ror.org/04sjchr03
Abstracts
Résumé
Le trouble bipolaire est une condition chronique ayant des conséquences tangibles sur le fonctionnement et la qualité de vie des personnes atteintes. Des interventions psychologiques reconnues efficaces, comme la psychoéducation, ont le potentiel de pallier certaines lacunes observées lorsque la pharmacothérapie est utilisée comme seule modalité de traitement. Toutefois, il semble que les personnes ayant un trouble bipolaire n’ont pas facilement accès à ce type de programme fondé sur les données probantes. En effet, le transfert des connaissances acquises dans la recherche vers le milieu clinique pose un défi. Ainsi, au-delà de l’évaluation de l’efficacité des traitements en recherche, il est nécessaire de considérer l’implantation de ces traitements dans la pratique clinique. L’objectif de la présente étude est donc de décrire l’implantation d’un programme psychoéducatif pour le traitement du trouble bipolaire, le Life Goals Program (LGP), à l’intérieur de milieux cliniques québécois. Dix-sept groupes de psychoéducation basés sur le LGP ont donc été offerts à l’intérieur de milieux cliniques publics québécois. Les animateurs de ces groupes ont rempli des journaux de bord et participé à une entrevue de groupe. Des analyses de contenu ont été réalisées pour documenter la mise en place du LGP. L’analyse des données qualitatives a permis d’identifier 4 principaux domaines de facteurs qui pourraient être tributaires de la variabilité dans l’implantation : les caractéristiques des intervenants, les caractéristiques des participants, le contexte organisationnel et la facilitation. En particulier, les facteurs déterminants dans les différences observées semblent être le soutien de l’équipe de recherche, le roulement de personnel et la formation des intervenants.
Mots-clés :
- trouble bipolaire,
- psychoéducation,
- implantation,
- transfert des connaissances
Abstract
Objectives Bipolar disorder is a chronic condition which significantly impacts the functioning and quality of life of patients with the disorder. Recognized efficacious psychological interventions, such as group psychoeducation, can help better address some of the limitations observed when pharmacotherapy is used alone in the management of bipolar disorder. However, access to these evidence-based interventions seems to be limited for most patients. Indeed, the translation of knowledge acquired through research towards actual clinical settings poses a significant challenge. Assessing the implementation of these efficacious interventions in clinical practice is thus a priority. The objective of this study is to describe the implementation of a psychoeducative intervention, the Life Goals Program (LGP), for the treatment of bipolar disorder in community mental health settings in Quebec City.
Methods The LGP was implemented in three different clinical settings located in Quebec City. Fifteen healthcare service providers chosen by their respective clinical site were trained to deliver the intervention. They delivered the treatment to 73 patients with a diagnosis of bipolar disorder. Healthcare service providers filled a log book after each group session, in order to assess whether they had properly delivered the content of the program. At the end of the study, they also participated in a group interview in order to get a better understanding of their experience delivering the intervention and their appreciation of the research process.
Results Following qualitative content analysis, four main categories of factors that could influence the implementation of the intervention were identified: 1) healthcare service providers’ characteristics (academic training, clinical experience, personality, knowledge of the program, and dynamic between animators); 2) participants’ characteristics; 3) organizational context (physical and material environment, staff stability, administrative management and research requirements); and 4) facilitation (perception of research, research team support, and facilitation tools). These categories derived from data analysis coincide with those observed in the literature. The following factors seemed to have had the most impact in the differences observed between sites in the implementation of the LGP: the support offered by the research team; staff stability; and the academic training of healthcare services providers.
Conclusion Dissemination and implantation studies can not only help determine factors that are important to consider when implementing a program, but can also help improve and adapt these programs in order to increase acceptability and effectiveness in real world clinical settings.
Keywords:
- life goals program,
- implementation,
- psychoeducation,
- bipolar disorder
Appendices
Bibliographie
- American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5).
Washington, DC : American Psychiatric Publishing. 10.1176/appi.books.9780890425596 Google Scholar Search this bibliographic reference on Google Scholar
- Aubry, J.-M., Charmillot, A., Aillon, N., Bourgeois, P., Mertel, S., Nerfin, F.,… de
Andrés, R. D. (2012). Long-term impact of the life goals group therapy program for bipolar
patients. Journal of Affective Disorders, 136(3), 889-894.
