Lisa M Lix

McGill University, Montréal, Quebec, Canada

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Publications (247)1093.18 Total impact

  • International Journal for Equity in Health 12/2015; 14(1). DOI:10.1186/s12939-015-0231-6 · 1.71 Impact Factor
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    ABSTRACT: Prescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes. Data sources that capture medication information, which include surveys, medical charts, administrative health databases, and clinical assessment records, may not collect concordant information, which can result in comparable prevalence and effect size estimates. The purpose of this research was to estimate agreement between two population-based electronic data sources for measuring use of several medication classes among LTCF residents: outpatient prescription drug administrative data and the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0. Prescription drug and RAI-MDS data from the province of Saskatchewan, Canada (population 1.1 million) were linked for 2010/11 in this cross-sectional study. Agreement for anti-psychotic, anti-depressant, and anti-anxiety/hypnotic medication classes was examined using prevalence estimates, Cohen’s κ, and positive and negative agreement. Mixed-effects logistic regression models tested resident and facility characteristics associated with disagreement. The cohort was comprised of 8,866 LTCF residents. In the RAI-MDS data, prevalence of anti-psychotics was 35.7%, while for anti-depressants it was 37.9% and for hypnotics it was 27.1%. Prevalence was similar in prescription drug data for anti-psychotics and anti-depressants, but lower for hypnotics (18.0%). Cohen’s κ ranged from 0.39 to 0.85 and was highest for the first two medication classes. Diagnosis of a mood disorder and facility affiliation was associated with disagreement for hypnotics. Agreement between prescription drug administrative data and RAI-MDS assessment data was influenced by the type of medication class, as well as selected patient and facility characteristics. Researchers should carefully consider the purpose of their study, whether it is to capture medication that are dispensed or medications that are currently used by residents, when selecting a data source for research on LTCF populations.
    BMC Geriatrics 12/2015; 15(1). DOI:10.1186/s12877-015-0023-2 · 1.68 Impact Factor
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    ABSTRACT: Objective: Because of pervasive poor general medical and mental health status among patients receiving Medicaid, there has been substantial debate about whether Medicaid, as currently financed and delivered, is better than no insurance. The study aimed to address whether insurance status is associated with the subsequent incidence and persistence of common mental disorders. Methods: Data came from a nationally representative U.S. population-based longitudinal survey that assessed mental disorders at two time points three years apart. Propensity score methods were used to adjust for potential confounding and to assess the association between three mutually exclusive insurance status groups (no insurance, private insurance only, and Medicaid only) and the subsequent incidence and persistence of mood, anxiety, and substance use disorders for persons ages 18-65 (N=26,410). Results: Compared with private insurance, lack of insurance was associated with higher odds of both the incidence and persistence of substance use disorders and with higher odds of persistence of any mood or anxiety disorder. Compared with having private insurance, having Medicaid insurance was associated with increased odds of persistent mood and anxiety disorders during follow-up. Overall, findings did not significantly differ between the uninsured and Medicaid groups. Conclusions: The findings do not support prior reports that U.S. adults with Medicaid have worse mental health outcomes than uninsured adults. Lacking insurance may put individuals at higher risk of developing substance use disorders, and uninsured individuals with preexisting mental conditions were more likely to have mood, anxiety, and substance use problems that persist over time.
    Psychiatric services (Washington, D.C.) 11/2015; DOI:10.1176/ · 2.41 Impact Factor
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    ABSTRACT: Background: Electronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification. Methods: We included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011. Results: Compared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records with a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE. Conclusions: Different definitions should be used for different study purposes. The definition of 'diagnosis code or two abnormal blood pressure records with a 2-year period' could be used for hypertension surveillance in THIN.
    Journal of Public Health 11/2015; DOI:10.1093/pubmed/fdv155 · 2.04 Impact Factor
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    ABSTRACT: Purpose: The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. Methods: One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. Results: Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. Conclusion: Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research. Implications for Rehabilitation Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important. Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient's ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls. Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.
