▼ Schizophrenia is a common and serious mental disorder affecting approximately 1% of the population (WHO, 1973). That genetic and other developmental factors give rise to a predisposition or vulnerability to schizophrenia is well recognized. However, the role of the environment in conferring risk for the disorder is now indisputable. Psychosocial, economic and cultural factors all impact on risk as evidenced by recent epidemiological studies reporting variable incidence in relation to factors including unemployment, urbanicity, migration and trauma. Complex gene-gene and gene-environment (GxE) interactions lie at the origin of this common human disorder and account for the diversity of epidemiological findings and clinical presentations that we encounter in research and clinical practice. This thesis comprises of six research papers and includes data from two separate studies of first-episode psychosis (FEP) conducted in KwaZulu-Natal, South Africa. The first study (Chapter 2) explored the impact of income inequality and poverty on the incidence of FEP and the results provide the first evidence for an association between increasing income inequality and increased incidence of FEP. The second study (Chapter 3) investigated the impact of a number of psychosocial, economic and cultural factors on the clinical presentation of FEP. Previous experiences of trauma were associated with positive and affective symptoms at psychosis onset, while cannabis use was associated with clinical features of FEP that previously have been associated with better outcome. Cultural factors such as spiritual attributions of cause and previous consultation with traditional healers may delay entry to psychiatric care and thereby negatively impact on prognosis of FEP. Chapter 4 addresses the issue of how the environment acts through GxE interactions to modify risk and alter the clinical presentation and course of schizophrenia. In this paper, new epidemiological findings are integrated with an evolutionary genetic theory of schizophrenia. In Chapter 5, I present a human rights perspective on the inequities and inequalities that characterize the lives of those with serious mental disorders such as schizophrenia, resulting from psychosocial, political, economic and cultural forces in the environment. The concluding chapter draws all of the data together, highlights key findings and conclusions from the thesis, addresses weaknesses and limitations of these conclusions and identifies priority areas for future research in this field. Advisors/Committee Members: Emsley, R (advisor).

▼ Background: Cannabis among patients admitted in psychiatric units is higher than the general population and this has been shown in various countries where studies on cannabis use have been undertaken. Such an observation has been made by psychiatrists in South Africa and the association between cannabis use and psychotic presentation among these patients has also been observed. Cannabis use by patients with severe or chronic medical illnesses to ameliorate the symptoms of such illnesses has been documented in the literature. A study to explore use of cannabis among psychiatric inpatients as well as medical patients was undertaken. Purpose: The purpose of this study was to firstly determine the prevalence of cannabis use in psychiatric patients admitted to an acute admissions unit in King Edward VIII Hospital and to correlate it with the psychiatric diagnosis. Secondly, it was to compare the cannabis use in psychiatric patients admitted to an acute admissions unit to patients admitted in a medical ward at King Edward VIII Hospital. Thirdly, to assess self reporting of cannabis use by psychiatric and medical patients. Methods: A case control study was conducted at King Edward VIII Hospital, Durban, where cannabis use among 64 subjects included in the study admitted in a psychiatric ward was compared with a control group of 63 control subjects admitted in a medical ward. Both groups were tested for urinary cannabinoids and a questionnaire was filled. The questionnaire contained demographic details as well as a question on use of substances including cannabis. Results: 17 subjects (26.6%) in the study group tested positive for urinary cannabinoids and 2 subjects (3.2%) in the control group tested positive. Cannabis use was significantly higher among males when compared to females in both the study group and the control group. Only 7 subjects in the study group reported cannabis use and out of those 7 subjects, 4 subjects tested positive for urinary cannabinoids. The commonest diagnosis among the study group subjects were the psychotic disorders and schizophrenia being the most common psychotic disorder. Conclusion: Cannabis use is significantly higher among psychiatric patients as compared to medical patients and it is probably higher than in the general population. Self reporting of cannabis use among psychiatric patients is low and unreliable and psychiatrists treating these patients must continue to use objective measures such as objective testing as well as collateral information to determine such use. In this study most subjects who tested positive for urine cannabis were likely to have a psychotic disorder and tended to be of younger age groups. The low prevalence of cannabis use in the control group makes it unlikely that there was a significant number of subjects in this group who were using cannabis for medicinal purposes. Advisors/Committee Members: Nair, Margaret Gemma (advisor), Mkize, Dan Lamla (advisor).

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Psychedelic substances occupy a central role in medical and spiritual paradigms throughout the world. Yet, they have been criminalized in nearly every country over the course of the 20th century. Users of psychedelics face a host of legal and political barriers in spite of mounting evidence for the safety of these substances in culturally-integrated contexts. The research presented in this thesis focuses on a Canadian branch of Santo Daime, a Brazilian syncretic religion structured around the ritualized consumption of the psychedelic plant decoction called Santo Daime, known outside the religion as ayahuasca. Generating data with participant observation and in-depth interviewing, I employ critical discourse analysis and thematic analysis—methodologies derived from qualitative research—to analyze models of spirituality and healing embedded in the discourse of members of Santo Daime, and frame the group’s adaptation to the Canadian cultural context within larger trends in Canadian law and drug policy. By locating Santo Daime at a controversial intersection of mental health and culture, I bring the concepts of ontology and epistemology to bear on Santo Daime members’ worlds and worldviews, and explore their construal as radically other in relation to their largely secular cultural-political surroundings.

Les substances psychédéliques occupent un rôle central dans des paradigmes médicaux et spiritueux à travers le monde. Pourtant, avec quelques exceptions dans quelques pays, ils sont presque uniformément criminalisé. Les consommateurs de psychédéliques font face à divers barrières politiques et légales, malgré une croissance de recherche scientifique attestant à la sécurité de ces substances dans les contextes culturellement-intégrés. La recherche présentée dans cette thèse concentre sur une succursale canadienne du Santo Daime, une religion Brésilienne syncrétique organisé autour de la consommation rituel de la préparation psychédélique Santo Daime, reconnu hors de la religion sous le nom ayahuasca. En générant des donnés avec l’observation de participants et des interviews profonds, j’emplois l’analyse de discours critique et l’analyse thématique—des methodologies dérivées de la recherche qualitatif—pour analyser des modèles de la spiritualité et de la guérison intégrés dans le discours des membres du Santo Daime, et pour formuler l’adaptation du groupe au contexte culturel canadien, en considérant des tendances globals dans le loi canadien et de la politique sur les drogues. Localisant le Santo Daime à l’intersection controversé de la santé mentale et la culture, j’emploi les concepts de l’ontologie et de l’épistémologie sur les mondes et les conceptions du monde des membres du Santo Daime, et j’explore leurs conceptions comme étant radicalement "autre" en relation de leurs alentours culturels et politiques, plutôt séculaire.

Advisors/Committee Members: Amir Raz (Internal/Supervisor).

▼ Introduction: Reconsolidation theory postulates that following retrieval, previously consolidated memories enter a state of lability prior to being reconsolidated. Additionally, the administration of certain pharmacological agents (e.g., the beta-blocker propranolol) during the period of memory reactivation (i.e. recall) is believed to interfere with and block at least in part the reconsolidation process in disorders with maladaptive and pathological emotional memories. However, while the main emotion examined in previous studies was fear or craving, it remains unclear whether other types of emotion can be disrupted. In this study, we aimed to elucidate whether these observed effects do in fact extend to memories linked to non-fear, non-craving emotions in humans. Methods: We elicited joy, fear, sadness, disgust and anger in 45 healthy adults by exposing them to visual stimuli mainly drawn from the IAPS (International Affective Picture System). Using a pre/post placebo-controlled randomized study design, we tested whether propranolol can block consolidation and/or reconsolidation of other forms of emotional memories as categorized by each participant according to emotion-type. Results: A series of 2 way, mixed design ANOVAs, with Group as a between subjects factor and Emotion-type as a within subjects factor were performed for primary and secondary endpoints. Consolidated and Reconsolidated image recognition data yielded a significant effect of Emotion-type, F(5, 185) = 26.13, p < 0.001, and F(5, 185) = 16.11, p < 0.001, respectively, with significant effects within each Group. Mean differences in subjective emotional arousal ratings between T2 and T1 yielded a significant Group x Emotion-type interaction, F(10, 185) = 2.84, p < 0.01. Simple main effect tests conducted between groups indicated that the consolidation blockade effects of propranolol for images eliciting fear was significantly greater than placebo, F(2, 189) = 6.04, p < 0.01. No such significant results were observed for anger- or joy-related images. Similarly, mean differences in subjective emotional arousal ratings between T3 and T1 did not yield any significant results. Conclusion: Overall, propranolol was associated with a significant increase in arousal difference over time to emotional stimuli for fear-related images, as compared to neutral images, as had been previously demonstrated. This demonstrates that propranolol may, in fact, disrupt the consolidation of the emotional component of a fear-related memory. Furthermore, we found no evidence for propranolol affecting the consolidation of the declarative component of emotional memory, including those related to fear (previously shown) or sadness (not yet shown). Unlike other investigators, we were unable to demonstrate a disruptive effect of propranolol on emotional memory reconsolidation. This study was designed to evaluate whether propranolol can modulate the consolidation and reconsolidation of emotional memories unrelated to fear or craving. However, we saw no effects on these memories. … Advisors/Committee Members: Alain Brunet (Internal/Supervisor).

