Marie-Josée Fleury

McGill University | McGill · Department of Psychiatry

Objectives This study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes. Methods A cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019...

The study was designed to identify factors associated with the diversity of professionals consulted by 212 individuals affected by at least one mental disorder in the past 12 months in a Montreal catchment area. For inclusion in the study, participants had to be aged 15 to 65 and reside in the study zone. A comprehensive set of variables were analy...

Importance The use of antipsychotics, antidepressants, and benzodiazepines may influence the risk of mortality in people with schizophrenia. However, many observational studies have not accounted for immortal time bias (ITB), which occurs when there is a period during which patients in the exposed group are necessarily alive and misclassified as ex...

Background End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied. Objective T...

For patients with mental illnesses (MIs), emergency departments (EDs) are often the entry point into the healthcare system, or their only resort for quickly accessing mental health treatment. A better understanding of the various barriers justifying high ED use among patients with MIs may help recommend targeted interventions that better meet their...

Participation in decision-making is crucial to healthcare workers collaborating across professions. Important correlates of participation in decision-making include task interdependence, informational role self-efficacy, and beliefs in the benefits of interprofessional collaboration. We hypothesised that although task interdependence is directly re...

Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012–2017), using Quebec (Cana...

Rationale Though it is crucial to contribute to patient recovery through access, diversity, continuity and regularity of outpatient care, still today most of these are deemed nonoptimal. Identifying patient profiles based on outpatient service use and quality of care indicators might help formulate more personalized interventions and reduce adverse...

Purpose The increasing number of high emergency department (ED) users is a growing concern worldwide. Patients with mental disorders (MD) are among the largest contributors to high ED use. As high ED use is often seen as an indicator of a healthcare system’s shortcomings, high ED users with MD may perceive unique barriers to care. Analyzing the ass...

Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents’ profiles may help stakeholde...

This study is original in that it assesses various types of care needs, barriers to care, and factors associated with higher unmet needs among 308 permanent supportive housing (PSH) residents in Quebec (Canada). Data from structured interviews that featured the Perceived Need for Care Questionnaire were collected from 2020 to 2022, controlling for...

Aims: This study examined the reasons for high emergency department (ED) use among patients with common mental disorders (MDs), substance-related disorders (SRDs) or co-occurring MDs-SRDs. Method: Following content analysis, 42 high ED users (three-plus visits/year) recruited in two Quebec EDs were interviewed. Results: The reasons included ba...

As permanent supportive housing (PSH) is the main strategy promoted to reduce homelessness, understanding how PSH resident profiles may be differentiated is crucial to the optimization of PSH implementation – and a subject that hasn’t been studied yet. This study identified PSH resident profiles based on their housing conditions and service use, as...

Introduction Patients with mental health diagnoses (MHD) are among the most frequent emergency department (ED) users, suggesting the importance of identifying additional factors associated with their ED use frequency. In this study we assessed various patient sociodemographic and clinical characteristics, and service use associated with low ED user...

This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results hig...

Emergency department (ED) overcrowding is a growing problem worldwide. High ED users have been historically targeted to reduce ED overcrowding and associated high costs. Patients with psychiatric disorders, including substance-related disorders (SRDs), are among the largest contributors to high ED use. Since EDs are meant for urgent cases, they are...

Abrégés de recherche du RISQ

Objectives Few are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors. Methods T...

Background Although attention-deficit hyperactivity disorder (ADHD) is often comorbid with schizophrenia spectrum and other psychotic disorders (SZSPD), concerns about an increased risk of psychotic events have limited its treatment with either psychostimulants or atomoxetine. Aims To examine whether the risk of hospital admission for psychosis in...

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 (M...

The present systematic review and meta-analysis assessed the prevalence, sociodemographic factors, mental health disorders, and type of drug use disorders associated with problem/pathological gambling among individuals with substance use disorders (SUDs). Published studies before January 1, 2023, were reviewed. Out of 8351 papers initially identife...

Objectives Hospital emergency departments (ED) are often overcrowded, and patients using ED for mental health (MH) reasons contribute in great part to this situation. In Quebec, in 2014-15, 17% of ED users with mental disorders had visited ED at least 4 times for various reasons. These patients' frequent ED use usually reflects the inadequacy of th...

This study aimed to identify sociodemographic and clinical characteristics and service use associated with deterioration in quality of life (QoL) among individuals residing in permanent supportive housing (PSH) during the COVID-19 pandemic. Between 2020-2022, PSH residents (n=231) were recruited from congregate and scattered site PSH in Montreal (Q...

Background: Scarce are the studies focusing on initiation of new mental health service use (MHSU) and distinguishing individuals who have sought services but have been unsuccessful in accessing these. Aims: Assessing the factors associated with initiating new MHSU as compared to no MHSU due to self-reported no need, no MHSU due to health system...

