@article{pmid42521894,

title = {Long‑Term Gambling Disorder Care Trajectories and Associated Patient Characteristics and Quality of Care},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier and Sylvia Kairouz and Francine Ferland},

doi = {10.1007/s10899-026-10540-0},

issn = {1573-3602},

year  = {2026},

date = {2026-07-01},

journal = {J Gambl Stud},

abstract = {Given the limited evidence on the long‑term course of gambling disorder (GD), this study identified GD care trajectories, estimated GD duration, and examined their associations with patient and gambling characteristics and quality of care. A cohort of 2,154 patients with GD was examined using Quebec's administrative health records. We generated 13‑year GD care trajectories (2009-2022) using group‑based trajectory modeling. Multinomial logistic regression assessed the influence of sociodemographic, clinical, and gambling characteristics and quality‑of‑care indicators on trajectory membership. Four care trajectories were identified: Trajectory 1 (Transient GD, 34%), Trajectory 2 (Low‑intensity GD, 32%), Trajectory 3 (High initial, decreasing GD, 18%), and Trajectory 4 (Chronic GD, 16%). Two thirds of patients had GD records for an average of 1-2 years (Trajectories 1-2); GD persisted for 4 years in Trajectory 3 and 8 years in Trajectory 4. Compared with Trajectory 1, Trajectories 4 and 3 included patients more likely to be in their 50s and at higher risk of presenting severe clinical conditions, whereas Trajectory 2 patients were likelier to be younger, more socioeconomically deprived, and at greater risk of having a criminal history and co‑occurring alcohol‑ and drug‑related disorders. Patients in Trajectories 4 and 3 were more likely to receive GD‑specific treatments than those in Trajectories 1 and especially 2; however, Trajectories 2, 3, and 4 were at higher risk of showing lower treatment motivation. Trajectories 4 and 2 were also more likely to use non‑GD health services. Patients with long‑standing GD would benefit from enhanced follow‑up and crisis‑intervention strategies. Overall, improved detection across non‑GD care settings is needed to increase help‑seeking and support this vulnerable population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42526764,

title = {Emergency department use trajectories over a 10-year period among patients with substance-related disorders},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier and Xiangfei Meng},

doi = {10.1016/j.josat.2026.210081},

issn = {2949-8759},

year  = {2026},

date = {2026-07-01},

journal = {J Subst Use Addict Treat},

volume = {191},

pages = {210081},

abstract = {OBJECTIVES: Overutilization of the emergency department (ED) is costly and often reflects unmet needs and suboptimal care, raising concerns when patients rely on the ED persistently over many years. Long-term ED use trajectories for patients with substance-related disorders (SRDs) have never been investigated. This study aimed to identify ED use trajectories over a 10-year period and examine associations with patients' sociodemographic and clinical characteristics, quality-of-care indicators, and subsequent adverse outcomes.nnMETHODS: A cohort of 9642 patients with long-standing SRDs was examined using Québec (Canada) medical records (1996-2022). Group-Based Trajectory Modeling identified 10-year ED use trajectories. Multinomial logistic regression assessed associations between trajectories and covariates, while Cox models examined links to subsequent adverse outcomes (suicidal behavior, hospitalization, death).nnRESULTS: Four ED use trajectories were identified: Trajectory 1 ("Low ED users," 50% of cohort), Trajectory 2 ("Increasing ED users," 20%), Trajectory 3 ("Sinusoidal ED users," 20%), and Trajectory 4 ("Very frequent ED users," 10%). Half of the cohort showed frequent ED use (≥3 visits/year), including 10% who were very frequent users (≥8 visits/year), underscoring substantial unmet needs. ED use frequency was strongly linked to social and health conditions-most favorable in Trajectory 1, who were mostly men, and markedly worse in Trajectories 4, 2, and 3. Adverse outcomes were also strongly associated with poorer social and health conditions and lower treatment motivation, even though Trajectories 4, 2, and 3 received more healthcare services.nnCONCLUSION: Findings indicate that the healthcare system is not adequately structured to meet the needs of patients with severe multimorbidity involving SRDs, mental disorders, chronic physical illnesses, and social instability, contributing to care quality insufficiently meeting the complex needs of Trajectories 2-4. Tailored interventions may be warranted, including Integrated Treatment for Dual Disorders and Assertive Community Treatment for Trajectories 2 and 4, and Intensive Case Management, Recovery Management Checkups, or mobile health technologies for Trajectory 3. Across Trajectories 2-4, enhanced motivational interventions, social support, reduced stigma, optimized medication management, peer-helper programs, and stronger ED-outpatient collaboration remain essential. Improving services for patients with frequent ED use-particularly those in Trajectory 4 with recurrent very frequent use-should be prioritized to reduce costs, optimize service use, and support recovery.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42537246,