▼ Background: Upon retrieval, a consolidated memory destabilizes and becomes labile once more. During this time it can be manipulated prior to re-stabilizing to long-term memory storage. This process called reconsolidation, allows for the updating, strengthening or weakening of memories. Previous research suggests that reconsolidation blockade using propranolol can be used as a treatment for posttraumatic stress disorder (PTSD). However the use of open label designs or of a single treatment session per study participant limits the interpretation and generalizability of the results. The present Master’s thesis reports on a study that sought to overcome these limitations. Objectives: The primary objective was to investigate the treatment’s efficacy (i.e., six sessions of reconsolidation blockade using propranolol) for patients suffering from PTSD, as indexed by the psychophysiological responses produced by a script-driven imagery session of the traumatic event conducted after treatment. A secondary objective consisted in determining if the treatment led to a pre- vs. post-treatment decrease in overall PTSD symptom severity. Additionally, we aimed to explore sex differences in treatment efficacy. Methods: In a placebo-controlled randomized trial, twenty-nine participants read an account of their traumatic event once weekly for 6 consecutive weeks under the influence of double-blind propranolol or placebo. (Another 5 participants did so under single-blind propranolol). Those thirty-four participants were treated as 'per protocol’ study completers. One week after completing the treatment, skin conductance, heart rate, and left corrugator and frontalis electromyograms activity were measured while participants engaged in script-driven mental imagery of their traumatic event. Pre- and post-treatment PTSD symptom severity was also measured by means of a reliable and valid semi-structured interview. Data Analysis: A MANOVA, followed by univariate tests, was conducted to determine the effect of reconsolidation blockade of traumatic memories on the overall psychophysiological responses to script-driven imagery. An independent samples t-tests was used to examine the pre- vs. post-treatment difference scores in PTSD symptom severity. A gender analysis was also performed for all outcomes. Results: As hypothesized, subjects assigned to the treatment group displayed lower overall psychophysiological responding than those in the placebo group while the univariate tests yielded mixed findings depending on the specific outcome measure. There was no between-group significant difference in PTSD symptoms severity. A gender analysis revealed that women had lower overall psychophysiological responses to the script-driven imagery compared to their respective counterpart placebo. Treated women also reported a nearly significant trend (p = .06) toward improvement of their PTSD symptoms compared to women in the placebo group. On the other hand, compared to their placebo counterpart, men in the active treatment did not differ statistically in… Advisors/Committee Members: Alain Brunet (Internal/Supervisor).

▼ Risky driving is an important factor associated with road traffic crashes, which is the leading cause of death among young people. An internal form of distraction, known as mind wandering (i.e., shifting attention from the immediate environment and ongoing tasks to unrelated thoughts and feelings), is associated with a reduction in driver visual attention, impairments in driving performance, and increased likelihood of being responsible for a crash. Individuals who show a propensity for mind wandering (i.e., trait absentmindedness) also experience more routine task errors, but whether trait absentmindedness also predicts risky driving behaviour is unknown. Moreover, mind wandering interferes with sensory information processing, but whether driver visual attention mediates the relationship between trait absentmindedness and risky driving has yet to be determined. Finally, executive control (i.e., the system responsible for deliberate and effortful goal-oriented cognition) is thought to facilitate and regulate mind wandering. It is currently unclear, however, whether it moderates the association between trait absentmindedness and behaviour. The present study examines the relationships between trait absentmindedness, executive control capacity, driver visual attention, and risky driving behaviour in young male drivers. We hypothesized that: H1) greater trait absentmindedness is associated with higher risky driving behaviour; H2) greater trait absentmindedness is associated with less driver visual attention; H3) visual attention mediates the relationship between trait absentmindedness and risky driving; and H4) executive control capacity moderates the relationship between trait absentmindedness and risky driving behaviour. A sample (N = 30) of young male drivers aged 18-21 years was administered the Sustained Attention to Response Task, the Daydreaming Frequency Scale, and the Dundee Stress State Questionnaire to measure trait absentmindedness, as well as the Color-Word Interference Test for executive control capacity. Mean driving speed in a simulator was used to measure risky driving, and eye tracking was used to quantify visual attention. Results showed that greater trait absentmindedness is significantly associated with higher risky driving, with trait absentmindedness explaining 32% of the variance in mean driving speed (i.e., H1). Greater executive control capacity was significantly associated with higher risky driving as a function of trait absentmindedness, with executive control explaining an additional 16% of the variance in mean driving speed (i.e., H4). The expected association between trait absentmindedness and driver visual attention (i.e., H2 and H3) was not detected. Exploratory analyses hinted that explicit awareness of mind wandering may be associated with reduced risky driving, and that greater trait absentmindedness may be associated with higher mean vertical gaze position. Trait absentmindedness is a significant marker of risky driving among young male drivers in a simulator. Moreover, executive… Advisors/Committee Members: Marie-Claude Ouimet (Internal/Cosupervisor2), Thomas Gordon Brown (Internal/Supervisor).

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Magicians produce impossible scenarios for their audiences. Cognitive manipulations employed by magicians remain reliable even under intense scrutiny. In particular, misdirection—the practice of diverting the spectator's focus away from the hidden elements of a magic trick—offers a powerful avenue for examining how and what people attend to when observing magic. The current thesis examines misdirection using repeated viewings of a trick and investigates potential reasons for its continued efficacy, i.e., the durability of misdirection. We pair precision eyetracking with the classic 3-card Monte trick to examine how participants visually react to their answers during feedback. Furthermore, we wanted to see whether participant answers deviate from the expected distributions in an effort to counter misdirection. The methodology exposes participants to multiple viewings of four versions of the Monte with or without the presence of misdirection, presented in video format. Participant data, e.g., predictions of the target card's location and their accuracy, confidence ratings, and pupillary responses are collected via button inputs and gaze fixation recordings. Analyses of the data reveal predictions are highly inaccurate in the presence of misdirection and the pattern of answers conforms to the expected distributions. Participants seem aware that the game is rigged, as corroborated by the pupillary response analyses. However, participants do not alter their overt visual strategy even after multiple encounters with misdirection, suggesting a lack of viable alternate strategies coupled with risk aversion rather than a misallocation of attention. The findings demonstrate that effective misdirection can persist as long as participants believe there is only one way to solve the problem, even if they anticipate potential misdirection.

Les magiciens produisent des scénarios impossibles pour leur public. Les manipulations cognitives employées par les magiciens demeurent fiables, même lorsqu'elles sont examinées minutieusement. En particulier, une directive erronée-la pratique de détourner l'attention du spectateur loin des éléments cachés d'un tour de magie-offre une avenue puissante pour examiner ce sur quoi les spectateurs portent leur attention. La thèse actuelle examine l'attention détournée lors de visionnements répétés d'un tour de magie et examine les raisons possibles de son efficacité continue. Nous jumelons un suivi des mouvements occulaires de l'oeil de précision avec le classique 3-carte Monte astuce pour examiner la façon dont les participants réagissent visuellement à leurs réponses lors de la rétroaction. De plus, nous voulions voir si participant répond diffèrent des distributions attendues dans un effort pour contrer une directive erronée. La méthodologie expose les participants à de multiples visionnages de quatre versions du Monte avec ou sans la présence de directives erronées, présentées en format vidéo. Les données des participants, par exemple, les prévisions concernant…

Advisors/Committee Members: Naguib Mechawar (Internal/Supervisor).

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Episodic memory is the ability to remember an item or event in rich contextual detail. Healthy aging is associated with declines in this ability in addition to widespread cortical thinning. These parallel declines suggest that age-related changes in cortical thickness may contribute to episodic memory decline with age. As few studies have directly examined this association, the current study aims to cross-sectionally explore whether regional cortical thickness (CT) mediates the relationship between age and episodic memory as measured by a context memory task for faces. The brain regions examined in the current study have been previously associated with episodic memory performance and demonstrate age-associated cortical thinning in the current healthy lifespan sample (N= 114). The regions on the left were lingual, fusiform, rectus, parahippocampal, superior frontal, caudal middle frontal, inferior frontal, angular, and supramarginal gyri; and the regions on the right were parahippocampal, rectus, angular, supramarginal, superior temporal, middle temporal, superior frontal, caudal middle frontal, and inferior frontal gyri. Conditional mediation models were tested using bootstrapping in order to determine whether and how these regions mediate age-associated changes in performance on the context memory task. It was found that CT of the right parahippocampal and superior frontal gyri were related to performance differentially with age, lending support to the conception that grey matter-episodic memory relationships change with age. The models also demonstrated that regional CT mediated age-associated variance in context memory performance in a way that is conditional upon age. Furthermore, the current analysis identified a dissociation between CT of a region mediating age-associated variance in accuracy, and predicting accuracy after controlling for age. Overall, these findings underscore the importance of implementing a longitudinal approach because the examination of intra-individual changes over time would better tease out how age-related changes in CT affect context memory, without the need to account for CT-episodic memory relationships due to factors other than age.

