Résumés
Résumé
Introduction : Le trouble concomitant est complexe et nécessite idéalement des services intégrés. Actuellement, sa prise en charge reste fragmentée et l’influence des déterminants sociaux de la santé est peu examinée, rendant l’accès aux services difficile. Une approche syndémique, adoptant une vision holistique, pourrait améliorer la prise en charge et l’accès aux services, mais celle-ci est présentement peu étudiée.
Objectif : Explorer la perspective syndémique du trouble concomitant par une étude de cas multiples, en analysant les trajectoires de soins et de services à l’urgence et les transitions vers les services de 1re et de 2e ligne.
Méthodes : Cette étude, réalisée au Québec, a analysé les dossiers médicaux de trois personnes utilisant fréquemment les services d’urgence. Les données incluent les visites à l’urgence sur 12 mois, les références vers les soins de 1re et de 2e ligne en santé mentale et en dépendance, ainsi que les interventions des infirmières de liaison en santé mentale, en dépendance et des travailleuses sociales.
Résultats : Les cas étudiés révèlent des schémas d’utilisation des services reflétant une perspective syndémique. Les besoins variés, souvent liés aux déterminants sociaux de la santé, ont fréquemment nécessité un arrimage avec divers services de 1re et de 2e ligne. Les interventions des infirmières et des travailleuses sociales variaient en fréquence et en intensité selon les trois cas.
Conclusion : Une approche syndémique pourrait améliorer la prise en charge des personnes présentant un trouble concomitant, considérant l’importance pour elles d’avoir accès à des services distincts et complémentaires. Les infirmières et les travailleuses sociales pourraient jouer un rôle clé dans l’évaluation et l’accompagnement vers des soins adaptés. De nombreuses opportunités sont possibles pour renforcer leur implication.
Mots-clés :
- trouble concomitant,
- syndémie,
- trouble de santé mentale,
- trouble de l’usage de substance,
- services intégrés,
- déterminants sociaux de la santé
Abstract
Introduction: Dual disorder is complex and optimally requires integrated services delivery. However, current management strategies remain fragmented, with limited attention given to the role of social determinants of health, making challenging access to appropriate services. A syndemic approach, which adopts a holistic perspective, has the potential to improve care delivery and access, but remains underexplored in the context of dual disorder.
Objective: To explore the syndemic perspective of dual disorder through a multiple-case study, focusing on emergency department care pathways and transitions to outpatient services.
Methods: This study was conducted in Quebec, using medical records from three individuals who were frequent users of emergency services. Data included a 12-month review of emergency department visits, referrals to outpatient mental health and addiction services, and interventions performed by mental health and addiction liaison nurses as well as social workers.
Results: Findings revealed service utilization patterns aligning with a syndemic perspective. The individual’s diverse needs, often linked to social determinants of health, frequently required coordination across outpatient services. The involvement of nurses and social workers varied in frequency and intensity across the three cases.
Conclusion: A syndemic approach could enhance the management of individuals with dual disorder by facilitating access to complementary and integrated services. Nurses and social workers are well-positioned to play a pivotal role in assessing needs and guiding individuals toward appropriate care. Strengthening their involvement presents numerous opportunities for optimizing care delivery and addressing the complex interplay of factors affecting this population.
Keywords:
- dual disorder,
- syndemic,
- mental health disorder,
- substance use disorder,
- integrated services,
- social determinants of health
Resumen
Introducción: El trastorno concomitante es complejo y requiere idealmente servicios integrados. En la actualidad la atención médica es fragmentada y no está suficientemente estudiada la influencia de los determinantes sociales de la salud, lo que dificulta el acceso a los servicios. Un enfoque sindémico y la adopción de una visión holística, podría mejorar los servicios médicos, pero este enfoque está poco estudiado en la actualidad.
Objetivo: Explorar la perspectiva sindémica del trastorno concomitante mediante un estudio de casos múltiples, analizando las trayectorias de la atención y de los servicios en la urgencia y las transiciones hacia los servicios de primera y segunda línea.
Métodos: Este estudio, realizado en Québec, se basa en el análisis de las historias clínicas de tres personas que utilizan frecuentemente los servicios de urgencia. Los datos incluyen las visitas a la urgencia sobre 12 meses, las referencias hacia la atención de primera y segunda línea en salud mental y en dependencia, así como las intervenciones de las enfermeras de enlace en salud mental y en dependencia y de las asistentes sociales.
Resultados: Los casos estudiados revelan esquemas de uso de los servicios que reflejan una perspectiva sindémica. Las diferentes necesidades, a menudo relacionadas con determinantes sociales de la salud, han requerido la colaboración entre diferentes servicios de primera y segunda línea. Las intervenciones de las enfermeras y de las asistentes sociales varían en frecuencia y en intensidad, según los tres casos.
Conclusión: Un enfoque sindémico podría mejorar la atención médica de las personas que presentan un trastorno concomitante, considerando la importancia que tiene para ellas tener acceso a servicios diferentes y complementarios, Las enfermeras y las asistentes sociales podrían cumplir un papel clave en la evaluación y el acompañamiento hacia la atención adecuada. Numerosas oportunidades son posibles para reforzar su implicación.
