Clinical practice guideline recommendations to improve the mental health of adult trauma patients: protocol for a systematic review.

INTRODUCTION: Mental disorders are common in adult patients with traumatic injuries. To limit the burden of poor psychological well-being in this population, recognised authorities have issued recommendations through clinical practice guidelines (CPGs). However, the uptake of evidence-based recommendations to improve the mental health of trauma patients has been low until recently. This may be explained by the complexity of optimising mental health practices and interpretating CGPs scope and quality. Our aim is to systematically review CPG mental health recommendations in the context of trauma care and appraise their quality. METHODS AND ANALYSIS: We will identify CPG through a search strategy applied to Medline, Embase, CINAHL, PsycINFO and Web of Science databases, as well as guidelines repositories and websites of trauma associations. We will target CPGs on adult and acute trauma populations including at least one recommendation on any prevention, screening, assessment, intervention, patient and family engagement, referral or follow-up procedure related to mental health endorsed by recognised organisations in high-income countries. No language limitations will be applied, and we will limit the search to the last 15 years. Pairs of reviewers will independently screen titles, abstracts, full texts, and carry out data extraction and quality assessment of CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) II. We will synthesise the evidence on recommendations for CPGs rated as moderate or high quality using a matrix based on the Grading of Recommendations Assessment, Development and Evaluation quality of evidence, strength of recommendation, health and social determinants and whether recommendations were made using a population-based approach. ETHICS AND DISSEMINATION: Ethics approval is not required, as we will conduct secondary analysis of published data. The results will be disseminated in a peer-reviewed journal, at international and national scientific meetings. Accessible summary will be distributed to interested parties through professional, healthcare quality and persons with lived experience associations. PROSPERO REGISTRATION NUMBER: (ID454728).

The current state of knowledge on care for co-occurring chronic pain and opioid use disorder: A scoping review.

BACKGROUND AND AIMS: Opioid use disorder often co-occurs with chronic pain but assessment and treatment of these co-occurring disorders is complex. This review aims to identify current treatments and delivery models for co-occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature. DESIGN: Scoping review. METHODS: The review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA-ScR checklist was used to guide reporting. RESULTS: Forty-seven publications addressing the issue of co-occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness-Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs. CONCLUSIONS: The scoping review reveals gaps in evidence-based knowledge to effectively care for co-occurring chronic pain and OUD, but several experts recommend the uptake of known 'best' practices such as integrated treatment of the multiple biopsychosocial dimensions of the co-occurring disorders as well as collaborative interdisciplinary work. CLINICAL RELEVANCE: Improving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder.

Bénéfices d'un partenariat pour l'évaluation d'un programme de prévention des surdoses initié par des pairs.

In 2015, in partnership with a research team, the PROFAN program was initiated by a group of peers to counter the increasing number of overdose-related deaths in Montreal. As of 2018, they have offered, in collaboration with the Association des intervenants en dépendance du Québec (AIDQ) (Quebec Association of Addiction Workers), over 160 training sessions, and have connected with 500 Québec organizations, resulting in a total of over 2,000 participants. A participative evaluation process was undertaken with respect to the expansion of the program. The level of engagement of both partners was evaluated for each stage of the research process, as well as the benefits reported by each party. Examining the level of engagement during the evaluation process highlighted the leadership exhibited by the PROFAN team regarding funding and the dissemination of results. The research team provided leadership for the production of the protocol and analysis, and helped with dissemination among researchers and specialists in the domain. Data collection involved a collaboration between both parties. As for reported benefits, some were associated with the program’s operations (increased credibility, support for it being updated, establishing partnerships), and others involved peer empowerment (skills development). The need to urgently intervene to decrease the number of overdose deaths seems to have facilitated the funding of the program and the development of partnerships. The partnership between PROFAN and the research team has been marked by collaboration and a sharing of expertise.

People with opioid use disorders: A taxonomy of treatment entrants to support the development of a profile-based approach to care.