    Disability and Rehabilitation 10/2015; DOI:10.3109/09638288.2015.1085102 · 1.99 Impact Factor
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    ABSTRACT: sec> Objectives Electronic physician claims databases are widely used for chronic disease research and surveillance, but quality of the data may vary with a number of physician characteristics, including payment method. The objectives were to develop a prediction model for the number of prevalent diabetes cases in fee-for-service (FFS) electronic physician claims databases and apply it to estimate cases among non-FFS (NFFS) physicians, for whom claims data are often incomplete. Design A retrospective observational cohort design was adopted. Setting Data from the Canadian province of Newfoundland and Labrador were used to construct the prediction model and data from the province of Manitoba were used to externally validate the model. Participants A cohort of diagnosed diabetes cases was ascertained from physician claims, insured resident registry and hospitalisation records. A cohort of FFS physicians who were responsible for the diagnosis was ascertained from physician claims and registry data. Primary and secondary outcome measures A generalised linear model with a γ distribution was used to model the number of diabetes cases per FFS physician as a function of physician characteristics. The expected number of diabetes cases per NFFS physician was estimated. Results The diabetes case cohort consisted of 31&emsp14;714 individuals; the mean cases per FFS physician was 75.5 (median=49.0). Sex and years since specialty licensure were significantly associated (p<0.05) with the number of cases per physician. Applying the prediction model to NFFS physician registry data resulted in an estimate of 18&emsp14;546 cases; only 411 were observed in claims data. The model demonstrated face validity in an independent data set. Conclusions Comparing observed and predicted disease cases is a useful and generalisable approach to assess the quality of electronic databases for population-based research and surveillance. </sec
    BMJ Open 08/2015; 5(8). DOI:10.1136/bmjopen-2014-006858 · 2.27 Impact Factor
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    ABSTRACT: Objectives: The purpose of this study is to estimate and compare smoking prevalence over two time periods in a Manitoba First Nation community. Methods: Data fromtwo independent Diabetes Screening Studies in Sandy Bay First Nation, collected in 2002/2003 (n = 482) and 2011/2012 (n = 596),were used. Crude prevalence of current and ever smoking as well as current smoke exposure was estimated. Change over time was tested using a χ2 statistic. Results: The crude prevalence of current smoking was 74.0% (95% confidence interval [CI]: 70.1, 78.0) in 2002/2003 and 80.0% (95% CI: 76.8, 83.2) in 2011/2012. The crude prevalence of ever smoking was 83.0% in 2002/2003 and 91.4% in 2011/2012. The prevalence of both current smoking status and ever smoking were significantly higher in 2011/2012 compared to 2002/2003 (p = 0.020 and p < 0.001 respectively). Among participants who were not current smokers, 58.5% (95% CI: 49.6, 67.4) and 76.5% (95% CI: 68.9, 84.1) reported at least one person who smoked in the home in 2002/2003 and 2011/2012 respectively (p = 0.003). In 2011/2012, 96.5% (95% CI: 94.8, 98.2) of those who reported having any children under the age of 18 living in the home were either a current smoker and/or reported that someone else smoked in the home. Conclusion: Public health and policy initiatives are needed to address the increase in smoking prevalence in the study community.