Palabras clave:
- trastorno concomitante,
- sindemia,
- trastorno de salud mental,
- trastorno de uso de una sustancia,
- servicios integrados,
- determinantes sociales de la salud
Parties annexes
Bibliographie
- American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, 5th Ed.). American Psychiatric Publishing.
- Andermann, A. (2018). Screening for social determinants of health in clinical care: moving from the margins to the mainstream. Public Health Reviews, 39, 19. https://doi.org/10.1186/s40985-018-0094-7
- Arya, D. K. (2020). Case management, care-coordination and casework in community mental health services. Asian Journal of Psychiatry, 50, 101979.
- Association des intervenants en dépendance du Québec. (2025, 18 juillet). Troubles concomitants. https://www.aidq.org/fr/projet-troubles-concomitants?utm_source=yapla_infolettres&utm_medium=email&utm_campaign=infolettre-professionnelle_avril_2024
- Ayano, G. (2019). Co-occurring medical and substance use disorders in patients with schizophrenia: a systematic review. International Journal of Mental Health, 48(1), 62-76. https://doi.org/10.1080/00207411.2019.1581047
- Bahji, A. (2024). Navigating the complex intersection of substance use and psychiatric disorders: a comprehensive review. Journal of Clinical Medicine, 13(4), 999. https://doi.org/10.3390/jcm13040999
- Baker, O., Wellington, C., Price, C. R., Tracy, D., Powell, L., Loffredo, S., Moscariello, S. et Meyer, J. P. (2023). Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity. BMC Public Health, 23, 222. https://doi.org/10.1186/s12889-023-15108-w
- Barker, L. C., Sunderji, N., Kurdyak, P., Stergiopoulos, V., Gonzalez, A., Kopp, A. et Vigod, S. N. (2020). Urgent outpatient care following mental health ED visits: a population-based study. Psychiatric Services, 71(6), 616-619. https://doi.org/10.1176/appi.ps.201900466
- Berkowitz, S. A., Hulberg, A. C., Hong, C., Stowell, B. J., Tirozzi, K. J., Traore, C. Y. et Atlas, S. J. (2016). Addressing basic resource needs to improve primary care quality: a community collaboration programme. BMJ quality & safety, 25(3), 164–172. https://doi.org/10.1136/bmjqs-2015-004521
- Blanchette-Martin, N., Tremblay, J., Ferland, F., Rush, B., Garceau, P. et Danielson, A.-M. (2016). Co-location of addiction liaison nurses in three Quebec city emergency departments: portrait of services, patients, and treatment trajectories. Canadian Journal of Addiction, 7(3), 34-40.
- Bruckner, T. A., Huo, S., Huynh, M., Du, S., Young, A. et Ro, A. (2023). Psychiatric emergencies in Los Angeles county during, and after, initial COVID-19 societal restrictions: an interrupted time-series analysis. Community Mental Health Journal, 59(4), 622–630. https://doi.org/10.1007/s10597-022-01043-4
- Butt, Z. A., Shrestha, N., Wong, S., Kuo, M., Gesink, D., Gilbert, M., Wong, J., Yu, A., Alvarez, M., Samji, H., Buxton, J. A., Johnston, J. C., Cook, V. J., Roth, D., Consolacion, T., Murti, M., Hottes, T. S., Ogilvie, G., Balshaw, R. et Tyndall, M. W. (2017). A syndemic approach to assess the effect of substance use and social disparities on the evolution of HIV/HCV infections in British Columbia. PLoS ONE, 12(8), 1-16. https://doi.org/10.1371/journal.pone.0183609
- Card, K. G., Lachowsky, N. J., Armstrong, H. L., Cui, Z., Wang, L., Sereda, P., Jollimore, J., Patterson, T. L., Corneil, T., Hogg, R. S., Roth, E. A. et Moore, D. M. (2018). The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men. Addictive Behaviors, 82, 158-165. https://doi.org/10.1016/j.addbeh.2018.03.005
- Caron, R. M. et Adegboye, A. R. A. (2021). COVID-19: a syndemic requiring an integrated approach for marginalized populations. Frontiers In Public Health, 9, 675280. https://doi.org/10.3389/fpubh.2021.675280
- Carra, G., Bartoli, F., Crocamo, C., Brady, K. T. et Clerici, M. (2014). Attempted suicide in people with co-occurring bipolar and substance use disorders: systematic review and meta-analysis. Journal of Affective Disorders, 167, 125-135. https://doi.org/10.1016/j.jad.2014.05.066
- Caselli, I., Lelmini, M., Bellini, A., Marchetti, S., Lucca, G., Vitiello, E., Carbone, M. G. et Callegari, C. (2023). The impact of Covid-19 pandemic on mental health services: a comparison between first psychiatric consultations before and after the pandemic. Clinical neuropsychiatry, 20(4), 233–239. https://doi.org/10.36131/cnfioritieditore20230402
