title: Continuum of care for persons with common mental health disorders in Nunavik: a descriptive study.
abstract: BACKGROUND
  Changing Directions, Changing Lives, the Mental Health Strategy for Canada, prioritizes the development of coordinated continuums of care in mental health that will bridge the gap in services for Inuit populations.
  
  
  OBJECTIVE
  In order to target ways of improving the services provided in these contexts to individuals in Nunavik with depression or anxiety disorders, this research examines delays and disruptions in the continuum of care and clinical, individual and organizational characteristics possibly associated with their occurrences.
  
  
  METHODS
  A total of 155 episodes of care involving a common mental disorder (CMD), incident or recurring, were documented using the clinical records of 79 frontline health and social services (FHSSs) users, aged 14 years and older, living in a community in Nunavik. Each episode of care was divided into 7 stages: (a) detection; (b) assessment; (c) intervention; (d) planning the first follow-up visit; (e) implementation of the first follow-up visit; (f) planning a second follow-up visit; (g) implementation of the second follow-up visit. Sequential analysis of these stages established delays for each one and helped identify when breaks occurred in the continuum of care. Logistic and linear regression analysis determined whether clinical, individual or organizational characteristics influenced the breaks and delays.
  
  
  RESULTS
  More than half (62%) the episodes of care were interrupted before the second follow-up. These breaks mostly occurred when planning and completing the first follow-up visit. Episodes of care were more likely to end early when they involved anxiety disorders or symptoms, limited FHSS teams and individuals over 21 years of age. The median delay for the first follow-up visit (30 days) exceeded guideline recommendations significantly (1-2 weeks).
  
  
  CONCLUSIONS
  Clinical primary care approaches for CMDs in Nunavik are currently more reactive than preventive. This suggests that recovery services for those affected are suboptimal.
authors.affiliation: Department of Nursing Sciences, Université du Québec à Rimouski, Levis and Rimouski, Canada.|Faculty of Nursing Sciences, Université Laval, Québec, Canada; lily_lessard@uqar.ca.
authors.forename: Lily
authors.initials: L
authors.lastname: Lessard
authors.affiliation: Faculty of Nursing Sciences, Université Laval, Québec, Canada.|Department of Social and Preventive Medicine, Faculty of Medicine, CRCHUM, Université de Montréal, Montreal, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Fournier
authors.affiliation: Department of Nursing Sciences, Université du Québec à Rimouski, Levis and Rimouski, Canada.|Expert in Organization of Care and Services in Rural and Remote Areas, Health and Social Service System Analysis and Evaluation, Institut national de santé publique du Québec, Rimouski, Canada.
authors.forename: Josée
authors.initials: J
authors.lastname: Gauthier
authors.affiliation: Faculty of Nursing Sciences, Université Laval, Québec, Canada.|Institut universitaire de recherche et de formation en soins, University of Lausanne, Lausanne, Switzerland.
authors.forename: Diane
authors.initials: D
authors.lastname: Morin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003081:Cold Climate; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D016017:Odds Ratio; D015397:Program Evaluation; D011792:Quebec; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult
keywords: Community Mental Health Services; Inuit; MESH; Primary Health Care; Quality of Patient Care; Rural Health Services; anxiety disorders; care pathways; continuity of care; depression