The effect of an Internet-based cognitive behavioral therapy intervention on social support in disaster evacuees.

INTRODUCTION: Both exposure to a natural disaster and psychological symptoms may lead to decreases in social support. Few studies have examined ways to improve social support among victims of natural disasters. AIMS: The objective of the study was to assess emotional and tangible support following a 12-session Internet-based cognitive behavioral therapy (ICBT) targeting posttraumatic stress (PTS), insomnia, and depression symptoms and to examine the association between posttreatment symptoms and emotional and tangible support. MATERIALS AND METHODS: One hundred and seventy-eight wildfire evacuees with significant PTS, depression and/or insomnia symptoms were given access to the ICBT. They completed questionnaires at pre- and posttreatment to measure social support and symptom severity. RESULTS: Results show that completion of the treatment led to an improvement in emotional support. Lower posttreatment PTS and insomnia symptoms were associated with higher posttreatment emotional support. CONCLUSION: ICBT may contribute to enhance emotional support through symptom improvement and probably more so when social support is address directly in treatment.

Screening for Psychological Distress in Healthcare Workers Using Machine Learning: A Proof of Concept.

The purpose of this study was to train and test preliminary models using two machine learning algorithms to identify healthcare workers at risk of developing anxiety, depression, and post-traumatic stress disorder. The study included data from a prospective cohort study of 816 healthcare workers collected using a mobile application during the first two waves of COVID-19. Each week, the participants responded to 11 questions and completed three screening questionnaires (one for anxiety, one for depression, and one for post-traumatic stress disorder). Then, the research team selected two questions (out of the 11), which were used with biological sex to identify whether scores on each screening questionnaire would be positive or negative. The analyses involved a fivefold cross-validation to test the accuracy of models based on logistic regression and support vector machines using cross-sectional and cumulative measures. The findings indicated that the models derived from the two questions and biological sex accurately identified screening scores for anxiety, depression, and post-traumatic stress disorders in 70% to 80% of cases. However, the positive predictive value never exceeded 50%, underlining the importance of collecting more data to train better models. Our proof of concept demonstrates the feasibility of using machine learning to develop novel models to screen for psychological distress in at-risk healthcare workers. Developing models with fewer questions may reduce burdens of active monitoring in practical settings by decreasing the weekly assessment duration.

Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study.

BACKGROUND: Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later. METHODS: We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points. RESULTS: Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression. CONCLUSIONS: Healthcare workers' occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important factors over time.

Assessment of Psychological Distress in Health-care Workers during and after the First Wave of COVID-19: A Canadian Longitudinal Study: Évaluation de la Détresse Psychologique Chez Les Travailleurs de la Santé Durant et Après la Première Vague de la COVID-19: une étude longitudinale canadienne.

OBJECTIVES: Health-care workers (HCW) exposed to COVID-19 are at risk of experiencing psychological distress. Although several cross-sectional studies have been carried out, a longitudinal perspective is needed to better understand the evolution of psychological distress indicators within this population. The objectives of this study were to assess the evolution of psychological distress and to identify psychological distress trajectories of Canadian HCW during and after the first wave of COVID-19. METHOD: This prospective cohort study was conducted from May 8 to September 4, 2020, and includes a volunteer sample of 373 HCW. Symptoms of post-traumatic disorder, anxiety, and depression were assessed using the Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders fifth edition (PCL-5), the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9. Descriptive statistics were used to illustrate the evolution of psychological distress indicators, whereas latent class analysis was carried out to identify trajectories. RESULTS: During and after the first wave of COVID-19, the rates of clinical mental health symptoms among our sample varied between 6.2% and 22.2% for post-traumatic stress, 10.1% and 29.9% for depression, and 7.3% and 26.9% for anxiety. Finally, 4 trajectories were identified: recovered (18.77%), resilient (65.95%), subchronic (7.24%), and delayed (8.04%). CONCLUSION: The longitudinal nature of our study and the scarcity of our data are unique among existing studies on psychological distress of HCW in COVID-19 context and allow us to contextualize prior transversal data on the topic. Although our data illustrated an optimistic picture in showing that the majority of HCW follow a resilience trajectory, it is still important to focus our attention on those who present psychological distress. Implementing preventive mental health interventions in our health-care institutions that may prevent chronic distress is imperative. Further studies need to be done to identify predictors that may help to characterize these trajectories.

