamas problemos sprendimo progresas ir Konsultanto vertinamo problemos sprendimo progreso skalė, o psichologinio funkcionavimo problemų laipsniui ir jo kitimui vertinti – Standartizuotas interviu paauglių problemoms įvertinti ir Paauglio elgesio klausimynas. Tyrimo rezultatai atskleidė, kad psichikos sveikatos sutrikimas paauglių psichologinį funkcionavimą paveikia labiau nei somatinės sveikatos sutrikimas, tačiau savęs... [toliau žr. visą tekstą]

Background: Nutritional psychiatry is an emerging field of research and it is currently exploring the impact of nutrition and obesity on brain function and mental illness. Prior studies links between obesity, nutrition and depression among women. However, less is known how food insecurity may moderate that relationship. Methods: Data were employed from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003. Two logistic regression models were Logistic regression was used to determine the association between obesity, gender, food insecurity, and past year Major Depressive Disorder (MDD). We then stratified by gender, and tested the association between obesity and past year MDD, and if food insecurity moderated the association. Results: Obesity was associated with an increased risk for past year Major Depressive Disorder (MDD) among females (AOR = 1.35; 95% CI 1.17-1.55) and was not associated among males (AOR = 1.07; 95% CI, 0.86-1.32). Women who reported that reported both obesity and food insecurity reported higher odds of past year MDD episode (AOR = 3.16; 95% CI, 2.36-4.21, than women who did not report food insecurity (AOR = 1.08; 95% CI, 1.02-1.38). Conclusion: With rising rates of mental health problems, females should be closely monitored to understand how poor diets, food insecurity, and obesity play a role in mental health outcomes. It is recommended that clinicians and treatment providers consider the patient's diet and access to nutritious foods when conducting their assessment.

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Contexte : Chez les adolescents, les troubles de santé mentale sont fréquemment associés à des troubles liés à l’usage de substances psychoactives. Ce double diagnostic complique le traitement et le pronostic des patients, en entraînant par ailleurs des coûts effarants pour la société. Selon la récente littérature ainsi que les priorités que les gouvernements fédéral et provincial de la santé se sont fixés, une approche intégrée des soins est celle à privilégier dans la prise en charge globale des troubles concomitants. Trois études randomisées contrôlées ont démontré qu’une intervention ciblée à certains profils de personnalité à haut risque de problèmes de consommation (Désespoir/Pensées négatives, Impulsivité, Sensibilité à l’anxiété, Recherche de sensations fortes), et prédisposant également à des troubles psychiatriques, réduit la consommation excessive d’alcool, la quantité et la fréquence de consommation ainsi que les problèmes liés à celle-ci. Dans ce mémoire, il a été postulé qu’une intervention brève ciblée à des facteurs de risque communs aux troubles concomitants, soit ces différents profils de personnalité, et visant la prévention et la réduction de la consommation et problèmes associés aurait aussi un effet bénéfique chez une population clinique psychiatrique d’adolescents. Méthode : Pour tester cette hypothèse, deux études ont été conduites dans le cadre de ce mémoire. Dans la première, ce sont des données d’une cohorte déjà existante d’adolescents en milieu scolaire qui ont été analysées afin de déterminer si parmi ces adolescents, ceux à haut risque de problèmes de consommation et présentant des symptômes de problèmes psychiatriques pourraient bénéficier de cette intervention brève. La même intervention a ensuite été testée auprès d’un échantillon d’adolescents en milieu clinique; cette étude, qui constitue la deuxième partie de ce mémoire, s’est déroulée au sein d’un département psychiatrique en centre hospitalier. Résultats : La première étude a permis de démontrer que les adolescents à haut risque de problèmes de consommation présentant des symptômes dépressifs et anxieux bénéficiaient tout autant de l’intervention. Ceux présentant des symptômes d’hyperactivité/impulsivité et problèmes de conduite en ont quant à eux bénéficié autant sinon davantage, les effets étant d’ailleurs plus prononcés pour certaines variables de consommation chez les adolescents présentant davantage de symptômes externalisés. Dans la seconde étude, aucun résultat significatif n’a pu être obtenu quant aux variables de consommations ou de problèmes de santé mentale. Les adolescents ayant reçu l’intervention ont davantage répondu au suivi à 6 mois comparativement à ceux n’ayant pas reçu l’intervention (p =0,003). Conclusion : La première étude est prometteuse quant à l’applicabilité de l’intervention chez des jeunes présentant des symptômes de problèmes psychiatriques. En ce sens, l’absence de résultat significatif pour la seconde étude pourrait possiblement être en partie due à une attrition à 6 mois plus substantielle que celle attendue et donc aux limites statistiques encourues. Cependant, il est aussi possible que l’intervention telle qu’elle a été offerte n’était pas suffisamment approfondie ou n’adressait pas suffisamment d’enjeux propres à cette population clinique. Il a néanmoins pu être observé que l’évaluation et l’organisation des soins des patients n’incluaient pas d’emblée la prise en charge de leur consommation ou problèmes associés. La coordination entre clinique et recherche devrait être optimisée, autant pour supporter la mission que se sont donnée les gouvernements d’harmoniser ces deux dimensions, que pour suivre leurs recommandations quant à la nécessité de prioriser une intégrité des soins chez les patients souffrant de troubles concomitants. / Background: In adolescents, mental health disorders frequently co-occurs with substance misuse, a dual diagnosis that tends to complicate the patient’s treatment and prognosis, resulting in astounding costs for society. Thus, it is critical to investigate how to prevent and reduce substance use problems in this population and optimize their global treatment. According to recent literature and to health provincial and federal governments’ priorities, an integrated services approach has been identified as the