Prevalence and Correlates of Autism Spectrum Disorders in Quebec: Prévalence et corrélats des troubles du spectre de l'autisme au Québec.

OBJECTIVE: To estimate the prevalence, comorbidities, and service use of people with autism spectrum disorders (ASDs) based on data from Quebec Integrated Chronic Diseases Surveillance System (QICDSS). METHODS: We included all residents up to age 24 eligible for health plan coverage who were in Quebec for at least 1 day from January 1, 1996, to March 31, 2015. To be considered as having an ASD, an individual had to have had at least 1 physician claim or hospital discharge abstract from 2000 to 2015 indicating one of the following ASD diagnosis codes: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents. RESULTS: The QICDSS shows that the prevalence of ASD has risen steadily over the past decade to approximately 1.2% ( n = 16,940) of children and youths aged 1 to 17 years in 2014 to 2015. The same prevalence was obtained using Ministry of Education data. Common medical comorbidities included congenital abnormalities of the nervous system, particularly in the first year of life. Psychiatric comorbidity was much more highly prevalent, especially common mental disorders like anxiety and attention-deficit/hyperactivity disorder. Children and youths with ASDs made on average 2.3 medical visits per year compared with 0.2 in the general population. Between 18 and 24 years old, the mental health needs of individuals with ASDs were met less by medical specialists and more by general practitioners. CONCLUSION: Information derived from this database could support and monitor development of better medical services coordination and shared care to meet the continuous and changing needs of patients and families over time.

A Surveillance System to Monitor Excess Mortality of People With Mental Illness in Canada.

OBJECTIVE: Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. METHODS: We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. RESULTS: We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. CONCLUSIONS: Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces.

[Suicide prevention from a public health perspective]. / Perspectives de la santé publique pour la prévention du suicide.

Suicide and suicide prevention represent major public health challenges. The public health perspective juxtaposes a multifactor understanding of society's health phenomena to a mobilization around determinants on which actions can be taken. Public health has encountered success with infectious diseases as well as chronic diseases such as hypertension. In this article, the phenomenon of suicide is detailed with data drawn from Quebec, Canada and international research. Population-based suicide prevention policies are generally multimodal, and often involve strategies aiming at improving mental health services. The success of these strategies lies in their steady application and in the close surveillance of this application.

Influence of social and material individual and area deprivation on suicide mortality among 2.7 million Canadians: a prospective study.

BACKGROUND: Few studies have investigated how area-level deprivation influences the relationship between individual disadvantage and suicide mortality. The aim of this study was to examine individual measures of material and social disadvantage in relation to suicide mortality in Canada and to determine whether these relationships were modified by area deprivation. METHODS: Using the 1991-2001 Canadian Census Mortality Follow-up Study cohort (N = 2,685,400), measures of individual social (civil status, family structure, living alone) and material (education, income, employment) disadvantage were entered into Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for male and female suicide mortality. Two indices of area deprivation were computed - one capturing social, and the other material, dimensions - and models were run separately for high versus low deprivation. RESULTS: After accounting for individual and area characteristics, individual social and material disadvantage were associated with higher suicide mortality, especially for individuals not employed, not married, with low education and low income. Associations between social and material area deprivation and suicide mortality largely disappeared upon adjustment for individual-level disadvantage. In stratified analyses, suicide risk was greater for low income females in socially deprived areas and males living alone in materially deprived areas, and there was no evidence of other modifying effects of area deprivation. CONCLUSIONS: Individual disadvantage was associated with suicide mortality, particularly for males. With some exceptions, there was little evidence that area deprivation modified the influence of individual disadvantage on suicide risk. Prevention strategies should primarily focus on individuals who are unemployed or out of the labour force, and have low education or income. Individuals with low income or who are living alone in deprived areas should also be targeted.

Firearms regulation and declining rates of male suicide in Quebec.