Quality of Life After Violent Crime: The Impact of Acute Stress Disorder, Posttraumatic Stress Disorder, and Other Consequences.

Victims of violent crime (VVC) are at risk of developing acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD). In addition, VVC are more likely to have low social support due to stigmatization and victim-blaming, and PTSD is frequently associated with depression, anxiety, and impaired quality of life (QoL). The present study aimed to determine the impact of ASD, PTSD, depressive symptoms, anxiety symptoms, and perceived social support in relation to four domains of QoL among VVC. Individuals were recruited as part of a longitudinal study assessing the efficacy of a brief cognitive behavioral treatment for ASD. Participants (N = 127) were interviewed and completed self-report measures within 30 days of experiencing a violent crime (T0 ) and at assessments 2 months (T1 ) and 6 months (T2 ) after the event. Depressive symptoms, ASD, and PTSD were found to be associated with lower QoL ratings in all four domains. Anxiety symptoms were found to be associated with lower ratings in the physical health and psychological QoL domains. Perceived social support was found to be associated with higher QoL ratings in all domains. The proportions of QoL variance explained by the combined fixed and random effects combined ranged from 70% to 79%. Future research considerations include an examination of how early interventions for VVC could prevent QoL deterioration by targeting ASD and PTSD development, depressive and anxiety symptoms, and social support.

A Portrait of Mental Health Services Utilization and Perceived Barriers to Care in Men and Women Evacuated During the 2016 Fort McMurray Wildfires.

This study examines the influence of gender on mental health services utilization and on perceived barriers to treatment one year after the 2016 Fort McMurray wildfires. Data was collected through a phone survey from May to July 2017 (N = 1510). Participants were English-speaking evacuees aged 18 and older. Mental health services utilization and barriers to mental health care were assessed with the Perceived Need for Care questionnaire. Probable diagnoses of posttraumatic stress disorder, depression and insomnia were assessed with validated self-report questionnaires. Multiple logistic regressions confirmed that gender was a significant predictor of services utilization, after controlling for associated sociodemographic variables and presence of probable diagnoses. Women were respectively 1.50, 1.55 and 1.86 times more likely than men to receive information, medication and psychological help. Self-reliance was the most frequently reported reason for not receiving help, and motivational barriers, such as pessimism and stigma, were reported in a higher proportion than structural barriers, including nonresponse and finance. No significant gender differences were found in the types of perceived barriers to services. Among the Fort McMurray fire evacuees, mental health services utilization was similar to other studies on natural disaster victims, and higher in women than in men. Efforts to increase services utilization in natural disaster victims should focus on motivational barriers and offering treatments fostering people's autonomy, such as online treatments.

Education and training for preventing and minimizing workplace aggression directed toward healthcare workers.