INTRODUCTION: People with opioid use disorders (OUD) present with high levels of medical and psychosocial vulnerabilities. In recent years, studies have highlighted a shift in demographic and biopsychosocial profiles of people with OUD. In order to support the development of a profile-based approach to care, this study aims to identify different profiles of people with OUD in a sample of patients admitted to a specialised opioid agonist treatment (OAT) facility. METHODS: Twenty-three categorical variables (demographic, clinical, indicators of health and social precariousness) were retrieved from a sample of 296 patient charts in a large Montréal-based OAT facility (2017-2019). Descriptive analyses were followed by a three-step latent class analysis (LCA) to identify different socio-clinical profiles and examine their association with demographic variables. RESULTS: The LCA revealed three socio-clinical profiles: (i) "polysubstance use with psychiatric, physical and social vulnerabilities" (37% of the sample); (ii) "heroin use with vulnerabilities to anxiety and depression" (33%); (iii) "pharmaceutical-type opioid use with vulnerabilities to anxiety, depression and chronic pain" (30%). Class 3 individuals were more likely to be aged 45 years and older. DISCUSSION AND CONCLUSION: While current approaches (such as low- and regular-threshold services) may be suited for many OUD treatment entrants, there may be a need to improve the continuum of care between mental health, chronic pain, and addiction services for those characterised by the use of pharmaceutical-type opioids, chronic pain and older age. Overall, the results support further exploring profile-based approaches to care, tailored to subgroups of patients with differing needs or abilities.

Phlebotomy resulting in controlled hypovolemia to prevent blood loss in major hepatic resections (PRICE-2): study protocol for a phase 3 randomized controlled trial.

INTRODUCTION: Blood loss and red blood cell (RBC) transfusion in liver surgery are areas of concern for surgeons, anesthesiologists, and patients alike. While various methods are employed to reduce surgical blood loss, the evidence base surrounding each intervention is limited. Hypovolemic phlebotomy, the removal of whole blood from the patient without volume replacement during liver transection, has been strongly associated with decreased bleeding and RBC transfusion in observational studies. This trial aims to investigate whether hypovolemic phlebotomy is superior to usual care in reducing RBC transfusions in liver resection. METHODS: This study is a double-blind multicenter randomized controlled trial. Adult patients undergoing major hepatic resections for any indication will be randomly allocated in a 1:1 ratio to either hypovolemic phlebotomy and usual care or usual care alone. Exclusion criteria will be minor resections, preoperative hemoglobin <100g/L, renal insufficiency, and other contraindication to hypovolemic phlebotomy. The primary outcome will be the proportion of patients receiving at least one allogeneic RBC transfusion unit within 30 days of the onset of surgery. Secondary outcomes will include transfusion of other allogeneic blood products, blood loss, morbidity, mortality, and intraoperative physiologic parameters. The surgical team will be blinded to the intervention. Randomization will occur on the morning of surgery. The sample size will comprise 440 patients. Enrolment will occur at four Canadian academic liver surgery centers over a 4-year period. Ethics approval will be obtained at participating sites before enrolment. DISCUSSION: The results of this randomized control trial will provide high-quality evidence regarding the use of hypovolemic phlebotomy in major liver resection and its effects on RBC transfusion. If proven to be effective, this intervention could become standard of care in liver operations internationally and become incorporated within perioperative patient blood management programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT03651154 . Registered on August 29 2018.

Problematic Opioid Use: A Scoping Literature Review of Profiles.

Background and Objectives: Problematic opioid use can be defined as opioid use behaviors leading to social, medical, or psychological consequences. In some instances, people presenting problematic opioid use can also meet criteria for an opioid use disorder. A growing body of literature highlights different types of people who use opioids, with contrasting characteristics and initiation patterns. In recent years, dynamic trends in opioid use have been documented and studies have demonstrated a shift in profiles. Methods: A scoping literature review was conducted to identify profiles of people presenting problematic opioid use, in order to support the development of tailored interventions and services. Results: Nine articles met the inclusion criteria. Five classifications emerge from the literature reviewed to distinguish types of people presenting problematic opioid use, according to: (1) the type of opioids used, (2) the route of opioid administration, (3) the level of quality of life, (4) patterns of other drugs used, and (5) dependence severity. While samples, concepts, and measurement tools vary between studies, the most salient finding might be the distinct profile of people presenting problematic use of pharmaceutical-type opioids. Discussion and Conclusions: This scoping review highlights that few studies address distinctive profiles of people presenting problematic opioid use. Geographical and chronological differences suggest that local timely assessments may be needed to tailor the service offer to specific needs. Scientific Significance: Future studies should focus on providing a deep understanding of distinct experiential perspectives and service needs, through exploratory quantitative and qualitative designs.