10.1016/j.jad.2011.09.013 Google Scholar Search this bibliographic reference on Google Scholar
- Batista, T. A., Von
Werne Baes, C. et Juruena, M. F. (2011). Efficacy of psychoeducation in bipolar patients :
Systematic review of randomized trials. Psychology and Neuroscience, 4(3),
409-416. 10.3922/j.psns.2011.3.014 Google Scholar Search this bibliographic reference on Google Scholar
- Bauer, M.S et
McBride, L. (2001). Thérapie de groupe pour le trouble bipolaire : Une approche
structurée. Paris, France : Médecine & Hygiène.Google Scholar Search this bibliographic reference on Google Scholar
- Bauer, M.S. et McBride, L. (2003). Structured group
psychotherapy for bipolar disorder : The Life Goals Program (2nd ed.). New
York, NY : Springer. Google Scholar Search this bibliographic reference on Google Scholar
- Bauer, M. S., McBride, L.,
Williford, W. O., Glick, H., Kinosian, B., Altshuler, L., … Sajatovic, M. (2006).
Collaborative care for bipolar disorder : Part II. Impact on clinical outcome, function, and
costs. Psychiatric Services, 57(7), 937-945. 10.1176/appi.ps.57.7.937 Google Scholar Search this bibliographic reference on Google Scholar
- Becker, C. B., Stice, E., Shaw, H. et Woda, S. (2009). Use of
empirically supported interventions for psychopathology : Can the participatory approach
move us beyond the research-to-practice gap ? Behaviour Research and Therapy,
47(4), 265-74. 10.1016/j.brat.2009.02.007 Google Scholar Search this bibliographic reference on Google Scholar
- Begley, C. E., Annegers, J. F., Swann, A. C., Lewis, C., Coan, S., Schnapp, W. B. et
Bryant-Comstock, L. (2001). The lifetime cost of bipolar disorder in the US : An estimate
for new cases in 1998. PharmacoEconomics, 19(5), 483-495. Récupéré de http://www.ncbi.nlm.nih.gov/pubmed/1146530810.2165/00019053-200119050-00004 Google Scholar Search this bibliographic reference on Google Scholar
- Blais, M., et Martineau, S. (2006). L’analyse inductive générale : description d’une
démarche visant à donner un sens à des données brutes. Recherches qualitatives, 26
(2), 1-18. Récupéré de http://revue.recherche-qualitative.qc.ca/edition_reguliere/numero26(2)/blais_et_martineau_final2.pdfGoogle Scholar Search this bibliographic reference on Google Scholar
- Bond, K. et Anderson, I. M. (2015). Psychoeducation for
relapse prevention in bipolar disorder : A systematic review of efficacy in randomized
controlled trials. Bipolar Disorders, 17(4), 349-362.
10.1111/bdi.12287 Google Scholar Search this bibliographic reference on Google Scholar
- Bryant-Comstock, L., Stender, M.
et Devercelli, G. (2002). Health care utilization and costs among privately insured patients
with bipolar I disorder. Bipolar Disorders, 4(6), 398-405.
10.1034/j.1399-5618.2002.01148.x Google Scholar Search this bibliographic reference on Google Scholar
- Colom, F. et
Vieta, E. (2006). Psychoeducation manual for bipolar disorder. New York, NY :
University Press.10.1017/CBO9780511543685 Google Scholar Search this bibliographic reference on Google Scholar
- Colom, F., Vieta, E., Reinares, M.,
Martínez-Arán, A., Torrent, C., Goikolea, J. M. et Gastó, C. (2003). Psychoeducation
efficacy in bipolar disorders : Beyond compliance enhancement. Journal of Clinical
Psychiatry, 64(9), 1101-1105. 10.4088/JCP.v64n0917 Google Scholar Search this bibliographic reference on Google Scholar
- Colom, F., Vieta, E., Sánchez-Moreno, J., Martínez-Arán, A.,
Reinares, M., Goikolea, J. M. et Scott, J. (2005). Stabilizing the stabilizer : Group
psychoeducation enhances the stability of serum lithium levels. Bipolar Disorders,
7, 32-36. 10.1111/j.1399-5618.2005.00249.x Google Scholar Search this bibliographic reference on Google Scholar
- Colom, F., Vieta, E., Sánchez-Moreno, J., Martínez-Arán, A.,
Torrent, C., Reinares, M., … Comes, M. (2004). Psychoeducation in bipolar patients with
comorbid personality disorders. Bipolar Disorders, 6(4), 294-298.
