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Fleury MJ, Cao Z, Grenier G, Ferland F. Profiles of quality of life among patients using emergency departments for mental health reasons. Health Qual Life Outcomes 2023; 21:116. [PMID: 37880748 PMCID: PMC10601205 DOI: 10.1186/s12955-023-02200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use. METHODS Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them. RESULTS Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions. CONCLUSION The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Zhirong Cao
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Center, Laval University, National Capital University Integrated Health and Social Services Center, Quebec City, QC, Canada
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Joseph VW, Pearson MR, Witkiewitz K. Internalized Stigma Measurement in Substance Use Treatment Settings: A Narrative Review. ADDICTION RESEARCH & THEORY 2023; 32:160-166. [PMID: 38799505 PMCID: PMC11114794 DOI: 10.1080/16066359.2023.2227090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/15/2023] [Indexed: 05/29/2024]
Abstract
Stigma relating to substance use disorders is one of the many barriers to enrolling in substance use treatment. Stigma is also related to poorer substance use treatment outcomes, yet few studies of substance use and substance use treatment outcomes include measures of stigma. Stigma is a multi-level experience occurring as a result of discrimination within a systematic power structure promoting inequities among marginalized populations. Several domains of stigma are manifested among individuals seeking treatment for a substance use disorder, with internalized stigma being the most commonly measured. The current paper is a narrative review of measures that have been developed to measure internalized stigma related to substance use in treatment settings. Measures of stigma (n=8) in substance use treatment settings were identified using PubMed and PsycINFO databases. The review identified various strengths of existing measures, including a broad range of measures with mostly excellent internal consistency. The review also identified limitations including the general lack of consideration for multiple domains and intersecting forms of stigma, samples with limited racial and ethnic diversity, and the lack of assessments of polysubstance use. The development of measures of stigma that assess multiple domains of stigma and that are tested in a wide range of substance use treatment settings with racially and ethnically diverse participants is needed. This is of particular importance because stigma remains a crucial barrier to successful initiation and completion of substance use treatment.
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Affiliation(s)
- Verlin W Joseph
- University of New Mexico Health Sciences Center, United States, New Mexico, Albuquerque
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, United States, New Mexico, Albuquerque
- University of New Mexico, United States, Albuquerque
| | - Katie Witkiewitz
- University of New Mexico, United States, New Mexico, Albuquerque
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Hulaihel A, Gliksberg O, Feingold D, Brill S, Amit BH, Lev-Ran S, Sznitman SR. Medical cannabis and stigma: A qualitative study with patients living with chronic pain. J Clin Nurs 2023; 32:1103-1114. [PMID: 35488381 DOI: 10.1111/jocn.16340] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the ways in which stigma is experienced, and what strategies are used to manage stigma among patients using medical cannabis to ease suffering from chronic pain. BACKGROUND Various jurisdictions have legalised medical cannabis in recent decades. Despite increasing prevalence and more liberal attitudes towards medical cannabis, it is possible that patients who use medical cannabis experience stigma. DESIGN A phenomenological qualitative study. METHODS Fifteen patients living with chronic pain and licensed by the Israeli Ministry of Health to use medical cannabis to treat pain symptoms for at least 1 year participated in semi-structured interviews. Transcribed data were analysed using thematic analysis to identify themes related to stigma. The manuscript is in correspondence to SRQR EQUATOR checklist. RESULTS Expressions of stigma were more related to 'felt' than 'enacted' stigma. Stigma related to decisions to delay onset of medical cannabis treatment and the ways in which participants managed medical cannabis use during their everyday lives. Participants dissociated themselves from recreational cannabis users, by presenting themselves as responsible normative individuals and engaging in a form of normalisation known as 'normification', emphasising their own discrete and controlled medical cannabis use and cannabis' benefits. CONCLUSIONS Patients experienced 'felt' stigma which had consequences for their self-presentations and medical cannabis use. This suggests that medical cannabis is not normalised in Israel and interventions may be needed to handle stigma related to medical cannabis. RELEVANCE TO CLINICAL PRACTICE The findings emphasise the effects of 'felt' stigma on patients. Aiming to increase the effectiveness of medical cannabis treatment and reducing harms, we suggest that particular focus should be placed on managing stigma at the intrapersonal level. In addition, there may be a need to address stigma at the societal level including social interactions with friends, family and medical personnel.