BACKGROUND: Workplace aggression constitutes a serious issue for healthcare workers and organizations. Aggression is tied to physical and mental health issues at an individual level, as well as to absenteeism, decreased productivity or quality of work, and high employee turnover rates at an organizational level. To counteract these negative impacts, organizations have used a variety of interventions, including education and training, to provide workers with the knowledge and skills needed to prevent aggression.  OBJECTIVES: To assess the effectiveness of education and training interventions that aim to prevent and minimize workplace aggression directed toward healthcare workers by patients and patient advocates. SEARCH METHODS: CENTRAL, MEDLINE, Embase, six other databases and five trial registers were searched from their inception to June 2020 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: Randomized controlled trials (RCTs), cluster-randomized controlled trials (CRCTs), and controlled before and after studies (CBAs) that investigated the effectiveness of education and training interventions targeting aggression prevention for healthcare workers. DATA COLLECTION AND ANALYSIS: Four review authors evaluated and selected the studies resulting from the search. We used standard methodological procedures expected by Cochrane. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS: We included nine studies-four CRCTs, three RCTs, and two CBAs-with a total of 1688 participants. Five studies reported episodes of aggression, and six studies reported secondary outcomes. Seven studies were conducted among nurses or nurse aides, and two studies among healthcare workers in general. Three studies took place in long-term care, two in the psychiatric ward, and four in hospitals or health centers. Studies were reported from the United States, Switzerland, the United Kingdom, Taiwan, and Sweden. All included studies reported on education combined with training interventions. Four studies evaluated online programs, and five evaluated face-to-face programs. Five studies were of long duration (up to 52 weeks), and four studies were of short duration. Eight studies had short-term follow-up (< 3 months), and one study long-term follow-up (> 1 year). Seven studies were rated as being at "high" risk of bias in multiple domains, and all had "unclear" risk of bias in a single domain or in multiple domains. Effects on aggression Short-term follow-up The evidence is very uncertain about effects of education and training on aggression at short-term follow-up compared to no intervention (standardized mean difference [SMD] -0.33, 95% confidence interval [CI] -1.27 to 0.61, 2 CRCTs; risk ratio [RR] 2.30, 95% CI 0.97 to 5.42, 1 CBA; SMD -1.24, 95% CI -2.16 to -0.33, 1 CBA; very low-certainty evidence). Long-term follow-up Education may not reduce aggression compared to no intervention in the long term (RR 1.14, 95% CI 0.95 to 1.37, 1 CRCT; low-certainty evidence). Effects on knowledge, attitudes, skills, and adverse outcomes Education may increase personal knowledge about workplace aggression at short-term follow-up (SMD 0.86, 95% CI 0.34 to 1.38, 1 RCT; low-certainty evidence). The evidence is very uncertain about effects of education on personal knowledge in the long term (RR 1.26, 95% CI 0.90 to 1.75, 1 RCT; very low-certainty evidence). Education may improve attitudes among healthcare workers at short-term follow-up, but the evidence is very uncertain (SMD 0.59, 95% CI 0.24 to 0.94, 2 CRCTs and 3 RCTs; very low-certainty evidence). The type and duration of interventions resulted in different sizes of effects. Education may not have an effect on skills related to workplace aggression (SMD 0.21, 95% CI -0.07 to 0.49, 1 RCT and 1 CRCT; very low-certainty evidence) nor on adverse personal outcomes, but the evidence is very uncertain (SMD -0.31, 95% CI -1.02 to 0.40, 1 RCT; very low-certainty evidence). Measurements of these concepts showed high heterogeneity. AUTHORS' CONCLUSIONS: Education combined with training may not have an effect on workplace aggression directed toward healthcare workers, even though education and training may increase personal knowledge and positive attitudes. Better quality studies that focus on specific settings of healthcare work where exposure to patient aggression is high are needed. Moreover, as most studies have assessed episodes of aggression toward nurses, future studies should include other types of healthcare workers who are also victims of aggression in the same settings, such as orderlies (healthcare assistants). Studies should especially use reports of aggression at an institutional level and should rely on multi-source data while relying on validated measures. Studies should also include days lost to sick leave and employee turnover and should measure outcomes at one-year follow-up. Studies should specify the duration and type of delivery of education and should use an active comparison to prevent raising awareness and reporting in the intervention group only.

Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review.

The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.

Intimate Partner Violence and Psychological Distress Among Young Couples: The Role of the Pattern of Violence.

The objective of this study was to assess whether the psychological distress of young men and women involved in intimate partner violence (IPV) is predicted by their reported role in the pattern of violence. Dyadic structural equation modeling (SEM) analyses were performed on a sample of 205 young couples, controlling for income, cohabitation, children, and the length of the relationship. Findings revealed that the most common reported pattern of IPV was mutual in nature. Reported bidirectional violence within the couple was related to distress for both sexes. The couple's income and the length of their relationship were negatively associated with psychological distress, namely for young women. Findings point to the importance of considering therapy in a couple-context.

