Suchergebnisse

Comme intervenant professionnel, quelle aide convient-il d'offrir au jeune suicidant consultant ? Des résultats d'une étude exploratoire sont d'abord présentés pour illustrer les propos de vingt-quatre jeunes quant à leur demande d'aide formelle (contexte, recours et satisfaction) avant de faire leur tentative de suicide. Ces résultats sont ensuite discutés de manière à soulever divers enjeux d'intervention. Cette réflexion suggère qu'il est important pour l'intervenant : (1) d'accueillir et d'évaluer l'angoisse du jeune, (2) de cerner ses capacités d'intervention, (3) d'adopter envers le jeune une approche personnalisée et circonscrite et (4) d'être autocritique vis-à-vis l'aide à dispenser et la psychosociologie du jeune.

Au cours des deux dernières décennies, le taux de suicide québécois a presque doublé. Les hommes âgés de 35 à 39 ans sont actuellement les plus à risque de suicide. Le profil des suicides par génération suggère une augmentation des suicides non seulement chez les hommes les plus jeunes, mais aussi l'augmentation du risque suicidaire d'une génération à l'autre. Les taux de suicide chez les jeunes continuent de progresser de façon systématique et la suicidalité des générations du baby-boom semble se maintenir avec l'avancement en âge. Si les jeunes générations masculines maintiennent en vieillissant l'écart par rapport aux autres générations du baby-boom, elles pourraient présenter des taux de suicide très élevés au fur et à mesure de leur avancement en âge.

Abstract Background Population surveys and health services registers are the main source of data for the management of public health. Yet, the validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness and to the risk of recall bias. The main objectives of this study were to compare data on the use of mental health services from a large scale population survey and a national health services register and to identify the factors associated with the discrepancies observed between these two sources of data. Methods This study was based on the individual linkage of data from the cycle 1.2 of the Canadian Community Health Survey (CCHS-1.2) and from the health services register of the Régie de l'assurance maladie du Québec (RAMQ). The RAMQ is the governmental agency managing the Quebec national health insurance program. The analyses mostly focused on the 637 Quebecer respondents who were recorded as users of mental health services in the RAMQ and who were self-reported users or non users of these services in the CCHS-1.2. Results Roughly 75%, of those recorded as users of mental health services users in the RAMQ's register did not report using mental health services in the CCHS-1.2. The odds of disagreement between survey and administrative data were higher in seniors, individuals with a lower level of education, legal or de facto spouses and mothers of young children. They were lower in individuals with a psychiatric disorder and in frequent and more recent users of mental health services according to the RAMQ's register. Conclusions These findings support the hypotheses that social desirability and recall bias are likely to affect the self-reported use of mental health services in a population survey. They stress the need to refine the investigation of mental health services in population surveys and to combine survey and administrative data, whenever possible, to obtain an optimal estimation of the population need for mental health care.

It is not the purpose of this Article to reject all features of procompetitive proposals. Competitive health plans, multiple health plan choice, provider and consumer cost consciousness, and antitrust activity all may have some place in a larger strategy to rationalize the medical care system. Each of the proposals has some advantages in terms of increasing consumer choice and altering the balance of power between existing actors. As an approach to universal medical care system reform, however, competition alone is inadequate. In fact, one could argue that the most technically feasible way to both rationalize the medical care system and reduce total societal expenditures on health would be to nationalize a public budget for health care and to pass the total costs of medical care through the political budgetary process. Total societal costs might actually be reduced by increasing the program costs to government, as long as public authority is, as in Canada, adequately increased. The centralization of regulatory and allocative decisions could well result in a more suitably restrained form of American medicine. That, however, is a discussion about the alter-natives to procompetitive proposals, rather than the problems of procompetitive proposals, and is therefore beyond the scope of this Article.