La mémoire épisodique est la capacité à se souvenir d'un élément ou un événement dans le détail riche contextuel. Le vieillissement normale est associé à une baisse de cette capacité, en plus de l'amincissement cortical généralisée. Ces baisses parallèles suggèrent que les changements liés à l'âge dans l'épaisseur corticale (EC) peuvent contribuer au déclin de la mémoire épisodique avec l'âge. Comme peu d'études ont examiné directement cette association, cette étude vise à explorer par methode transversale si l'épaisseur corticale (EC) régionale médiatise la relation entre l'âge et la mémoire épisodique telle que mesurée par une tâche de mémoire de contexte pour les visages. Les régions du cerveau examinées dans la présente étude ont été précédemment associée à la performance de la mémoire épisodique et démontre un amincissement associée à l'âge dans…

Advisors/Committee Members: Maria Rajah (Internal/Supervisor).

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Introduction: Investigations have demonstrated that serotonergic antidepressants (SAds) may decrease the platelet aggregation due to intra-platelet serotonin depletion. One of our objectives was to assess whether this effect can possibly increase bleeding side effects in surgical patients in general and in particular patients undergoing breast biopsies. We also investigated whether SAds had a protective effect against ischemic cerebrovascular accidents (CVA).Materials and Methods: This study consists of three phases. Phase 1 was a systematic review of the literature on bleeding side effects of SAds in surgical patients. Phase 2 was a case-control study of 3890 patients undergoing breast biopsy procedures between Jan 2011 and Oct 2014 in the Breast Clinic of McGill University Health Centre to assess the correlation between abnormal bleeding and SAd use. Phase 3 was a retrospective cohort study based on a 5-year follow-up of 217 patients admitted to the psychiatric inpatient unit of the Jewish General Hospital between January 2003 and June 2008. Patients were subcategorized into groups exposed and unexposed to SAds and the main outcome measure was the incidence of CVA and any abnormal bleeding. Results: Our Phase 1 systematic review consisted of a total of 15 relevant studies across a broad variety of surgical procedures. In general, SAds were associated with an increased risk of peri-operative bleeding events (ORs 1.21–4.14). In our phase 2 study: SAds were significantly associated with increased bleeding risk during breast biopsy procedures (10.3% vs. 0.7%, Fisher's Exact p=0.001). However, the phase 3 results showed that there was no statistically significant difference in ischemic CVA events in patients using SAds compared to those not using SAds (5.6% vs 8.8%, χ2=0.86, p=0.35). Conclusion: In conclusion, although SAds use may be associated with platelet dysfunction and increased bleeding risks in patients undergoing different surgical and interventional procedures, they did not have any clinically meaningful impact on CVAs. Clinicians should be aware and watchful about the anti-platelet property of SAds, particularly bleeding risks in surgical contexts.

Introduction: Des enquêtes ont démontré que les antidépresseurs sérotoninergiques (SAds) peuvent diminuer l'agrégation plaquettaire pour épuisement de intra-plaquettaire sérotonine. L'un de nos objectifs était d'évaluer si cet effet peut éventuellement augmenter les effets secondaires d'hémorragie chez les patients chirurgicaux en général et en particulier des patients subissant des biopsies de sein. Nous avons également cherché à savoir si SAds avaient un effet protecteur contre les accidents vasculaires cérébraux ischémiques (AVC).Méthodes: Cette étude se compose de trois phases. La phase 1 était une revue systématique de la littérature sur les effets secondaires d'hémorragie de SAds chez les patients chirurgicaux. Phase 2 était une étude cas-témoins de 3890 patients subissant des procédures de biopsie du sein entre janvier 2011 et octobre 2014 dans la…

Advisors/Committee Members: Karl Julian Looper (Internal/Supervisor), Simon Louis Bacon (Internal/Cosupervisor2).

▼ Mass psychogenic illness (MPI) is widespread in Nepal. A large number of young children and adolescents in schools and adult women in some communities are affected in clusters by unintentional trance and possession episodes (chhopne in Nepali). However, the possible causes and correlates of these epidemics are not well understood and have not been widely studied. The dearth of studies on the potential causes and correlates of MPI in Nepal represents a significant knowledge gap with implications for intervention. Three studies were conducted to examine the social and psychological correlates of mass psychogenic illness involving a cluster of adult women in a community and adolescent children in schools in Nepal. The aim of these studies was to test existing hypotheses about the etiology of MPI by comparing afflicted and control populations with regard to (a) prior exposure to trauma, (b) underlying mental health problems, (c) personality traits, and (d) level of dissociative experiences. To achieve this aim, first, we conducted a case study following a mixed-methods case-control design in a village in central Nepal with a cluster of women experiencing unintentional spirit possession episodes. This study assessed sociocultural context, prior exposure to trauma, and prevalence of symptoms of common mental disorders in women who had and had not experienced chhopne (N=38). Quantitative results indicated that possessed women had higher rates of traumatic exposure and higher levels of symptoms of mental disorder compared to non-possessed women. However, qualitative data suggested that possession was more likely an attempt to cope with and communicate distress caused by difficulties in day-to-day living and other stressors. Secondly, we conducted a cross-sectional survey of adolescents (N=314) from five schools in three districts of Nepal. Using a path analysis model, this study evaluated the applicability of three existing theoretical models to explain dissociative experiences and behaviors (DEBs), namely: (1) childhood trauma; (2) cognitive and personality traits (i.e., cognitive failures, fantasy proneness, emotional contagion); and (3) current distress (i.e., quality of life, depression, posttraumatic stress). Results confirmed that the factors associated with all three models were correlates of DEBs, however, only cognitive failures (lapses in day-to-day memory) and posttraumatic stress emerged as significant predictors of DEBs in the integrated path analysis. Thirdly, we conducted a case-control study with adolescent children affected (cases) by MPI that involved dissociative trance and possession episodes (chhopne) and their friends who had never experienced chhopne (N=379). This study aimed to evaluate if DEBs and their correlates identified in the previous study could predict epidemics of episodes of chhopne among children in schools in Nepal affected by MPI episodes. Bivariate logistic regression models showed that the odds of being a case (being affected in MPI) among those who lived in the nuclear family,… Advisors/Committee Members: Laurence J Kirmayer (Supervisor).

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Objective: Depression and functional impairment frequently co-occur. Though both predict complications and mortality following surgery, there is a paucity of research examining functional status (FS) in depressed cancer patients awaiting surgery. Prehabilitation, a preoperative intervention including exercise, nutrition and stress-reducing strategies, may help to improve FS; however, the extent to which depressed individuals can benefit from this intervention has not yet been explored. The primary objectives were to assess whether preoperative depression is associated with poor FS, and whether prehabilitation can improve FS in depressed individuals. Method: A secondary analysis was conducted on 172 colorectal cancer (CRC) patients enrolled in three studies comparing prehabilitation with a control group (rehabilitation). FS was assessed with the Six-Minute Walk Test (6MWT), measuring distance walked during 6-minutes (6MWD), and the Hospital Anxiety and Depression Scale (HADS) was used to assess psychological symptoms. Measures were collected twice preoperatively, at 4-weeks and 48 hours before surgery, and at 4- and 8-weeks postoperatively. Subjects were divided into 3 groups: depression (HADS-D), anxiety (HADS-A), or no psychological symptoms (HADS-N). Main hypotheses were tested using analysis of variance, Chi-Square tests, and multivariate logistic regression. Results: At baseline, depressed individuals had lower 6MWD (p=0.003), and a greater proportion walked <400m (45%; p<0.001). Prehabilitation was associated with significant improvements in 6MWD in HADS-D group (OR=2.36, 95% CI:1.53-3.66), but not in HADS-N (OR=0.97 95% CI:0.44-2.16) or –A groups (OR=1.47 95% CI:0.69-3.16). Conclusion: CRC patients with depressive symptoms had poorer FS, and these individuals benefited most from prehabilitation intervention.

Objectifs : La dépression et la déficience fonctionnelle sont souvent observées ensemble. Alors qu'elles permettent de prédire les complications et la mortalité après une intervention chirurgicale, il y a peu de recherche sur la capacité fonctionnelle (CF) des cancéreux souffrant de dépression avant chirurgie. Des exercices préopératoires (préadaptation) pourraient améliorer la CF, mais l'étendue des bénéfices sur les personnes déprimées n'ont pas encore été explores. Les objectifs principaux étaient d'évaluer le lien entre la dépression préopératoire et une piètre CF, et l'amélioration de la CF par la préadaptation des personnes déprimées. Méthodes : Une analyse secondaire a été faite sur 172 patients atteints de cancer colorectal et participant à trois études comparant la préadaptation à un groupe témoin (réadaptation). La CF a été évaluée grâce au test mesurant la distance marchée en six minutes (6MWT). Les symptômes psychologiques ont été déterminés par l'échelle clinique de mesure d'anxiété et de dépression (HADS). Les relations entre les symptômes psychologiques préopératoires et la CF, chez les sujets répartis en trois groupes : déprimés (HADS-D), anxieux (HADS-A) et sans symptôme (HADS-N), ont…

Advisors/Committee Members: Franco Carli (Internal/Cosupervisor2), Leon Tourian (Internal/Supervisor).