title = {Routine follow-up care patterns after psychiatric hospital discharge and associations with rehospitalization and mortality: a longitudinal cohort study using latent class analysis},

author = {Pamela Obegu and Xiangfei Meng and Marie-Josée Fleury},

doi = {10.1016/j.genhosppsych.2026.07.011},

issn = {1873-7714},

year  = {2026},

date = {2026-07-01},

journal = {Gen Hosp Psychiatry},

volume = {102},

pages = {115--122},

abstract = {OBJECTIVE: The risk of psychiatric readmission and death is high in the year after discharge. Existing posthospitalization interventions show modest and sometimes inconsistent average effects, suggesting that optimizing routine follow-up care may require identifying clinically meaningful heterogeneity in routine care practice. This study aims to identify latent subgroups of follow-up care patterns during the 12 months after psychiatric discharge and examine their associations with patient characteristics, rehospitalization, and all-cause mortality.nnMETHODS: Using provincial linkable health administrative databases, we investigated a cohort of 3467 patients discharged after psychiatric hospitalization. Latent class analysis was used to identify subgroup memberships of follow-up care. Multivariable analyses estimated subgroups' associations with patient social and clinical correlates, and survival analyses estimated subgroups' associations with rehospitalization and all-cause mortality.nnRESULTS: Five distinct subgroups of follow-up care patterns were identified, including low to high quality of care, diversified care and high access to primary care, with two subgroups having frequent emergency (ED) use. Serious mental disorders and prior hospitalizations were concentrated in the high follow-up care subgroups, where rehospitalization hazards were significantly elevated and approached one-third. Mortality did not differ across subgroups.nnCONCLUSION: Follow-up care after psychiatric discharge is heterogeneous, reflecting patients' clinical risk profiles and outpatient contexts. Rehospitalization was driven primarily by clinical severity, while frequent ED use signalled unmet follow-up care needs, demonstrating two distinct post-discharge dynamics with different implications for quality monitoring and service improvement. These findings support subgroup-informed post-discharge optimization and may help explain the average modest effects of transitional interventions observed in prior research. Both carry direct relevance for policy and practice.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41936158,

title = {Care trajectories of Quebec patients with substance-related disorders within five years before death},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier},

doi = {10.1016/j.psychres.2026.117130},

issn = {1872-7123},

year  = {2026},

date = {2026-07-01},

journal = {Psychiatry Res},

volume = {361},

pages = {117130},

abstract = {AIMS: This study identifies care trajectories five years before death of 1468 patients with substance-related disorders (SRDs), associated with the patients' social and clinical characteristics, quality of care received, and causes of death.nnMETHODS: Care trajectories integrated outpatient SRD, mental health (MH) and physical health care, and acute care. Group-based multi-trajectory modeling identified service use patterns in three-month intervals across the five years preceding death. Multinomial logistic regression assessed associations between trajectory membership, patient characteristics, quality of care received, and causes of death.nnRESULTS: Four distinct trajectories emerged: "Low service users" (Profile 1, 34 % of sample, the reference group), "High physical health service users" (Profile 2, 30 %), "High but decreasing SRD service users" (Profile 3, 15 %), and "High but decreasing mental disorder (MD) service users, high users of other services" (Profile 4, 21 %). Profile 1 comprised mostly younger men with better health but poor continuity and regularity of care. Profile 3 patients had the most severe conditions, received the most intensive care, but had more accidental/intentional deaths than Profile 1. Profile 2 included older patients with severe chronic physical illnesses, injection drug use, and more emergency department users than Profile 1. Profile 4 had older patients reporting more MDs, suicidal behaviors, lower functioning, and greater use of specialized MH care.nnCONCLUSION: Service use was low overall and remained low even near death. Physical health care was the most used, followed by acute care. SRD and MH care declined before death across all profiles. Tailored interventions for each profile are suggested.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42169034,

