Alain D Lesage

Alain D Lesage
Université de Montréal | UdeM · Department of Psychiatry

MD, Mphil

About

413
Publications
52,903
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10,890
Citations
Citations since 2016
67 Research Items
3914 Citations
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20162017201820192020202120220100200300400500600
20162017201820192020202120220100200300400500600
20162017201820192020202120220100200300400500600

Publications

Publications (413)
Article
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Purpose Electroconvulsive therapy (ECT) is effective for treating several psychiatric disorders. However, only a minority of patients are treated with ECT. It is of primary importance to characterize their profile for epidemiological purposes and to inform clinical practice. We aimed to characterize the longitudinal profile of psychopathology and s...
Article
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PurposeTo describe long term clinical and functional outcomes of schizophrenia in a developed country.Method Long term longitudinal study of clinical and functional outcomes of incidence cohort of all consecutive admissions for a first hospitalization for schizophrenia between 1983 and 1987 in Montreal, Canada (n = 142). Data collection was conduct...
Article
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Several research contributions have depicted the impact of the pandemic environment on healthcare and social care personnel. Even though the high prevalence of burnout depression and anxiety in healthcare settings before COVID-19 has been well documented in the research, the recent increase in psychological distress and mental health issues in heal...
Article
Abstract Objective To compare the effectiveness and safety of various second-generation antipsychotics (SGAs), newer oral and long-acting injectable (LAI) SGAs, and first-generation antipsychotics (FGAs) treatments in patients with schizophrenia or schizoaffective disorder (SCZ). Methods This retrospective cohort study included medical-administr...
Article
Objective: This study aims to describe the utilization patterns of antipsychotic (AP) medication in patients with schizophrenia (SCZ), three years after initiating or reinitiating a given AP. Methods: Based on medico-administrative information on patients living in Quebec (Canada), this retrospective cohort study included 6,444 patients with a p...
Article
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Background Although recognised as the most effective antipsychotic for treatment-resistant schizophrenia, clozapine remains underused. One reason is the widespread concern about non-adherence to clozapine because of poor adherence before initiating clozapine. Aims To determine if prior poor out-patient adherence to treatmentbefore initiating cloza...
Article
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Background Administrative data have several advantages over questionnaire and interview data to identify cases of depression: they are usually inexpensive, available for a long period of time and are less subject to recall bias and differential classification errors. However, the validity of administrative data in the correct identification of depr...
Presentation
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The study investigated the impact of the emergency and quarantine on the well-being, work conditions and work practices of mental health services (MHS) personnel and professionals in Lombardy (Italy) and in Montreal area.
Article
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A community-centered approach to mental health care has been favoured over hospital-based psychiatry in Quebec over the last three decades. In England, crisis intervention services in the form of Crisis Resolution Teams (CRTs) were widely implemented in the early 2000s to offer an alternative care to hospitalization to patients with severe mental h...
Article
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Lombardy was the epicenter of the Covid-19 outbreak in Italy, and in March 2020 the rapid escalation in cases prompted the Italian Government to decree a mandatory lockdown and to introduce safety practices in mental health services. The general objective of the study is to evaluate the early impact of the Covid-19 emergency and quarantine on the w...
Article
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Background: Most existing conceptual models of residential environments and housing programs were developed over a decade ago or lack comprehensiveness. The attributes to be used to describe housing programs with adequate specification remain unclear including the attributes that mediate service user outcomes. In this study, group concept mapping...
Article
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Objective: The attitudes of mental health professionals towards consumers' recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medi...
Article
Importance Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a...
Article
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A small number of severely and persistently mentally ill in-patients awaiting residential or long-stay facilities represent an obstacle to the efficient utilization of acute care beds. These facilities are costly and currently reputed to be contrary to recovery principles. In 2013, all acute psychiatric care wards in Montreal identified 194 in-pati...
Article
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Aims No instrument has been developed to explicitly assess the professional culture of mental health workers interacting with severely mentally ill people in publicly or privately run mental health care services. Because of theoretical and methodological concerns, we designed a self-administered questionnaire to assess the professional culture of m...
Research
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Les personnes avec des troubles mentaux (TM), incluant les troubles liés aux substances (TLS), utilisent plus fréquemment les services d'urgence que la population générale. Basée sur l'analyse de banques de données médico-administratives regroupant 98% de la population du Québec, cette étude permet de mieux cerner les besoins de services des patien...