An online peer support program to improve mental health among university students: A randomized controlled trial.

Despite recent calls for more peer support initiatives aimed at promoting mental health in postsecondary institutions, those initiatives remain scarce. In this study, a multisite randomized controlled trial was designed to assess the effect of an online peer support intervention based on acceptance and commitment therapy using mental health and school indicators. Undergraduate students were recruited in three Canadian universities and randomly assigned to an intervention (n = 54) or a wait-list control group (n = 53). Compared to control participants, those who took part in the program self-reported reduced psychological inflexibility, stress, anxiety and depression, and increased psychological flexibility and well-being. The intervention had no effect on academic satisfaction and engagement. These results were found both in completer and intent-to-treat samples. The findings provide evidence that peer support may be a beneficial adjunct to mental health interventions offered to college and university students.

Identifying and Exploring Sustainability Determinants of Mental Health Recovery-Oriented Interventions: A Mixed Methods Study Protocol.

Mental health recovery is the new paradigm in the mental health service delivery system worldwide. Recovery-oriented services go beyond traditional clinical care that is centered on symptom remission, aiming to help people: restore social connections with other individuals and the community; develop hope and optimism for the future; reconstruct an identity beyond that of a "mental patient"; discover meaning in life; and feel empowered to gain control over treatment (CHIME framework). Over the last ten years, several efforts at implementation of recovery-oriented interventions have been documented in the scientific literature. However, little attention has been given to their sustainability, even though it is reported that not all health interventions can fully sustain their activities beyond the initial implementation phase. The aim of this mixed methods case study is to better understand the factors that determine the sustainability of two recovery-oriented interventions (peer support and recovery training) after their roll-out in four organizations in Canada that provide community housing for adults with mental health challenges. Qualitative and quantitative data will be collected from managers, service providers, and implementation team members that oversaw the implementation process along with organizational documents. Data collection and analysis will be guided by the Consolidated Framework for Sustainability Constructs in Healthcare, the Framework for Reporting Adaptations and Modifications, and the Program Sustainability Assessment Tool. Findings will expand our current evidence base on the intersection of sustainability and mental health recovery interventions that remains under-explored.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review.

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

Profiles of Patients with Opioid Use Disorders Presenting a History of Suicidal Ideations and Attempts.

Suicide rates are higher for people with an opioid use disorder, compared to the general population. This study aims to characterize opioid agonist treatment entrants who present a history of suicidal ideations or suicide attempts, according to concurrent comorbidity profiles, in an opioid use disorder treatment facility. A chart review design was used. Data was collected from 202 patient files. Bivariate and multivariate analyses were conducted. In multivariate analysis, patients with a diagnosis or symptoms of a mood disorder were 2.48 [1.01 - 6.11] times more likely to report suicidal ideations and 2.64 [1.05 - 6.62] times more likely to report suicide attempts. Those with a diagnosis or symptoms of an anxiety disorder were 2.41 [1.01 - 5.81] times more likely to report suicidal ideations. Patients who report chronic pain were 2.59 [1.06 - 6.35] times more likely to report suicidal ideations as well. The probability to report suicide attempts was 5.09 [1.16 - 22.4] times higher for those with a confirmed or suspected personality disorder. Clinicians should bear in mind the high suicide rates in people with opioid use disorder, as well as the importance of addressing suicidal risk and providing easy access to mental health and chronic pain treatment as part of the service offer in opioid agonist treatment. Future research should focus on evaluating the effectiveness of treatments aimed at addressing the needs of opioid agonist treatment patients with interrelated mental health and pain comorbidity profiles to reduce risks associated with suicide.

Improving Transfer of Care Between Psychiatrists and Residents: Participants' Perspective on the Implementation of a Handover Protocol in a Psychiatric Emergency.