This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better in...

Objectives: This study identified predictors of prompt (1+ outpatient physician consultations/within 30 days), adequate (3+/90 days) and continuous (5+/365 days) follow-up care from general practitioners (GPs) or psychiatrists among patients with an incident mental disorder (MD) episode. Methods: Study data were extracted from the Quebec Integra...

Objectives: There is little research conducted to systematically synthesize the evidence on psychological interventions for social isolation and loneliness among older adults during medical pandemics. This systematic review aims to address this information gap and provides guidance for planning and implementing interventions to prevent and reduce...

Background The present study aimed to identify sociodemographic characteristics, risky behaviors, type of drug use, and service use variables associated with emergency department (ED) use and hospitalization among people who inject drugs (PWID). Methods Studies in English published from January 1, 1995, to December 15, 2021, were searched for on P...

Objectives: This study investigated the use of outpatient care, and sociodemographic and clinical characteristics of patients with substance-related disorders (SRD) to predict treatment dropout from specialized addiction treatment centers. The study also explored risks of adverse outcomes, frequent emergency department (ED) use (3+ visits/year), a...

Introduction: Identifying determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRDs) can improve health services to address unmet health needs. Aim: The present study aimed to identify the prevalence rates of ED use and hospitalization, and their associated determinants among patients...

Objectives Using Andersen’s model of health care seeking behavior, we examined the predisposing, enabling, and need factors associated with mental health service use (MHSU) during the first wave of the COVID-19 pandemic across Canada. Methods The sample included n = 45,542 participants in the 5 established regional cohorts of the Canadian Partners...

Background: Patients with alcohol-use disorders (AUDs) are highly heterogenous and account for an increasing proportion of general medical hospital visits. However, many patients with AUDs do not present with severe medical or psychiatric needs requiring immediate attention. There may be a mismatch between some patients' needs and the available se...

This study identified profiles of hospitalized patients with mental disorders (MD) based on their 3-year hospitalization patterns and clinical characteristics and compared sociodemographic profiles and other service use correlates as well as risk of death within 12 months after hospitalization. Quebec (Canada) medical administrative databases were...

Background This study identified patient profiles in terms of their quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes based on frequent emergency department (ED) use, hospitalization, and death from medical causes. Methods A cohort of 18,215 patients with substance-related disorders (SRD...

Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic cha...

Objectives: This study aimed to identify variables and profiles of individuals experiencing homelessness associated with service use and satisfaction, suicidal behaviors, residential stability, quality of life and adequacy of needs, and to evaluate whether one type of accommodation (shelters, transitional, permanent housing) is more closely associ...

Background Human immunodeficiency virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a public health issue of global importance. To our knowledge, no previous meta-analysis documenting the prevalence, socio-demographic, and service use determinants associated with HIV/AIDS disclosure to infected children has been conducted. The present study...

Background Patients with substance use disorder (SUD) usually report lower quality of life (QoL) than other patients and as much as patients with other mental disorders. The present study investigated variables associated with QoL domains among patients with SUD. Methods Studies in English published before December 1 st 2021, were searched for on...

Introduction Few studies have investigated correlates of inconsistent condom use (ICU) among people who inject drugs (PWID). This study aimed to determine sociodemographic characteristics, type of drug use, risky behaviors, and service utilization associated with ICU among PWID. Methods The study was cross-sectional, conducted between April 2020 a...

Length of hospitalization, if inappropriate to patient needs, may be associated with early readmission, reflecting sub-optimal hospital treatment, and translating difficulties to access outpatient care after discharge. This study identified predictors of brief-stay (1–6 days), mid-stay (7–30 days) or long-stay (≥31 days) hospitalization, and evalua...

Objective: This study identified patient clinical and sociodemographic characteristics, and, more originally, service use patterns as predictors of death from physical illness or accidental/intentional causes. Methods: A cohort of 19,015 patients with substance-related disorders (SRD) from 14 addiction treatment centers was investigated using Qu...

Aims This study measures the impact of 90-day physician follow-up care after psychiatric hospitalization among 3,311 adults and youth, with risk of subsequent readmission within six months. Methods A 5-year investigation was conducted based on Quebec (Canada) medical administrative databases. Cox proportional-hazards regression was performed, with...

Background Suicidal behaviors including ideations and attempts may ultimately lead to suicide especially among intravenous drug users (IVDUs). The present study assessed the prevalence, sociodemographic characteristics, risky behaviors, mental health conditions, and type of drug use associated with suicidal behaviors among IVDUs. Methods Studies i...