▼ Background. Mood disorders (Major Depressive Disorder (MDD) and Bipolar Disorder Type I and Type II (BPI & BPII)) can have large negative impacts on individuals affected by them, and on the community as a whole. Childhood adversity has been found to be a risk factor for mood disorders. Additionally, childhood adversities, in the form of physical abuse and neglect, have been associated with insecure attachment styles in adulthood. Insecure attachment styles have also been found to be more prevalent in individuals with mood disorders compared to those without. The association between childhood adversity and attachment in mood disorder populations has not been well examined. Objectives. (1) To examine the prevalence and severity of different forms of childhood adversity in a clinical mood disorders population (patients with MDD, BPI or BPII). (2) To examine the prevalence of attachment styles in a clinical mood disorders population. (3A) To examine the association between different forms of childhood adversity and attachment styles in a clinical mood disorders population. (3B) To determine if mood disorder type modifies the association between childhood adversity and attachment style.Methods. This was a cross-sectional study of 230 outpatients from a university-based, tertiary-care clinic in Montreal, Quebec, with a diagnosis of MDD (N=71), BP type I (N=68), and BP type II (N=52). Psychiatric diagnoses were determined using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Childhood adversity was assessed using the Childhood Experience of Care and Abuse Questionnaire, which measures antipathy, parental loss, neglect, role reversal, and physical, psychological, and sexual abuse. Attachment styles were assessed using the Experiences in Close Relationships Questionnaire, anxious and avoidant attachment styles were examined. One-way ANOVA and Tukey post-hoc tests were conducted for continuous variables, and chi-square tests were conducted for dichotomous variables, to examine the prevalence of childhood adversities and attachment styles within each diagnostic group. Linear regressions adjusted for age and sex were used to find the association between specific types of childhood adversity and insecure attachment in the mood sample.Results. Sixty-five percent of subjects experienced at least one form of childhood adversity. Fifty-eight percent suffered from physical abuse from at least one parent, about a quarter experienced marked antipathy, neglect and psychological abuse from at least one parent (25.9%, 22.4% and 27.4%, respectively), 32.4% suffered from sexual abuse, 26.0% experienced parental death or separation, and 15.9% experienced marked role reversal. The mean attachment score was 4.0 for anxious attachment and 3.8 for avoidant attachment, with the BPII group scoring higher than the BPI group (4.5 vs. 3.7) on anxious attachment, and both the BPII and MDD groups scoring higher than the BPI group (4.0 and 4.0 vs. 3.4) on avoidant attachment. Antipathy, psychological abuse and role reversal were… Advisors/Committee Members: Nancy Low (Internal/Supervisor).

▼ Introduction: A first episode of psychosis (FEP) is often a severe and highly traumatic mental illness. However, FEP may also present an opportunity for positive change. While positive changes have been reported following various physical illnesses (e.g., HIV) or traumatic events (e.g., war), little research has investigated positive changes following FEP. To address this knowledge gap, this dissertation addressed two research questions: 1) What are the positive changes persons experience following FEP, and 2) What factors or processes facilitate such changes? Methods: These research questions were addressed through synthesizing the extant scientific knowledge in two systematic reviews (i.e., a scoping and systematic mixed studies review), and through conducting one empirical mixed methods study that was separated into two chapters. The scoping review was carried out in six steps: identifying the research question and relevant studies, selecting studies, charting the data, coding and summarizing results, and consulting with stakeholders. All data were charted and subject to thematic analysis. The systematic mixed studies review employed a convergent qualitative synthesis design, and was conducted in five steps: formulating a review question, defining eligibility criteria, identifying sources of information, identifying and selecting studies, and appraising the quality of studies. Data were analyzed using thematic synthesis. The empirical mixed methods study employed a mixed methods convergent design, whereby participants completed a quantitative (n = 94) and qualitative component (n = 12). In the quantitative component, participants completed validated questionnaires assessing positive change (i.e., the Posttraumatic Growth Inventory) and predictors of positive change (i.e., the Subjective Experiences of Psychosis Scale, Brief COPE, Recovery Assessment Scale, Child and Youth/Adult Resilience Measure, and Multidimensional Scale for Perceived Social Support). In the qualitative component, participants partook in semi-structured interviews assessing why participants felt they came to receive services at an early intervention service; how they feel they changed following their FEP; and what they perceive facilitated such change. Quantitative data were analyzed using descriptive statistics and multiple regression, while qualitative data were analyzed using thematic analysis. Results: Findings across studies revealed that following FEP, participants (including persons with lived experience of FEP themselves as well as their families and friends) experienced positive change at the individual level (e.g., developing a stronger sense of self, improved mental health, etc.), interpersonal level (e.g., improving relationships with others) and spiritual/religious level (e.g., experiencing greater spirituality). These changes were facilitated by factors and processes at the personal level (e.g., coping, experiencing personal recovery, engaging in spirituality, etc.), relational or social level (e.g., social support, etc.),… Advisors/Committee Members: Ashok Malla (Supervisor1), Srividya Iyer (Supervisor2).

▼ Background: The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) requires a clinical synthesis of information obtained from various sources including parents and teachers. This project aimed to answer two key questions relating to therapeutic response (TR) observed with Methylphenidate (MPH) and Placebo:1. What is the role of observation setting (parent, teacher, classroom simulated situation-RASS, neuropsychological-CPT Overall Index, clinical staff)?2. What is the role of the gender of the child and the observer (parent, teacher)?Methods: The ADHD Pharmaco-behavioral study is an ongoing study at the Douglas Hospital in Montreal. Following a one week washout period, children with ADHD undergo a two week double-blind, randomized, cross-over clinical trial with MPH and placebo. Clinical information (Conner's Global Index) on therapeutic response is obtained from teachers (CON-T) and parents (CON-P) at baseline and during the two weeks of the clinical trial. Children also participate in the classroom-simulated test, the Restricted Academic Activity Scale (RASS), and neuropsychological tests including the Conner's Performance Test (CPT), which is repeated during the two weeks. Assessment is done by trained observers to arrive at a clinical global impression of improvement (CGI-I) during the two weeks. Finally, a group consensus of response to treatment taking into account all the available information (GIP) and prior to the blind being broken is made on the basis of improvement relative to the baseline state. The difference scores between the treatment and placebo weeks were calculated for all the measures. Pearson's correlation was performed to examine the correlation of behavioral changes across observation settings, independent sample t-tests were carried out to examine the role of gender. Results: For the first question based on observer setting, baseline scores by parents and teachers are significantly correlated for Restless-Impulsive (RI), Emotional-Labile (EL) dimensions of the Conners'Index scores and with CPT Overall Index baseline scores. Therapeutic response correlations are seen mainly with regard to the RI dimension. The CPT Overall Index, RASS, CGI-I, GIP show significant correlations among them, but are not correlated with parent and teacher assessments. For the second question based on gender, significant interactions between child's gender and teacher's gender on CGI-T scores at baseline and on treatment response were noted. Only main effects of child's gender and parent's gender at baseline were noted on the CGI-P. No significant gender differences were seen in CPT Overall Index, RASS, CGI-I, GIP with treatment. Conclusion: Significant treatment response is noted with MPH in all observation settings. Parents and teachers have significantly correlated baseline assessments and their evaluations correlate with CPT Overall Index baseline assessment. However, parents and teachers' assessments of TR correlate poorly and do not correlate with other neuropsychological and clinical assessments of… Advisors/Committee Members: Ridha Joober (Internal/Supervisor).

▼ Background: While some symptoms of schizophrenia and psychotic disorders (e.g., hallucinations and delusions) can be alleviated with proper treatment, most patients are left with social and functional limitations. Negative symptoms, cognitive impairment and insight deficits represent key therapeutic targets given their strong predictive power of psychotic conversion and relapse, and their robust association with functioning. These three dimensions still represent unmet therapeutic needs and efforts must be pursued to develop more efficient treatments. The heterogeneous and changing nature of the illness represents a significant barrier to improve current treatments. One source of such variation has to do with the different stages of the illness. According to the clinical staging model, psychotic disorders most often present first during the ultra high-risk stage (UHR) as attenuated symptoms, such as vague perceptual abnormalities. These sub-threshold symptoms later evolve into full-blown symptoms, including hallucinations, during the first-episode of psychosis (FEP) stage. After a period of psychotic symptom remission, a significant proportion of patients will experience a psychotic relapse, characterizing the multiple-episode of psychosis (MEP) stage. Studies comparing the different stages of the psychosis continuum are scarce and filling such a gap in the literature could help developing stage-adapted interventions. Objectives: This thesis globally set out to explore the heterogeneous and changing nature of psychosis. To do so, patients in the different stages of the psychosis continuum were compared on the aforementioned key clinical dimensions. Specific research questions that had a high translational potential for care were elaborated for each of the three studies comprised in this thesis. Study 1 aimed to estimate the prevalence of negative symptoms across the psychosis continuum. The objective of study 2 was to compare cognitive clusters across FEP and MEP patients to determine whether cognitive heterogeneity was comparable across stages. Finally, the goal of study 3 was to verify whether stage of illness moderates the association between cognitive capacity and insight into symptoms. Methods: In the first study, we reviewed the literature to compare the prevalence of each negative symptom across illness stages. For the second and third studies, we analyzed the data of FEP and MEP patients. In study 2, we used cluster analysis, while in study 3, we used structural equation modeling and moderated multiple regression analysis. Interpreted results: Forty-seven articles were included in study 1 and our analyses showed that the prevalence of negative symptoms decreased between the UHR and FEP stages to subsequently increase in the later stage. This indicates that negative symptoms are already present in the early stages and that they are most prevalent in the MEP stage. Results of study 2 revealed that cognitive heterogeneity was similar in FEP and MEP patients, with some patients presenting normal cognitive… Advisors/Committee Members: Martin Lepage (Supervisor).

