Synthèse systématique des écrits : les instruments d’évaluation de la comorbidité psychiatrique présentée par les adolescent(e)s

Ce mémoire présente les résultats d’une synthèse systématique (SS) des écrits traitant des instruments d’évaluation multidimensionnelle des troubles concomitants qui peuvent être présentés par les adolescent(e)s. La SS a permis d’identifier 11 instruments en mesure d’évaluer les troubles comorbides de l’Axe I du DSM-IV, incluant chaque fois les troubles liés à l’utilisation de substances psychoactives (TUS). Une fois les instruments répertoriés, une seconde recherche fut effectuée afin identifier les études les ayant mis à l’épreuve du point de vue de leur validité et de leur fidélité diagnostique : 57 études furent identifiées. La robustesse méthodologique de ces études fut analysée à l’aide de la grille du QUADAS-2 et 47 études furent retenues pour l’échantillon final. Les résultats sont présentés par diagnostics (troubles liés à l’utilisation des substances (TUS) (obligatoire), trouble d’anxiété généralisée (TAG), épisode dépressif majeur (ÉDM), troubles des conduites (TC), trouble du déficit de l’attention /hyperactivité (TDA/H), état de stress post-traumatique (ÉSPT) et par instrument retenu. Suite à l’analyse des données recueillies, il s’avère difficile de comparer les instruments les uns aux autres, étant donnée la très grande diversité des échelles qu’ils contiennent, ainsi que les devis fort différents des études qui les ont mis à l’épreuve. Par contre, deux instruments se distinguent par la robustesse méthodologique des études à leur sujet, ainsi que leur excellente performance globale. Il s’agit du ChIPS et du K-SADS.

Reciprocal Prospective Associations Between Depressive Symptoms and Perceived Relationship With Parents in Early Adolescence

Objective: Adolescent depressive symptoms are associated with difficult family relationships. Family systems and interpersonal theories of depression suggest that this association could reflect a circular process in which symptoms and family functioning affect each other over time. Few longitudinal studies have tested this hypothesis, and the results of these studies have been equivocal. In this study, we examine reciprocal prospective associations in early adolescence between depressive symptoms and 2 important aspects of parent–child relationships: communication and conflict. Methods: Participants were 3862 students who annually filled out self-reports. Path analysis was used to examine prospective associations between depressive symptoms and perceived communication and conflict with parents from the age of 12 to 13 and 14 to 15 years. Independence of these associations was assessed by controlling for family context (parental separation and family socioeconomic status) and adolescent behaviour problems (delinquent behaviours and substance use). Sex differences were evaluated with multiple group analysis. Results: Reciprocal prospective associations were found between depressive symptoms and perceived conflict with parents, but not between depressive symptoms and communication with parents. Depressive symptoms were found to predict poorer communication with parents over time, but communication was not predictive of lower depressive symptoms in subsequent years. All paths were sex-invariant and independent from family context and behaviour problems. Conclusion: This study highlights the importance of considering the potential impact of adolescent symptomatology on parent–child relationships and suggests that reciprocity may characterize the association between depressive symptoms and negative aspects of parent–child relationships. The role of adolescent perceptions in the interplay between depressive symptoms and family relationships remains to be clarified.

Moderators of two Indicated Cognitive-Behavioral Depression Prevention Approaches for Adolescents in a School-Based Effectiveness Trial

Objective: Our aim was to identify moderators of the effects of a cognitive behavioral group-based prevention program (CB group) and CB bibliotherapy, relative to an educational brochure control condition and to one another, in a school-based effectiveness randomized controlled prevention trial. Method: 378 adolescents (M age ¼ 15.5, 68% female) with elevated depressive symptoms were randomized in one of three conditions and were assessed at pretest, posttest, and 6-month follow-up. We tested the moderating effect of three individual (baseline depressive symptoms, negative attributional style, substance use), three environmental (negative life events, parental support, peer support), and two sociodemographic (sex, age) characteristics. Results: Baseline depressive symptoms interacted with condition and time. Decomposition indicated that elevated baseline depressive symptoms amplified the effect of CB bibliotherapy at posttest (but not 6-month follow-up) relative to the control condition, but did not modify the effect of CB group relative to the control condition or relative to bibliotherapy. Specifically, CB bibliotherapy resulted in lower posttest depressive symptoms than the control condition in individuals with elevated, but not average or low baseline symptoms. We found no interaction effect for other putative moderators. Conclusions: Our findings suggest that bibliotherapy is effective only in participants who have elevated depressive symptoms at baseline. The fact that no study variable moderated the effects of CB group, which had a significant main effect in reducing depressive symptoms relative to the control condition, suggests that this indicated prevention intervention is effective for a wide range of adolescents.