title = {A longitudinal study of the trajectory of life satisfaction before, during and after the outbreak of the COVID-19 pandemic, and its associations with sociodemographic characteristics, psychological distress, and stressors during the pandemic},

author = {Saleh Molla and Xiang Wang and Yingying Su and Marie-Josée Fleury and Carl D'Arcy and Muzi Li and Chris Barrington-Leigh and Danielle Maltais and Jean Caron and Sajedeh Nejatian and Xiangfei Meng},

doi = {10.1186/s12889-026-27735-0},

issn = {1471-2458},

year  = {2026},

date = {2026-05-01},

journal = {BMC Public Health},

abstract = {BACKGROUND: There has been a paucity of literature on the long-term changes in well-being since the outbreak of COVID-19 pandemic. We explored a 12-year change in life satisfaction (LS) in Canada before and after COVID-19 and identified sociodemographic, psychological, and stressors during the pandemic associated with LS in 2024.nnMETHODS: Data were drawn from a community-based longitudinal population cohort established in 2007. Multivariate logistic regression was used to examine LS trajectories across four data collections: T3 (2012-2013), T4 (2014-2015), T7 (2022-2023), and T8 (2024), and LS in 2024 and their related correlates.nnRESULTS: Compared to pre-pandemic, participants at T7 (Adjusted Odds Ratio (AOR) = 0.71; 95% CI: 0.55-0.91) and T8 (AOR = 0.66; 95% CI: 0.51-0.85) reported having lower odds of high LS. Singles, middle-aged adults, and those with higher psychological distress were less likely to report high LS. Income-related stressors at T8 and financial hardship at T7 were also associated with lower odds of high LS at T8.nnCONCLUSION: Compared to pre-pandemic, LS declined during the pandemic (T7) and remained lower in 2024 (T8), with no evidence of recovery. Certain population subgroups were at even elevated risk of experiencing a decline in LS and of reporting low LS in 2024, which underscores the importance of financial support for individuals experiencing income instability and psychological distress.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41916947,

title = {Understanding depression through an intersectional framework: the joint impact of childhood adversities and social determinants using Canadian longitudinal study on aging (CLSA) data},

author = {Yingying Su and Muzi Li and Marie-Josée Fleury and G Camelia Adams and Xiangfei Meng},

doi = {10.1038/s41398-026-03973-z},

issn = {2158-3188},

year  = {2026},

date = {2026-04-01},

journal = {Transl Psychiatry},

volume = {16},

number = {1},

abstract = {While previous research has focused on individual risk factors, few studies have utilized an intersectionality-informed framework to examine how multiple social factors collectively impact depression risk, particularly in the context of childhood adversities. This study investigates the association between adverse childhood experiences (ACEs) and depression while considering the intersecting roles of sex, socioeconomic status (SES), and ethnicity in identifying high-risk population subgroups. Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative prospective cohort comprising over 50,000 adults aged 45 and older. We included 20,559 participants from the Comprehensive cohort who completed both baseline and first follow-up assessments. Depression was measured using a validated scale (CES-D-10). Key variables included ACE exposure, sex, SES, ethnicity, and other sociodemographic covariates. Latent class analysis was conducted to explore latent ACEs groups. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was employed to investigate whether ACE patterns and intersectional social groups predicted differential risks of depression. Three distinct patterns of ACEs were identified. The high ACE group was associated with an elevated risk of depression, especially among females, individuals with low SES, and non-White groups. This risk was compounded among those with multiple marginalized identities, such as females with low SES and exposure to high ACE, highlighting the cumulative nature of depression vulnerability. In contrast, male sex and high SES were protective, particularly in the absence of ACE exposure. Integrating ACEs with an intersectional framework reveals the complex etiology of depression and underscores the need for targeted, equity-oriented prevention strategies considering cumulative disadvantage.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42014609,

title = {Factors Associated with the Frequency of Treatment Admissions Over A 13-year Period Among Patients with Gambling Disorder},

author = {Marie-Josée Fleury and Ovidiu Tatar and Guy Grenier and Sharmin Sharker and Francine Ferland and Nadine Banchette-Martin},

doi = {10.1007/s10899-026-10490-7},

issn = {1573-3602},

year  = {2026},

date = {2026-04-01},

journal = {J Gambl Stud},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41857378,