Impact of a Program for the Management of Aggressive Behaviors on Seclusion and Restraint Use in Two High-Risk Units of a Mental Health Institute.

The Omega Program for the Management of Aggressive Behaviors aims to reduce patients' dangerous behaviors, towards themselves or others, and to reduce the use of seclusion and restraint (S/R). A previous study in a Mental Health Institute (Montreal, Canada) showed that implementing this program allowed employees of the intensive care and emergency units to gain confidence in coping with patients' aggressions and to reduce their psychological distress. The present study, conducted in the same high-risk units, assesses the effect of the program on S/R use. We hypothesize that the incidence and duration of S/R should diminish significantly following the implementation of the program in both units. This naturalistic, prospective study covered archival data between April 2010 and July 2014. Pre-training data (April 2010-December 2011) were compared to data during training (January 2012-October 2012) and to post-training data (November 2012-July 2014) for both units. In the intensive care unit, we confirmed an increase of both mean daily number and duration of S/R by admissions in pre-training, followed by a decrease during the training and post-training. In the emergency unit, a decreasing trend is seen during the entire period thus suggesting that the decrease in S/R may be independent of the training. These findings suggest that Omega is a promising intervention program to use in an intensive care unit. However, a more global approach, including institutional changes in culture and attitude, can be important factors to develop to increase the positive outcomes.

Psychosocial Difficulties in Adolescents nine Months after a Railway Accident.

A railway accident which occurred in Lac-Megantic in Quebec, Canada, caused disruption for an entire community. This study examines the psychosocial difficulties in a group of exposed adolescents aged between 11 to 17, nine months after the tragedy. The analyses were conducted on a sample of 515 adolescents, attending high school, and living near the impact area. Post-traumatic stress disorder (PTSD), mental health problems (depression, anxiety), and problem use of alcohol or drugs prevalence were estimated. Multiple logistic regression was used to identify risk factors for PTSD clinical threshold. Almost half (43.4%) of adolescents reported being severely exposed to the railway accident and one third (31.3%) have reported a PTSD. Serious injuries, depression and anxiety (p < .05) were associated with greater risks for adolescents with a PTSD. However, sex, victimization, and emerging problems or problem use of alcohol or drugs are not associated with the PTSD. The results of the study highlight the relationship between a traumatic event such as the railway accident and the presence of PTSD nine months after, as well as risk factors for PTSD in adolescents. Paying close attention to mental health problems in adolescents when a traumatic event occurs and provide adequate aid is essential.

Longitudinal assessment of psychological distress and its determinants in a sample of firefighters based in Montreal, Canada.

Introduction: Firefighters face elevated risks of common mental health issues, with distress rates estimated at around 30%, surpassing those of many other occupational groups. While exposure to potentially traumatic events (PTEs) is a well-recognized risk factor, existing research acknowledges the need for a broader perspective encompassing multidimensional factors within the realm of occupational stress. Furthermore, this body of evidence heavily relies on cross-sectional studies. This study adopts an intensive longitudinal approach to assess psychological distress and its determinants among firefighters. Methods: Participants were recruited from 67 fire stations in Montreal, Canada, meeting specific criteria: full-time employment, smartphone ownership, and recent exposure to at least one PTE, or first responder status. Subjects underwent a telephone interview and were directed to use an app to report depressive, post-traumatic, and generalized anxiety symptoms every 2 weeks, along with work-related stressors, social support, and coping styles. Analyses involved 274 participants, distinguishing between those exceeding clinical thresholds in at least one distress measure (the "distressed" subgroup) and those deemed "resilient." The duration and onset of distress were computed for the distressed group, and linear mixed models were employed to evaluate determinants for each psychological distress variable. Results: Clinical psychological distress was observed in 20.7% of participants, marked by depressive, post-traumatic, and anxiety symptoms, often within the first 4-week reference period. Contextual factors (operational climate, social support, solitude) and individual factors (coping style, solitude and lifetime traumatic events in private life) exhibited more significant impacts on psychological distress than professional pressures within the firefighters' work environment. Discussion: This study reports lower rates of psychological distress than previous research, possibly attributable to sample differences. It highlights that reported symptoms often represent a combined and transient layer of distress rather than diagnosable mental disorders. Additionally, determinants analysis underscores the importance of interpersonal relationships and coping mechanisms for mental health prevention interventions within this worker group. The findings carry implications for the development of prevention and support programs for firefighters and similar emergency workers.