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Asian immigrant LGBTQ+ youth hold multiple marginalized identities. Though literature specific to their experiences is sparse, disparate veins of research suggest that these youth may contend with a variety of challenges, with negative consequences for their mental health and wellbeing. As previous research with immigrants, visible minorities, and LGBTQ+ youth suggests that each group encounters distinct issues in using mental health and social services, it is possible that Asian immigrant LGBTQ+ youth may face all of these barriers simultaneously, and that these barriers may intersect to shape a novel experience within such services. The contemporary knowledge gap with regards to this group is particularly worrisome in Canada: statistics indicate that large populations of Asian immigrants reside in the three most populated cities and, considering baseline rates of non-heterosexuality and transgender identities, it is likely that the needs of many Asian immigrant LGBTQ+ youth in these cities are not being adequately met. To help address this knowledge gap, a qualitative study was conducted to examine the interactions between their identities and explore their experiences within mental health and social support services. Semi-structured interviews were completed in Montreal with 10 young adults identifying with the group in question and six service providers that provide services relevant to these youth. Interviews were transcribed and thematically analyzed. Results illustrate that on the one hand, Asian immigrant LGBTQ+ youth negotiate challenges with their family related to their sexual and/or gender identity, suffer alienation in various domains of their lives, and use a variety of coping strategies to deal with these experiences. On the other hand, they also expressed appreciation for the positive aspects of their lives. Service providers and young adults identified a number of weaknesses and possible improvements in mental health and social support services in relation to serving Asian immigrant LGBTQ+ youth. Obtaining ethical approval for this study shed light on issues that may hamper research with racialized LGBTQ+ youth. These issues are explored in a second article by contextualizing them in the history of ethical review processes and discussing the dilemmas faced in the process of conducting this study with Asian immigrant LGBTQ+ youth. Finally, avenues of change are explored to promote research with racialized LGBTQ+ youth.

Les jeunes immigrants asiatiques LGBTQ+ se retrouvent marginalisés d'un point de vue identitaire de multiples façons. Bien que la littérature qui traite spécifiquement de leur expérience soit limitée, différents courant de recherche suggèrent que ces jeunes doivent faire face à une diversité de défis, ayant des conséquences négatives sur leur santé mentale et leur bien-être. Tout comme les recherches antérieures au sujet des immigrants, des minorités visibles, et des jeunes LGBTQ+ suggèrent que chacun de ces groupes rencontre divers enjeux quant à l'utilisation des services sociaux…

Advisors/Committee Members: Lucie Nadeau (Internal/Supervisor), Srividya Iyer (Internal/Cosupervisor2).

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AbstractThis thesis explores the complexity of the emotional, psychological and cognitive processes of an expressive writing intervention experienced by adolescents in a school-based setting. More specifically, the primary objective is to evaluate the journals written by participating adolescents for evidence of recurring theories proposed in the literature to explain why and how expressive writing works. This study aimed to answer two key questions: What are the emotional, psychological and cognitive processes of expressive writing, and how are these processes reflected in the students' journals during the expressive writing intervention? The expressive writing intervention proceeded for four weeks, and data was generated through randomized collection of student journals. Data analysis combines both methods of thematic inductive and conceptual deductive analysis for understanding the student journals and consisted of exploring each journal for evidence of 8 theories that could explain the underlying mechanisms of how expressive writing may operate to impact adolescents. The results from the conceptual deductive analysis find that 3 of the 5 theories proposed in the literature as suspected underlying mechanisms appeared in the student journals with the following results: emotion regulation/self-regulation theory was the strongest; empowerment theory being the second strongest theory, coping theory the third strongest; and cognitive processing the fourth strongest and well-being theory being the fifth. Also, thematic inductive analysis showed that the three most common themes emerging from the journals were the students' abilities to: 1) have a healthier outlook/more positive perception; 2) apply the intervention teachings in other contexts; and 3) think about how their story can impact others after they had completed the expressive writing intervention. In conclusion these findings support the idea that cognitive processing, emotion/self-regulation and coping theories- all suggested in the literature- as well as empowerment and well-being theories -proposed by the author of this study- may be important underlying mechanisms that help explain how expressive writing impacts adolescents' mental states. Furthermore, the study concludes that even though evidence for emotional disinhibition, exposure/habituation and constructivism theories did not appear in the analysis, this lack of finding is more likely an artifact of the experimental methodology rather than evidence that these theories are not relevant theories. Keywords: Qualitative, expressive writing, adolescents, school, mental health, emotional disclosure, journals, intervention.

RésuméCette thèse examine les processus émotionnels, psychologiques et cognitifs complexes d'une intervention d'expression écrite (EC) dont des adolescents font l'expérience dans un cadre scolaire. Plus spécifiquement, son objectif premier est l'évaluation de journaux à la recherche d'éléments d'hypothèses récurrentes avancées dans la littérature pour expliquer le pourquoi et le…

Advisors/Committee Members: Danielle Groleau (Internal/Supervisor).

▼ Objective: The objective of this study was to see if an informational intervention specifically designed for parents to increase knowledge, dispel misconceptions and reduce concerns about medications for ADHD would increase their children’s compliance with medication treatment plans. We hypothesized that an information intervention specific to ADHD medication would increase children’s adherence to medication, and would increase parental knowledge of ADHD and ADHD medications over a 4-month period when compared to an information intervention consisting of general information about ADHD. Methods: The sample consisted of 31 parents of children who meet the DSM-IV and DSM-5 diagnostic criteria for ADHD and who were currently on or about to start medication to treat ADHD. These participants were recruited from the Montreal Children’s Hospital’s Psychiatric and Pediatric ADHD Outpatient Clinics (n=10), as well as the Sainte-Justine Developmental Clinic (n=13), and by referrals from community doctors and psychologists (n=8). The children ranged in age from 5 to 12 years old. Participants were randomly assigned into either the Medication-Specific Information group or the ADHD General information group. The Medication-Specific intervention consisted of a 14-minute video that described ADHD medication, its efficacy, side effects, and how to manage side effects. The ADHD General group consisted of a 11-minute video that described ADHD in general, without information specific to medication. The Attitudes, Satisfaction, Knowledge and Medication Experiences (ASK-ME) was be used to measure changes in parental knowledge, misconceptions and concerns about medication. Pill counts and weekly medication logs were used to measure adherence with medication treatment plans over a 4-month period. Results: No significant effect of the Medication-Specific intervention was found on parents’ attitudes or knowledge towards ADHD, or their children’s medication adherence throughout the four-month follow-up period. For some analyses, current data was pooled with pilot data and increased the sample size to 55. As a result, participants’ attitudes towards ADHD medication became more positive immediately at post-intervention for those in the Medication-Specific group only. However, knowledge was not effected when data was pooled. Conclusion: Adherence rates in the current study were quite high, being 96.88% and 94.64% in the Medication-Specific group and ADHD General group, respectively, when compared to the rates most often reported in the literature, ranging from 15-85%. This is possibly due to the fact that most (23 of 31) of the participants in the current study were recruited from major pediatric outpatient clinics of the Montreal Children’s Hospitals and Sainte-Justine Hospital, and were therefore likely to be experiencing more severe ADHD symptomology. The lack of an effect of the Medication-Specific intervention on parents’ knowledge and attitudes, and children’s medication adherence, may be due to the small sample size. This is suggested… Advisors/Committee Members: Lily T Hechtman (Internal/Supervisor).

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Background: Individuals with mental health problems have many support needs that are often inadequately met. Youth with first-episode psychosis (FEP) represent a group with particularly great needs for support. While various parties are currently involved in supporting persons with mental health problems, perceptions of who should be responsible for meeting the various needs of these individuals remain unexplored. This is an important knowledge gap, as varying perceptions among different stakeholders could be the cause of unmet needs for support. Objectives: The objectives of the following studies were (1) to discover what is known about perceptions of locus of responsibility for supporting individuals with mental health problems, what factors shape these perceptions, and how these factors relate to one another; and (2) to explore various key stakeholders' perceptions of who should be responsible for supporting individuals with mental health problems. Methods: A critical literature review was conducted, in which the conceptual contributions and limitations of relevant works were critically evaluated and a concept map was created. A qualitative descriptive study was then undertaken. Focus groups were conducted with FEP patients, their families, and treatment providers and individual interviews were conducted with mental health policy/decision makers. Transcripts were analyzed thematically. Results: The critical review identified salient concepts from literature on public attitudes towards the welfare state and views of individual versus governmental responsibility for need provision and health; the morality of caring; and attributions of responsibility for mental illness. A conceptual framework was built from these findings. The qualitative study revealed that individuals with mental health problems themselves; stakeholders in the immediate and extended social networks of these individuals; macro-level stakeholders with influence; and society as a whole were perceived to have a wide range of responsibilities for supporting persons with mental health problems. Themes relating to the structure and nature of roles and responsibilities were also identified. Discussion: The critical review and resulting concept map have shed light on the different factors that may shape perceptions about locus of responsibility for supporting individuals with mental health problems, while the qualitative study has revealed that key stakeholders ascribe a wide range of roles and responsibilities to various parties. Together, these studies fill a large knowledge gap about perceptions of who should be responsible for supporting individuals with mental health problems, and the findings have significant implications for mental health practices, policies, and research.

