[Mental income inequality: a "virus" which affects health and happiness]. / L'inégalité de revenus : un « virus ¼ qui affecte la santé mentale et le bonheur.

AIM: The purpose of this paper is to demonstrate the impact of income inequality on various indexes of mental health and on happiness in wealthy nations. Initially, the unequal distribution of income is documented in wealthy nations, especially in the United States of America. After the World War II, income equality was at a level never reached before, but since the eighties, income inequality has raised dramatically in many industrialized countries. The 2008 crisis has worsened the situation in many of them, particularly in the United States. Furthermore, prejudices have increased against women, Blacks, Spanish-speakers and those who receive social welfare. METHOD: A selective review of the literature is made in order to document the impact of income inequality on a few indicators of mental health (from WHO, UN, UNICEF, OCDE and World Bank) and on happiness, defined here as life satisfaction. RESULTS: Income inequality is positively related to the following indexes: Index of Mental Illness from the WHO (0.73), Index of the United Nations' Office on Drug Consumption (0.63) and a composite Index of ten psychosocial problems, constituted by Wilkinson and Pickett, 2013 (0.87). On the other hand, income inequality is negatively associated to the UNICEF Index of Child Well-Being (-0.71). Furthermore, the level of anxiety and of depression is higher in countries where income inequality is greater. The correlation between happiness and income inequality in the 23 wealthy nations is -0.48; this correlation becomes -0.41 after control of the effect of the GNP (Gross National Product). These results support the idea that it is relative income - not absolute income - which matters in the evaluation of our life and of our happiness. In underdeveloped nations, any increase in GNP promotes the well-being of the citizens; whereas in wealthy nations, it is the equality of the distribution that is more important. Many arguments supporting the causal relation from income inequality to psychosocial problems and unhappiness are presented. In reality, this income inequality is like a "virus" which affects the well-being of the entire population. CONCLUSION: Even if the increase of mental problems may be explained by many factors - historical, cultural, ethnic, social, and societal - these factors do not eliminate the effect of income inequality. In order to counter the effects of income inequality and to promote a "flourishing" mental health, the professionals of human sciences are invited to take into account this reality in the implementation of their interventions and to participate to the elaboration of social politics as well as in the education process of the general population.

Daily hassles, physical illness, and sleep problems in older adults with wishes to die.

BACKGROUND: Factors associated with the wish to die should be investigated in order to gain more opportunities for preventive interventions targeting older adults at risk for suicide. The goal of the research was to study the prevalence and associated factors of wishes to die in older adults living in the community using the data from a survey on the prevalence of mental disorders in this population. METHODS: With a representative sample of community living older adults aged 65 years and over (N = 2777), we compared individuals with the wish to die (n = 163) to those without the wish to die on the basis of the presence and severity of daily hassles, physical illness, and sleep quality. RESULTS: Logistic regression revealed that when depression and sociodemographic variables were held constant, self-rated physical health, number of chronic illnesses, number and intensity of daily hassles, as well as sleep problems were significantly associated with the wish to die in older adults. Painful illnesses and daytime dysfunction due to sleep problems were also associated factors with the wish to die. CONCLUSION: Since desire for death is the first step into the suicidal process, health professionals should seriously consider the important and unique contribution of these variables in order to have more opportunities for detection and intervention.

Prevalence of psychiatric disorders in community-dwelling older men and women with cognitive impairment no dementia: results from the ESA study.