The Signature Biobank: A longitudinal biopsychosocial repository of psychiatric emergency patients.

The Signature Biobank is a longitudinal repository of biospecimen, psychological, sociodemographic, and diagnostic data that was created in 2012. The Signature Consortium represents a group of approximately one hundred Quebec-based transdisciplinary clinicians and research scientists with various expertise in the field of psychiatry. The objective of the Signature Biobank is to investigate the multi-faceted underpinnings of psychiatric disorders among patients in crisis. The Signature Consortium is expanding and includes new active members that seek to highlight the contributions made by Signature Biobank since its inception. This article details our research protocol, directions, and summarizes contributions. To date, we have collected biological samples (n = 1,986), and questionnaire data (n = 2,085) from psychiatric emergency patients of the Institut universitaire en santé mentale de Montréal (Quebec, Canada), with a large proportion from whom both data types were collected (n = 1,926). In addition to this, a subsample of patients was followed-up at hospital discharge, and two additional outpatient clinic appointments (n = 958 with at least one follow-up). In addition, a socio-demographically matched comparison group of individuals who were not hospitalized for psychiatric disorders (n = 149) was recruited from the surrounding catchment area. To summarize, a systematic review of the literature shows that the Signature Biobank has contributed to better characterizing psychiatric comorbidities, biological profiles, and psychosocial functioning across some of the most common psychiatric disorders, including psychosis, mood, anxiety, and substance use disorders. The Signature Biobank is now one of the world's largest repositories of data collected from patients receiving care at a psychiatric emergency unit.

Prospective effects of peer support and gender roles on the mental health and work functioning of child protection workers exposed to potentially traumatic events.

BACKGROUND: Child protection workers (CPWs) are regularly exposed to potentially traumatic events (PTEs), especially, aggressive behaviors from the service users. OBJECTIVES: This study aimed to evaluate the effects of a peer support program on the mental health and work functioning of CPWs exposed to a PTE, while considering the moderating effect of gender roles. PARTICIPANTS AND SETTING: Participants were recruited in two youth social services centers (YSS) in Canada and assessed one month (n = 176), two months (n = 168), six months (n = 162), and 12 months (n = 161) following exposure to a PTE. Three groups were formed: workers from the first YSS who received peer support (intervention group), workers from the first YSS who did not receive peer support (first control group), and workers from the second YSS where no peer support program was available (second control group). METHODS: Linear mixed models were used to compare the three groups across time. RESULTS: The intervention group did not differ from the control groups on any outcome variables at any time points. Gender roles did not moderate any effect. However, compared with the first control group, the intervention group scored lower on masculine gender roles, suggesting that lower masculinity may facilitate help seeking behaviors. CONCLUSION: The results point toward the need to improve the peer support intervention, to complement this intervention with other forms of support, and to promote organizational changes that would favor the workers' well-being and facilitate their recovery following a PTE.

Longitudinal assessment and determinants of short-term and longer-term psychological distress in a sample of healthcare workers during the COVID-19 pandemic in Quebec, Canada.