doi:10.1111/j.1399-5618. 2004.00127.xGoogle Scholar Search this bibliographic reference on Google Scholar
- Coulthard, K.,
Patel, D., Brizzolara, C., Morriss, R. et Watson, S. (2013). A feasibility study of expert
patient and community mental health team led bipolar psychoeducation groups : Implementing
an evidence based practice. BMC psychiatry, 13(1), 301.
10.1186/1471-244X-13-301 Google Scholar Search this bibliographic reference on Google Scholar
- Damschroder, L. J., Aron,
D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A. et Lowery, J. C. (2009). Fostering
implementation of health services research findings into practice : A consolidated framework
for advancing implementation science. Implementation Science, 4(50),
40-55. 10.1186/1748-5908-4-50 Google Scholar Search this bibliographic reference on Google Scholar
- De Andrés, R. D.,
Aillon, N., Bardiot, M.-C., Bourgeois, P., Mertel, S., Nerfin, F.,… Aubry, J.-M. (2006).
Impact of the life goals group therapy program for bipolar patients : An open study.
Journal of Affective Disorders, 93(1-3), 253-257. 10.1016/j.jad.2006.03.014 Google Scholar Search this bibliographic reference on Google Scholar
- Marchand, E., Stice, E., Rohde, P. et Becker, C. B.
(2011). Moving from efficacy to effectiveness trials in prevention research. Behaviour
Research and Therapy, 49(1), 32-41. 10.1016/j.brat.2010.10.008 Google Scholar Search this bibliographic reference on Google Scholar
- McHugh, R. K. et Barlow, D. H. (2010). The dissemination and
implementation of evidence-based psychological treatments. A review of current efforts.
The American Psychologist, 65(2), 73-84. 10.1037/a0018121 Google Scholar Search this bibliographic reference on Google Scholar
- McHugh, R. K. et Barlow, D. H. (2012). Dissemination and
implementation of evidence-based psychological interventions. Oxford, R.-U. :
University Press.Google Scholar Search this bibliographic reference on Google Scholar
- Meyers, D. C., Durlak, J. A. et
Wandersman, A. (2012). The quality implementation framework : A synthesis of critical steps
in the implementation process. American Journal of Community Psychology,
50(3-4), 462-480. 10.1007/s10464-012-9522-x Google Scholar Search this bibliographic reference on Google Scholar
- Mirabel-Sarron, C. et Giachetti, R. (2012). Les thérapies non
médicamenteuses dans les troubles bipolaires. L’Encéphale : Revue de psychiatrie
clinique biologique et thérapeutique, 38 (4), 160-166. doi:10.1016/S0013-7006
(12) 70094-5Google Scholar Search this bibliographic reference on Google Scholar
- Miziou, S., Tsitsipa, E., Moysidou, S.,
Karavelas, V., Dimelis, D., Polyzoidou, V. et Fountoulakis, K. N. (2015). Psychosocial
treatment and interventions for bipolar disorder : a systematic review. Annals of
General Psychiatry, 14, 19. 10.1186/s12991-015-0057-z Google Scholar Search this bibliographic reference on Google Scholar
- Provencher, M. D., Côté, G., Lemelin,
S., O’Connor, K., Taillon, A., Pélissier, M.-C., Bouchard, S. et St-Amand, J. (2009).
Traitements psychologiques éprouvés en milieux hospitaliers pour les troubles mentaux
graves. Revue québécoise de psychologie, 30 (2), 219-241. Récupéré de http://cat.inist.fr/?aModele=afficheN&cpsidt=22587849Google Scholar Search this bibliographic reference on Google Scholar
- Provencher, M. D., Hawke, L. D., Bélair, M. et Guimond, A.-J.
(2012). La psychoéducation pour les troubles bipolaires : recension des écrits et
recommandations pour le système de santé québécois. Santé mentale au Québec, 37
(1), 157-187.