    08/2015; 106(4):e184-8. DOI:10.17269/CJPH.106.4940
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    ABSTRACT: Behaviours of concern ( e.g. aggression) are often present in residents of long-term care (LTC) facilities diagnosed with dementia and may impact quality of life. Prior uncontrolled research has shown that an intervention involving sharing resident life histories may be effective in reducing aggressive behaviours and improving quality of life, perhaps by increasing staff empathy. We used a randomised controlled design, involving a considerably larger sample than previous investigations. We also examined staff perceptions of LTC resident personhood in relation to aggressive behaviour. Seventy-three residents were randomised to either a life history intervention (N = 38) or a control condition (N = 35). Ninety-nine nurses and care aides answered questionnaires about their own attitudes and the residents' behaviours and quality of life at baseline, post-intervention and at follow-up. Results of mixed-effects modelling indicated significant differences between groups in personhood perception and resident quality of life. Personhood perception mediated the relationship between the intervention and improved quality of life. We identified significant negative correlations between resident cognitive impairment and staff perceptions of resident personhood. Qualitative findings suggested that staff primarily changed their verbal interactions with residents following the intervention, which may be particularly helpful for residents with the most severe dementia. Our results indicate that LTC residents benefit when life histories are constructed with their families and shared with nursing staff.
    Ageing and Society 08/2015; DOI:10.1017/S0144686X15000902 · 1.23 Impact Factor
  • W D Leslie · J T Schousboe · L M Lix ·

    Osteoporosis International 08/2015; DOI:10.1007/s00198-015-3281-0 · 4.17 Impact Factor
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    ABSTRACT: Most studies report that longer hip axis length (HAL) is associated with increased hip fracture risk in women, but comparable data in men are sparse. Using a registry of all dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada, we identified 4738 men and 50,420 women aged 40 yr and older with baseline hip DXA results, HAL measurements, and Fracture Risk Assessment Tool (FRAX) hip fracture probability computed with femoral neck bone mineral density (BMD). Population-based health service records were assessed for a subsequent hospitalization with a primary diagnosis of hip fracture. During mean 6.2 yr of follow-up, 70 men and 1020 women developed incident hip fractures. Mean HAL was significantly greater in those with vs without incident hip fractures (men 123.0 ± 7.6 vs 121.3 ± 7.4 mm, p = 0.050; women 106.9 ± 6.2 vs 104.6 ± 6.2 mm, p < 0.001). When adjusted for age and femoral neck BMD, each millimeter increase in HAL increased hip fracture risk by 3.6% in men (p = 0.022) and 4.6% in women (p < 0.001); this association was unaffected by sex (p value for interaction = 0.477). When adjusted for log-transformed FRAX hip fracture probability, each millimeter increase in HAL increased hip fracture risk by 3.4% in men (p = 0.031) and 4.8% in women (p < 0.001); this association was again unaffected by sex (p interaction = 0.409). A bilinear adjustment applicable to both men and women was developed: relative increase in hip fracture probability 4.7% for every millimeter that HAL is above the sex-specific average, relative decrease in hip fracture probability 3.8% for every millimeter that HAL is below the sex-specific average. We concluded that greater DXA-derived HAL is associated with increased incident hip fracture risk in both men and women, and this risk is independent of BMD and FRAX probability. Copyright © 2015 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.
    Journal of Clinical Densitometry 08/2015; DOI:10.1016/j.jocd.2015.07.004 · 2.03 Impact Factor
  • W D Leslie · S L Brennan-Olsen · S N Morin · L M Lix ·
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    ABSTRACT: We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment. We report that repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy. In clinical practice, many patients selectively undergo repeat bone mineral density (BMD) measurements. We investigated whether repeat BMD measurements in clinical populations are useful for fracture risk assessment and whether this is affected by preceding change in BMD or recent osteoporosis therapy. We identified women and men aged ≥50 years who had a BMD measurement during 1990-2009 from a large clinical BMD database for Manitoba, Canada (n = 50,215). Patient subgroups aged ≥50 years at baseline with repeat BMD measures were identified. Data were linked to an administrative data repository, from which osteoporosis therapy, fracture outcomes, and covariates were extracted. Using Cox proportional hazards models, we assessed covariate-adjusted risk for major osteoporotic fracture (MOF) and hip fracture according to BMD (total hip, lumbar spine, femoral neck) at different time points. Prevalence of osteoporosis therapy increased from 18 % at baseline to 55 % by the fourth measurement. Total hip BMD was predictive of MOF at each time point. In the patient subgroup with two repeat BMD measurements (n = 13,481), MOF prediction with the first and second measurements was similar: adjusted-hazard ratio (HR) per SD 1.45 (95 % CI 1.34-1.56) vs. 1.64 (95 % CI 1.48-1.81), respectively. No differences were seen when the second measurement results were stratified by preceding change in BMD or osteoporosis therapy (both p-interactions >0.2). Similar results were seen for hip fracture prediction and when spine and femoral neck BMD were analyzed. Repeat BMD measurements are a robust predictor of fracture in clinical populations; this is not affected by preceding BMD change or recent osteoporosis therapy.