Introduction: Previous research has demonstrated the negative impact of the COVID-19 pandemic emergency on the wellbeing of healthcare workers. However, few research contributions reported a longitudinal evaluation of psychological distress and examined determinants of its duration and course over time. The present study aims to explore the impact of the pandemic emergency on HCWs mental health by adopting a longitudinal design and assessing mental health as combination of overlapping clinical symptoms (post-traumatic stress disorder, depression and anxiety). Methods: Data were collected weekly through a mobile application during and after the first wave of COVID-19 in the province of Quebec, Canada, in 2020. Analysis was conducted on a final sample of 382 participants. Participants were grouped into "resilient" (RES) if they did not manifest clinical-level psychological distress during monitoring, "short-term distress" (STD) if distress exceeded the clinical threshold for 1-3 weeks, and longer-term distress (LTD) if it occurred for four or more weeks, even if not consecutively. Descriptive statistics for all variables were computed for each subgroup (RES, STD and LTD), and pairwise comparisons between each group for every descriptive variable were made using chi square statistics for categorical variables and t-test for continuous variables. Predictors of distress groups (STD and LTD vs RES) were assessed running multinomial hierarchical logistic regression models. Results: In our sample, almost two third (59.4%) HCWs did not manifest moderate or severe distress during the monitoring time. Short-term distress, mostly post-traumatic symptoms that lasted for less than 4 weeks, were the most common distress response, affecting almost one third of participants. Longer psychological distress occurred only in a smaller percentage (12.6%) of cases, as a combination of severe posttraumatic, depressive and anxiety symptoms. Perceived occupational stress was the most significant risk factor; moreover individual, peritraumatic work and family risk and protective factors, were likely to significantly affect the stress response. Discussion: Results tend to provide a more complex and resiliency-oriented representation of psychological distress compared to previous cross-sectional studies, but are in line with stress response studies. Findings allow us to better describe the profiles of distress response in STD and LTD groups. Participants that manifest short term distress experience acute stress reaction in which the interplay between personal, family and professional life events is associated with the stress response. Conversely, longer term distress response in HCWs presents a more complex mental health condition with an higher level of impairment and support needs compared to participants with short-term distress.

Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD, Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial.

This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires. One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128, p = .001; d = .519, 95% CI = .142-.895), depression (F[1,118.29] = 9.978, p = .002; d = .519, 95% CI = .141-.898) insomnia (F[1,117.60] = 4.574, p = .035; d = .512, 95% CI = .132-.892), and anxiety (F[1,119.64] = 5.465, p = .021; d = .421, 95% CI = .044-.797) symptom severity and disability (F[1,111.55] = 7.015, p = .009; d = .582, 95% CI = .200-.963). Larger effect sizes (d = 0.823-1.075) were observed in participants who completed at least half of the treatment. The RESILIENT online treatment platform was successful to provide access to specialized evidence-based mental health care after a disaster.

[Alcohol and drug consumption in students exposed to the Dawson College shooting: a gender-based analysis]. / La consommation d'alcool et de drogue des étudiants suite à la fusillade de Dawson : une analyse différenciée selon le sexe.

OBJECTIVE: To study alcohol and drug addiction incidence in students exposed to the Dawson College shooting within the 18 months following the event, to identify the precursors of a psychoactive substance addiction development while considering the severity of event exposure, and to examine whether alcohol use, 18 months after the event, is related to any of the various posttraumatic stress disorder (PTSD) symptom groups. METHOD: The population of this study was comprised of all the Dawson College students at the time of the event. Analyses were conducted with 854 students enrolled in the college at the time of the shooting. RESULTS: Five per cent of women and 7% of men showed, for the first time in their life, a problem with substance addiction following the shooting. In men, young age, lifetime suicidal ideation, and having seen the killer during the shooting are the main precursors of incident accident cases. None of the studied precursors were significant in women. Men and women were also different in terms of PTSD symptoms predicting alcohol use 18 months after the shooting. CONCLUSION: The study highlights the importance of considering a person's sex when studying their psychoactive substance use following a trauma.

Assessment of Psychological Distress in Health Care Workers During the First two Waves of COVID-19: A Follow-up of a Canadian Longitudinal Study.