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Affiliation(s)
- Amany Hulaihel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Or Gliksberg
- Department of Psychology, Ariel University, Ariel, Israel
| | | | - Silviu Brill
- Institute of Pain Medicine, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ben H Amit
- Cannabis Clinic, Reuth Rehabilitation Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaul Lev-Ran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center on Addiction, Netanya, Israel.,Lev Hasharon Medical Center, Netanya, Israel
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Klusaritz H, Bilger A, Paterson E, Summers C, Barg FK, Cronholm PF, Saine ME, Sochalski J, Doubeni CA. Impact of Stigma on Clinician Training for Opioid Use Disorder Care: A Qualitative Study in a Primary Care Learning Collaborative. Ann Fam Med 2023; 21:S31-S38. [PMID: 36849482 PMCID: PMC9970664 DOI: 10.1370/afm.2920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE We undertook a study to examine how stigma influences the uptake of training on medication for opioid use disorder (MOUD) in primary care academic programs. METHODS We conducted a qualitative study of 23 key stakeholders responsible for implementing MOUD training in their academic primary care training programs that were participants in a learning collaborative in 2018. We assessed barriers to and facilitators of successful program implementation and used an integrated approach to develop a codebook and analyze the data. RESULTS Participants represented the family medicine, internal medicine, and physician assistant fields, and they included trainees. Most participants described clinician and institutional attitudes, misperceptions, and biases that enabled or hindered MOUD training. Perceptions included concerns that patients with OUD are "manipulative" or "drug seeking." Elements of stigma in the origin domain (ie, beliefs by primary care clinicians or the community that OUD is a choice and not a disease), the enacted domain (eg, hospital bylaws banning MOUD and clinicians declining to obtain an X-Waiver to prescribe MOUD), and the intersectional domain (eg, inadequate attention to patient needs) were perceived as major barriers to MOUD training by most respondents. Participants described strategies that improved the uptake of training, including giving attention to clinician concerns, clarifying the biology of OUD, and ameliorating clinician fears of being ill equipped to provide care for patients. CONCLUSIONS OUD-related stigma was commonly reported in training programs and impeded the uptake of MOUD training. Potential strategies to address stigma in the training context, beyond providing content on effective evidence-based treatments, include addressing the concerns of primary care clinicians and incorporating the chronic care framework into OUD treatment.
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Affiliation(s)
- Heather Klusaritz
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Bilger
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Paterson
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Courtney Summers
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frances K Barg
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Elle Saine
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie Sochalski
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chyke A Doubeni
- The National Center for Integrated Behavioral Health in Primary Care, Rochester, Minnesota and Philadelphia, Pennsylvania .,Department of Family and Community Medicine, The Ohio State University, Columbus, Ohio
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Asseervatham RA, Eng S, Eang S, Tuot S, Yi S. Barriers and facilitators of post-violence help-seeking behavior among 21-49-year-old transgender women in Phnom Penh: A qualitative study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:368-380. [PMID: 37901056 PMCID: PMC10601521 DOI: 10.1080/26895269.2021.1985677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background: Transgender women are disproportionately affected by gender-based violence (GBV). However, little is known about how they respond to GBV. Aims: This study aims to understand transgender women's response to GBV and identify barriers and facilitators in accessing healthcare and legal aid after experiencing the violence. Methods: We conducted a qualitative study between February to March 2020 in Phnom Penh, Cambodia. Data were collected through in-depth interviews with 20 transgender women aged between 21 and 49 who had experienced GBV or knew a peer who had experienced GBV. Thematic analysis was conducted for the coding process, and an inductive approach was used to develop a coding frame. Results: All participants had experienced at least one form of GBV in their lifetime, and most participants had experienced multiple forms of GBV. However, most of them did not seek any services from healthcare providers, law enforcement officers, or assistance for healthcare and legal aid from non-governmental organizations (NGOs). Participants reported the following barriers to access to GBV services: anticipated stigma, the internalized stigma, which resulted in shame and low self-esteem, a lack of knowledge on NGOs' services that can assist with healthcare and legal aid, the perception that mental health services were unavailable, a lack of social support, enacted stigma by the police, and the perceived healthcare cost. The participants reported social support and knowledge of NGOs' services as facilitators of access to GBV service. Social media and NGO staff were reported to be preferred sources of information. Participants wanted more effective law enforcement services, comprehensive healthcare catered to the unique transgender women's needs, and non-discriminating service providers. Discussion: Interventions to address GBV and improve the health outcomes of transgender women should involve creating an enabling environment for help-seeking with the partnership between NGOs and different sectors and building social support.
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Affiliation(s)
- Rysheila Anne Asseervatham
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health, Singapore, Singapore
| | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Songheang Eang
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Social Sciences and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, California, USA
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Davison KM, Thakkar V, Lin S(L, Stabler L, MacPhee M, Carroll S, Collins B, Rezler Z, Colautti J, Xu C(C, Fuller-Thomson E, Hey B, Kelly K, Mullaly L, Remick R, Ravindran A, Paric A, D’Andreamatteo C, Smye V. Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7265. [PMID: 34299716 PMCID: PMC8303838 DOI: 10.3390/ijerph18147265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.
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Affiliation(s)
- Karen M. Davison
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Vidhi Thakkar
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Shen (Lamson) Lin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Lorna Stabler
- CASCADE Children’s Social Care Research and Development Centre, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;
| | - Maura MacPhee
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada;
| | - Simon Carroll
- Department of Sociology, Cornett Building, University of Victoria, A333, Victoria, BC V8W 3P5, Canada;
| | - Benjamin Collins
- Department of Anthropology, University of Manitoba, 432 Fletcher Argue Building, 15 Chancellor Circle, Winnipeg, MB R3T 2N2, Canada;
| | - Zachary Rezler
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Jake Colautti
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Chaoqun (Cherry) Xu
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Brandon Hey
- COVID 19 Policy, Programs and Priorities, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada;
| | - Krystal Kelly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Laura Mullaly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Ron Remick
- Lookout Housing and Health Society, 544 Columbia St, New Westminster, BC V3L 1B1, Canada;
| | - Arun Ravindran
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Angela Paric
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Carla D’Andreamatteo
- Department of Food and Human Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB R3T 2N2, Canada;
| | - Victoria Smye
- Arthur Labatt School of Nursing, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada;
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