Article
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Introduction Depression is a common and disabling health problem that contributes to an important social and economic burden, particularly among the working age population. The deleterious effect of psychosocial work factors on depression has been documented. However, the most recent systematic reviews had restrictive eligibility criteria and, sinc...
Article
Objective There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use d...
Article
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Physical and sexual abuse in childhood is a worldwide phenomenon with potentially dramatic consequences of both a psychological and a physical nature. Measures of primary prevention have been developed in some countries. In the United States, child protection services reports and research surveys indicate that child sexual abuse has been on the dec...
Article
Objectives: The study of suicide notes and the evolution of their content could contribute to a better understanding of reasons conducive to suicide mortality and offer further prevention strategies. Methods: From 1895 to 1985, 706 Coroner’s inquests of individuals who died by suicide and were 20 or younger years old, were found in the province of...
Article
Objectives: This study aimed to describe the data collection systems routinely used by electroconvulsive therapy (ECT) units across the province of Quebec, Canada. Methods: We conducted a descriptive, cross-sectional study. Using an online survey, 31 ECT units delivering inpatient or outpatient ECT treatments in the province of Quebec provided i...
Research
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Review of litterature on mobile crisis resolution teams and interviews on the context of delivery in Quebec. Cette revue de littérature et la mise en contexte québécoise révèlent qu’une ERCD/CRT est une intervention intéressante et bien définie qui pourrait solidifier l’offre de services québécoise pour la gestion de la crise.
Article
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Introduction Mental health problems (MHPs) are frequent and disabling and are the first or second leading cause of certified sickness absences from work in industrialised countries. They are generally long lasting and generate a considerable human and socioeconomic burden. The deleterious effect of adverse psychosocial work factors on MHP has been...
Article
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Background: Canada has a publicly-funded universal healthcare system with information systems managed by 13 different provinces and territories. This context creates inconsistencies in data collection and challenges for research or surveillance conducted at the national or multi-jurisdictional level. Objective: Using a recent Canadian research p...
Article
Les homicides-suicides sont des événements aussi graves qu’exceptionnels. À l’interface de la criminologie et de la suicidologie, leur étude et leur prévention butent sur une indistinction de statut : sont-ils à considérer comme une sous-catégorie du suicide ou comme une entité à part entière ? Pour le clarifier, nous avons mené une méta-analyse de...
Article
Objective: To measure the provincial government cost of mental health-related activities for youth ages 12 to 17 in Alberta in 2014 to 2015. Methods: The target population was Alberta youth ages 12 to 17 (the federal justice definition) who received or were funded for mental health-related or complementary services from Alberta Health Services,...
Article
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Background There is growing recognition of the need for consistent and reliable reporting on mental health and addiction (MHA) services in Canada. While there have been improvements in the area of reporting within provinces, comparable measures across provinces are often confined to hospitalization data. The aim of this project was to test the feas...
Article
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Since 2000, 5 studies have been published that each purported to estimate aggregate national mental health costs in Canada. Each of these studies used a different method. Our aim was to compare the studies, and we created a framework for the different elements used to assess mental health costs (direct costs, indirect costs, transfer payments, and...
Article
Objective: To assess whether neighbourhood deprivation is associated with exposure to an antidepressant drug treatment (ADT) and its quality among individuals diagnosed with unipolar depression and insured by the Quebec public drug plan. Method: We conducted an administrative database cohort study of adults covered by the Quebec public drug plan...
Poster
Using CCHS data we see a decrease in reports of child abuse in younger generation.
Poster
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According to Bloor and Dawson (1994), members of a particular professional group, such as psychiatrists, nurses or social workers share a common “professional culture”, i.e. a system of values, schema and knowledge, that orients cognitive appraisal, professional behavior and coping to unforeseen and changing situations. Currently, there are no stud...
Article
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Objective: The purpose of this study is to measure provincial spending for mental health services in fiscal year (FY) 2013 and to compare these cost estimates to those of FY 2003. Methods: This study estimated the costs of publicly funded provincial mental health services in FY 2013 and compared them to the estimates for FY 2003 from a previousl...
Article
Purpose: Recent reviews concluded that past depression symptoms are not independently associated with high school dropout, a conclusion that could induce schools with high dropout rates and limited resources to consider depression screening, prevention, and treatment as low-priority. Even if past symptoms are not associated with dropout, however,...