    Osteoporosis International 08/2015; DOI:10.1007/s00198-015-3259-y · 4.17 Impact Factor
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    ABSTRACT: Existing literature demonstrating the negative impact of delayed hip fracture surgery on mortality consists largely of observational studies prone to selection bias and may overestimate the negative effects of delay. We conducted an intervention study to assess initiatives aimed at meeting a 48-hour benchmark for hip fracture surgery to determine if the intervention achieved a reduction in time to surgery, and if a general reduction in time to surgery improved mortality and length of stay. We compared time to surgery, length of stay and mortality between pre- and postintervention patients with a hip fracture using the Kaplan-Meier estimator and Cox proportional hazards model adjusting for age, sex, comorbidities, type of surgery and year. We included 3525 pre- and 3007 postintervention patients aged 50 years or older. The proportion of patients receiving surgery within the benchmark increased from 66.8% to 84.6%, median length of stay decreased from 13.5 to 9.7 days, and crude in-hospital mortality decreased from 9.6% to 6.8% (all p < 0.001). Adjusted analyses revealed reduced mortality in hospital (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.57-0.81) and at 1 year (HR 0.87, 95%CI 0.79-0.96). Independent of the intervention period, having surgery within 48 hours demonstrated decreased adjusted risk of death in hospital (HR 0.51, 95%CI 0.41-0.63) and at 1 year postsurgery (HR 0.72, 95% CI 0.64-0.80). Coordinated, region-wide efforts to improve timeliness of hip fracture surgery can successfully reduce time to surgery and appears to reduce length of stay and adjusted mortality in hospital and at 1 year.
    Canadian journal of surgery. Journal canadien de chirurgie 08/2015; 58(3):257-63. DOI:10.1503/cjs.017714 · 1.51 Impact Factor
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    ABSTRACT: A safety signal regarding cases of AKI after exposure to serotonin-norepinephrine reuptake inhibitors (SNRIs) was identified by Health Canada. Therefore, this study assessed whether the use of SNRIs increases the risk of AKI compared with selective serotonin reuptake inhibitors (SSRIs) and examined the risk associated with each individual SNRI. Multiple retrospective population-based cohort studies were conducted within eight administrative databases from Canada, the United States, and the United Kingdom between January 1997 and March 2010. Within each cohort, a nested case-control analysis was performed to estimate incidence rate ratios (RRs) of AKI associated with SNRIs compared with SSRIs using conditional logistic regression, with adjustment for high-dimensional propensity scores. The overall effect across sites was estimated using meta-analytic methods. There were 38,974 cases of AKI matched to 384,034 controls. Current use of SNRIs was not associated with a higher risk of AKI compared with SSRIs (fixed-effect RR, 0.97; 95% confidence interval [95% CI], 0.94 to 1.01). Current use of venlafaxine and desvenlafaxine considered together was not associated with a higher risk of AKI (RR, 0.96; 95% CI, 0.92 to 1.00). For current use of duloxetine, there was significant heterogeneity among site-specific estimates such that a random-effects meta-analysis was performed showing a 16% higher risk, although this risk was not statistically significant (RR, 1.16; 95% CI, 0.96 to 1.40). This result is compatible with residual confounding, because there was a substantial imbalance in the prevalence of diabetes between users of duloxetine and users of others SNRIs or SSRIs. After further adjustment by including diabetes as a covariate in the model along with propensity scores, the fixed-effect RR was 1.02 (95% CI, 0.95 to 1.10). There is no evidence that use of SNRIs is associated with a higher risk of hospitalization for AKI compared with SSRIs. Copyright © 2015 by the American Society of Nephrology.