- Castelpietra, G., Skrindo Knudsen, A. K., Agardh, E. E., Armocida, B., Beghi, M., Moesgaard Iburg, K., Logroscino, G., Ma, R., Starace, F., Steel, N., Addolorato, G., Andrei, C. L., Andrei, T., Ayuso-Mateos, J. L., Banach, M., Bärnighausen, T. W., Barone-Adesi, F., Bhagavathula, A. S., Carvalho, F., … Monasta, L. (2022). The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990−2019: findings from the Global Burden of Disease Study 2019. The Lancet Regional Health – Europe, 16, 100341. https://doi.org/10.1016/j. lanepe.2022.100341
- Centre canadien sur les dépendances et l’usage de substances. (2023). Operational guidelines for integrated mental health, substance use and concurrent disorder service delivery. https://www.ccsa.ca/sites/default/files/2023-07/integrated-mental-health-substance-use-and-concurrent-disorder-service-delivery-fr.pdf
- Centre de toxicomanie et de santé mentale. (2002). Meilleures pratiques – Troubles concomitants de santé mentale et d’alcoolisme et de toxicomanie. (No de catalogue : H39-599/2001-2F). Santé Canada. http://www.hc-sc.gc.ca/hc-ps/pubs/adp-apd/bp_disorder-mp_concomitants/index-fra.php
- Centre d’expertise et de collaboration en troubles concomitants (CECTC). (2019). Les troubles concomitants - Synthèse des connaissances. https://ruisss.umontreal.ca/wp-content/uploads/sites/61/2024/02/CECTC_2019_Texte_synthese_troubles_concomitants.pdf
- Chase, J., Bilinski, J. et Kanzaria, H. K. (2020). Caring for emergency department patients with complex medical, behavioral health, and social needs. Journal of the American Medical Association (JAMA), 324(24), 2550-2551. https://doi.org/10.1001/jama.2020.17017
- Chichetto, N. E., Kundu, S., Freiberg, M. S., Butt, A. A., Crystal, S., So-Armah, K. A., Cook, R. L., Braithwaite, R. S., Fiellin, D. A., Khan, M. R., Bryant, K. J., Gaither, J. R., Barve, S. S., Crothers, K., Bedimo, R. J., Warner, A. L., Tindle, H. A. et Veterans Aging Cohort Study. (2019). Association of syndemic unhealthy alcohol use, cigarette use, and depression with all-cause mortality among adults living with and without HIV infection: veterans aging cohort study. Open Forum Infectious Diseases, 6, ofz188. https://doi.org/10.1093/ofid/ofz188
- Chichetto, N. E., Gebru, N. M., Plankey, M. W., Tindle, H. A., Koethe, J. R., Hanna, D. B., Shoptaw, S., Jones, D. L., Lazar, J. M., Kizer, J. R., Cohen, M. H., Haberlen, S. A., Adimora, A. A., Lahiri, C. D., Wise, J. M. et Freiberg, M. S. (2023). Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017. Drug & Alcohol Dependence, 249, 110838. https://doi.org/10.1016/j.drugalcdep.2023.110838
- Chichetto, N. E., Canidate, S., Gebru, N. M., McNeely, K. V., Ding, D. D., Hanna, D. B., Parikh, Z., Shoptaw, S. J., Jones, D. L., Lazar, J. M., Kizer, J. R., Cohen, M. H., Haberlen, S. A., Lahiri, C. D., Wise, J. M., Palella, F., Levine, A., Friedman, M. R. et Plankey, M. (2025). Impact of syndemic heavy drinking, smoking, and depression on mortality among MSM with and without HIV: a longitudinal study. Drug and Alcohol Dependence, 266, 112523. https://doi.org/10.1016/j.drugalcdep.2024.112523
- Chikwava, F., Cordier, R., Ferrante, A., O’Donnell, M. et Pakpahan, E. (2024). Trajectories of homelessness and association with mental health and substance use disorders among young people transitioning from out-of-home care in Australia. Child Abuse & Neglect, 149, 106643. https://doi.org/10.1016/j.chiabu.2024.106643
- Chochinov, A., Innes, G., Kollek, D., Kreindler, S. et Petrie, D. (2023). A systems approach to the future of emergency care. Chapter 2. Canadian Association of Emergency Physicians. https://caep.ca/section-one-a-systems-approach-to-the-future-of-emergency-care/
- Clementi, E., Bartlett, S., Otterstatter, M., Buxton, J. A., Wong, S., Yu, A., Butt, Z. A., Wilton, J., Pearce, M., Jeong, D., Binka, M., Adu, P., Alvarez, M., Samji, H., Abdia, Y., Wong, J., Krajden, M. et Janjua, N. Z. (2020). Syndemic profiles of people living with hepatitis C virus using population-level latent class analysis to optimize health services. International Journal of Infectious Diseases, 100, 27-33. https://doi.org/10.1016/j.ijid.2020.08.035
- Coid, J., Zhang, Y., Bebbington, P., Ullrich, S., de Stavola, B., Bhui, K. et Tsai, A. C. (2021). A syndemic of psychiatric morbidity, substance misuse, violence, and poor physical health among young Scottish men with reduced life expectancy. SSM - Population Health, 15, 100 858. https://doi.org/10.1016/j.ssmph.2021.100858
- Commission de la santé mentale du Canada et Centre canadien sur les dépendances et l’usage de substances. (2023). Substance use health and mental health service provision: emerging themes from the academic literature - scoping review 2018-2021. Commission de la santé mentale du Canada.