OBJECTIVES: To assess the prevalence rate of mood disorders, anxiety disorders, benzodiazepine dependence, and insomnia in older men and women with probable cognitive impairment no dementia (CIND) and to examine the independent associations between each disorder and CIND. METHOD: Participants were a random sample of community-dwelling individuals aged 65-96 (N = 2414). Semi-structured in-home interviews based on DSM-IV-TR (DSM, Diagnostic and Statistical Manual of Mental Disorders) criteria evaluated the prevalence rates of mood disorders, anxiety disorders, benzodiazepine dependence, and insomnia. Participants were classified as probable CIND based on their Mini-Mental State Examination score using sex, age, and education-stratified cut-offs (lower than the 15th percentile). RESULTS: In men, 22.7% of individuals with probable CIND and 12.1% of those with normal cognition had at least one psychiatric disorder (crude odds ratio (OR): 2.13, 95% confidence interval (CI): 1.23-3.69). More specifically, mood disorders (3.43, 1.74-6.75), benzodiazepine dependence (5.10, 1.23-21.11), and comorbid anxiety and mood disorders (8.67, 2.00-37.68) were significantly associated with probable CIND, but not anxiety disorders alone and insomnia. The prevalence rate of psychiatric disorders was similar in women with probable CIND (23.1%) and in women without CIND (23.9%; 0.95, 0.64-1.42). No specific psychiatric disorder was significantly associated with probable CIND in women. All associations remained unchanged after adjustments for potential confounders. CONCLUSIONS: The association between psychiatric disorders and probable CIND appears to be sex-specific. In clinical practice, mood disorders, and benzodiazepine dependence should receive particular attention since these disorders are associated with a condition increasing the risk of dementia.

Associations of social relationships with consultation for symptoms of depression: a community study of depression in older men and women in Québec.

To assess associations between social relationships and consultation for symptoms of depression, data from a representative sample of 2,811 French-speaking community-dwelling older adults in Québec were used. Less than half of the older adults meeting DSM criteria for depression (N = 379; 47.1%) had sought consultation about their depression-relevant symptoms in the preceding 12 months. Having a cohabitant partner or having children were not associated with frequency of consultation for women. Men without a partner tended to consult more frequently than men with a cohabiting partner (OR = 2.5; 95% CI = 0.81, 7.88). None of the men without a confidant had consulted. Among the 67 men with a confidant, consultation was more frequent among those not cohabiting with a partner (70%) than among those with a cohabiting partner (46%). The influence of social relationships on consultation for depression differed in men and women in this population of depressed elderly people in Québec.

Social relationships and depression among people 65 years and over living in rural and urban areas of Quebec.

OBJECTIVE: To compare the prevalence of depression within the elderly Quebec population residing in rural areas, urban areas and metropolitan Montreal, and to assess differences in the associations between social relationships and depression across these urban and rural settings. METHODS: Data originate from the first wave of the ESA (Etude de Santé des Ainés) longitudinal study on mental health of community dwelling older persons aged over 65 (n = 2670). Depression, including major and minor depression, measured using a computer questionnaire; the ESA-Q developed by the research team and based on the DSM-IV criteria. Assessments of associations between depression and geographic area, informal social networks and community participation were estimated adjusting for demographic, socioeconomic and health characteristics. RESULTS: The prevalence of depression was higher in rural (17%) and urban areas (15.1%) than in metropolitan Montreal (10.3%). The odds ratio of rural (OR = 2.01 95% CI 1.59-2.68) and urban (OR = 1.75; 95% CI 1.25-2.45) areas compared to the metropolitan area increased slightly after adjustment by all social and health covariates. Our study indicated that social support and the lack of conflict in intimate relationships were associated with lower prevalence of depression in all areas. CONCLUSION: Geographic differences in depression exist within the elderly population in Quebec that may generate significant impact on their health and functional abilities. Further research should be conducted to explain these differences.

[Normative date for the Mini-Mental State Examination (MMSE) in a sample of community dwelling French speaking residents from Quebec aged 65 and older].

ABSTRACTThis study was aimed at providing normative data for the Mini-Mental State Examination (MMSE). The norms were built from a sample (n = 2409) of community-dwelling French speaking residents from Québec aged 65 and older. The analyses indicated that socio-demographic variables such as education level, age, and gender of individuals influenced significantly the scores of older adults on the MMSE. More precisely, MMSE scores increased with education level and decreased with age. Moreover, women had significantly higher scores than men. On this basis, distinct tables of normative data were produced for women and men. In each table, the MMSE scores corresponding to percentiles 5, 10, 15 and 50 were identified according to four age categories and three education levels. Overall, the use of the present normative data by clinicians will improve their accuracy in detecting cognitive impairment in older adults from Québec.