Objectives: This study identified profiles of patients with suicidal behaviors, their sociodemographic and clinical correlates, and assessed the risk of death within a 12-month follow-up period. Methods: Based on administrative databases, this 5-year study analyzed data on 5064 patients in Quebec who used emergency departments (ED) or were hospi...

Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hosp...

Objective: This study aimed to identify predictors of emergency department (ED) use for suicide ideation or suicide attempt compared with other reasons among 14,158 patients with substance-related disorders (SRD) in Quebec (Canada). Methods: Longitudinal data on clinical, sociodemographic, and service use variables for patients who used addictio...

Background Prompt follow-up at emergency department discharge is a key indicator of healthcare quality and patient recovery. To improve services, better knowledge of predictors for out-patient physician follow-up within 30 days after discharge is needed. Aims We investigated clinical and sociodemographic characteristics and service use to predict...

For patients at high-risk for developing schizophrenia, a delayed diagnosis could be affected, among many reasons, by their patterns of healthcare use. This study aims to describe and generate a typology of patients’ care trajectories (CTs) in the 2 years preceding a first diagnosis of schizophrenia, over a medico-administrative database of 3712 ad...

Objective This 5-year longitudinal study evaluated patients with an onset of mental disorder (MD) following index emergency department (ED) visits, in terms of (1) patient profiles based on 12-month outpatient follow-up care received, (2) sociodemographic and clinical correlates, and (3) adverse health outcomes for the subsequent 2 years. Methods...

Introduction: Patients with substance-related disorders and mental disorders (MD) contribute substantially to emergency department (ED) overcrowding. Few studies have identified predictors of ED use integrating service use correlates, particularly among patients with cannabis-related disorders (CRD). This study compared predictors of low (1-2 visi...

Background Stigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS ha...

Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Austr...

Background There was an increase in self-reported mental health needs during the COVID-19 pandemic in Canada, with research showing reduced access to mental health services in comparison to pre-pandemic levels. This paper explores 1) barriers and facilitating factors associated with mental health service delivery via primary care settings during th...

Background: Profiles of individuals with cannabis-related disorders (CRD) in specialized addiction treatment centers serving high-need patients have not been identified. This longitudinal study developed a typology for 9,836 individuals with CRD attending Quebec (Canada) addiction treatment centers in 2012-2013. Methods: Data on sociodemographic, c...

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...

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...

Background This study aimed to (1) identify profiles of high emergency department (ED) users (3+ visits/year) among 5409 patients with mental disorders (MD) based on their patterns of ED use and clinical characteristics; (2) identify sociodemographic and service use correlates linked to high ED user profiles; and (3) assess mortality risk in a 12-m...

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...

Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical,...

Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with...

Background Defining HIV-related stigma (HRS) can be problematic due to structural inequalities, cultural differences, discrimination by health care providers and the limitations of tools measuring stigma for people living with HIV (PLWH). This meta-analysis aimed to determine self-reported HRS and its association with socio-demographic and clinical...

This study developed a typology of specialist respondentpsychiatrists (SRP) based on their perceptions related to the capacity of the SRP function to improve treatment of mental health disorders (MHD) in primary care and youth centers. A self-administered survey collected information on 126 active SRP in Quebec (Canada). Cluster analysis was used t...

This study identified profiles among 455 currently or formerly homeless individuals in Quebec (Canada), based on health and social service use. Using latent class analysis, four profiles were identified that grouped individuals with: (1) few health problems, and using few case managers and family doctors, but with high frequency of psychiatric cons...

Introduction Le suivi ambulatoire après une visite aux urgences pour les personnes ayant des troubles de santé mentale (TM) est essentiel pour optimiser leurs résultats de santé et éviter les réadmissions. En la matière, plusieurs indicateurs de qualité des soins existent, dont celui préconisant un suivi sous 30 jours après une visite aux urgences...

While gender and professional status influence how decisions are made, the role played by health care professionals’ informational role self-efficacy appears as a central construct fostering participation in decision-making. The goal of this study is to contribute to a better understanding of how gender and profession affect the role of self-effica...

Impact des types de logements sur l'utilisation des services, la satisfaction, les comportements suicidaires, la stabilité résidentielle, la qualité de vie et l'adéquation des besoins des personnes en situation d'itinérance Cette étude décrit les variables associées et profils de personnes en situation d'itinérance (PSI) selon leur utilisation des...

Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and...

We assessed the prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among patients with substance use disorders (SUD). Studies in English published from January 1, 1995 to December 31, 2020 were searched on PubMed, Scopus, Cochrane and Web of Science to identify studies on variable...

Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014-2015. Multinom...

Background In health and social service evaluations, including research on homelessness, quality of Life (QOL) is often used as a key indicator of well-being among service users. However, no typology has been developed on changes in QOL over a 12-month period for a heterogenous sample of homeless individuals. Methods Cluster analysis was employed...