OBJECTIVES: To examine whether significant changes in method-specific male suicide rates occurred in the province of Quebec after stronger firearms regulations were introduced in Canada in 1991; to ascertain whether more stringent firearms regulations influence firearms and total suicide trends among men and to determine whether different results are obtained according to the statistical methods used. STUDY DESIGN: Descriptive analyses of time trends in method-specific suicide rates for men from 1981 to 2006 using Joinpoint regression models and pre-post firearms regulation analyses. SETTING: Quebec (Canada). PATIENTS OR SUBJECTS: Men who have commited suicide aged 15-34, 35-64 and 65 years and over, based on the Quebec mortality database, 1981-2006. INTERVENTIONS: A national firearms control initiative enacted in 1991. RESULTS: The Joinpoint regression models suggest that firearm suicide rates declined towards the end of the 1990 s. Since 1996, the pace of decline was twice as great in men aged 15-34 years (annual percentage change (APC) -11.1%) compared with men aged 35-64 years (APC -5.6%). Total suicide rates also declined among men aged 15-34 and 35-64 years during this period. Pre-post firearms regulation Poisson regression analyses failed to detect the specific point in time when significant changes in the trend occurred. CONCLUSIONS: Male firearm suicide rates declined following the introduction of restrictive firearms regulations in Canada. Whether this represents a causal relationship requires further study.

[Estimating the Prevalence and Incidence Rate of Autism Spectrum Disorder (ASD): Interprovincial Comparisons]. / Estimation de la prévalence et du taux d'incidence du trouble du spectre de l'autisme (TSA). Comparaison interprovinciale.

Objective The prevalence of diagnosed autism spectrum disorders (ASD) has risen steadily over time. There is therefore a need for the monitoring of treated ASD for timely policy making. The objective of this study is to report and compare over a 10-year period the prevalence and incidence rate of diagnosed ASD in four Canadian provinces. Methods This study utilized data from the provinces of Manitoba, Ontario, Quebec and Nova Scotia with access to linked administrative database sources used in the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence rate of a physician diagnosis of ASD. Estimates were produced using health datasets for outpatient and inpatient care (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the three other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were extracted. The target population consisted of all residents aged 24 and under eligible for healthcare coverage under provincial law between 1999 and 2012. To be considered as having ASD, an individual had to have at least one physician claim or hospital discharge abstract indicating one of the following: ICD-9 codes 299.0 to 299.9 or their ICD-10 equivalents, F84.0 to F84.9. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by sex and age groups. The main analyses focused on those aged 17 years or less, with the 18 to 24 years group added to show the subsequent progression of the disorder. Results Our findings show that the annual prevalence of ASD rose steadily between 1999 and 2012 in all provinces and for all age groups although this increase varied across Canadian provinces. There were higher annual prevalence estimates in Ontario (4.8 per 1,000) and Nova Scotia (4.2 per 1,000) compared to Quebec (3.0 per 1,000) and Manitoba (2.5 per 1,000), among persons aged 17 years and younger in 2011. As compared to 1999, Quebec and Ontario reported a fivefold and fourfold increase in 2010-2012, the highest among provinces. The prevalence was four times higher in boys than in girls. By age group, the highest prevalence was observed in those aged between 1 to 4 and 5 to 9 years depending on the province. ASD was generally diagnosed before age 10. Incident cases were more frequently diagnosed by pediatricians followed by either psychiatrists or general practitioners depending on the province. Conclusion Our research confirms that ASD has risen steadily in terms of prevalence and incidence rate and that it varies considerably across provinces. It also demonstrates that health administrative databases can be used as registers for ASD. Information derived from these databases could support and monitor development of improved coordination and shared care to meet the continuous and changing needs of patients and families over time. Implication for future research include exploring the etiology of ASD in more recent cohorts as well as investigating the association between variations in health service availability and the prevalence of ASD.

The impact of media coverage of the suicide of a well-known Quebec reporter: the case of Gaëtan Girouard.

Evidence of a media impact on suicide is mixed and needs further research. The main objective of this article is to document the effects of the media coverage following the suicide of a well-known and popular television reporter in Quebec, Canada. A content analysis of the printed media and an analysis of suicide rates during the following year, of coroners' records and of calls to Suicide Prevention Centres during the following 3 months was conducted. Most guidelines for responsible reporting of a suicide were not applied. The results showed a rise in the suicides rates immediately after the reporter's suicide, especially by hanging as in the original case. A cluster of six suicides by hanging also took place in the small municipality where the reporter's suicide occurred. There was also an indication of direct influence in the coroners' records and a rise in calls to Suicide Prevention Centres. This research indicates that the reporting of the suicide of a popular figure preceded an important rise in the number of suicides. A possible theoretical explanation is that a positive role model appeared to suddenly fail to cope with life, thus creating high distress and cognitive dissonance in the audience. The news media should apply more caution and follow recommended guidelines in reporting this type of news.