Article
Objective: As part of a quality improvement process, we propose a model of routinely monitoring electroconvulsive therapy (ECT) in Canadian provinces using linked health administrative databases to generate provincial periodic reports, influence policy, and standardise ECT practices. Methods: ECT practice in Quebec was studied from 1996 to 2013,...
Article
Objective: To estimate the prevalence, comorbidities, and service use of people with autism spectrum disorders (ASDs) based on data from Quebec Integrated Chronic Diseases Surveillance System (QICDSS). Methods: We included all residents up to age 24 eligible for health plan coverage who were in Quebec for at least 1 day from January 1, 1996, to...
Article
Objective: The objective of this review is to identify the features and components of a comprehensive system of services for people living with schizophrenia. A comprehensive system was conceived as one that served the full range of people with schizophrenia and was designed with consideration of the incidence and prevalence of schizophrenia. The...
Article
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Background: Limited evidence on the costs of homelessness in Canada is available. We estimated the average annual costs, in total and by cost category, that homeless people with mental illness engender from the perspective of society. We also identified individual characteristics associated with higher costs. Methods: As part of the At Home/Chez...
Article
Objective: There is a need for the routine monitoring of treated attention-deficit hyperactivity disorder (ADHD) for timely policy making. The objective is to report and assess over a decade the prevalence and incidence of diagnosed ADHD in Canada. Methods: Administrative linked patient data from the provinces of Manitoba, Ontario, Quebec, and N...
Article
Contexte Cet article vise à décrire les facteurs associés à la prescription d’antipsychotiques par un psychiatre plutôt qu’un omnipraticien, la prescription d’un antipsychotique de seconde plutôt que de première génération, la prescription d’une multithérapie d’antipsychotiques et le non-renouvellement de la prescription initiale. Méthodologie Il s...
Article
Objective: The study estimated costs and effects associated with increasing access to publicly funded psychological services for depression in a public health care system. Methods: Discrete event simulation modeled clinical events (relapse, recovery, hospitalizations, suicide attempts, and suicide), health service use, and cost outcomes over 40...
Article
Background: Cluster B personality disorders (PDs) are prevalent mental health conditions in the general population (1%-6% depending on the subtype and study). Affected patients are known to be heavier users of both mental and medical health care systems than patients with other clinical conditions such as depression. Methods: Several rates were...
Article
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In recent years, patient partnership has gained traction with regards to physical healthcare, while recovery has become the guiding principle of transformative action plans throughout the world, this time in terms of mental healthcare. Recovery-oriented mental health policies and systems seek to support the individuals with mental illness to live a...
Article
Social casino games (i.e., free-to-play online gambling-themed games) are now ubiquitous on social network platforms such as Facebook. Their popularity and similarity to gambling games has raised concern that, among other things, social casino games will normalize gambling behaviour, which may contribute to gambling participation and to a rise in t...
Article
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In 2008, the National Institute of Mental Health (NIMH) announced that in the next few decades, it will be essential to study the various biological, psychological and social ‘signatures’ of mental disorders. Along with this new ‘signature’ approach to mental health disorders, modifications of DSM were introduced. One major modification consisted o...
Article
Background Non-adherence is a major obstacle to optimal treatment of schizophrenia. Community pharmacists are in a key position to detect non-adherence and put in place interventions. Their role is likely to be more efficient when individuals are loyal to a single pharmacy. Objective To assess the association between the level of community pharmac...
Article
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Aims Information is crucial in mental healthcare, yet it remains undervalued by stakeholders. Its absence undermines rationality in planning, makes it difficult to monitor service quality improvement, impedes accountability and human rights monitoring. For international organizations (e.g., WHO, OECD), information is indispensable for achieving bet...
Article
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Background This study aimed to 1) identify the characteristics of individuals with substance use disorders (SUDs) who make high use of services provided by general practitioners (GP) and psychiatrists while receiving services concurrently from an addiction rehabilitation center (ARC), and 2) to compare high service users to moderate and low service...
Article
Objective: The objective was to compare, in a real-world setting, the risk of mental and physical health events associated with different antipsychotic drugs (clozapine, olanzapine, risperidone, quetiapine and first-generation antipsychotics) in patients with SZ. Methods: This is a retrospective cohort study using administrative data. Outcome me...
Article
Objectives: Beyond male/female binaries, gender roles represent masculine and feminine traits that we assimilate and enact throughout life span development. Bem proposed that "androgynous" individuals adeptly adapt to different contexts by alternating from a strong repertoire of both masculine and feminine gender roles. By contrast, "undifferentia...