OBJECTIVES: Handover refers to the transfer of information from one professional to another during transitions of care. I-PASS is a mnemonic tool which stands for Illness severity; Patient summary; Action list; Situation awareness and contingency planning; and Synthesis by receiver. It was developed to standardize the handover process. Psychiatrists, nurses, and residents at the Montreal Jewish General Hospital psychiatric emergency were trained and the I-PASS handover model was implemented. METHODS: Thirty-one psychiatrists, nurses, and residents participated in this quality improvement project. Participants filled a pre-training questionnaire to examine the baseline status of handovers before attending a training session on I-PASS. Participants then filled a second questionnaire assessing the perceived quality of the handover training session, as well as anticipated benefits and challenges of I-PASS prior to its implementation. Finally, following implementation, two focus groups were held to collect feedback from participants. RESULTS: Pre-training, most participants reported that information provided during handovers was incomplete. Training was overall much appreciated. The most significant anticipated obstacle for implementing I-PASS was lack of time to properly fill out the form. Post-implementation, participants unanimously reported an improvement in the handover process. Handovers were perceived as faster, providing all key information about patients, and the perceived quality of the information was better. CONCLUSION: Overall, the implementation of the I-PASS handover model was much appreciated by participants, who perceived that handovers were more comprehensive, efficient, and of better quality.

Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans.

BACKGROUND: Injectable opioid agonist treatment (iOAT) is an emerging evidence-based option in the continuum of care for opioid use disorder in parts of Canada. Our study objective was to identify and describe iOAT programs operating during the ongoing opioid overdose crisis. METHODS: We conducted 2 sequential environmental scans. Programs were eligible to participate if they were in operation as of Sept. 1, 2018, and Mar. 1, 2019. Information was collected over 2-3 months for each scan (September-October 2018, March-May 2019). Programs that participated in the first scan and newly established programs were invited to participate in the second scan. The scans included questions about location, service delivery model, clinical and operational characteristics, numbers and demographic characteristics of clients, and program barriers and facilitators. Descriptive analysis was performed. RESULTS: We identified 14 unique programs across the 2 scans. Eleven programs located in urban centres in British Columbia and Ontario participated in the first scan. At the time of the second scan, 2 of these programs were on hold and 2 of 3 newly established programs were in Alberta. The total capacity of all participating programs was 420 clients at most. Four service delivery models were identified; iOAT was most commonly integrated within existing health and social services. All programs offered hydromorphone, and 1 program also offered diacetylmorphine. In the first scan, 73% of clients (133/183) were male; the mean age of clients was 47 years. Limited capacity, pharmacy operations and lack of diacetylmorphine access were among the most frequently reported barriers. The most commonly reported facilitators included client-centred care, client relationships and access to other health and social support. INTERPRETATION: Evidence indicates that iOAT can be successfully implemented using diverse service delivery models. Future work should facilitate scale-up of this evidence-based treatment where gaps persist in high-risk communities.

Group Cognitive Behavioral Analysis System of Psychotherapy (CBASP): A Pilot Study for Bipolar Depression.

OBJECTIVES: Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an individually administered treatment model designed specifically for Persistent Depression however bipolar patients have traditionally been excluded from CBASP studies. There is a perception that bipolar depression will be harder to treat and requires a unique psychological approach. This pilot study reports on the feasibility of administering the same 20-week manualized group CBASP therapy with bipolar patients currently in a depressive episode. METHODS: This non-randomized, single-arm prospective pilot study, reports on an a posteriori exploration of benefits to bipolar depressed patients (n=26) of the same 20-week group CBASP intervention administered to unipolar depressed patients (n=81). The clinical trial for the initial phase examining benefits of the manualized 20-week group CBASP intervention with unipolar patients was registered with the ISRCTN registry, study ID: ISRCTN95149444. Results reported here include mixed ANOVA analyses, across group treatment models and diagnostic categories. Changes over time in self-reported depressive symptoms (Inventory of Depressive Symptoms -IDS-SR), self-reported social functioning, interpersonal problems and interpersonal dispositions are documented for all patients. An exploratory longitudinal latent class analysis was used to examine patients' trajectories of improvement in depressive symptoms. Finally, the best predictors of change in reported depressive symptoms were explored with a logistic regression for all patients. RESULTS: Improvements in depressive symptoms and in social functioning over time were significant for all patients with bipolar patients trending towards a greater improvement in depressive symptoms after controlling for baseline differences. An exploratory Latent Class Analysis identified two different treatment trajectories for the entire sample: 1) moderate to severely depressed patients who improved significantly (49%) and 2) severely depressed patients who did not improve (51%). The best predictors of non-response to group therapy include high baseline problems in social functioning and low rates of self-reported Perceived Improvements in overall health. CONCLUSION: Bipolar patients in a depressive episode appear to benefit from the same 20-week group CBASP model designed originally for the treatment of Persistent Depressive Disorder. Bipolar patients seem more easily mobilized both during and outside of group therapy sessions and report more interpersonal confidence and more agency than unipolar depressed patients.