title = {Profiles of Quality of Outpatient Care Received Among Adolescents and Young Adults with Health Mental Disorders},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier and Elham Rahme},

doi = {10.1007/s11126-026-10271-w},

issn = {1573-6709},

year  = {2026},

date = {2026-03-01},

journal = {Psychiatr Q},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41630023,

title = {Profiles of care trajectories among patients with substance-related disorders, assessed over nine years considering other patient characteristics and subsequent adverse outcomes},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier},

doi = {10.1186/s13011-026-00708-7},

issn = {1747-597X},

year  = {2026},

date = {2026-02-01},

journal = {Subst Abuse Treat Prev Policy},

volume = {21},

number = {1},

abstract = {BACKGROUND: This study is original in that it identified the care trajectories of patients with substance-related disorders (SRDs) over a 9-year period, and associated these trajectories with the patients' sociodemographic and clinical characteristics, quality of care received, and subsequent adverse outcomes (high emergency department use, repeated hospitalizations, suicidal behaviors, death).nnMETHODS: Health administrative databases from Quebec, Canada (1996-2022) were used to investigate a cohort of 4075 patients with SRDs. Group-based multi-trajectory modeling was produced to identify profiles of care trajectories from April 1st 2012 to March 31st 2021. Multinomial regressions and survival analysis were conducted to associate profiles to patient characteristics, and adverse outcomes over the following year.nnRESULTS: Five profiles of care trajectories were identified: "Low overall but increasing care use" (Profile 1, 30% of sample); "High, increasing outpatient physical health care use" (Profile 2, 26%); "High, increasing outpatient SRD care use" (Profile 3, 15%); "High overall care use" (Profile 4, 14%); and "Increasing but moderate outpatient care use" (Profile 5, 15%). Profiles 3 and 4 used substantially more SRD outpatient care. Patients in Profiles 4 and 5 had more complex health conditions and engaged in more varied, sustained care over time, but subsequently experienced the worst adverse outcomes. In contrast, Profile 1 patients had better overall health conditions, followed by Profile 2 (older at SRD onset, less materially deprived) and 3 (more SRD issues), which both exhibited higher continuity of care than Profile 1. Profile 3 had the lowest rate of treatment dropouts.nnCONCLUSION: Use of care and adverse outcomes were strongly linked to the patients' clinical conditions. Tailored interventions may be recommended for each profile: outreach and motivational interventions for Profile 1; applying the chronic care model for Profile 2; high continuity of physician and SRD care for Profile 3; assertive community treatment for Profile 4; and intensive case management for Profile 5. To better address the unmet needs of patients with SRDs, overall outpatient services may be substantially consolidated and improved. Acute care providers and general practitioners may also play a key role in identifying patients with SRDs and referring them to appropriate outpatient services.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41545975,

title = {Profiles of quality of care among individuals with suicidal behaviors},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier and Xiangfei Meng},

doi = {10.1186/s12913-026-14055-7},

issn = {1472-6963},

year  = {2026},

date = {2026-01-01},

journal = {BMC Health Serv Res},

volume = {26},

number = {1},

pages = {221},

abstract = {OBJECTIVES: This study identified profiles of individuals with suicidal behaviors (ideations, plans, attempts) and quality of outpatient care received, associated these profiles to the respondents' sociodemographic and clinical characteristics, and measured outcomes.nnMETHODS: Using a representative population-based 2015-2016 survey from Quebec (Canada) merged with the province's health registry (1996-2017), cluster analysis and multinomial logistic regressions were conducted on 569 respondents experiencing suicidal behaviors.nnRESULTS: Among the four identified profiles, 63% had suicidal ideations only (Profile 1, 40% of the cohort; Profile 2, 23%), while 37% reported suicidal plans (mostly Profile 4, 15%) or attempts (mainly Profile 3, 22%) - of Profiles 3 and 4 about one-third reported suicide attempts over their lifetime. Before exhibiting suicidal behaviors, 56% had received low quality of outpatient care - mainly Profiles 1 and 4. Those with the worst social and health conditions, including more serious mental disorders, received the best MH care: Profile 2 patients (suicidal ideations only) received high continuity and regularity of recovery-oriented care; those of Profile 3 (more suicide attempts and unmet needs) received more intensive care. Being older with higher rates of suicidal plans or attempts - and with over 50% of them having mental disorders -, Profile 4 patients received low quality of care and showed the worst outcomes (acute care use, lower quality of life, bad or poor physical/mental health conditions), followed by Profiles 3, 2 and 1. Profile 1 patients also received low quality of care, but showed the best outcomes, probably because of better social and clinical conditions and the fact all of them only had suicidal ideations.nnCONCLUSION: Quality of care was higher in patients with worse social and health conditions (Profiles 2 and 3). However, findings showed that services could be substantially improved to prevent suicidal behaviors, with outreach interventions significantly strengthened for Profiles 1 and 4. Services could protect patients better against suicidal behaviors and adverse outcomes if they more closely matched their needs and the severity of their conditions. In this sense, Profile 3 and 4 patients would benefit from more continuous follow-up care over time.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41294106,

title = {Care Trajectories Among Patients With Substance-Related Disorders in the 3 Years Before Their Last Suicide Attempt},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier and Elham Rhame},

doi = {10.1111/sltb.70065},

issn = {1943-278X},

year  = {2025},

date = {2025-12-01},

journal = {Suicide Life Threat Behav},

volume = {55},

number = {6},

pages = {e70065},

abstract = {OBJECTIVES: Among patients with substance-related disorders (SRDs) and suicide attempts in 2014-2021, we identified care trajectories within a 3-year period preceding their last suicide attempt (index date). We also determined associations between care trajectories and patients sociodemographic and clinical characteristics, quality of care received, and risk of death in the following year.nnMETHODS: Using Quebec (Canada) medical databases, we produced Group-based Multi-Trajectory Modeling, Multinomial Logistic Regression, and Cox Proportional Hazards models.nnRESULTS: We identified five care trajectories (profiles) among the 2297 study patients. Profile 1 (31%, reference profile) had low outpatient care with late increase in acute care use. It included more men, younger patients and individuals with overall better conditions. Profile 2 (22%) received high physical healthcare and had more chronic physical illnesses. Profile 3 (19%), with more serious mental disorders, and Profile 4 (16%), with more polysubstance-related disorders, used more outpatient mental health (MH) or SRD care, decreasing before index date. Profiles 2, 3 and 4 increasingly used acute care before index date. Profile 5 patients (12%) had more health problems, and so showed the highest overall care use and highest risk of death.nnCONCLUSION: Tailored interventions are suggested for all profiles, with improved screening and SRD-MH care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41393003,

title = {Barriers to Care Among High Emergency Department Users With Mental Disorders-A Mixed Methods Study},

author = {Tiffany Chen and Marie-Josée Fleury},

doi = {10.1111/inm.70196},

issn = {1447-0349},

year  = {2025},

date = {2025-12-01},

journal = {Int J Ment Health Nurs},

volume = {34},

number = {6},

pages = {e70196},

abstract = {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. Analysing the associated patient characteristics and service use along with structural and motivational barriers to outpatient care use could help explain the high ED use among patients with MD, and help recommend more patient-centered interventions. Data were extracted from a 2021-2022 survey and medical records of 182 high ED users with MD in four large ED networks from Quebec (Canada), including open-ended questions administered to 20 of these patients. A mixed methods approach (multivariable regression, thematic analysis) identified variables associated with the number of unmet care needs, and structural and motivational barriers to care explaining high ED use. The study partially confirmed its first hypothesis that patients with more health issues who were dissatisfied with services would have more barriers to care. The study confirmed its second hypothesis: structural barriers were more prevalent than motivational ones in relation to high ED use, and patients with high unmet needs had more care barriers than those with no unmet needs. Findings suggest services could be greatly improved to reduce high ED use, and that unmet needs should be investigated further to better address the care barriers of this vulnerable population.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40972473,

title = {Predictors of readmission to substance-related disorder treatment over a five-year period},

author = {Marie-Josée Fleury and Sharmin Sharker and Guy Grenier and Myriam Beaulieu and Christophe Huỳnh},

doi = {10.1016/j.drugpo.2025.105016},

issn = {1873-4758},

year  = {2025},

date = {2025-11-01},

journal = {Int J Drug Policy},

volume = {145},

pages = {105016},

abstract = {BACKGROUND: Treatment readmission is frequent among patients with substance-related disorders (SRDs). This study aimed to identify clinical, sociodemographic and service use predictors of readmission to SRD treatment within a 5-year period (2017-2022) following initial treatment episodes.nnMETHODS: Data from 8277 patients showing at least one SRD treatment episode in specialized addiction treatment centers in 2013-2017 (Quebec, Canada) were merged with provincial health administrative databases (1996-2022). Readmission predictors were tested using Cox proportional hazards to measure patient characteristics, and SRD treatment over the previous 8 years (2009-2017). Logistic regression assessed other service use for the 12 previous months, as co-occurring disorders could influence readmission.nnRESULTS: Over the 5 years following their last SRD treatment, 36 % of patients were readmitted. Were more likely to be readmitted: men, individuals who were younger, unemployed, not living in rural areas, had chronic SRDs, alcohol-related disorders, common mental disorders, 5+ prior SRD care episodes, got residential treatment, showed high dropout rates, and those who waited <30 days to access treatment. Readmission was likelier in patients who had access to psychiatrists and psychosocial services, had high continuity of physician care, and used more acute care - especially emergency departments.nnCONCLUSION: Patients with more social and health issues and high prior and diversified service use showed higher risk of readmission. This suggests that care could be improved significantly to reduce readmission, especially through better detection and need assessment of patients with multiple prior SRD treatment episodes, dropouts and acute care use, and by increasing long-term follow-up care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40495109,

title = {General Practitioners' Management of Individuals with Gambling Disorder: A Systematic Review of Practices, Knowledge, Attitudes and Beliefs},

author = {Ovidiu Tatar and Veronica Iammatteo and Magaly Brodeur and Marie-Josée Fleury},

doi = {10.1007/s10899-025-10402-1},

issn = {1573-3602},

year  = {2025},

date = {2025-06-01},

journal = {J Gambl Stud},

abstract = {Gambling disorder (GD) has a significant impact on individuals, the healthcare system, and the society. The vast majority of individuals with GD do not use healthcare services for their GD. Since primary care is the first point of contact, exploring barriers to GD treatment is of utmost importance. For this systematic review, we searched five major databases up to October 2024 and included empirical studies describing the practices of general practitioners (GPs) and emergency department physicians regarding GD, as well as their knowledge, attitudes, and beliefs about GD management. We retained six quantitative and six qualitative articles that reported GP data on GD management; however, no studies conducted in emergency departments met our inclusion criteria. The narrative synthesis revealed that none of the GPs routinely screened for GD, only 7-14% treated GD themselves, and approximately half referred these individuals to mental health specialists. While more than half of GPs were knowledgeable about GD-related harms, only 17-38% were confident in their knowledge of GD or care pathways. Although over 65% acknowledged their potential role in managing GD, multiple barriers to care were identified. These included negative attitudes, such as attributing gambling-related harms to individual character weakness, insufficient training on GD screening tools and treatment modalities, and the low prioritization of GD treatment within the healthcare system. Given the higher risk of GD among individuals with mental health disorders (e.g., depression, anxiety) and substance use disorders, prioritizing GD screening and treatment for these high-risk groups in primary care is essential.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40316416,

title = {Trends and socioeconomic inequalities in acute mental health service use in Canada, 2004-2019: a nationally representative retrospective cohort study},

author = {Jasleen Arneja and Brice Batomen and Marie-Josee Fleury and Arijit Nandi},

doi = {10.1136/bmjment-2025-301600},

issn = {2755-9734},

year  = {2025},

date = {2025-05-01},

journal = {BMJ Ment Health},

volume = {28},

number = {1},

abstract = {BACKGROUND: Acute mental health service use (AMHSU), that is, hospitalisations and emergency department (ED) visits for mental health, have been rising in the Canadian province of Ontario and globally; however, national-level estimates are not available. We examine trends and socioeconomic inequalities in AMHSU in the Canadian adult population between 2004 and 2019.nnMETHODS: Using the Canadian Community Health Survey linked to tax and health administrative datasets, we reported prevalence rates of AMHSU using negative binomial regression models. Income-based absolute inequalities in AMHSU were reported using the Slope Index of Inequality.nnRESULTS: Over the study period, hospitalisations for mood disorders decreased from 144.8 (95% CI: 116.0-173.7) to 67.5 (95% CI: 54.5-80.4) per 100 000, while those for substance-related disorders (SRD) increased. Rates of ED visits increased for all conditions, with the largest increase for anxiety disorders, from 252.3 (95% CI: 210.9-293.6) to 434.1 (95% CI: 382.2-486.1) per 100 000. Females had higher rates of hospitalisations and ED visits for all conditions except SRD. We found pronounced income-based inequalities in both hospitalisations and ED visits for mental health, comparing those at the top versus bottom of the income distribution. Absolute inequalities for hospitalisations widened for SRD, from -93.6 (95% CI: -131.1 to -56.1) to -135.2 (95% CI: -203.4 to -67.1) per 100 000, and decreased for mood disorders, from -309.5 (95% CI: -443.8 to -175.3) to -126.0 (95% CI: -182.0 to -69.9) per 100 000. Additionally, absolute inequalities increased for ED visits across all mental health conditions.nnCONCLUSION: Interventions aimed at improving access to preventive services could mitigate observed inequalities in AMHSU.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39755156,

title = {Classes of outpatient quality of care among individuals with substance-related disorders, based on a survey and health insurance registry},

author = {Marie-Josée Fleury and Zhirong Cao and Guy Grenier and Christophe Huỳnh and Xianghei Meng},

doi = {10.1016/j.josat.2024.209619},

issn = {2949-8759},

year  = {2025},

date = {2025-03-01},

journal = {J Subst Use Addict Treat},

volume = {170},

pages = {209619},

abstract = {OBJECTIVES: Improving quality of care for individuals with substance-related disorders (SRD) should be a priority considering SRD are associated with high morbidity. This study aimed to identify classes of individuals with SRD based on their clinical characteristics and the quality of outpatient care they received, and to verify whether better quality of care was associated with other respondent characteristics and more favorable subsequent outcomes.nnMETHODS: Data came from the 2013-14 and 2015-16 Canadian Community Health Survey (N = 42,099), merged with administrative data from Quebec's health insurance registry. Investigating a cohort of 1473 individuals with SRD, we conducted Latent class analysis based on the respondents' diagnoses and outpatient quality of care indicators such as access, diversity, continuity and regularity of care received in the 12 months preceding interview. Chi-Square, Fisher's exact tests or t-tests, and logistic regression associate classes with sociodemographic and health behavior (e.g., suicidal behaviors) correlates, and outcomes (repeated emergency department use, hospitalization, quality of life) over the three months following interview, respectively.nnRESULTS: The study identified four classes: (1) Individuals with polysubstance-related disorders and other health disorders, receiving high diversity and moderate regularity of care (6 % of sample); (2) Individuals with alcohol-related disorders, receiving low quality of care (41 %); (3) Individuals with drug-related disorders, receiving high overall quality of care (9 %); and (4) Individuals with alcohol-related disorders, receiving high continuity of family doctor care (44 %). Classes 2 and 4 showed better social conditions (e.g., higher education), health behaviors, and subsequent outcomes than Classes 1 and 3, despite receiving lower quality of care - especially mental healthcare.nnCONCLUSION: Study outcomes related more to health and social conditions than to the quality of outpatient care received, especially as outpatient care alone might not meet needs of Classes 1 and 3 individuals having important health and social issues, unmet care needs and worse outcomes. Results suggest that interventions like assertive community treatment or intensive case management with integrated SRD-mental health disorders treatment could better respond to the needs of Classes 1 and 3. Overall, enhanced care, including peer support, might benefit all individuals with SRD.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39334334,

title = {Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives},

author = {Marie-Josée Fleury and Francine Ferland and Lambert Farand and Guy Grenier and Armelle Imboua and Firas Gaida},

doi = {10.1111/inm.13442},

issn = {1447-0349},

year  = {2025},

date = {2025-02-01},

journal = {Int J Ment Health Nurs},

volume = {34},

number = {1},

pages = {e13442},

abstract = {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 needs. This explorative qualitative study aimed to identify such barriers and the solutions brought forth to reduce ED use based on the perspectives of clinicians and managers working in EDs, other hospital departments or the community sector. Interviews were conducted between April 2021 and February 2022; 86 mental health professionals (22% were nurses) from four large urban ED sites in Quebec (Canada) were interviewed. Barriers were identified in relation to patient profiles, healthcare system and organisational features and professional characteristics. The key barriers that were found to explain high ED use were patients having serious MIs (e.g., psychotic disorders) or social issues (e.g., poverty), lack of coordination and patient referrals between EDs and other health services, insufficient access to mental health and addiction services and inadequacy of care. Very few solutions were implemented to improve care for high ED users. Better deployment of ED interventions in collaboration with outpatient care may be prioritised to reduce high ED use for patients with MIs. Improvements to the referral and transfer processes to outpatient care, particularly through care plans and case management programs, may be implemented to reduce high ED use and improve outpatient care among patients with multiple health and social needs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41052957,