Contexte: Les personnes ayant des problèmes de santé mentale ont de nombreux besoins de support qui sont souvent remplis de manière inadéquate. Les jeunes avec un premier épisode psychotique (PEP) représentent un groupe avec des besoins particulièrement grands de soutien. Bien…

Advisors/Committee Members: Ashok Malla (Internal/Supervisor), Srividya Iyer (Internal/Cosupervisor2).

▼ Geriatric psychiatry populations present high prevalence and re-admission rates of depression and anxiety disorders, report subjective cognitive complaints that often precedes the onset of cognitive decline and are in gross need of service assessment. Evaluation of Mental Health services places important attention to the assessment of patient's perspectives, especially as treatment outcome studies typically assess clinician ratings rather than patient ratings. Pre-post measures of changes in depression (GDS), anxiety (BAI), well-being (GWBS) and self-assessments of recovery (RAS) were collected in a sample of 34 older adults (age = 71.32±6.46 years) participating on an ongoing psycho-educational program. Post -testing data included perceived improvement (PIQ) rated by patients and clinicians, and clinician assessment on depressive symptoms (CS-GDS). The first study examined the association between patient's perceived improvement and patient and clinician ratings on symptomatology. First, relationships between patient's perceived improvement and symptomatic change were studied. Second, patient's perceived improvement and post-measures of depression measured by patients and clinicians were also examined. Results indicate that while pre-post patient assessments on depressive symptomatology are associated to patient's perception of improvement, assessments on changes of anxiety and well-being are not. Moreover, patient and clinician ratings on depression symptoms post-treatment were associated to perceived improvement. In this context, patients report stronger associations. Interestingly, components of perceived improvement that assess aspects of social relations are associated to patient assessments of depression symptoms but not to clinician assessments. It appears that differences between patient and clinician ratings emerge as they place attention to different aspects of treatment outcome. In light with this, the second study explored associations between patient changes in recovery and patient and clinician assessments on perceived improvement, as aspects other than symptomatology change are considered relevant to the assessment of treatment outcome. Despite recovery improvements are observed, patient assessments are not associated while examining recovery change and perceived improvement. Clinician assessments implied that patient improvement declines as recovery changes increase. Results from both studies imply patient and clinician differences on what they consider important within the assessment of treatment outcome. First, patient results on symptomatology change may be subject to their representation of illness, whereas longitudinal effects of treatment duration and service settings may have hindered recovery changes. Second, clinician assessments on symptomatology change may have been influenced by their tendency to focus on the assessment of depression symptomatology, whereas in the context of recovery, clinicians may differ in their perceptions of patient's improvement due to their own expectations. Future… Advisors/Committee Members: Michel Perreault (Internal/Supervisor).

▼ Background: Depression accounts for more years lived with disability than any other medical condition. Routine screening for depression has been recommended to improve access to depression care. However, a previous study from 2011 found that a large proportion of the diagnostic accuracy of depression screening studies have been conducted in samples that inappropriately include patients currently diagnosed or being treated for depression. These findings from primary studies suggest that estimates of the diagnostic test accuracy of depression screening tools may be exaggerated. Similarly, concerns have been raised regarding exaggerated accuracy estimates based on meta-analyses of the diagnostic test accuracy of depression screening tools. Meta-analyses have the ability to account for biases that may be present within primary studies of diagnostic test accuracy of depression screening tools. However, the extent to which this occurs is currently unknown, thus, the objectives of the three studies in this thesis were to determine (1) the proportion of recent diagnostic test accuracy primary studies of depression screening tools that appropriately excluded patients with a current diagnosis of depression and assess if recent meta-analyses of depression screening tools noted the potential bias due to the inappropriate inclusion of these patients (study 1), (2) the quality and transparency of diagnostic test accuracy meta-analyses of depression screening tools by applying an adapted A Measurement Tool to Assess Systematic Reviews (AMSTAR) quality tool (study 2) and an adapted Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Abstracts reporting checklist to a sample of diagnostic test accuracy of depression screening tool meta-analyses (study 3). Methods: To gather recent primary studies of diagnostic accuracy of depression screening tools we searched the PubMed online database from January 1, 2013 through March 27, 2015. We determined the proportion of these studies that accurately excluded patients with a current diagnosis of depression or were being treated for depression. To obtain recent diagnostic test accuracy meta-analyses of depression screening tools, we searched PubMed and PsycINFO from January 1, 2011 through October 31, 2014 and assessed if meta-analyses mentioned potential bias of inappropriate samples. Next, we obtained all meta-analyses published in PubMed and PsycINFO between January 1, 2005 through October 31, 2014. We evaluated 1) the quality of meta-analyses using an adapted AMSTAR and 2) the transparency of abstract reporting using an adapted PRISMA for Abstract tools.Results: Only 5 of the 90 (5.6%) primary studies specifically excluded already diagnosed or treated patients, while none of 5 eligible meta-analyses commented on the possible bias from including primary studies that used inappropriate samples. The quality of 16 meta-analyses were evaluated using an adapted AMSTAR tool, where five of 14 AMSTAR items were fulfilled by at least half of the meta-analyses. Two of the 16… Advisors/Committee Members: Brett David Thombs (Internal/Supervisor).

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Empirical evidence in research on posttraumatic stress disorder (PTSD) within representative populations in Canada remains sparse. The goal of this dissertation was to comprehensively study, replicate, and extend existing findings of rates of trauma and PTSD, quality of life and neighbourhood environment, and importantly, examine their association over time. Data were drawn from the Zone d'étude en épidémiologie sociale et psychiatrique du sud-ouest de Montréal (ZEPSOM) project, Canada's only ongoing social and psychiatric epidemiology catchment area. Based in Southwest Montreal, ZEPSOM'S use of a large, representative, general population provided an opportune environment to carry out the research included in this dissertation. The first study assessed differences in reported trauma exposure and rates of PTSD using single-question and list-based trauma assessments. Findings indicated increases in reported trauma exposure rates from the single-question to list-based assessment and differences were more pronounced in women and in younger participants. Furthermore, list-based assessment identified few additional current cases of PTSD, leading to a discussion of the implications of using different assessment measures within both clinical and epidemiological research. The second study examined how individuals across the full trauma spectrum perceived their neighbourhood environment. Results revealed that neighbourhood disorder was associated with increased trauma exposure and lifetime PTSD. Perceived neighbourhood social cohesion was indirectly associated with trauma exposure through neighbourhood disorder. Neighbourhood social cohesion was also directly associated with lower odds of having current PTSD and higher odds of being in remission. Results highlight the need to better understand how neighbourhood contexts are linked to an individual's trauma exposure, risk of, and resilience for, PTSD. Finally, the third study entailed a longitudinal analysis of global and specific domains of quality of life in relation to trauma and PTSD. Results confirmed that trauma and PTSD diagnosis demonstrate significant, lasting effects on an individual's global as well as specific domains of quality of life. This thesis broadens current knowledge of PTSD, trauma assessment methods, perceived neighbourhood context, and longitudinal effects on quality of life through replicating and expanding previous findings both longitudinally and in breadth. Importantly, by drawing from the ZEPSOM dataset, this thesis lends significant strength to the generalizability of our reported findings, overcoming an enduring limitation in previous trauma literature.

Les données empiriques portant sur l'état de stress post-traumatique (ÉSPT) recueillies auprès de populations canadiennes représentatives sont rares. L'objectif de cette thèse est d'étudier, de répliquer et d'accroître les connaissances existantes quant aux taux d'exposition à un traumatisme et aux taux d' ÉSPT, à la qualité de vie et à l'environnement du quartier ainsi que d'examiner leur…

Advisors/Committee Members: Alain Brunet (Supervisor).

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Following immigration and trauma experiences, memory, adjustment, and personal transformation prove to be complex processes across the lifespan. The overall aim of this thesis is to examine how elderly Polish individuals who experienced childhood trauma reflect on their lives and remember both their life experiences and their migration trajectories. During WWII, after having been exiled from their homes at the onset of war to Soviet labour camps (gulags), Polish children and youth spent several years in international refugee camps beginning in 1942 before settling, often very successfully, in Canada or New Zealand. The first study focuses on the individual and collective memories of those who were in African refugee camps (the "Africans", or "Afrykanczycy"), through the content analysis of individual interviews (N=10) and collective reunion materials, respectively. Individual memories reveal a diversity of lived experiences in the camps, while the collective memories emphasize timeless friendships in an idealized past. The second study looks to the publicly available testimonials (N=51) of those who were New Zealand's first refugees. Evidence of posttraumatic growth presents itself as changes in relationships and changes in self, in the context of a welcoming and supportive society. Taken together, these studies of a common trauma and migration experience, as expressed through various lenses, provide representations of subjective experiences and recollections in late life, which is helpful for understanding the resiliency process. They inform our understanding of memory processes following migration and trauma, the use of qualitative life trajectory research as a tool for longitudinal studies, and what may help or hinder well-being across the lifespan.