Transitional Employment and Psychological Distress: a Longitudinal Study.

Although it has been established that employed status is generally associated with better mental health than unemployed status, the psychological mechanisms that underlie the longitudinal association between employment status and psychological distress remain to be understood. Initial mental health, lower coping skills and social support, and more stressful events could potentially preselect certain vulnerable individuals to be at higher risk for unemployment or employment instability. The aim of this study was to examine the longitudinal association between employment status (including transitional employment status) and psychological distress, controlling for the effect of initial psychological distress, coping skills, social support, and stressful events. In 2009, residents from the epidemiological catchment area of south-west Montréal responded to a randomized household survey for adults. Follow-up surveys were conducted in 2011 and 2013 (n = 1168). Psychological distress was measured using the K-10 scale. Employment status was not significantly associated with psychological distress over time, however there were significant differences between the groups with the continually employed reporting the lowest average levels of psychological distress over time. Controlling for coping skills, social support, stressful events and initial psychological distress changed the strengths of the association between transitional employment status and psychological distress at follow-up. A significant longitudinal association between continual unemployment and psychological distress was observed. Initial psychological distress was significantly associated with becoming unemployed. Results suggest initial psychological distress as a risk factor for becoming unemployed and that the negative psychological implications of employment transitions can be significantly reduced when conditions for coping are optimized.

Montreal Cross-Training Program: The contribution of positional clarification activities to help bridge fragmented prevention and treatment services for co-occurring disorders.

Co-occurring disorders in mental health and addiction present a high prevalence, but services available to prevent and treat them are often fragmented. Cross-training activities have been used to help minimise breaks in service continuity. This study assesses to what extent positional clarification (a specific type of cross-training activity) can help bridge fragmented services for co-occurring disorders by providing information and promoting interactions to help professionals better orient and treat their clientele. A total of 2,107 participations were recorded for 11 positional clarification events taking place within the Montreal Cross-Training Program for mental health and substance use disorders between 2010 and 2016. The Kirkpatrick four-level training evaluation model was used to evaluate these activities. Evaluation questionnaires (n = 1,650) and interviews with a convenience sample of 32 participants were analysed using descriptive statistics and thematic analysis. More than three-quarters of participants reported that the activity met their expectations and was relevant to their practice. Respondents also reported receiving useful information to better orient their clientele, discovering new resources, learning about the functioning of other resources, identifying members of other networks who could orient them when needed, and learning more about the theme of the activity and the different mechanisms for collaboration among the related services. Among those who participated in more than one positional clarification event, roughly three-quarters reported that they were able to call upon new resources at least once as a result of their participation, and were able to establish referrals towards resources that were unknown or less familiar to them prior to their participation. Results suggest that the programme meets its service integration objectives and that positional clarification events can lead to changes that can help facilitate the integration of fragmented services by improving participants' knowledge of specific themes and available resources to better orient and treat their clientele.

Examining the link between cocaine binging and individual, social and behavioral factors among street-based cocaine users.

AIMS: To estimate the prevalence of cocaine binging and examine associated factors, to characterize binge episodes and to study the relationship between cocaine binging and HIV and HCV risk behaviors among street-based cocaine users. METHODS: A prospective cohort study was conducted in Montréal, Canada. Interviewer-administered questionnaire were carried out at 3-month intervals. Cocaine binging was defined as using large quantities of cocaine, without stopping, over a limited period of time, until resources run out or until being physically incapable of consuming. Generalized Estimation Equations (GEE) analyses were used. Covariates considered included demographic, behavioral, mental health and social risk factors. FINDINGS: In total, 605 participants were recruited. Prevalence of cocaine binging over the month prior to recruitment was 24.5%. Correlates of cocaine binging were older age (AOR 1.46), homelessness (AOR 1.44), criminal/marginal income strategies (AOR 1.61), high psychological distress (AOR 1.31), high cocaine dependence (AOR 3.71), drug overdoses (AOR 1.56) and smoking as the main route of cocaine administration (AOR 1.38). Additional GEE analyses showed that cocaine binging was significantly associated with the sharing of drug paraphernalia (AOR 1.35) and sexual relations under the influence of cocaine (AOR 1.21). CONCLUSION: Cocaine binging is frequent among street-based cocaine users and is associated with markers of vulnerability. It is also associated with increased odds of both sexual and drug use risk behaviors. Interventions need to be tailored in order to help cocaine bingers develop personal strategies that could prevent binging. Harm reduction programs should help cocaine bingers adequately assess their drug equipment needs.