strategy to favour. In three randomised-controlled trials, brief personality-targeted interventions have shown to be effective in preventing adolescent onset and growth of drinking, binge-drinking and drinking problems. The personality profiles targeted (Hopelessness/Negative thinking, Impulsivity, Anxiety-Sensitivity, Sensation Seeking) play an important role in the onset and development of both substance misuse and psychiatric symptoms. In this thesis, we hypothesized that brief personality-targeted interventions aiming to prevent and reduce substance misuse in a high-risk population would also benefit a psychiatric clinical sample of adolescents. Methods: To test this hypothesis, 2 studies were conducted as part of this thesis. In the first one, data from an existing sample of adolescents from a school cohort were analysed to determine if among these students, those at high risk of alcohol misuse and presenting with psychiatric symptoms could benefit from this brief intervention. The same intervention was then delivered to a clinical sample of adolescents; this second study was conducted in a psychiatric department in a hospital setting. Results: The first study showed that the intervention was as effective regardless of whether the adolescents reported depression and anxiety symptoms; these symptoms did not moderate the intervention effects on substance misuse and associated problems. However, reporting hyperactivity/impulsivity symptoms and conduct problems did significantly moderate the intervention effects on some drinking outcomes, showing mainly more beneficial intervention effects in adolescents reporting higher levels of externalizing symptoms. In the second study, no significant intervention effects were found regarding substance use and psychiatric symptoms outcomes. Adolescents who received the intervention significantly had higher rates of follow-up compared to those who did not receive the intervention (p =0,003). Conclusion: The first study is promising regarding the applicability of the intervention with adolescents with psychiatric disorders’ symptoms. In that sense, the lack of significant findings in the second study could potentially be explained by attrition and small sample size at follow-up and therefore to the statistical limits encountered. It is also possible that the intervention as delivered did not address the issues specific to this clinical population in enough depth. Nevertheless, it was observed that the evaluation and organization of patient care did not simultaneously include support for patients’ substance use or associated problems. The coordination between treatment and research should be optimized, not only to support the stated mission of governments to harmonize these two dimensions, but also to follow their recommendations as to the need to prioritize the integration of care for patients with comorbid disorders.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Alors que, dans les années soixante, l’étude des conditions sociales dans leurs conséquences sur la santé mentale semblait une voie d’avenir pour la recherche psychiatrique (Sicot, 2001), il semble que, dans le contexte actuel, elle soit redevenue « hors propos ». Dans ce contexte où la plupart reconnaissent l’hégémonie de l’approche biologique en psychiatrie, quelle place peut être réservée aux conditions sociales pour expliquer l’origine des problèmes de santé mentale? Plusieurs auteurs, issus de la psychiatrie et des sciences humaines, se sont attardés à cette question. De leur avis, certaines conditions sociales, comme celles vécues par les bonnes à tout faire, les assistés sociaux, les immigrants, seraient particulièrement propices au développement de problèmes de santé mentale. Il est proposé dans ce mémoire de se concentrer sur l’impact d’une condition sociale particulière, l’itinérance, sur la santé mentale des personnes qui la vivent. Au terme d’une recension des écrits, des auteurs comme Furtos (2007) ont conclu que l’itinérance, en tant que forme extrême d’exclusion sociale, est à même d’engendrer des problèmes de santé mentale. Toujours avec l’objectif de répondre à la question de l’impact des conditions sociales sur la santé mentale, ce mémoire s’intéresse au point de vue des premières concernées, c’est-à-dire celui des personnes en situation d’itinérance ayant des problèmes de santé mentale. Sur le plan méthodologique, il se fonde sur 10 récits de vie de participants au projet Chez soi, projet de recherche et démonstration sur la santé mentale et l’itinérance de Montréal. Ce mémoire met en lumière les facteurs explicatifs soulignés par les participants au fil de leurs récits de vie et les compare à ceux identifiés dans la littérature se situant dans le courant sociogénétique. / During the 1960s, the study of the impact of social conditions on mental health seemed to be a logical path for psychiatric research (Sicot, 2001), it seems that it has once again become ''irrelevant'' in the present context. In a context wherein most are acknowledging the biological approach in psychiatry, where is the role of social conditioning to explain the roots of mental health issues? Many authors from the field of social sciences and psychiatry have adressed that issue. From their perspective, specific social conditions, immigration, welfare recipients or housekeepers are particularly favorable to mental illness. The objective of this Dissertation is to focus on the impact of homelessness on the mental health of people living with that condition. Authors such as Furtos (2007) have acknowledged that homelessness - as an extreme form of social exclusion- can readily generate mental health disorders. Keeping with the objective of adressing the issue of the consequences of social conditioning on mental health, thie aim of this Dissertation is to present the views of homeless people living with mental health problems. The methodology used is based on the life histories of 10 participants in the At home initiative, a research and demonstration project in Montreal. The objective of the Dissertation is to identify explanatory factors brought by participants during the sharing of their life stories and to compare them with the available and current sociological data in the field of socio-genesis.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal