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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a paper, a part of a planned series of Elements of Care papers, focusing on identifying common elements which are important for providing appropriate psychiatric care in different models of care in Canada. It focuses on direct patient care or service for payment in traditional care model and also discusses indirect services involved in such models, like diagnostic assessment or patient management. It also focuses on involvement of family or caregivers in indirect services.

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample.Method: Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health.Results: Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys.Conclusions: Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders. [ABSTRACT FROM AUTHOR]

Patient safety research in mental health has focused mainly on suicide and violence risk at the expense of other domains of safety. In Canada, we lack a national strategy or research agenda for this important area. This piece calls on psychiatrists to consider the scope of missed opportunities in patient safety in current practice and presents how to begin to consider the safety of our patients in a systematic manner. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Over the past quarter-century, Canadian researchers, clinical practitioners, and policy specialists have made several notable contributions to the broad field of violence risk assessment and management. In part, these contributions have been fostered by major changes in law over this period; in part, they have been spurred by findings from large-scale Canadian prediction--outcome studies. This paper offers references for a range of Canadian-inspired assessment schemes designed to evaluate psychopathy and potential for violence against others. [ABSTRACT FROM AUTHOR]

Background: Major depression makes an important contribution to disease burden in Canada. In principle, the burden of major depression can be reduced by the provision of treatment within the health care system. In a previous data analysis, the National Population Health Survey (NPHS) reported an increase in antidepressant (AD) use between 1994 and 1998. In this paper, the analysis is extended to 2000, and additional aspects of health care utilization are described.Methods: The NPHS provides a unique source of longitudinal data concerning major depression and its treatment in Canada. In this survey, probable cases of major depression were identified using a brief predictive instrument; health care utilization was evaluated using additional survey items; and the latest data release from Statistics Canada (that is, 2000) was used to make weighted estimates of the frequency of health care utilization in relation to major depression status.Results: The use of ADs has continued to escalate. These increases have been largest in men and in persons aged under 35 years. There has been an increase in polypharmacy: in 2000, almost 9% of persons taking an AD reported taking more than 1 AD medication-a tripling since 1994. The frequency of consultations with alternative practitioners has also grown. Although the overall proportion of persons with major depression who report consulting with health professionals about their mental health has not increased, the number of persons with major depressive disorder reporting 6 or more visits to nurses, social workers, and psychologists may have.Conclusion: The provision of AD treatment continues to expand in Canada. This probably represents a changing pattern of practice, because the frequency of professional consultation has not increased. More detailed data are required to evaluate the extent to which treatment needs are being met. [ABSTRACT FROM AUTHOR]

This article provides an overview of papers presented at the 2004 Canadian Academy of Psychiatric Epidemiology meeting. Canada has been a major player in the development of diagnostic criteria, methodology and structured interviews to determine the prevalence of treated and untreated mental disorders. However, most studies in Canadian psychiatric epidemiology were conducted in a specific region. As a consequence, researchers do not have any national estimates of the prevalence of major psychiatric conditions in the country. The Canadian Community Health Survey Cycle 1.2. remedies this, being a study of the entire country. At the meeting, representatives from Statistics Canada outlined the design of the Canadian Community Health Survey Cycle 1.2., whose major focus was on factors that predisposed people to or protected them from psychological problems.

Objectives: Research on the mental health and service needs of homeless seniors has been scant. This paper reviews the available literature and presents findings of a Toronto survey in an effort to describe the demographics of homeless seniors, their level of impairment, and their mental and physical health needs.Methods: We searched the Medline, AgeLine, and PsycINFO databases, using the following key words: elderly homeless, elderly hostel users, and urban geriatrics. To better describe the service needs of the elderly homeless, we obtained demographic data from the Community and Neighbourhood Services Department and distributed a survey questionnaire to 11 Toronto hostel directors. The questionnaire elicited data relating to reasons for shelter use, problem behaviours, and mental health needs of those over age 65 years.Results: Although seniors represent a small percentage of the homeless population, their numbers are growing. The available literature suggests a high prevalence of psychiatric disorders and cognitive impairment in this population, with a greater proportion of older women than men having severe mental illness. Further, our survey suggests that the service needs of elderly hostel users in Toronto differ from those of their younger counterparts.Conclusion: The homeless elderly are the most vulnerable of this impoverished population. Although more research is needed to define their mental and physical health needs and ways of meeting them, their characteristics appear to be unique. Geriatric psychiatrists could play a significant role in evaluating and treating this population more comprehensively. [ABSTRACT FROM AUTHOR]

This paper reviews some recent research on the mental health of the First Nations, Inuit, and Métis of Canada. We summarize evidence for the social origins of mental health problems and illustrate the ongoing responses of individuals and communities to the legacy of colonization. Cultural discontinuity and oppression have been linked to high rates of depression, alcoholism, suicide, and violence in many communities, with the greatest impact on youth. Despite these challenges, many communities have done well, and research is needed to identify the factors that promote wellness. Cultural psychiatry can contribute to rethinking mental health services and health promotion for indigenous populations and communities. [ABSTRACT FROM AUTHOR]

Confusion regarding definitions and standards of prevention and promotion programs is pervasive, as revealed by a review of such programs in Canada. This paper examines how a discussion of scientific paradigms can help clarify models of prevention and mental health promotion and proposes the complementary development of prevention and promotion programs. A paradigm shift in science contributed to the emergence of the transactional model, advocating multiple causes and dynamic transactions between the individual and the environment. Consequently, the view of prevention applying over a linear continuum and of single stressful events causing mental disorders may no longer be appropriate. It is the author's belief that the new science of chaos theory, which addresses processes involved in the development of systems, can be applied to child development and thus to the heart of prevention and promotion programs. Critical moments followed by transitions or near-chaotic behaviours lead to stable states better adapted to the environment. Prevention programs would focus on the critical moments and target groups at risk to reduce risk factors. Promotion programs would focus on stable states and target the general population to develop age-appropriate life skills. The concept of sensitive dependence on initial conditions and certain empirical studies suggest that the programs would have the greatest impact at the beginning of life. It is hoped that this effort to organize knowledge about conceptual models of prevention and mental health promotion programs will foster the development of these programs to meet the urgent needs of Canadian children. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The author reflects on the developments surrounding the August 1997 issue of the journal "The Canadian Journal of Psychiatry." In the leading paper, author Michael Ruiner familiarizes the reader with his latest preoccupation. He defines genetic research to include a thorough understanding of the multiple interplays between genetic structures and the outside world.

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: First-responder mental health, especially in Canada, has been a topic of increasing interest given the high incidence of poor mental health, mental illness, and suicide among this cohort. Although research generally suggests that resiliency and stigma reduction programs can directly and indirectly affect mental health, little research has examined this type of training in first responders. The current paper examines the efficacy of the Road to Mental Readiness for First Responders program (R2MR), a resiliency and anti-stigma program.Methods: The program was tested using a pre-post design with a 3-month follow-up in 5 first-responder groups across 16 sites.Results: A meta-analytic approach was used to estimate the overall effects of the program on resiliency and stigma reduction. Our results indicate that R2MR was effective at increasing participants' perceptions of resiliency and decreasing stigmatizing attitudes at the pre-post review, which was mostly maintained at the 3-month follow-up.Conclusions: Both quantitative and qualitative data suggest that the program helped to shift workplace culture and increase support for others. [ABSTRACT FROM AUTHOR]

Objective: Our paper presents findings from the first population survey of stigma in Canada using a new measure of stigma. Empirical objectives are to provide a descriptive profile of Canadian's expectations that people will devalue and discriminate against someone with depression, and to explore the relation between experiences of being stigmatized in the year prior to the survey among people having been treated for a mental illness with a selected number of sociodemographic and mental health-related variables. Method: Data were collected by Statistics Canada using a rapid response format on a representative sample of Canadians (n = 10 389) during May and June of 2010. Public expectations of stigma and personal experiences of stigma in the subgroup receiving treatment for a mental illness were measured. Results: Over one-half of the sample endorsed 1 or more of the devaluation discrimination items, indicating that they believed Canadians would stigmatize someone with depression. The item most frequently endorsed concerned employers not considering an application from someone who has had depression, Over one-third of people who had received treatment in the year prior to the survey reported discrimination In 1 or more life domains. Experiences of discrimination were strongly associated with perceptions that Canadians would devalue someone with depression, younger age (12 to 15 years), and self-reported poor general mental health. Conclusions: The Mental Health Experiences Module reflects an important partnership between 2 national organizations that will help Canada fulfill its monitoring obligations under the United Nations Convention on the Rights of Persons with Disabilities and provide a legacy to researchers and policy-makers who are interested in monitoring changes in stigma over time. [ABSTRACT FROM AUTHOR]

Focuses on the research determining the clinical skills of various psychiatrists in Canada. Assessment on the quality of medical services; Awareness on the needs of the patients; Creation of several mental health programs.

A position statement regarding COVID-19 and Canadian psychiatry, developed by the Public Policy Committee of the Canadian Psychiatric Association and approved by its board of directors on November 1, 2020, is presented. Topics covered include burden of the COVID-19 disease among people with psychiatric illness, general care for psychiatric patients, and public health policies.

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Eating disorders are common and have a high public health burden. However, existing clinically relevant data sources are scarce, limiting the capacity to accurately measure the burden of eating disorders. This study tests the feasibility of generating a large clinically relevant cohort of individuals with eating disorders using health administrative data.Methods: We developed 3 clinically relevant eating disorder prevalence cohorts using health administrative data from Ontario, Canada, between 1990 and 2014. Cohort 1 included patients with a hospitalization where an eating disorder diagnosis was the primary diagnosis, cohort 2 included patients with a hospitalization where an eating disorder diagnosis was any diagnosis, and cohort 3 included cohort 2 plus any patient with an emergency department visit with an eating disorder diagnosis.Results: Cohort 1 had 7268 patients, cohort 2 had 13,197 patients, and cohort 3 had 17,373 patients. As cohort size increased, the proportion of eating disorder patients with diagnoses of bulimia nervosa and eating disorder not otherwise specified increased. Although the cohorts differed according to demographic and clinical characteristics, these differences were small compared to the degree to which they differed from the Ontario population.Discussion: It is feasible to use health administrative data to measure the clinically relevant burden of eating disorders. The cohorts differed significantly in the eating disorder diagnostic composition. Eating disorders have a high burden, but poor data availability has resulted in fewer public health-related eating disorders studies in comparison to other mental disorders. The use of administrative data can address this evidence gap. [ABSTRACT FROM AUTHOR]

The United Nations adopted the Convention on the Rights of Persons with Disabilities (CRPD) in 2006. When Canada ratified the CRPD, it reserved the right to continue using substitute decision making schemes even if the CRPD was 'interpreted as requiring their elimination'. This was a prescient decision because the CRPD Committee, which is tasked with overseeing the interpretation and implementation of the CRPD, subsequently opined that all legislation supporting substitute decision making schemes contravene the CRPD and must be revoked. The CRPD Committee insists that every person can make decisions with sufficient support and that if a person lacks capacity to make a decision, we must rely on their 'will and preferences'. Many international legal scholars have called this interpretation unrealistic. We agree and, in this article, describe how this unrealistic approach would result in extensive harm and suffering for people with severe cognitive or psychotic disorders. The reader should also be aware that the CRPD Committee also calls for the elimination of all mental health acts and the United Nations Commissioner for Human Rights for the abandonment of the not criminally responsible (NCR) defence. [ABSTRACT FROM AUTHOR]

Objective: This study sought to examine differences in sociodemographic risk factors, comorbid mental conditions, clinical presentations, and functional impairments associated with past-year generalized anxiety disorder (GAD) between Canadian Armed Forces (CAF) Regular Force personnel and the Canadian general population (CGP).Method: Data were from 2 nationally representative surveys collected by Statistics Canada: 1) the Canadian Community Health Survey on Mental Health, collected in 2012 ( N = 25,113; response rate = 68.9%); and 2) the Canadian Forces Mental Health Survey, collected in 2013 ( N = 8,161; response rate = 79.8%).Results: The prevalence of lifetime and past-year GAD was significantly higher in the CAF (12.1% and 4.7%) than in the CGP (9.5% and 3.0%). Comorbid mental disorders were strongly associated with GAD in both populations. Although the content area of worry and the GAD symptoms endorsed were similar, CAF personnel were significantly more likely to endorse specific types of worries (i.e., success at school/work, social life, mental health, being away from home or loved ones, and war or revolution) and specific symptoms of GAD (i.e., restless, keyed up, or on edge and more irritable than usual) than civilians, after adjusting for sociodemographic covariates and comorbid mental disorders. CAF personnel with past-year GAD reported significantly higher functional impairment at home than civilians with past-year GAD.Conclusion: GAD is a substantial public health concern associated with significant impairment and disability in both military and civilian populations. GAD in military and civilian populations shows similarities and differences: Key similarities include its extensive comorbidity and significant functional impairment, whereas key differences include the focus of worries and symptom profile. [ABSTRACT FROM AUTHOR]

This article focuses on the new editor and new policy of the "Canadian Journal of Psychiatry." With the change of editorship. The journal will introduce several other changes. The journal's mission is to publish papers of the highest scientific quality that are relevant for the theory and practice of psychiatry. All the articles in the journal are either empirical studies or systematic reviews. As a result, our impact factor has steadily gone up. While Canada is small in relation to its larger neighbor country, one do not see why one cannot have an impact similar to that of journals from Britain and Scandinavia.

The article discusses research on the insufficient scientific evidence to prove that physician-assisted deaths of those with mental disorders is putting patients' safety at risk. It references to a study by S. van Veen and colleagues published in the 2020 issue of the "Canadian Journal of Psychiatry." It argues that among the reasons for lack of scientific data is the limited number of high quality accurate research that tackles irremediable and incurable health conditions.

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on consequences of child mental health and fetal alcohol spectrum disorder. Topics discussed include problem of prenatal alcohol exposure (PAE) associated with fetal alcohol syndrome, children referred to fetal alcohol spectrum disorders (FASD) clinics are found to have risk exposures in addition to PAE like physical abuse and exposure to parental substance use after birth, and requirement of evidence in alcohol-related neurodevelopmental disorder (ARND) diagnosis.

Introduces a series of articles about aboriginal psychiatry and mental health in Canada.

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)