Adolescent Trajectories of Depressive Symptoms : co-development of Behavioral and Academic Problems

Purpose: Increasing evidence suggests the existence of heterogeneity in the development of depressive symptoms during adolescence, but little remains known regarding the implications of this heterogeneity for the development of commonly co-occurring problems. In this study, we derived trajectories of depressive symptoms in adolescents and examined the codevelopment of multiple behavioral and academic problems in these trajectories. Methods: Participants were 6,910 students from secondary schools primarily located in disadvantaged areas of Quebec (Canada) who were assessed annually from the age 12 to 16 years. Trajectories were identified using growth mixture modeling. The course of behavioral (delinquency, substance use) and academic adjustment (school liking, academic achievement) in trajectories was examined by deriving latent growth curves for each covariate conditional on trajectory membership. Results: We identified five trajectories of stable-low (68.1%), increasing (12.1%), decreasing (8.7%), transient (8.7%), and stable-high (2.4%) depressive symptoms. Examination of conditional latent growth curves revealed that the course of behavioral and academic problems closely mirrored the course of depressive symptoms in each trajectory. Conclusions: This pattern of results suggests that the course of depressive symptoms and other adjustment problems over time is likely to involve an important contribution of shared underlying developmental process(es).

Crenças e atitudes dos adolescentes associadas ao uso de substâncias psicoativas: álcool, tabaco e outras substâncias psicoativas ilegais

A adolescência é usualmente marcada por mudanças ao nível do corpo, do pensamento, das atitudes e da vida social que tornam os jovens mais vulneráveis a desenvolver comportamentos irracionais e impulsivos como o consumo de substâncias psicoativas. Neste sentido, o principal objetivo deste estudo é compreender as crenças e atitudes que motivam os jovens adolescentes a usar substâncias como álcool, tabaco e outras substâncias psicoativas. Para tal, foi escolhida uma amostra por conveniência entre os estudantes de três escolas pertencentes ao Instituto Politécnico de Portalegre, nomeadamente a Escola Superior de Educação de Portalegre, a Escola Superior de Tecnologia e Gestão de Portalegre e a Escola Superior de Saúde de Portalegre. A amostra é constituída por 193 estudantes, sendo que a idade dos participantes oscila entre os 18 anos e os 25 anos. Deste modo, foi aplicado o questionário HIT-D&A que permite medir as crenças e atitudes dos jovens, associadas ao uso de substâncias psicoativas como o álcool, o tabaco e outras substâncias psicoativas ilegais. Os resultados evidenciaram que as principais substâncias psicoativas consumidas pelos jovens são o álcool, seguindo-se o tabaco e a marijuana. Outra conclusão é a existência de diferenças significativas entre os dois géneros, sendo que os rapazes apresentam uma média superior face às raparigas de forma estatisticamente significativa. Embora não haja diferenças estatisticamente significativas entre faixas etárias, conclui-se que há mais consumos de substâncias psicoativas entre os jovens mais velhos. No que respeita às médias das três escolas analisadas, estas são superiores na Escola Superior de Tecnologia e Gestão de Portalegre. Os resultados também mostraram a existência de uma forte associação entre as três distorções cognitivas (centração no eu, culpar os outros e assumir o piro e minimizar e etiquetar) e os consumos das várias substâncias psicoativas.

Description des relations familiales : la perspective d’hommes en situation d’itinérance atteints de troubles concomitants

Les personnes en situation d’itinérance, principalement des hommes, représentent pour certains une culture au sein de laquelle on identifie des personnes atteintes de troubles concomitants de santé mentale et d’abus de substances. Déjà vulnérables de par leur statut domiciliaire précaire, les personnes atteintes de cette concomitance le sont davantage et tendent à être plus isolées de leur famille que celles ne rencontrant pas cette double problématique. Le soutien familial est toutefois reconnu comme un élément favorisant l’engagement de comportements de santé et réduisant l’itinérance. Le but de cette étude était alors de décrire, du point de vue des hommes en situation d’itinérance atteints de troubles concomitants de santé mentale et d’abus de substances, les relations qu’ils entretiennent avec leur famille. Pour ce faire, le devis choisi fût une ethnographie ciblée. Différents degrés d’observation participante au sein de la Mission Old Brewery et des entrevues avec neuf informateurs-clés ont été les principales méthodes de collecte des données. L’analyse des données qualitative était soutenue par le guide proposé par Roper et Shapira (2000) ainsi que l’épistémologie constructiviste et l’approche systémique familiale de Calgary (Wright & Leahey, 2013) qui furent les cadres de référence de cette étude. Les résultats font ressortir trois thèmes explicitant 1) l’influence du contexte de vie dans les relations familiales, 2) la teneur conflictuelle de ces relations ainsi que 3) le soutien familial perçu. Finalement, des recommandations pour la pratique infirmière ainsi que des pistes pour de futures recherches sont suggérées.

