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.

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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.

No description available.

This program of research investigated the mental health of Mandaean refugees living in Sydney, Australia (N=315). Participants evidenced high rates of psychological disorders including posttraumatic stress disorder (PTSD, 23%), depression (34%), anger attacks (58%), complicated grief (10%) and impaired mental health-related functioning (42%). Participants also reported high levels of exposure to traumatic events, and experiencing multiple resettlement stressors. It was found that intrusive fear regarding traumatic events that may be experienced by family members remaining in Iraq contributed to PTSD, depression and mental health-related disability over and above the effects of past trauma and post-migration living difficulties. In addition, fear for family predicted frequency of anger attacks beyond the contribution of past trauma, living difficulties and PTSD. Fear of cultural extinction emerged as a salient concern for the Mandaean community, with path analyses revealing it was directly predicted by symptoms of PTSD. The effects of change in visa status on the mental health of Mandaean refugees who had also taken part in a previous survey were explored. Participants who had attained permanent residency status after previously holding Temporary Protection Visas (TPVs) evidenced greater reductions in psychological distress than those who had consistently held permanent residency. Results suggested that that temporary protection may have exerted negative effects on mental health by creating high levels of post-migration living difficulties. Analyses modelling pathways from trauma and loss to other mental health outcomes at both the individual and family levels indicated that grief played a key role in the mental health of the Mandaean community, and that the refugee experience has implications for family mental health and functioning. This thesis represents an attempt to extend knowledge regarding factors that influence refugee mental health, and common psychological outcomes, by examining the relationship between circumstances of ongoing threat to the individual and the collective, family-level processes, and psychological difficulties including PTSD, depression, grief, anger and mental health-related disability. These findings have implications for government policies and service providers working with refugee groups.

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No description available.

Through this hermeneutic study I sought to explicate the practice knowledge of nursing on residential adolescent mental health units. I did this by seeking to understand what nurse's and adolescent's stories of nursing, or being nursed, revealed about the knowledge informing practice within that context. Seven nurses and seven young people shared their experiences. Taped and written stories, and survey material, provided texts for analysis and interpretation. As stories centred around specific nurse-adolescent interactions they pointed to the knowledge informing practice within those encounters. Thus, practice knowledge was explicated through interpretation of the actual experiences of nurses and adolescents. Study findings were conceptualised as sub-elements, elements and a meta-element of practice knowledge. Ninety one

This program of research investigated the mental health of Mandaean refugees living in Sydney, Australia (N=315). Participants evidenced high rates of psychological disorders including posttraumatic stress disorder (PTSD, 23%), depression (34%), anger attacks (58%), complicated grief (10%) and impaired mental health-related functioning (42%). Participants also reported high levels of exposure to traumatic events, and experiencing multiple resettlement stressors. It was found that intrusive fear regarding traumatic events that may be experienced by family members remaining in Iraq contributed to PTSD, depression and mental health-related disability over and above the effects of past trauma and post-migration living difficulties. In addition, fear for family predicted frequency of anger attacks beyond the contribution of past trauma, living difficulties and PTSD. Fear of cultural extinction emerged as a salient concern for the Mandaean community, with path analyses revealing it was directly predicted by symptoms of PTSD. The effects of change in visa status on the mental health of Mandaean refugees who had also taken part in a previous survey were explored. Participants who had attained permanent residency status after previously holding Temporary Protection Visas (TPVs) evidenced greater reductions in psychological distress than those who had consistently held permanent residency. Results suggested that that temporary protection may have exerted negative effects on mental health by creating high levels of post-migration living difficulties. Analyses modelling pathways from trauma and loss to other mental health outcomes at both the individual and family levels indicated that grief played a key role in the mental health of the Mandaean community, and that the refugee experience has implications for family mental health and functioning. This thesis represents an attempt to extend knowledge regarding factors that influence refugee mental health, and common psychological outcomes, by examining the relationship between circumstances of ongoing threat to the individual and the collective, family-level processes, and psychological difficulties including PTSD, depression, grief, anger and mental health-related disability. These findings have implications for government policies and service providers working with refugee groups.