- Côté, P.-B., MacDonald, S.-A. et Renard-Robert, G. (2022). Favoriser la continuité : des activités de liaison post-hospitalières auprès des personnes en situation d’itinérance, Revue du CREMIS, 13(2), 4-9.
- De Ruysscher, C., Vandevelde, S., Vanderplasschen, W., De Maeyer, J. et Vanheule, S. (2017). The concept of recovery as experienced by persons with dual diagnosis: a systematic review of qualitative research from a rirst-person perspective. Journal of Dual Diagnosis, 13(4), 264-279. https://doi.org/10.1080/15504263.2017.1349977
- Dong, K. R., Must, A., Tang, A. M., Beckwith, C. G. et Stopka, T. J. (2018). Competing priorities that rival health in adults on probation in Rhode Island: substance use recovery, employment, housing, and food intake. BMC Public Health, 18(289), 1-10. https://doi.org/10.1186/s12889-018-5201-7
- Düring, S. W., Austin, S. F., Mårtensson, S. et Johansen, K. S. (2024). Perceived advantages and disadvantages of substance use in a dual diagnosis population with severe mental disorders and severe substance use disorder. Considering the self-medication hypothesis. Nordic Journal of Psychiatry, 78(4), 281-289. https://doi.org/10.1080/08039488.2024.2318649
- Équipe de recherche Michel Perreault. (2025, 18 juillet). Formation croisée. https://formationcroisee.com/
- Eshak, T. B., Hobkirk, A. L., Whitener, C. J., Conyers, L. M., Hwang, W. et Sznajder, K. K. (2024). Syndemic of substance abuse, depression, and type 2 diabetes and their association with retention in care among people living with HIV. AIDS and Behavior, 28(5), 1612-1620. https://doi.org/10.1007/s10461-024-04275-5
- Fantuzzi, C. et Mezzina, R. (2020). Dual diagnosis: a systematic review of the organization of community health services. International Journal of Social Psychiatry, 66(3), 300-310. https://doi.org/10.1177/0020764019899975
- Fleury, M. J., Rochette, L., Fortin, M., Vasiliadis, H. M., Huynh, C., Grenier, G., Pelletier, E. et Lesage, A. (2019). Surveillance de l’utilisation des urgences au Québec par les patients ayant des troubles mentaux. Institut national de santé publique du Québec. https://www.inspq.qc.ca/sites/default/files/publications/2580_surveillance_utilisation_urgences_patients_troubles_mentaux.pdf
- Fleury, M. J., Grenier, G., Bamvita, J. M. et Ferland, F. (2020). Typology of patients who use emergency departments for mental and substance use disorders. BJPsych Open, 6(e59), 1-8. https://doi.org/10.1192/bjo.2020.39
- Fujita, A. W., Ramakrishnan, A., Mehta, C. C., Yusuf, O. B., Thompson, A. B., Shoptaw, S., Carrico, A. W., Adimora, A. A., Eaton, E., Cohen, M. H., Jain, J. P., Adedimeji, A., Plankey, M., Jones, D. L., Chandran, A., Colasanti, J. A. et Sheth, A. N. (2024). Co-utilization of HIV, substance use, mental health services among women with current substance use: opportunities for integrated care? Journal of Primary Care & Community Health, 1-10. https://doi.org/10.1177/21501319241285531
- Gabet, M., Cao, Z. et Fleury, M. J. (2022). Profiles, correlates and outcomes among patients experiencing an onset of mental disorder based on outpatient care received following index emergency department visits. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 67(10), 787-801. https://doi.org/10.1177/07067437221087004
- Gaida, F., Ferland, F., Farand, L. et Fleury, M. J. (2023). Facteurs encourageant ou limitant l’utilisation des services d’urgence pour des raisons de santé mentale par les patients grands utilisateurs de ces services. Santé mentale au Québec, 48, 179-208. https://doi.org/10.7202/1109838ar
- Gerke, D. R., Call, J. et Auslander, W. F. (2022). The syndemic factors of violence exposure, substance use, and mental health problems: relationships to sexual risk behaviors in HIV-negative young men who have sex with men. Journal of the Society for Social Work and Research, 13(2), 235-259. https://doi.org/10.1086/711612
- Glover‐Wright, C., Coupe, K., Campbell, A. C., Keen, C., Lawrence, P., Kinner, S. A. et Young, J. T. (2023). Health outcomes and service use patterns associated with co‐located outpatient mental health care and alcohol and other drug specialist treatment: a systematic review. Drug & Alcohol Review, 42(5), 1195-1219. https://doi.org/10.1111/dar.13651
- Glynn, T. R., Khanna, S. S., Hasdianda, M. A., O’Cleirigh, C. et Chai, P. R. (2025). Characterizing syndemic HIV risk profiles and mHealth intervention acceptability among patients in the emergency department. Psychology, Health & Medicine, 30(1), 30-46. https://doi.org/10.1080/13548506.2024.2407450