Cross-training to work better together with women in Quebec who use substances: care providers' perceptions.

Some authors have called attention to the lack of service integration related to evaluation and treatment of parental substance abuse, an ongoing challenge for service providers. A cross-training project involving exchanges (immersion sessions) among clinical teams was established to improve the integration, effectiveness and coherence of interventions for pregnant women and mothers with problematic substance use, and to prevent negative impacts of substance abuse on parenting skills and on foetal and child development. The research goal was to understand, from the perspectives of care providers, how cross-training either fosters or fails to foster changes in the practices of care providers who work with young pregnant women and mothers whose use of psychotropic drugs puts them at risk of neglecting their children. The cross-training project was carried out between 2009 and 2013. During the last phase of the project, focus group data were collected from 14 different clinical teams (N = 121) from the fields of substance abuse, child protection, perinatality and early childhood. The responses of each focus group yielded data for thematic analysis, performed using a mixed coding approach that included predefined and emerging themes. Points of convergence and divergence were identified by comparing what was said in different groups and types of clinical settings. At the conclusion of the project, the care providers said they knew their clinical partners better, communicated more with each other and made more referrals to those partners, and were better able to express themselves clearly about the effects of psychotropic drug use on the foetus, the child and the parenting role. In conclusion, the project helped create a culture of co-operation and partnership that has direct effects on services for pregnant women and young mothers who use substances.

Employment Status and Mental Health: Mediating Roles of Social Support and Coping Strategies.

Although it has been established that unemployment and underemployment increase distress and depression, the psychological mechanisms involved are not very clear. This study examines the roles of social support and coping strategies as mediators of the association between employment status and mental health, as well as gender and age differences as moderators. Residents from the epidemiological catchment area of south-west Montreal responded to a randomized household survey for adults in 2009. A follow-up was conducted based on participants' employment status 2 and 4 years later. ANOVAs tests were computed with SPSS to evaluate group differences, and structural equation modeling was performed with AMOS to test mediation effects. At baseline, among participants between 18 and 64 years old (n = 2325), 14.3 % were unemployed/not studying, 14.4 % worked part-time, and 56.5 % worked full-time. Employment status was found to significantly affect depression among those under 45 years old (chi-square = 23.4, p < 0.001). Results showed a negative association of full-time employment with depression, which was fully mediated by social support, less coping with drugs/medication, and less distress. A negative association with full-time employment was also noted with distress, which was partially mediated by increased social support, coping with alcohol, and less coping with drugs/medication. The total indirect effect suggests that full-time employees generally have more resources and do not tend to use avoidance strategies like coping with drugs/medication, resulting in less distress (ß = -0.05; p < 0.01) and depression (ß = -0.028; p < 0.01). Results suggest that optimal impact on mental health could be attained when increasing employment, namely full-time employment, in communities.

Experiences of peer-trainers in a take-home naloxone program: Results from a qualitative study.

BACKGROUND: Take-home naloxone programs (THN) are harm reduction programs with the aim of reducing the number of deaths caused by opioid overdoses. A THN program in Montreal called the PROFAN project was implemented with the goal of reducing overdoses through the use of peer-trainers. Peer-trainers are people who are currently or have previously used drugs, who are trained in overdose prevention and are then responsible for delivering a training session to other individuals who use drugs. While studies on other peer-led programs have shown that peer-helpers gain numerous benefits from their role, little attention has been devoted to understanding this role in the context of overdose prevention. Additionally, to our knowledge, this is the first time that the impacts of the peer-trainer role are being studied and documented for a scientific journal. METHODS: This research represents a qualitative study using individual interviews with the six peer-trainers of the Montreal program to explore the benefits and challenges encountered in their role. RESULTS: Interview results suggest that there are psychological benefits received through the peer-trainer role, such as empowerment and recovery. As well, there are a number of challenges associated with their role and suggestions to improve the program. CONCLUSION: Knowledge about the impacts of the peer-trainer role will contribute to the development of THN programs. Additionally, the findings may also serve to demonstrate that THN programs are capable of not only reducing the number of deaths by opioid overdose, but that these programs may also have wider effects on a psychological level.