Background: Health care workers (HCW) exposed to COVID-19 risk experiencing psychological distress. Little is known regarding longitudinal perspectives and evolutions of psychological distress within this population. The objective of this study is to extend the results of our previous study to the pandemic's second wave. Method: This prospective cohort study was conducted from May 8, 2020, to January 24, 2021, and includes 787 HCW. Symptoms of anxiety and depression were assessed using the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics illustrated the evolution of psychological distress indicators, whereas latent class analysis helped identify trajectories. Results: The results showed that a lower proportion of HCW exceeded the clinical threshold during the second wave (36,5% vs. 31,1%). As in the first wave, most of our sample fell onto the resilient trajectory (67.22%). We adapted the name of the remaining trajectories to better suit their evolution: rapid recovery (15.76%), slow recovery (9.66%), and delayed (7.37%). Conclusion: Approximately two-thirds of the HCW did not manifest significant distress. For those who did, the distress was transient. We observed a trend of positive adaptability among HCW, considering that the proportion of HCW experiencing psychological distress exceeding clinical threshold remained lower than during the first wave. Our data highlight the dynamic nature of psychological distress. To be able to detect psychological distress as it arises, HCW should use self-monitoring as an essential tool. This vigilance would allow institutions to offer timely support and resources for those experiencing psychological distress.

Stigma and Mental Health of Sexual Minority Women Former Victims of Intimate Partner Violence.

Sexual minority women (SMW) are at high risk of experiencing stigma, mental health problems, and being victims of intimate partner violence (IPV). This vulnerability can be explained by the sexual and gender minority stress model, stating that sexual and gender minority people suffer from specific stress factors added to general stressors, leading to more mental health and relationships problems. OBJECTIVE: The main goal of this study was to assess the impact of minority stress factors and former IPV victimization on the current mental health of Canadian SMW, as a function of their sexual and gender identity. METHOD: In total, 209 individuals identifying as women (M age = 33.9), living in Canada and who lived in a past violent relationship with a woman responded to an online survey. Well-validated questionnaires assessed sexual orientation and gender identity, former IPV behaviors, minority stress factors, depression, and anxiety. RESULTS: Hierarchical regressions showed that past psychological aggression was positively associated with anxiety symptoms and past sexual coercion with depressive symptoms. Not being monosexual was also associated more severe symptoms of depression and age was negatively associated with the severity of anxiety symptoms. After controlling for age, race/ethnicity, sexual and gender identity and former IPV victimization, having negative feelings about being a SMW was strongly associated with both depression and anxiety symptoms. CONCLUSION: These results provide new information on the interconnected associations between former IPV, minority stress and SMW's mental health. Findings highlight the need to adapt clinical interventions to help buffer against victimization faced by IPV victims who identify as sexual and gender minorities.

Investigating the cyclical hypothesis of client aggression as a 'loss spiral': Can child protection worker distress lead to more client aggression?

Working in a stressful environment, child protection workers (CPWs) are often victims of psychological and physical acts of aggression perpetrated by their clients. This can be emotionally distressing for CPWs. Previous authors have suggested that this distress could place CPWs at greater risk for subsequent victimisation if they become emotionally unavailable to their clients. This study sought to investigate whether the distress experienced after an act of client aggression or other types of potentially traumatic events could indeed predict subsequent victimisation over time. Using cross-lagged panel analysis, researchers administered standardised questionnaires to 173 CPWs who had experienced an act of client aggression or other type of potentially traumatic event in the month prior. Participants were asked to fill out additional questionnaires 2, 6 and then 12 months later. Researchers found that CPW distress did in fact predict subsequent victimisation at the 2-month time point only. Researchers then conducted a generalised linear model analysis to test the influence of sociodemographic variables and the moderating influence of supervisor support. Supervisor support did not moderate the relationship between initial distress levels and increased aggression 2 months later. The study concludes by examining how the emotional distress of CPWs can negatively impact clients and how organisations can best provide support, in part, by rethinking aggression prevention.