    Clinical Journal of the American Society of Nephrology 07/2015; DOI:10.2215/CJN.11271114 · 4.61 Impact Factor
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    ABSTRACT: Although some individual and organizational contributors to person-centred care or quality of care have been studied, they have rarely been examined together. Our goal was to investigate the association of personal and organizational-environmental characteristics with self-reported person-centred behaviours in long-term residential care settings. We asked 109 long-term care staff from two Canadian long-term care homes to complete scales assessing self-reported person-centred care, organizational support for person-centred care, beliefs about personhood in dementia, and burnout. Independent variables included four employee background characteristics (age, gender, occupation, and years of education), beliefs about personhood in dementia, burnout, and three aspects of organizational support for person-centred care (the physical environment of residents, collaboration on care, and support from management). Dependent variables included five aspects of person-centred care: autonomy, personhood, knowing the person, comfort care, and support for relationships .We used multiple linear regression analysis and changes in R(2) to test variable associations. Including organizational variables in regression models resulted in statistically significant (p < .05) changes in R(2) for each of the five dependent variables. Including personal variables resulted in statistically significant changes in R(2) for some dependent variables, but not others. In particular, including employee background characteristics resulted in a statistically significant change in R(2) for comfort care, and including beliefs about personhood and burnout resulted in statistically significant changes in R(2) for personhood but not for other dependent variables. Organizational characteristics are associated with several aspects of person-centred dementia care. Individual characteristics, including gender, beliefs about personhood, and burnout, appear to be more important to some aspects of person-centred dementia care (e.g., respect for personhood and comfort care) than others.
    Aging and Mental Health 06/2015; DOI:10.1080/13607863.2015.1056771 · 1.75 Impact Factor
  • W. Kouokam · L.M. Lix ·

    Revue d Épidémiologie et de Santé Publique 05/2015; 63. DOI:10.1016/j.respe.2015.03.037 · 0.59 Impact Factor
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    ABSTRACT: Conclusion Across all analyses—estimated population based, matched, and propensity score—we found that smoking was associated with an increased burden on the healthcare system. The dichotomous ever-versus-never-smoked analyses consistently showed that individuals who reported having ever smoked used more health services than those who reported having never smoked. When we separated individuals into more refined categories we found that much of the healthcare burden was concentrated among individuals in three categories: current daily smokers, former daily smokers who quit daily smoking five years or less before survey date, and former daily smokers who quit daily smoking over five years before survey date. A common perception is that while smokers may use more healthcare services, they die younger. It is believed that these individuals’ burden is truncated resulting in few or no additional costs in the long run. However, our results show that if smokers live to the age of 50, they typically live well into their late 70s and early 80s. Thus, not only did we find that smoking was associated with increased healthcare use; we also found that this increase was not curtailed by smokers dying young. Those in Manitoba who ever smoked use significantly more healthcare services and they do so over a considerably long period—into their late 70s and early 80s. When we estimated the costs of those healthcare services used by those who ever smoked compared with those who never smoked we found that those who ever smoked cost the healthcare system more, even after adjusting for several confounding characteristics. Our estimates suggest that, on average, smoking costs the Manitoba healthcare system an additional $226,034,777 per year, plus another $18,342,017 for cancer-related costs.
