Helen-Maria Vasiliadis

Objective: We sought to compare unintentional opioid and other drug poisoning (OODP) and suicide deaths regarding clinical and service use profiles. Method: We undertook a retrospective, administrative data-based study to identify these deaths in Quebec from 2003 to 2018. Descriptive variables were chosen among those available in the Quebec Integrated Chronic Disease Surveillance System, classified according to Anderson's model of health services as determinants of health outcomes. We also used multivariable logistic regression to compare OODP and suicide deaths. Results: We identified 2,002 OODP deaths and 16,555 suicides. In both groups, a considerable proportion were male, aged 30–64 years, and pertained to materially and socially deprived areas, and most presented with at least one mental health or substance-related disorder (SRD) and used primary and specialist healthcare services in the last year before death. When comparing the two groups, some factors predominantly characterized OODP deaths (e.g., living in the Montreal area, several past-year physical comorbidities, SRDs) or suicide deaths (e.g., male sex, depression and bipolar disorder, psychiatrist visit). Similarities also emerged, including several psychiatric comorbidities (anxiety disorder, cluster B personality disorder, schizophrenia and other psychotic disorder), most past-year physical comorbidities and several factors regarding service use in the last year before death (e.g., hospitalizations and general practitioner visits/psychotherapy visits). Conclusions: While some distinctions in individual clinical and service use emerged between OODP and suicide deaths, several similarities also arose, including the generally high burden of mental disorders for both populations. Suicide prevention recommendations of better detection, engagement and management of individuals with depression or SRDs at the primary care and general hospital levels, with support from coordinated mental health and addiction services, might also represent a potentially effective strategy alongside existing overdose prevention efforts and key involvement of peer-led and community-based resources to decrease OODP deaths.

Background: Effective hypertension management depends partly on medication adherence. Mental health disorders, such as anxiety and depression, may influence adherence, but evidence in older populations is limited. This secondary analysis of a cohort study identifies adherence trajectories to antihypertensive medications among older adults and assesses whether anxiety and depression are associated with trajectory membership. Patients and Methods: A cohort of 986 older adults (aged 65 and above) using antihypertensive treatments was analyzed. Adherence was measured using prescription claims over a 12-month period. Adherence patterns over time were characterized using Group-Based Trajectory Modeling (GBTM). Self-reported symptoms and diagnostic codes for anxiety and depression were used to assess for mental health disorders. Associations between depression or anxiety and adherence trajectories were investigated using logistic regression models adjusting for potential confounders. Results: We identified two stable adherence trajectories: a high-adherence group (83.6%) and a low-adherence group (16.4%). No evidence of an association was observed between the presence of anxiety (adjusted odds ratio (OR) of 1.2, 95% confidence interval (CI): 0.8–1.9) or depression (adjusted OR of 1.0, 95% CI: 0.6–1.6) and adherence trajectories. Conclusions: While most older adults in the study maintained high adherence to antihypertensive medications, a notable minority consistently demonstrated low adherence. These findings suggest that additional determinants of adherence trajectory, beyond mental health, should be investigated.

Objective: The prevalence of attention-deficit/hyperactivity disorder (ADHD) has risen in recent decades. The objective of this study was to identify trends in prevalence rates of ADHD medication use as well as any patterns of ADHD medication use among individuals aged up to 24 years in Quebec, Canada. Method: We conducted a repeated cross-sectional study using medico-administrative data between the fiscal years 2000 to 2001 and 2022 to 2023. We estimated crude and age-adjusted prevalence rates along with their 99% confidence intervals according to sex, age (only for crude estimates), material and social deprivation, and ADHD medication type, namely stimulants (amphetamine-based and methylphenidate-based medications) and non stimulants (atomoxetine and guanfacine). We also analyzed prescribing by prescriber type. Results: Among the 4,771,183 individuals aged ≤24 years, 7.7% claimed ADHD medications. Age-adjusted prevalence of ADHD medication use increased from 2000 to 2001 (1.9%) until 2017 to 2018 (7.9%) and plateaued afterwards. The analysis highlighted not only variations in medication use over time but also by sex, with males more likely to be prescribed these medications than females. Family physicians have become the primary prescribers, overtaking pediatricians in recent years. Stimulant medications were the most common treatment throughout the study period, though we observed diversification in prescribed ADHD medication types across age groups. Conclusions: This study emphasizes a significant increase in ADHD medication use from 2000 to 2018 and a stabilization in use afterwards. The expansion of diagnostic criteria in 2013 and heightened awareness may have narrowed the disparity between the condition's prevalence and its management and may explain the increase in use observed in earlier years and the stabilization observed over the more recent years. The disparities between males and females, as well as between age groups, highlight the need for continuous monitoring of prescribing trends and support targeted equity evaluations to inform service planning and improve access where needed.