Addressing suicidal ideations through the realization of meaningful personal goals.

A personal goal intervention program was offered to early retirees aged 50 to 65 years with the objective of increasing their subjective well-being. The program was aimed at helping the participants set, plan, pursue, and realize their personal goals. A subsample of 21 participants with suicidal ideas was identified from a larger sample (N = 354) of retirees living in the community who took part in the study to evaluate the program. The experimental (n = 10) and control (n = 11) groups were compared on their answers to 16 goal and psychological well-being questionnaires. By the end of the program, the experimental group had improved significantly more than the control group on hope, goal realization process, serenity, flexibility, and positive attitude toward retirement. The levels of depression and psychological distress significantly decreased. These gains were maintained 6 months later. The positive results obtained from this study could lead to an innovative way to help people with suicidal ideations.

Development and validation of an instrument measuring individual empowerment in relation to personal health care: the Health Care Empowerment Questionnaire (HCEQ).

PURPOSE: The purpose of this study was to develop and validate a questionnaire that measures the degree of individual empowerment in relation to personal health care and services. DESIGN: The questionnaire was developed by identifying individual empowerment indicators from the literature, generating corresponding items, and pretesting the tool with older persons. SETTING: The Health Care Empowerment Questionnaire (HCEQ) was developed and validated with subjects participating in the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in the Sherbrooke and Quebec City area. SUBJECTS: Eight hundred seventy-three subjects agreed to participate, for a response rate of 56.28%. The mean ages of men and women were 81.1 and 82.4 years, respectively. Analysis. Factor analysis (exploratory and confirmatory) determined the validity of the questionnaire, and the reliability was assessed using measures of internal consistency and temporal stability (test-retest). RESULTS: The multidimensional nature of the concept of individual empowerment was confirmed by three factors that explain more than 68% of the total variance. The Cronhbach's alpha coefficient of internal consistency was .83 and the intraclass correlation coefficients (test-retest) was .70 (95% CI: .48-.83). CONCLUSION: In light of these findings, the characteristics and multidimensional perspective of the HCEQ appear to be useful in advancing knowledge about individual empowerment in relation to personal health care and services.

Development and validation of the Health Care Satisfaction Questionnaire (HCSQ) in elders.

The Health Care Satisfaction Questionnaire (HCSQ) was designed for the evaluation of health care and services in a manner that controls acquiescence bias yet is characterized by a simple structure. The HCSQ was developed and validated within the context of the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in the Sherbrooke and Quebec City areas of Quebec, Canada. Exploratory and confirmatory factor analyses were done with 873 subjects and confirmed the multidimensional nature of the concept of satisfaction. Three factors explained more than 52% of the total variance. The analysis of internal consistency produced Cronbach alpha coefficients of .93, .74, and .78 for Factors 1, 2, and 3, respectively. The alpha of the overall scale was .92. The intraclass correlation coefficient (test-retest) for the entire scale was .72 (95% CI: .52-.84). In light of these findings, the characteristics and multidimensional perspective of the HCSQ appear to be useful for measuring and advancing knowledge about health care and services satisfaction.

[Mental health through management of personal projects: an intervention with young retired people]. / La santé mentale par la gestion des projets personnels: une intervention auprès de jeunes retraités.

A personal goal-based intervention was offered to retired people aged 50 to 65 years with the objective of increasing their subjective well-being and their mental health. More specifically, the program presented here was aimed to promote the setting, planning, and realization of personal projects through a learning process based on a cognitive approach. At the end of the program, the experimental group (n = 117) had improved significantly more than the control group (n = 177) on all the goal and subjective well-being indicators, and this gain was maintained six months later. Some ideas to make the program more effective are discussed.

Pattern of Change of Depressive Disorder over a One-Year Period among Community-Dwelling Older Adults in Québec.