    First 05/2015; Winnipeg MB: Manitoba Centre for Health Policy., ISBN: ISBN 978-1-896489-77-3
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    ABSTRACT: As individuals experience changes in their health, they may alter the way they evaluate health and quality of life. The purpose of this study is to estimate the extent to which individuals with IBD change their rating of health over time because of response shift (RS). This is a reanalysis of a population-based longitudinal study of IBD in Manitoba, Canada (n = 388). RS was examined using trajectories of the difference between observed and predicted health. Logistic regression and dual trajectories were used to identify predictors of RS. Disease activity, vitality, pain, somatization, and physical and social function explained 51% of the variation in general health over two years with no evidence of RS in 82% of the sample. Negative RS was found for 8%, who initially rated health better than predicted; positive RS was found for 6%. The positive RS group was younger and had better baseline scores on measures of general health, hostility, pain, mental health and social and role function; less pain and better social function scores at baseline were predictors of negative RS. In conclusion, the majority of people with IBD did not demonstrate a RS indicating that the health rating over time was stable in relation to that predicted by known time varying clinical variables. This adds to the evidence that the single question on self-rated health is useful for monitoring individuals over time.
    Health and Quality of Life Outcomes 05/2015; 13(1):52. DOI:10.1186/s12955-015-0232-6 · 2.12 Impact Factor
  • J.P. Kuwornu · L. Lix · J. Quail · E. Wang · M. Osman · G. Teare ·

    Value in Health 05/2015; 18(3):A16. DOI:10.1016/j.jval.2015.03.101 · 3.28 Impact Factor
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    ABSTRACT: Social Anxiety Disorder (SAD) models implicate social threat cue vigilance (i.e., attentional biases) in symptom development and maintenance. A modified dot-probe protocol has been shown to reduce SAD symptoms, in some but not all studies, presumably by modifying an attentional bias. The current randomized controlled trial was designed to replicate and extend such research. Participants included treatment-seeking adults (n=108; 58% women) who met diagnostic criteria for SAD. Participants were randomly assigned to a standard (i.e., control) or modified (i.e., active) dot-probe protocol condition and to participate in-lab or at home. The protocol involved twice-weekly 15-min sessions, for 4 weeks, with questionnaires completed at baseline, post-treatment, 4-month follow-up, and 8-month follow-up. Symptom reports were assessed with repeated measures mixed hierarchical modeling. There was a main effect of time from baseline to post-treatment wherein social anxiety symptoms declined significantly (p<.05) but depression and trait anxiety did not (p>.05). There were no significant interactions based on condition or participation location (ps>.05). Reductions were maintained at 8-month follow-up. Symptom reductions were not correlated with threat biases as indexed by the dot-probe task. The modified and standard protocol both produced significant sustained symptom reductions, whether administered in-lab or at home. There were no robust differences based on protocol type. As such, the mechanisms for benefits associated with modified dot-probe protocols warrant additional research. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Anxiety Disorders 04/2015; 33. DOI:10.1016/j.janxdis.2015.03.011 · 2.96 Impact Factor

Publication Stats

4k Citations
1,093.18 Total Impact Points


  • 2015
    • McGill University
      • Division of General Internal Medicine
      Montréal, Quebec, Canada
  • 1996-2015
    • University of Manitoba
      • • Department of Community Health Sciences
      • • Manitoba Centre for Health Policy
      • • Department of Internal Medicine
      • • Department of Psychology
      Winnipeg, Manitoba, Canada
  • 2014
    • The University of Winnipeg
      Winnipeg, Manitoba, Canada
    • Canadian Academy of Dental Health and Community Sciences
      Mississauga, Ontario, Canada
  • 2013
    • The University of Sheffield
      • Medical School
      Sheffield, England, United Kingdom
    • University of British Columbia - Vancouver
      • Department of Obstetrics and Gynaecology
      Vancouver, British Columbia, Canada
    • University of Regina
      • Department of Psychology
      Regina, Saskatchewan, Canada
  • 2009-2013
    • University of Saskatchewan
      • School of Public Health
      Saskatoon, Saskatchewan, Canada
  • 2000
    • Health Canada
      Ottawa, Ontario, Canada