Synthèse systématique des écrits : les instruments d’évaluation de la comorbidité psychiatrique présentée par les adolescent(e)s.

Ce mémoire présente les résultats d’une synthèse systématique (SS) des écrits traitant des instruments d’évaluation multidimensionnelle des troubles concomitants qui peuvent être présentés par les adolescent(e)s. La SS a permis d’identifier 11 instruments en mesure d’évaluer les troubles comorbides de l’Axe I du DSM-IV, incluant chaque fois les troubles liés à l’utilisation de substances psychoactives (TUS). Une fois les instruments répertoriés, une seconde recherche fut effectuée afin identifier les études les ayant mis à l’épreuve du point de vue de leur validité et de leur fidélité diagnostique : 57 études furent identifiées. La robustesse méthodologique de ces études fut analysée à l’aide de la grille du QUADAS-2 et 47 études furent retenues pour l’échantillon final. Les résultats sont présentés par diagnostics (troubles liés à l’utilisation des substances (TUS) (obligatoire), trouble d’anxiété généralisée (TAG), épisode dépressif majeur (ÉDM), troubles des conduites (TC), trouble du déficit de l’attention /hyperactivité (TDA/H), état de stress post-traumatique (ÉSPT) et par instrument retenu. Suite à l’analyse des données recueillies, il s’avère difficile de comparer les instruments les uns aux autres, étant donnée la très grande diversité des échelles qu’ils contiennent, ainsi que les devis fort différents des études qui les ont mis à l’épreuve. Par contre, deux instruments se distinguent par la robustesse méthodologique des études à leur sujet, ainsi que leur excellente performance globale. Il s’agit du ChIPS et du K-SADS.

Reciprocal Prospective Associations Between Depressive Symptoms and Perceived Relationship With Parents in Early Adolescence

Objective: Adolescent depressive symptoms are associated with difficult family relationships. Family systems and interpersonal theories of depression suggest that this association could reflect a circular process in which symptoms and family functioning affect each other over time. Few longitudinal studies have tested this hypothesis, and the results of these studies have been equivocal. In this study, we examine reciprocal prospective associations in early adolescence between depressive symptoms and 2 important aspects of parent–child relationships: communication and conflict. Methods: Participants were 3862 students who annually filled out self-reports. Path analysis was used to examine prospective associations between depressive symptoms and perceived communication and conflict with parents from the age of 12 to 13 and 14 to 15 years. Independence of these associations was assessed by controlling for family context (parental separation and family socioeconomic status) and adolescent behaviour problems (delinquent behaviours and substance use). Sex differences were evaluated with multiple group analysis. Results: Reciprocal prospective associations were found between depressive symptoms and perceived conflict with parents, but not between depressive symptoms and communication with parents. Depressive symptoms were found to predict poorer communication with parents over time, but communication was not predictive of lower depressive symptoms in subsequent years. All paths were sex-invariant and independent from family context and behaviour problems. Conclusion: This study highlights the importance of considering the potential impact of adolescent symptomatology on parent–child relationships and suggests that reciprocity may characterize the association between depressive symptoms and negative aspects of parent–child relationships. The role of adolescent perceptions in the interplay between depressive symptoms and family relationships remains to be clarified.

Moderators of two Indicated Cognitive-Behavioral Depression Prevention Approaches for Adolescents in a School-Based Effectiveness Trial

Objective: Our aim was to identify moderators of the effects of a cognitive behavioral group-based prevention program (CB group) and CB bibliotherapy, relative to an educational brochure control condition and to one another, in a school-based effectiveness randomized controlled prevention trial. Method: 378 adolescents (M age ¼ 15.5, 68% female) with elevated depressive symptoms were randomized in one of three conditions and were assessed at pretest, posttest, and 6-month follow-up. We tested the moderating effect of three individual (baseline depressive symptoms, negative attributional style, substance use), three environmental (negative life events, parental support, peer support), and two sociodemographic (sex, age) characteristics. Results: Baseline depressive symptoms interacted with condition and time. Decomposition indicated that elevated baseline depressive symptoms amplified the effect of CB bibliotherapy at posttest (but not 6-month follow-up) relative to the control condition, but did not modify the effect of CB group relative to the control condition or relative to bibliotherapy. Specifically, CB bibliotherapy resulted in lower posttest depressive symptoms than the control condition in individuals with elevated, but not average or low baseline symptoms. We found no interaction effect for other putative moderators. Conclusions: Our findings suggest that bibliotherapy is effective only in participants who have elevated depressive symptoms at baseline. The fact that no study variable moderated the effects of CB group, which had a significant main effect in reducing depressive symptoms relative to the control condition, suggests that this indicated prevention intervention is effective for a wide range of adolescents.