10.7202/1012650ar
Google Scholar
Search this bibliographic reference on Google Scholar
- Provencher,
M. D., Hawke, L. D., Bélair, M., Guimond, A.-J., Pouliot, L. et Baruch, P. (2014).
Dissemination of a Brief Psychoeducational Intervention for Bipolar Disorder in Community
Mental Health Settings. International Journal of Clinical Psychiatry and Mental Health,
2, 93-103. 10.12970/2310-8231.2014.02.02.2 Google Scholar Search this bibliographic reference on Google Scholar
- Provencher, M. D., St-Amand, J., Thienot, E. et Hawke, L. (2007). Groupe psychoéducatif
pour le traitement du trouble bipolaire : Révision et adaptation québécoise de la phase
psychoéducative de la deuxième édition anglophone du manuel de Bauer, M. S. et McBride, L.
(2003).Structured group psychotherapy for bipolar disorder : The Life Goals
Program (2nd ed.). Document non publié, Université Laval.Google Scholar Search this bibliographic reference on Google Scholar
- Rouget, B. W. et Aubry, J.-M. (2007). Efficacy of
psychoeducational approaches on bipolar disorders : A review of the literature. Journal
of Affective Disorders, 98(1-2), 11-27. 10.1016/j.jad.2006.07.016 Google Scholar Search this bibliographic reference on Google Scholar
- Salcedo, S., Gold, A. K., Sheikh, S., Marcus, P. H.,
Nierenberg, A. A., Deckersbach, T. et Sylvia, L. G. (2016). Empirically supported
psychosocial interventions for bipolar disorder : Current state of the research. Journal
of Affective Disorders, 201, 203-214. 10.1016/j.jad.2016.05.018 Google Scholar Search this bibliographic reference on Google Scholar
- Schaffer, A., Cairney, J., Cheung, A., Veldhuizen, S. et
Levitt, A. (2006). Community Survey of Bipolar Disorder in Canada : Lifetime Prevalence and
Illness Characteristics. The Canadian Journal of Psychiatry, 51(1), 9-16. Récupéré
de http://www-ncbi-nlm-nih-gov.ezproxy.bibl.ulaval.ca/pubmed/1649197910.1177/070674370605100104 Google Scholar Search this bibliographic reference on Google Scholar
- Scott, J. et Colom, F. (2007). Gaps
and limitations of psychological interventions for bipolar disorders. Psychotherapy and
Psychosomatics, 77(1), 4-11. 10.1159/000110054 Google Scholar Search this bibliographic reference on Google Scholar
- Simon, G. E., Ludman, E. J., Bauer,
M. S., Unützer, J. et Operskalski, B. (2006). Long-term Effectiveness and Cost of a
Systematic Care Program for Bipolar Disorder. Archives of General Psychiatry,
63(5), 500-508. 10.1001/archpsyc.63.5.500 Google Scholar Search this bibliographic reference on Google Scholar
- Sobell, L. C. (1996). Bridging the
gap between scientists and practitioners : The challenge before us. Behavior
Therapy, 27(3), 297-320. doi:10.1016/S0005-7894 (96) 80019-0Google Scholar Search this bibliographic reference on Google Scholar
- Stirman, S. W., Crits-Christoph, P et DeRubeis, R. J. (2004).
Achieving successful dissemination of empirically supported psychotherapies : A synthesis of
dissemination theory. Clinical Psychology : Science and Practice, 11(4),
343-359. 10.1093/clipsy/bph091 Google Scholar Search this bibliographic reference on Google Scholar
- Yatham, L. N.,
Kennedy, S. H., Parikh, S. V, Schaffer, A., Beaulieu, S., Alda, M.,… Berk, M. (2013).
Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for
Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of
patients with bipolar disorder : Update 2013. Bipolar Disorders, 15(1), 1-44.
10.1111/bdi.12025 Google Scholar Search this bibliographic reference on Google Scholar
- Yatham, L. N., Kennedy, S. H.,
Schaffer, A., Parikh, S. V, Beaulieu, S., O’Donovan, C., … Kapczinski F. (2009). Canadian
Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar
Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients
with bipolar disorder : Update 2009. Bipolar Disorders, 11(3), 225-255.
10.1111/j.1399-5618.2009.00672.x Google Scholar Search this bibliographic reference on Google Scholar