Article
To the Editor We are very familiar with the linked health administrative databases used by Boukhris et al1 in their article investigating the association between prenatal antidepressant use and risk of autism spectrum disorders in the offspring. Therefore, we have 3 suggestions to bring more light to their report. We have been running a Canadian In...
Article
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Objectives: A formal meta-analysis of the use of electroconvulsive therapy (ECT) has never been conducted before in literature reviews or syntheses. Such a study would be hampered by heterogeneity and potential reporting biases. However, it would provide a single comparable measure to allow an analysis of statistical key dimensions such as trends...
Article
Introduction The epidemiology of attempted suicide has not been well characterized because of lack of national data or an International Classification of Diseases (ICD) code for suicide attempts. We conducted a retrospective chart review in 2 adult general hospitals (tertiary and community) in Montreal, Canada, in 2009-2010 to 1) describe the chara...
Article
Introduction: Excess mortality from physical chronic disease in patients with serious mental illness (SMI) is such that their life expectancy could be lessened by up to 20 years. This paper reports the results of a pilot study aimed at raising awareness among Primary Care Providers (PCPs) about communication barriers that stand in the way of better...
Article
Background Cluster B personality disorder (PD) is a highly prevalent mental health condition in general population (1 to 6% depending on the subtype and study). Patients affected are known to be heavier users of both mental and medical healthcare than other clinical conditions such as depression. Few studies have highlighted their elevated mortalit...
Article
The aim of the present study was to evaluate the interaction between depressive symptoms and metabolic dysregulations as risk factors for type 2 diabetes. The sample comprised of 2525 adults who participated in a baseline and a follow-up assessment over a 4.5-year period in the Emotional Health and Wellbeing Study (EMHS) in Quebec, Canada. A two-wa...
Article
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Background: Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known. Aims: This study aims to investigate ac...
Article
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Objective: Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the C...
Article
Results: In multivariable logistic regression models (odds ratio, 95% CI), students were younger (per 5-year increase: 0.22, 0.12–0.41), less likely to be born in Canada (0.17, 0.06–0.44), and more likely to use less violent methods (laceration, poisoning, other, multiple methods) versus more violent methods (collision, jump, fire burns, firearm, h...
Article
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Background: Little is known about the costs and effects of suicide prevention programs at the population level. Aims of the study: We aimed to determine (i) the costs associated with a suicide death and using prospective values (ii) the costs and effects of transferring, into a Canadian context, the results of the European Nuremberg Alliance aga...
Article
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Introduction: Even in countries with universal healthcare systems, excess mortality rates due to physical chronic diseases in patients also suffering from serious mental illness like schizophrenia is such that their life expectancy could be lessened by up to 20 years. The possible explanations for this disparity include: unhealthy habits (i.e. smo...
Article
Cet essai, rédigé en deux articles compagnons (Partie I & II), est destiné mettre en valeur le service public de psychiatres du Département de psychiatrie de l’Université de Montréal ayant oeuvré au niveau du ministère de la Santé et des Services sociaux (MSSS) pour les politiques de désinstitutionnalisation et l’organisation des services de psychi...
Article
Traumatic brain injury (TBI) in late adolescence and adulthood is associated with a higher risk of suicide; however, it is unknown whether this association is also present in people who sustained a TBI during childhood. The purpose of the present study was to determine whether experiencing a TBI during childhood is a risk factor for suicide later i...
Article
Heuristic model of depressive disorders as systemic chronic disease - Volume 24 Issue 4 - Alain Lesage
Article
Objective: Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (...
Article
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L’objectif de ce feuillet est de décrire l’utilisation des banques de données administratives afin d’estimer la prévalence diagnostiquée des troubles de la personnalité du groupe B, l’utilisation des services ainsi que la mortalité. Ce groupe sera comparé aux troubles de la personnalité hors du groupe B et à des conditions psychiatriques graves ou...
Article
Objective: The aim of the study was to identify factors associated with suicide death occurring in the month following an outpatient visit, emergency room contact, or hospitalization. Methods: The results of this study are based on data for 8,851 individuals ages 11 years and older who died between January 1, 2000, and December 15, 2007, and who...
Article
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While 90% of suicide victims have suffered from mental health disorders, less than one-half are in contact with a mental health professional in the year preceding their death. Service use in the last year of life of young suicide victims and control subjects was studied in Quebec. We wanted to determine what kinds of health care services were neede...