Adolescent Trajectories of Depressive Symptoms : co-development of Behavioral and Academic Problems

Purpose: Increasing evidence suggests the existence of heterogeneity in the development of depressive symptoms during adolescence, but little remains known regarding the implications of this heterogeneity for the development of commonly co-occurring problems. In this study, we derived trajectories of depressive symptoms in adolescents and examined the codevelopment of multiple behavioral and academic problems in these trajectories. Methods: Participants were 6,910 students from secondary schools primarily located in disadvantaged areas of Quebec (Canada) who were assessed annually from the age 12 to 16 years. Trajectories were identified using growth mixture modeling. The course of behavioral (delinquency, substance use) and academic adjustment (school liking, academic achievement) in trajectories was examined by deriving latent growth curves for each covariate conditional on trajectory membership. Results: We identified five trajectories of stable-low (68.1%), increasing (12.1%), decreasing (8.7%), transient (8.7%), and stable-high (2.4%) depressive symptoms. Examination of conditional latent growth curves revealed that the course of behavioral and academic problems closely mirrored the course of depressive symptoms in each trajectory. Conclusions: This pattern of results suggests that the course of depressive symptoms and other adjustment problems over time is likely to involve an important contribution of shared underlying developmental process(es).

Partnering with Parents to Promote High School Graduation: An Evidence-based Program Evaluation

Thesis (Master's)--University of Washington, 2016-06

Improving family functioning and child outcome in methadone maintained families: the Parents Under Pressure programme

Twelve families responded to posters displayed in a methadone clinic for inclusion in a pilot study assessing the viability and potential utility of an intensive, multi-component family-focused intervention, the Parents Under Pressure programme. The programme was designed to improve child behaviour, decrease parental stress and improve family functioning in methadone-maintained families by targeting affect regulation, mood, views of self as a parent, drug use and parenting skills. Nine of the families completed the programme delivered in their homes; eight were recontacted at 3 months. Each family reported significant improvements in three domains: parental functioning, parent - child relationship and parental substance use and risk behaviour. In addition to the changes in family functioning, the majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behaviour and maintenance dose of methadone. The families reported high levels of satisfaction with the programme. It is recommended that future studies include independent measures (e.g. behavioural observations) of child outcome and parental functioning. The results were optimistic and provided the impetus to evaluate the treatment programme using a randomized controlled trial.

The epidemiology and genetics of smoking initiation and persistence: Crosscultural comparisons of twin study results

We examined whether there are crosscultural differences in the magnitude of genetic and environmental contributions to risk of becoming a regular smoker and of persistence in smoking in men and women. Standard methods of epidemiologic and genetic analysis were applied to questionnaire data on history of cigarette use obtained from large samples of male and female like-sex twins from three different countries: Australia (N = 2284 pairs), Sweden (N = 8651 pairs), and Finland (N = 10,948 pairs). Samples were subdivided into three age groups (AG), 18-25 years, 26-35 years, and 36-46 years of age. The magnitude of genetic influence for lifetime smoking was found to be consistent across country and AG for women (46%) and men (57%), and estimates of the contribution from environmental influences shared by twin and co-twin could be equated across all countries by AG for the women (from youngest to oldest AG: 45%, 35%, and 26%), but not for men, with separate estimates obtained for the Scandinavian (33%, 29%, and 19%) and the Australian men (26%, 9%, and 11 %). There was no evidence for an important role for shared environmental influences on persistent smoking, and the genetic contribution was found to be consistent in magnitude in men and women, and the same across country and AG (52%). There are strong genetic influences on smoking behavior, and that risk of becoming a smoker (but not persistence in smoking) may be modified by experiences shared by twins that differ by AG and, at least for men, cultural background.

Occupational therapy and evidence-based practice in mental health

Evidence-based practice (EBP) represents a paradigm shift in health care. This review has two aims. The first is to consider the merits of EBP,especially in respect of its use in mental health settings. The second is both to identify psychosocial interventions that have an established evidence base for effectiveness and to provide an analysis of the quality of this evidence and its implications for occupational therapy. Supported employment, family psychoeducation, assertive case management and integrated substance use treatment are examined in detail. It is proposed that occupational therapists working in mental health give priority to psychosocial interventions that are based on evidence and incorporate these into their practice. It is further proposed that, in implementing EBP,practitioners take an active evaluating position in relation to published evidence, paying particular attention to the evidence of effectiveness in equivalent clinical environments.