- Gomez, K.U., McBride, O., Roberts, E., Angus, C., Keyes, K., Drummond, C., Buchan, I., Fleming, K., Gilmore, I., Donoghue, K., Bonnet, L. et Goodwin, L. (2023). The clustering of physical health conditions and associations with co-occurring mental health problems and problematic alcohol use: a cross-sectional study. BMC Psychiatry, 23, 89. https://doi.org/10.1186/s12888-023-04577-3
- Graham, K., Cheng, J., Bernards, S., Wells, S., Rehm, J. et Kurdyak, P. (2017). How much do mental health and substance use/addiction affect use of general medical services? extent of use, reason for use, and associated costs. Canadian Journal of Psychiatry, 62(1), 48-56. https://doi.org/10.1177/0706743716664884
- Gramling, L.F. et Carr, R. L. (2004). Lifelines: a life history methodology. Nursing Research, 53(3), 207-210. https://doi.org/10.1097/00006199-200405000-00008
- Gulbas, L. E., Pavelka, C., Hausmann-Stabile, C. et Zayas, L. H. (2024). Rethinking comorbidity: a case study of syndemic risk, eating disorders, and suicidal behaviors in adolescent girls of color. Qualitative Social Work, 20240108. https://doi.org/10.1177/14733250231225170
- Hakobyan, S., Vazirian, S., Lee-Cheong, S., Krausz, M., Honer, W. G. et Schutz, C. G. (2020). Concurrent disorder management guidelines. Systematic review. Journal of Clinical Medicine, 9(8), 2406. https://doi.org/10.3390/jcm9082406
- Helm, A. F., Andre, M. A., Shaffer, P. M., Bruzios, K. E., Marcus, S., Harter, J. et Smelson, D. (2024). Multicomponent co-occurring disorders treatment and wraparound services for individuals experiencing chronic homelessness. Community Mental Health Journal, 60(6), 1203-1213. https://doi.org/10.1007/s10597-024-01271-w
- Hsu, C., Cruz, S., Placzek, H., Chapdelaine, S., Levin, S., Gutierrez, F., Standish, S., Maki, I., Carl, M., Orantes, M. R., Newman, D. et Cheadle, A. (2019). Patient perspectives on addressing social needs in primary care using a screening and resource referral intervention. Journal of General Internal Medicine, 35, 481-489. https://doi.org/10.1007/s11606-019-05397-6
- Humphreys, E., Ladner, T. et van Draanen, J. (2023). A qualitative assessment of the treatment needs of women with concurrent eating and substance use disorders in a residential setting. Journal of Dual Diagnosis, 19(2-3), 153–165. https://doi.org/10.1080/15504263.2023.2192175
- Huynh, C., Ferland, F., Blanchette-Martin, N., Ménard, J.-M. et Fleury, M.-J. (2016). Factors influencing the frequency of emergency department utilization by individuals with substance use disorders. Psychiatric Quarterly, 87(4), 713-728. https://doi.org/10.1007/s11126-016-9422-6
- Institut national de santé publique du Québec (INSPQ). (2024, 20 septembre). Déterminants de la santé. https://www.inspq.qc.ca/exercer-la-responsabilite-populationnelle/determinants-sante
- Iudici, A., Girolimetto, R., Volponi, G. et Eletto, A. (2020). Dual diagnosis and application problems in the use of the construct: a review of literature. Journal of Nervous & Mental Disease, 208(3), 181-189. https://doi.org/10.1097/NMD.0000000000001092
- Jackson, K., Kaner, E., Hanratty, B., Gilvarry, E., Yardley, L. et O’Donnell, A. (2024). Understanding people’s experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: a qualitative study. Addiction, 119(2), 268–280. https://doi.org/10.1111/add.16350
- Jain, J. P., Santos, G.-M., Hao, J., Leonard, A., Miller, A. A., Cuca, Y. P. et Dawson-Rose, C. (2022). The syndemic effects of adverse mental health conditions and polysubstance use on being at risk of clinical depression among marginally housed and homeless transitional age youth living in San Francisco, California. PLoS ONE, 17(3), e0265397. https://doi.org/10.1371/journal.pone.0265397
- Jegede, O., Rhee, T. G., Stefanovics, E. A., Zhou, B. et Rosenheck, R. A. (2022). Rates and correlates of dual diagnosis among adults with psychiatric and substance use disorders in a nationally representative U.S. sample. Psychiatry Research, 315, 114720. https://doi.org/10.1016/j.psychres.2022.114720
- Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological Psychiatry, 56, 730-737. https://doi.org/10.1016/j.biopsych.2004.06.034
- Khan, S. (2017). Troubles concomitants de santé mentale et de consommation d’alcool ou de drogues au Canada – Rapport sur la santé. Statistique Canada, 28(8), 3-9.
- Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., Brown, T. A., Carpenter, W. T., Caspi, A., Clark, L. A., Eaton, N. R., Forbes, M. K., Forbush, K. T., Goldberg, D., Hasin, D., Hyman, S. E., Ivanova, M. Y., Lynam, D. R., Markon, K., … Zimmerman, M. (2017). The hierarchical taxonomy of psychopathology (HiTOP): a dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454-477. https://doi.org/10.1037/abn0000258
- Lavergne, M. R., Shirmaleki, M., Loyal, J. P., Jones, W., Nicholls, T. L., Schütz, C. G., Vaughan, A., Samji, H., Puyat, J. H., Kaoser, R., Kaulius, M. et Small, W. (2022). Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada. BMJ Open, 12(1), e057072. https://doi.org/10.1136/bmjopen-2021-057072
- Leddy, A. M., Zakaras, J. M., Shieh, J., Conroy, A. A., Ofotokun, I., Tien, P. C. et Weiser, S. D. (2021). Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: evidence of a syndemic in need of attention. PLoS ONE, 16(5), e0252338. https://doi.org/10.1371/journal.pone.0252338
- Lett, E., Abrams, M. P., Moberg, E., Benson, G. P. et Perlson, J. E. (2022). Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross‑sectional study using the U.S. youth risk behavior surveillance system. Social Psychiatry and Psychiatric Epidemiology, 57, 2293-2304. https://doi.org/10.1007/s00127-022-02348-1
- Livingston, J. D. (2020). La stigmatisation structurelle des personnes ayant des problèmes de santé mentale et de consommation de substances dans les établissements de soins de santé : Analyse documentaire. Commission de la santé mentale du Canada. https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2020-07/structural_stigma_in_healthcare_fr.pdf
- McDonald, L. R., Antoine, D. G., Liao, C., Lee, A., Wahab, M. et Coleman, J. S. (2020). Syndemic of lifetime mental illness, substance use disorders, and trauma and their association with adverse perinatal outcomes. Journal of Interpersonal Violence, 35(1/2), 476-495. https://doi.org/10.1177/0886260516685708
- Mendenhall, E. (2016). Beyond comorbidity: a critical perspective of syndemic depression and diabetes in cross-cultural contexts. Medical Anthropology Quarterly, 30(4), 462-478. https://doi.org/10.1111/maq.12215
- Mendenhall, E. (2017). Syndemics: a new path for global health research. Lancet, 389(10 072), 889-891. https://doi.org/10.1016/S0140-6736(17)30602-5
- Mendenhall, E., Kohrt, B. A., Norris, S. A., Ndetei, D. et Prabhakaran, D. (2017). Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet, 389(10 072), 951-963. https://doi.org/10.1016/S0140-6736(17)30402-6
- Menear, M., Gilbert, M. et Fleury, M.-J. (2017). Améliorer la santé mentale des populations par l’intégration des soins de santé mentale aux soins primaires. Santé mentale au Québec, 42(1), 243-271. https://doi.org/10.7202/1040253ar
- Merriam, S. B. et Tisdell, E. J. (2016). Qualitative research: a guide to design and implementation (4th éd.). Jossey-Bass.
- Ministère de la santé et des services sociaux. (2012). Évaluation de l’implantation du Plan d’action en santé mentale 2005-2010 - La force des liens. Ministère de la santé et des services sociaux. https://numerique.banq.qc.ca/patrimoine/details/52327/2267632?docref=tBaWI98D96i52r5CJcsj9g
- Ministère de la santé et des services sociaux. (2021). Mesure de l’accès aux soins de santé et aux services sociaux : indicateurs - Audit de performance. Rapport du Vérificateur général du Québec à l’Assemblée nationale pour l’année 2020-2021. Ministère de la santé et des services sociaux. https://www.vgq.qc.ca/Fichiers/Publications/rapport-annuel/165/vgq_ch03_sante_web.pdf
- Ministère de la santé et des services sociaux. (2022). Plan d’action interministériel en santé mentale 2022-2026 – S’unir pour un mieux-être collectif. https://publications.msss.gouv.qc.ca/msss/fichiers/2021/21-914-14W.pdf
- Ministère de la santé et des services sociaux. (2023). Santé mentale : efficacité du continuum de soins et de services pour les usagers ayant des troubles mentaux graves - Audit de performance. Rapport du Vérificateur général du Québec à l’Assemblée nationale pour l’année 2022-2023. Ministère de la santé et des services sociaux. https://www.vgq.qc.ca/Fichiers/Publications/rapport-annuel/203/04_vgq_ch4_mai2023_web_vf.pdf
- Ministère de la santé et des services sociaux. (2024). Suivi intensif dans le milieu (SIM) - Cadre de référence. Ministère de la santé et des services sociaux. https://publications.msss.gouv.qc.ca/msss/fichiers/2024/24-914-25W.pdf
- Motta-Ochoa, R., Bertrand, K., Flores-Aranda, J., Patenaude, C., Brunelle, N., Landry, M. et Brochu, S. (2017). A qualitative study of addiction help-seeking in people with different co-occurring mental disorders and substance use problems. International Journal of Mental Health & Addiction, 15(4), 883-899. https://doi.org/10.1007/s11469-017-9762-y
- Mueser, K. T., Drake, R. E. et Wallach, M. A. (1998). Dual diagnosis: a review of etiological theories. Addictive Behaviors, 23(6), 717-734.