La mémoire et divers processus d'adaptation sont au cœur de la transformation personnelle qui prend place tout au long de la vie, suite à une expérience d'immigration et à un vécu traumatique. L'objectif général de cette thèse est d'examiner comment des individus polonais âgés, ayant vécu un traumatisme durant l'enfance, réfléchissent et se souviennent de leur vie et de leur trajectoire de migration. Pendant la Seconde Guerre mondiale, après avoir été exilés et placés dans des camps soviétiques de travail (les goulags), un grand nombre d'enfants polonais ont passé plusieurs années dans des camps de réfugiés internationaux. Ils ont par la suite immigré au Canada ou en Nouvelle-Zélande. Cette thèse est composée de deux études portant sur les adultes qu'ils sont devenus. Une première porte sur les mémoires individuelles et collectives de ceux qui étaient dans les camps de réfugiés africains (les «Africains», ou «Afrykanczycy»). Une analyse de contenu des entrevues individuelles (N=10) et des matériaux des réunions collectives a été effectuée. Le contenu des mémoires individuelles illustre la diversité d'expériences vécues dans les camps, tandis que les mémoires collectives mettent l'accent sur des amitiés éternelles et un passé idéalisé. Une deuxième étude examine les…

Advisors/Committee Members: Cecile Rousseau (Internal/Supervisor).

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Existentialism offers a perspectival stance that reorients the inquiry of any discipline, be it philosophy, psychology, or neuroscience, from the abstract and theoretical to the direct and immediate concerns most central and proximal to human beings. Unique among these concerns is the inevitability of one's own death, which is always a pressing possibility that threatens to eliminate the all other possibilities for one's life. In the present manuscript, we conducted an Activation Likelihood Estimation (ALE) meta- analysis of the functional neuroimaging literature investigating the processing of linguistic stimuli relevant to death (i.e., mortality salience). Several of these studies have taken the name "Existential Neuroscience". We hoped that ALE analysis would offer a means to mediate the ongoing debate over whether mortality salience was a unique threat in the sense of involving a unique neurobiological signature. We supplemented ALE with seed-based intrinsic connectivity network analysis and computation of posterior probability of psychological functions associated with the peak coordinates of significant ALE clusters. Our results suggest that deactivation of the bilateral posterior insula is an important signature of existential threat over and above other kinds of threat (e.g., negative affect). Furthermore, these brain regions are members of the brain's salience network and are associated with a collection of psychological processes that fall under the rubric of interoceptive processing. We propose that an existential neuroscience does not reduce existential concerns to mere variations in neural activity, but could harness insights garnered through neuroscience in order to improve our understanding of the embodied mechanisms underlying existential threat and investigate candidate interventions to protect against the harmful consequences of existential terror.

L'existentialisme offre une perspective qui réoriente la recherche de toute discipline, que ce soit la philosophie, la psychologie, ou les neurosciences, de l'abstrait et du théorique, vers les préoccupations directes et immédiates les plus centrales et proximales aux êtres humains. Parmi ces préoccupations, l'inéluctabilité de sa propre mort est particulièrement unique, car elle représente toujours une possibilité pressante qui menace d'éliminer les toutes les autres possibilités de sa propre vie. Dans ce présent manuscrit, nous avons mené à partir de l'« Estimation de Probabilité d'Activation » (en anglais Activation Likelihood Estimation, ALE) une méta-analyse de la littérature de la neuro-imagerie fonctionnelle enquêtant sur le traitement des stimuli linguistiques pertinents à la mort (saillance de la mortalité). Plusieurs de ces études ont pris le nom de «Neuroscience existentielle». Nous espérions que l'analyse ALE apporterait des éléments au débat en cours pour déterminer si la saillance de la mortalité est une menace unique, dans le sens où elle implique une signature neurobiologique unique. Nous avons complété…

Advisors/Committee Members: N P Vasavan Nair (Internal/Supervisor), Pedro Rosa (Internal/Cosupervisor2).

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Radial glia are elongated non-neuronal cells in the nervous system. They were first recognized to act as migrational scaffolds for neuroblasts. With the deepening understanding that glial cells are not passive but engaged in multilevel communication with neurons and other components of the nervous system, new functions were revealed for radial glia. Radial glia and radial glia-like cells act as progenitors for multiple cell types, form transient axo-glial synapses, guide axons and dendrites, wrap synapses and probably perform many other functions yet to be discovered. It is also likely that radial glia have similar or overlapping duties with astrocytes, especially in organisms like Xenopus laevis that do not seem to have astrocytes. Data from the Ruthazer lab has revealed that radial glia in the developing Xenopus laevis optic tectum sense excitatory neural activity and respond to it with increased motility of their filopodial processes. We aimed to better understand the mechanisms and functions for these glial dynamics. Using the techniques of tectal electroporation of DNA constructs and in vivo time-lapse imaging of the cellular interactions in the brain, we determined that cGMP and cGMP-dependent protein kinase PKG1 are implicated in translating neural NMDA receptor activity levels to glial filopodia motility. We also noticed that antagonizing mGluR5 receptor has a small effect on the filopodial motility. We manipulated glial filopodial behaviour by overexpression of modified small GTPases in glia and investigated the effects on neighboring tectal excitatory neurons by patch-clamp electrophysiology measurements. In the case of glial expression of constitutively active RhoA, glial filopodia retracted severely and both frequency and amplitude of mEPSCs were decreased. Interestingly, when expressing another small GTPase - dominant negative Rac - glial filopodia were retained but moved less, and only mEPSC frequency but not amplitude was affected in nearby neurons. This indicates that not just the mere presence of the glial filopodia but also their motility is critical for normal excitatory neuron development.

Les cellules de la glie radiale sont des cellules allongées non neuronales du système nerveux. Elles ont d'abord été reconnues comme agissant à l'instar d'échafaudages pour la migration des neuroblastes. Avec l'approfondissement de la compréhension que les cellules gliales ne sont pas passives, mais engagées dans une communication à multiples niveaux avec les neurones et d'autres composants du système nerveux, de nouvelles fonctions ont été révélées pour la glie radiale. Glie radiale et cellules ressemblant aux cellules gliales radiales agissent comme des progéniteurs pour plusieurs types de cellules, forment des synapses transitoires axo-gliales, guident les axones et les dendrites, enveloppent les synapses et effectuent probablement de nombreuses autres fonctions encore à découvrir. Il est également probable que la glie radiale a des fonctions similaires ou chevauchantes avec les astrocytes, en particulier…

Advisors/Committee Members: Edward Ruthazer (Supervisor).

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A significant number of post-secondary students who struggle with mental health problems elect not to seek professional help. Increasing mental health literacy has been proposed as a method to potentially facilitate help-seeking behaviour via enhanced problem recognition, but this assertion has yet to be examined empirically. In the present study, 165 university students were recruited to take part in an online mental health study. Participants were randomly assigned to either a stigma reduction or mental health literacy condition. In addition, half of the participants within each group were assigned to complete a mental health symptom self-assessment. Pre-intervention data on symptomatology, barriers to treatment, and attitudes about mental health were collected pre- and post- intervention. Overall, students reported generally low levels of stigma about mental health and positive beliefs about treatment efficacy. However, participants reported a number of treatment barriers including: questioning the seriousness of their symptoms and a desire to handle the problem on their own. Post-intervention analysis found that those participants with an untreated mental illness reported significantly poorer attitudes about seeking treatment compared to those who were treated. Amongst untreated participants, the mental health literacy condition, but not stigma reduction condition increased positive attitudes about seeking mental health services. In addition, support was found for an explanatory model such that those in the mental health literacy condition with an affirmative mental health self-assessment reported increased problem identification, which in turn, was positively associated with greater help-seeking attitudes and intentions. These results add to the evidence that mental health literacy should be considered a critical barrier to help-seeking amongst post-secondary students, at least for those with low levels of stigma.

Un nombre important d'étudiants universitaires, particulièrement ceux avec une présentation atypique, n'ont pas recours aux services d'aide de santé mentale. Même si une connaissance accrue de ce sujet aurait pu mener à une augmentation du nombre de consultation, la preuve empirique de cette assertion manquait. Cette étude a recruté 165 étudiants pour un sondage internet sur la santé mentale. Les participants ont été randomisés soi à une intervention de déstigmatisation soi à une intervention centrée sur l'enseignement. De plus, la moitié des participants dans chaque groupe ont rempli une auto-évaluation complète sur leur santé mentale. Les données relatives à leur symptomatologie, leur attitude et les obstacles perçus comme allant à l'encontre d'une recherche d'aide ont été récupérées avant et après l'intervention. En somme, les participants signalaient peu de préjugés envers les stigmas de la santé mentale et une opinion positive quant à l'efficacité des traitements disponibles. Par contre, les participants signalaient plusieurs obstacles quant à la recherche à l'aide, tels que des doutes quant à…

Advisors/Committee Members: Nancy Low (Supervisor).