The objective of this study was to describe changes in depression and its correlates, in community-dwelling elderly, over a 12-month period. Data come from a longitudinal ESA Study (Enquête sur la Santé des Aînés) of elderly persons (n = 2752). Depression was measured using the DSM-IV criteria. Polytomous logistic regression was used to assess relations, over time, between participant's characteristics and depression. Among the 164 (5.9%) subjects, who were depressed at baseline, 19.5% were continuously ill cases and 80.4% had recovered, 12 months later. In polytomous regression, factors increasing the probability of the three depression states (persistence, recovery, and incidence) were daily hassles, stress intensity, and fair/poor self-rated mental health. Depression in old age is dynamic. Available prognostic factors can be taken into account to help direct treatment to elderly at highest risk of a poor prognosis.

Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults.

STUDY OBJECTIVES: To examine in cognitively intact older men and women the associations between subjective sleep quality and 1-yr incident cognitive impairment. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: 1,664 cognitively intact individuals age 65 to 96 years. MEASUREMENTS AND RESULTS: Sleep quality at baseline was measured using the Pittsburgh Sleep Quality Index (PSQI). Cognitive functioning was assessed at baseline and 12 months later using the Mini-Mental State Examination (MMSE). Incident general cognitive impairment was defined according to a follow-up MMSE score below the 15(th) percentile according to normative data and of at least 2 points below baseline. General cognitive impairments were also separated into amnestic and nonamnestic subtypes according to MMSE delayed recall performance. Associations between sleep quality indicators at baseline and incident cognitive impairment were assessed by odds ratio (OR) adjusted for age, education, baseline MMSE score, psychotropic drug use, anxiety, depressive episodes, cardiovascular conditions, and chronic diseases. Results revealed that global PSQI score was significantly linked with incident cognitive impairment (OR 1.17, 95% confidence interval (CI) 1.05-1.30) in men, but not in women. In women, sleep disturbance score (OR 2.62, 95% CI 1.41-4.86) and long sleep duration (≥ 9 hr; OR 3.70, 95% CI 1.49-9.17) were associated with nonamnestic and amnestic incident cognitive impairment, respectively. In men, short sleep duration (≤ 5 hr; OR 4.95, 95% CI 1.72-14.27) and habitual sleep efficiency score (OR 1.94, 95% CI 1.42-2.66) were associated with amnestic and general incident cognitive impairment, respectively. CONCLUSIONS: Sleep quality in older adults should receive particular attention by clinicians because poor sleep quality can be an early sign of cognitive decline.

The epidemiology of psychiatric disorders in Quebec's older adult population.

OBJECTIVE: To document the prevalence of psychiatric disorders in Quebec's older adult population. METHOD: Data came from the Enquête sur la santé des aînés study conducted in 2005--2006 using a representative sample (n = 2798) of community-dwelling older adults. RESULTS: Our results indicate that 12.7% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine dependency. The 12-month prevalence rate of major depression was 1.1% and the prevalence of minor depression 5.7%. A total of 5.6% of the respondents reported an anxiety disorder. The most prevalent anxiety disorders were specific phobia (2.0%), obsessive-compulsive disorder (OCD) (1.5%), and generalized anxiety disorder (GAD) (1.2%). Agoraphobia without panic disorder and panic disorder were reported by 0.3% and 0.6% of the respondents, respectively. The prevalence rate of benzodiazepine dependency was 2.3%. The 12-month comorbidity prevalence rate between any psychiatric disorders was 2.2%. Among those with depressive disorder, the most frequent comorbidity was observed between minor depression and specific phobia (4.3%), GAD (4.3%), OCD (3.7%), and mania (1.3%). Further, only 39% of those having at least one active DSM-IV diagnosis reported having used health services for their psychological distress symptoms during the previous 12 months. Among those who consulted health services, 85% visited a general practitioner. CONCLUSIONS: Our results indicate that a large proportion of the elderly population in Quebec presents mental health needs. Longitudinal research focusing on the individual and social consequences of mental health problems reported by older adults is needed to avoid misinterpretation of this finding.