- Patterson, M. L., Markey, M. A. et Somers, J. M. (2012). Multiple paths to just ends: using narrative interviews and timelines to explore health equity and homelessness. International Journal of Qualitative Methods, 11(2), 132-151. https://doi.org/10.1177/160940691201100202
- Plourde, A. (2024, 21 mai). Mythes et réalités de la pénurie de main-d’oeuvre en santé et services sociaux au Québec. Laboratoire de recherche et d’informations en santé et services sociaux. https://iris-recherche.qc.ca/publications/main-doeuvre-sante-services-sociaux/
- Poremski, D., Harris, D. W., Kahan, D., Pauly, D., Leszcz, M., O’Campo, P., Wasylenki, D. et Stergiopoulos, V. (2016). Improving continuity of care for frequent users of emergency departments: service user and provider perspectives. General Hospital Psychiatry, 40, 55-59. https://doi.org/10.1016/j.genhosppsych.2016.01.004
- Richmond, J. S., Dragatsi, D., Stiebel, V., Rozel, J. S. et Rasimas, J. J. (2021). American association for emergency psychiatry recommendations to address psychiatric staff shortages in emergency settings. Psychiatric Services, 72(4), 437–443. https://doi.org/10.1176/appi.ps.201900501
- Robinson, A. C., Knowlton, A. R., Gielen, A. C. et Gallo, J. J. (2016). Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework. Journal of Behavioral Medicine, 39(1), 1-12. https://doi.org/10.1007/s10865-015-9670-1
- Ross, L. E., Vigod, S., Wishart, J., Waese, M., Spence, J. D., Oliver, J., Chambers, J., Anderson, S. et Shields, R. (2015). Barriers and facilitators to primary care for people with mental health and/or substance use issues: a qualitative study. BMC Family Practice, 16(1), 1-13. https://doi.org/10.1186/s12875-015-0353-3
- Roy, M., Dagenais, P., Pinsonneault, L. et Déry, V. (2019). Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): a systematic and multisource literature review. The International Journal of Health Planning and Management, 34(1), e111-e130. https://doi.org/10.1002/hpm.2687
- Samuels-Kalow, M. E., Boggs, K. M., Cash, R. E., Herrington, R., Mick, N. W., Rutman, M. S., Venkatesh, A. K., Zabbo, C. P., Sullivan, A. F., Hasegawa, K., Zachrison, K. S. et Camargo, C. A. Jr. (2021). Screening for health-related social needs of emergency department patients. Annals of Emergency Medicine, 77(1), 62–68. https://doi.org/10.1016/j.annemergmed.2020.08.010
- Sather, E. W., Cabral Iversen, V., Folsvik Svindseth, M., Crawford, P. et Vasset, F. (2022). Exploring sustainable care pathways ‑ a scoping review. BMC Health Services Research, 22(1), 1595. https://doi.org/10.1186/s12913-022-08863-w
- Schrijvers, G., van Hoorn, A. et Huiskes, N. (2012). The care pathway: concepts and theories: an introduction. International Journal of Integrated Care, 12, special edition integrated care pathways, 1-7. https://doi.org/10.5334/ijic.812
- Schulz, J. A., Ramaswamy, M., Collie-Akers, V., Jordan, S., Koon, L. M. et Tryanski, R. (2021). Understanding the impact of an integrated crisis team: a qualitative study of emergency department staff. Community Mental Health Journal, 57(7), 1278-1287. https://doi.org/10.1007/s10597-020-00771-9
- Singer, M. (1994). AIDS and the health crisis of the US urban poor; the perspective of critical medical anthropology. Social Science & Medicine, 39(7), 931-948. https://doi.org/10.1016/0277-9536(94)90205-4
- Singer, M. (1996). A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic. Free Inquiry in Creative Sociology, 24(2), 99-110.
- Singer, M. et Clair, S. (2003). Syndemics and public health: reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17(4), 423-441. https://doi.org/10.1525/maq.2003.17.4.423
- Singer, M., Bulled, N., Ostrach, B. et Mendenhall, E. (2017). Syndemics and the biosocial conception of health. Lancet, 389(10 072), 941-950. https://doi.org/10.1016/S0140-6736(17)30003-X
- Singer, M., Bulled, N. et Ostrach, B. (2020). Whither syndemics? Trends in syndemics research, a review 2015–2019. Global Public Health, 15(7), 943-955. https://doi.org/10.1080/17441692.2020.1724317
- Statistique Canada. (2023a, 20 juin). Enquête sur les postes vacants et les salaires. Tableau 2 - Les six professions affichant les plus fortes hausses annuelles du nombre de postes vacants et leur salaire horaire moyen offert, premier trimestre de 2023. https://www150.statcan.gc.ca/n1/daily-quotidien/230620/t002a-fra.htm
- Statistique Canada. (2023b). Enquête sur la COVID-19 et la santé mentale, février à mai 2023. https://www150.statcan.gc.ca/n1/fr/daily-quotidien/231212/dq231212c-fra.pdf?st=dV2wWsG2
- St-Pierre, I. et Lessard, S. (2022). La démarche de soins infirmiers en santé mentale. Dans : M. C. Townsend, K. I. Morgan, P. Pariseau-Legault et M.-H. Goulet. Psychiatrie et santé mentale (3e éd., p. 123-147). Pearson ERPI.