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A central question for any publically subsidized healthcare system is the extent to which non-citizens should be granted access. Refugee claimants, by definition, are not yet citizens of the host state and a continued debate is over what legitimate claims they have on social resources like healthcare vis-à-vis citizens. In Canada, the question of what extent refugees and refugee claimants should have access to healthcare was contested publically in the wake of cuts to the Interim Federal Health Program (IFHP). For over 50 years the Canadian government provided relatively comprehensive health insurance coverage to refugees and refugee claimants through the IFHP. The federal Conservative government (February 2006 – November 2015) significantly reduced the scope of this health coverage on June 30, 2012. The present thesis research was conducted in the province of Quebec and responds to two related topics – the framing of refugee claimants in the media, and the understanding and experiences of claimants in regards to the healthcare access barriers that they faced. A first paper analyses the debate that ensued following the IFHP cuts, one that the pitted the Conservative government's framing of refugee claimants as 'bogus' against health provider advocates' framing of claimants as 'victims'. While the victim frame arguably "won", the language of advocates could be much enriched by incorporating rights-based arguments. This would lessen some of the negative ramifications of victim framing. In a second paper, refugee claimants' subjective experiences of the healthcare services are examined. Claimants reported experiencing a number of impacts of barriers, including to their physical, mental, and financial wellbeing, and to their sense of belonging in Canada. Results suggest that although there are actual limitations in health coverage, as well as confusion and prejudices from providers, it is noteworthy that claimants' understanding of their own situation has its own consequences, for instance diminished health-seeking.

Une question centrale pour tout système de soins de santé subventionné publiquement porte sur l'étendue des soins auxquels les personnes qui ne sont pas citoyennes doivent avoir accès. Les demandeurs du statut de réfugié, par définition, ne sont pas encore citoyens du pays d'accueil, et un débat persiste à propos de la légitimité de leurs revendications faces à des ressources sociales, telles que les soins de santé, par rapport aux citoyens. Au Canada, la question de l'accès à des soins de santé pour les réfugiés et les demandeurs d'asile a soulevé des contestations publiques suite aux coupes effectuées dans le Programme fédéral de santé intérimaire (PFSI). Depuis plus de 50 ans, le gouvernement canadien a fourni une couverture d'assurance-maladie relativement complète aux réfugiés et aux demandeurs d'asile par le biais du PFSI. Le 30 juin 2012, le gouvernement conservateur (février 2006 – novembre 2015) a diminué de façon substantielle l'étendue de cette couverture. Cette présente thèse de recherche a été…

Advisors/Committee Members: Cecile Rousseau (Internal/Supervisor), Monica Ruiz Casares Yebenes (Internal/Cosupervisor2).

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Background: There is mounting evidence to suggest that exposure to stress during critical periods of development may increase one's susceptibility to disease risk, including depression. Perinatal depression (PD) may not only be associated with adverse outcomes among the mothers experiencing it, but also for the children exposed to PD, via epigenetic programming. We sought to investigate how PD may be associated with certain epigenetic profiles among mother and child dyads. Specifically, we focused on the oxytocin receptor (OXTR) gene due to oxytocin's role in maternal behavior and stress regulation. It is hypothesized that increased OXTR methylation will be observed for those mothers who experience PD and among those children exposed to PD. Methods: Using longitudinal data from a cohort of mothers and their infants, we collected information about the mothers' depressive symptomology across 5 time points (twice during pregnancy and three times during the postpartum period). Depressive symptomology was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and four groups were established based on EPDS cut-off scores: no PD, prenatal or postpartum depression only and persistent PD (depression both prenatally and postpartum). DNA methylation was assessed using saliva obtained from both mother and child at the last time point – 2.9 years postpartum, for which the OXTR gene was interrogated for methylation patterns. Results: Those mothers with persistent PD had significantly higher OXTR methylation overall compared to the other groups. Specifically, 9 of the 22 CpG sites interrogated were significantly higher for the persistent PD group. However, average OXTR methylation among those children who were exposed to their mothers' persistent PD were not significantly different when compared to the other groups, with none of the 22 sites investigated within the exon 3 region showing significantly different methylation patterns. Discussion: For mothers, only persistent PD was associated with significantly higher OXTR methylation suggesting that more transient episodes of depression may not impact the epigenome to the same degree. The children's methylation profiles were not consistently associated with their mothers' depression. Given the link found between persistent PD and OXTR methylation among mothers, the combined psychological and epigenetic risk may have implications for the oxytocin system as well as compromise maternal behavior which may result in negative outcomes for the developing child.

Contexte: Il existe des preuves qui suggèrent que l'exposition au stress pendant les périodes critiques du développement peut augmenter la sensibilité au maladie, y compris la dépression. La dépression périnatale (DP) peut être associée à des effets indésirables non seulement chez les mères, mais aussi chez leurs enfants exposés à la PD, via la programmation épigénétique. Nous avons cherché à étudier comment la DP peut être associée à certains profils épigénétiques entre les dyades mère-enfant. Plus précisément, nous nous…

Advisors/Committee Members: Gustavo Turecki (Internal/Cosupervisor2), Phyllis Zelkowitz (Internal/Supervisor).

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This study examines the process of understanding of patients' stories, by mental health workers, through its narrative expression in multidisciplinary case presentations discussing transcultural situations. The analysis targeted interpretation, and its mediators. Results suggest that the interpretation of the discussed case implicates three distinct layers of understanding, namely: interpersonal understanding, historical understanding, and understanding by inference to explanatory theories (scientific and cultural). These three paths of understanding engage three articulation processes with three Alterities of different natures. In the first articulation, the participant implicated in the story of the discussed case, interprets its characters as Other minds, and makes hypotheses about their sufferings, living experiences, intentions, and anticipated reactions. In the second articulation, the participant pursues the other stories intersecting with the immediate story of the discussed case (historical Otherness); these intersecting stories can belong to the discussed family context (Verstehen), or to the context of the participant, or to the "co-contexts" of the family and the participant (intertextuality). In the third articulation, the participant pursues a theoretical grounding to the discussed family dilemma; inferring the particular dilemma of the discussed family to a general culturally acknowledged theory (ideological Alterity), intends, thus, a rational-semantic understanding. Those three paths of understanding are frequently simultaneous and interdependent. The pertinence of case discussion meetings in transcultural psychiatry can be associated to the fact that narrative and conversational configurations bring about a dialogical milieu promoting the elaboration and the interaction of the three paths of understanding.

Cette étude examine la compréhension des histoires des patients par les intervenants en santé mentale, au travers de la narration de celles-ci dans les réunions multidisciplinaires de présentation de cas portant sur des situations transculturelles. L'analyse a porté sur l'interprétation et ses médiateurs. Les résultats suggèrent que l'interprétation des histoires de cas dans ces réunions implique trois couches de compréhensions distinctes, à savoir: la compréhension interpersonnelle, la compréhension historique et la compréhension par inférences aux théories explicatives (scientifiques et culturelles). Ces trois voies de compréhension engagent trois processus d'articulations avec des Altérités de natures différentes. Dans la première articulation, le participant impliqué dans l'histoire interprète les personnages de l'histoire comme d'Autres esprits; à travers une simulation de leurs vécus dans son imaginaire, il essaie d'atteindre des postulats sur leurs affections, intentions, et réactions anticipées. Dans la deuxième articulation le participant poursuit les autres histoires entrecroisant l'histoire immédiate discutée (Altérité historique); il peut s'agir d'articulation avec des histoires…

Advisors/Committee Members: Cecile Rousseau (Internal/Supervisor).

▼ Background: Peer-led programs have been implemented in a variety of areas, particularly in addiction, mental health, and HIV/AIDS. Research on peer-helpers in these domains has documented numerous psychological benefits associated with the peer-helper role. Specifically, peer-helpers have reported benefits such as increased self-esteem, self-confidence, sense of responsibility, building or improving relationships, having a sense of giving back, hope for the future, and reducing drug use. While these results have been found in the areas of addiction, mental health, and HIV/AIDS, little is known about the peer-helper role in the area of overdose prevention programs. Take-home naloxone programs (THN) represent harm reduction programs with the aim of reducing the number of deaths caused by opioid overdose. Naloxone kits and training on naloxone administration through injection are provided to opioid drug users. Problem: The present problem is that there is a knowledge gap in the literature concerning the benefits and challenges associated with a peer role in overdose prevention research. A THN program, known as PROFAN (prevention and reduction of overdoses - training on, and access to, naloxone) in Montreal has implemented the use of peers training peers, also called peer-trainers. This involves first training drug users in overdose prevention, and giving them the responsibility to then deliver a training session to other users. To our knowledge, this is the first program to allow drug users to train others in overdose prevention. Therefore, the impact of this specific role of being a peer-trainer is unknown. Research Question and Objectives: The main research question guiding this thesis project is: what are the psychological impacts of being a peer-trainer in a THN program? The first manuscript in this thesis represents a literature review on the areas of addiction, overdose prevention, mental health, and HIV/AIDS to explore the experiences of peer-helpers in various domains of peer-led interventions. This review also helped to guide the development of the interview protocol, which was constructed for data collection. The theme of the second manuscript focuses on the personal impacts of being a peer-trainer, reporting on the individual qualitative interview results obtained from the six peer-trainers in the Montreal program. Method: The main objectives of the interviews were to explore peer-trainer experiences of 1) the overdose prevention training that they received, 2) their role as a trainer, and 3) the personal impact of taking on this role. In this thesis, psychological impact is operationalized as empowerment and recovery, as these are two broad themes that have been reported by studies on peer-helpers in the aforementioned areas. Results: Interview results reveal that the six peer-trainers did in fact experience benefits related to empowerment and recovery. As well, there are a number of challenges associated with their role, suggestions to improve the program for future participants, and the desire to be more… Advisors/Committee Members: Michel Perreault (Internal/Supervisor).