title = {[Not Available]},

author = {Marie-Josée Fleury and Guy Grenier and Nadia L'Espérance},

doi = {10.3917/spub.pr2.0077},

issn = {0995-3914},

year  = {2025},

date = {2025-01-01},

journal = {Sante Publique},

volume = {37},

number = {3},

pages = {87--98},

abstract = {OBJECTIVES: Permanent supportive housing (PSH) is the preferred strategy for eradicating homelessness. This study seeks to outline the specificities of PSH in Montreal (Quebec, Canada), to compare the different models and highlight their respective strengths and challenges.nnMETHOD: Data was collected in 2023 through 31 organizations from eight governmental bodies or Quebec associations and 23 Montreal PSH resources. A sample of 42 managers and practitioners from the homelessness/housing sector participated by completing an interview and/or a questionnaire. The study used a mixed-methods approach integrating descriptive and content analyses.nnRESULTS: Community-based PSH was the most prevalent model, although half of the resources offered both community-based and private-sector PSH. A median of 70 residents received support, with only one-third of those being followed at least once a week. Common challenges were mainly linked to funding (e.g., quality affordable housing) or due to the complexity of providing follow-up to residents. Key distinctions were based on whether the housing was contracted in the private sector, and on whether support was available onsite. Challenges specific to private-sector PSH included relationships with landlords, the remoteness of follow-up sites, and resident isolation. Community-based and social PSH faced issues associated with adherence to house rules and resident stigmatization.nnCONCLUSION: Findings indicate that increasing the number of resources, the intensity and diversity of support, and expanding relocation options would be beneficial to residents.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid39799284,

title = {Profiles of physician follow-up care, correlates and outcomes among patients affected by an incident mental disorder},

author = {Marie-Josée Fleury and Louis Rochette and Zhirong Cao and Guy Grenier and Victoria Massamba and Alain Lesage},

doi = {10.1186/s12875-024-02674-0},

issn = {2731-4553},

year  = {2025},

date = {2025-01-01},

journal = {BMC Prim Care},

volume = {26},

number = {1},

pages = {7},

abstract = {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.nnMETHODS: A cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year.nnRESULTS: Five profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled "Follow-up care by usual psychiatrist", Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), "Low MH follow-up care but high prior consultations for physical reasons", mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), "Follow-up care by general practitioners (GP) and psychiatrists", referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), "High follow-up care by usual GP and prior consultations for physical reasons", showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), "Low MH follow-up care and prior consultations for physical reasons", integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions - those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 - patients with severe health and social issues.nnCONCLUSION: The study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid38819494,

title = {Perceived Higher Unmet Care Needs among Adults in Permanent Supportive Housing},

author = {Bahram Armoon and Guy Grenier and Marie-Josée Fleury},

doi = {10.1007/s10488-024-01390-2},

issn = {1573-3289},

year  = {2024},

date = {2024-11-01},

journal = {Adm Policy Ment Health},

volume = {51},

number = {6},

pages = {843--856},

abstract = {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 the COVID-19 pandemic period. Eight types of care (e.g., information, counseling) were accounted for. Based on the Behavioral Model for Vulnerable Populations, predisposing, need, and enabling factors associated with higher unmet care needs were assessed using a negative binomial regression model. The study found that 56% of adult PSH residents, even those who had lived in PSH for 5 + years, had unmet care needs. Twice as many unmet needs were due to structural (e.g., care access) rather than motivational barriers. Living in single-site PSH, in healthier neighborhoods, having better quality of life and self-esteem, and being more satisfied with housing and outpatient care were associated with fewer unmet care needs. PSH residents with co-occurring mental disorders (MD) and substance use disorders (SUD), and with moderate or severe psychological distress were likely to have more unmet needs. Better access to care, counseling and integrated treatment for co-occurring MD-SUD might be improved, as well as access to information on user rights, health and available support. Welfare benefits could be increased, with more peer support and meaningful activities, especially in single-site PSH. The quality of the neighborhoods where PSH are located might also be better monitored.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}