- St-Pierre, I. et St-Pierre, L. (2024). Ensuring continuity of care for dual disorder: overview of outpatient services after emergency department discharge. Discover Health Systems, 3(1), 102. https://doi.org/10.1007/s44250-024-00167-6
- Trane, K., Aasbrenn, K., Rønningen, M., Odden, S., Lexén, A. et Landheim, A. (2021). Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers. International Journal of Mental Health Systems, 15(1), 1-12. https://doi.org/10.1186/s13033-021-00463-1
- Tsai, A. C. (2018). Syndemics: a theory in search of data or data in search of a theory? Social Science & Medicine, 206, 117-122. https://doi.org/10.1016/j.socscimed.2018.03.040
- Tsai, A. C., Mendenhall, E., Trostle, J. A., Ichiro, K. et Kawachi, I. (2017). Co-occurring epidemics, syndemics, and population health. Lancet, 389(10 072), 978-982. https://doi.org/10.1016/S0140-6736(17)30403-8
- Tsuyuki, K., Pitpitan, E. V., Levi-Minzi, M. A., Urada, L. A., Kurtz, S. P., Stockman, J. K. et Surratt, H. L. (2017). Substance use disorders, violence, mental health, and HIV: differentiating a syndemic factor by gender and sexuality. AIDS and Behavior, 21(8), 2270-2282. https://doi.org/10.1007/s10461-017-1841-3
- Turpin, R. E., Dyer, T. V., Dangerfield 2nd, D. T., Liu, H. et Mayer, K. H. (2020). Syndemic latent transition analysis in the HPTN 061 cohort: prospective interactions between trauma, mental health, social support, and substance use. Drug & Alcohol Dependence, 214, 108106. https://doi.org/10.1016/j.drugalcdep.2020.108106
- Urbanoski, K. A., Inglis, D. et Veldhuizen, S. (2017). Service use and unmet needs for substance use and mental disorders in Canada. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 62(8), 551-559. https://doi.org/10.1177/0706743717714467
- Vanhaecht, K., Panella, M., van Zelm, R. et Sermeus, W. (2010). An overview on the history and concept of care pathways as complex interventions. International Journal of Care Pathways, 14, 117-123. https://doi.org/10.1258/jicp.2010.010019
- Vereeken, S., Peckham, E. et Gilbody, S. (2023). Can we better understand severe mental illness through the lens of Syndemics? Frontiers in Psychiatry, 13, 1092964. https://doi.org/10.3389/fpsyt.2022.1092964
- Wakeman, S. E., Rigotti, N. A., Chang, Y., Herman, G. E., Erwin, A., Regan, S. et Metlay, J. P. (2019). Effect of integrating substance use disorder treatment into primary care on inpatient and emergency department utilization. Journal of General Internal Medicine, 34(6), 871-877. https://doi.org/10.1007/s11606-018-4807-x
- Willen, S. S., Knipper, M., Abadía-Barrero, C. E. et Davidovitch, N. (2017). Syndemic vulnerability and the right to health. Lancet, 389(10 072), 964-977. https://doi.org/10.1016/S0140-6736(17)30261-1
- Wittenberg, E., Barbosa, C., Hein, R., Hudson, E., Thornburg, B. et Bray, J. W. (2021). Health-related quality of life of alcohol use disorder with co-occurring conditions in the US population. Drug and Alcohol Dependence, 221, 108558. https://doi.org/10.1016/j.drugalcdep.2021.108558
- Wu, C. J., Ramis, M. A. et Skerman, H. (2019). Integrated approaches for comorbidity. Nursing & Health Sciences, 21(4), 413-415. https://doi.org/10.1111/nhs.12666
- Yellin, H., Beckwith, C., Kurth, A., Liu, T., Castonguay, B., Patrick, R., Trezza, C., Bazerman, L. et Kuo, I. (2018). Syndemic effect of mental illness and substance use on viral suppression among recently- incarcerated, HIV-infected individuals in the CARE+ Corrections study. AIDS Care, 30(10), 1252-1256. https://doi.org/10.1080/09540121.2018.1455961
- Yin, R. K. (2018). Case study research and applications: design and methods (6e éd.). SAGE.
- Zhang, Y. et Coid, J. (2024). Childhood adversity determines the syndemic effects of violence, substance misuse, and sexual behavior on psychotic spectrum disorder among men. Schizophrenia Bulletin, 50(3), 684–694. https://doi.org/10.1093/schbul/sbad165
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