This study identified sex-specific multi-trajectories of anxiety and depression symptoms among Canadians before and during the COVID-19 pandemic, and associated factors according to a public mental health framework for the surveillance of mental health. Data from 15,021 participants in the Canadian Partnership for Tomorrow's Health cohort, collected in 2018, 2020, 2021, and 2022, were analyzed. Anxiety and depression symptoms were assessed using the GAD-7 and PHQ-8 scales. Group-based multi-trajectory modeling identified distinct patterns of joint symptom evolution in males and females. Multinomial logistic regression analyses examined associations between trajectory groups and individual, living environment, and global/system level factors. Four anxiety-depression multi-trajectory groups were identified in females and males: resilient (26.6%, 37.0%), persistent minimal fluctuating (49.0%, 42.4%), persistent mild fluctuating (20.0%, 17.6%), and persistent moderate fluctuating (4.4%, 3.0%). Trajectory forms differed by sex, with males showing greater variation. Compared to the resilient group, membership in the three symptom trajectories was associated with individual (e.g., younger age, lower household income, multimorbidity, lifetime presence of a mental disorder), living environment (e.g. emotional/psychological support), and global/system level (e.g., reduced wages/h of work, barriers to mental health care) factors. These findings highlight inequities in mental health and access to care, calling for targeted clinical follow-up of individuals with pre-existing mental disorders, as well as public health campaigns and health policies aimed at reducing barriers to accessing mental health services.

Alors qu’il s’agit d’un déterminant important de la santé des personnes aînées, environ le tiers des Canadiens âgés ont une participation sociale limitée, une situation exacerbée par la pandémie de COVID-19. L’Accompagnement-citoyen personnalisé d’intégration communautaire (APIC) peut améliorer la participation sociale, mais on connaît peu son efficacité et son coût-efficacité. Objectifs : Évaluer l’efficacité de l’APIC pour améliorer la participation sociale, la santé et la satisfaction envers la vie des personnes aînées et l’utilisation des services de santé (USS); Analyser l’effet de l’APIC sur les coûts liés à l’USS et le rapport coût-efficacité incrémentiel (RCÉI) selon la perspective sociétale.

Objectives: This study aimed to assess the concordance between depression and anxiety case definitions derived from algorithms based on medico-administrative data and structured interviews aligned with the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in older adults. Methods: We analyzed data from 1405 primary care older adults (≥65 years) from the Étude sur la Santé des Aînés (ESA)-Services cohort (2011–2013) in Quebec, Canada, who had available survey and medico-administrative data. Cases of depression and anxiety were identified using algorithms incorporating combinations of hospitalization records, physician-visit claims, and medication claims for antidepressants or anxiolytics. The agreement was assessed with the kappa statistics (κ), and the algorithms’ sensitivity, specificity, and positive and negative predictive values were calculated using the case definitions derived from the DSM-IV-aligned ESA-Services interviews as the gold standard. Results: Agreements between the algorithms and the interviews were fair (κ: 0.06–0.22) for depression gooand slight (κ: 0.02–0.09) for anxiety. The algorithms had low sensitivity (2–39.7% for depression and 1.4–39.9% for anxiety) but high specificity (84.5–99.6% for depression and 73–99.2% for anxiety), depending on the algorithm. Conclusions: The agreement between algorithms based on administrative data and DSM-IV-aligned interviews for anxiety or depressive disorders was low. The two methods identified older adults with different characteristics. Despite these discrepancies, algorithms with high specificity provide valuable insights into healthcare utilization patterns associated with these disorders.