L’utilisation des services infirmiers de première ligne pour des raisons de santé mentale par des personnes souffrant de dépression et l’impact sur les besoins non comblés en fonction du sexe

To this day, little attention has been paid to differences between men and women with respect to the unmet needs of people with depression who consult primary-care nurses (PCN) for mental health reasons. In this context, the main objective of this study is to determine whether consulting a PCN for mental health reasons by people that were diagnosed with a major depressive episode (MDS) is associated with a decrease in the rate of unmet needs for mental health care (UNMHC) and whether this association is influenced by the sex of the person who consults. A cross-sectional non-experimental design was chosen in order to meet the objectives. Five other specific objectives were identified in relation to the consultation a PCN for mental health reasons by people that were diagnosed with a major MDS: describe the use of services, describe the types and rates UNMHC; describe the underlying reasons for the UNMHC; study the association between the use of the services of an PCN and the presence of UNMHC and finally study this same association separately for men and for women suffering from MDS. The purpose of the present Master's thesis is a secondary analysis of data obtained through the Dialogue Project (2006-2010), an extensive survey of organizational and contextual factors influencing the quality of primary mental health services (Qualaxia Network, 2008). The calculations of the prevalence rate and logistic regression analyzes were conducted on a sample of 915 people who experienced a major depressive episode in the 12 months preceding the interview T1 Dialogue project. The independent variables were selected according to the behavioral framework provided by Andersen and Newman (2005). The data analysis revealed that only one fifth of participants with an MDS consulted a PCN for mental health reasons in the 12 months preceding the interview T1 Dialogue project. The great majority of participants using PCN services only saw the same nurse once. Those who have consulted a PCN on several occasions have predominantly stated that they have not seen the same nurse at each visit. Subsequently, the PCN decided to refer approximately one in two patients to another health professionals (ex: family doctor, psychologist and psychiatrist). Although the difference is not considered statistically significant, PCN referred more men (67.3%) than women (51%) to other professionals. In addition, our findings confirm that individuals with MDS who consult a PCN for mental health reasons have high levels of UNMHC. The four most common types of UNMHC in both sexes are: psychotherapy or counseling, interpersonal skills assistance, information on available services, and information on mental disorders, treatment and medication. To explain the presence of UNMHC, the main reason reported by participants of both sexes is: not knowing where to seek help. Finally, four factors were significantly associated with having UNMHC in women: aged 18-24, married or common-law partnership, anxiety disorder associated with MDS, HADS-D scores between 11 and 13 or greater than 14. However, no confounding variables were significantly associated with having UNMHC in men. There is no association between having seen a PCN for mental health reasons and the risk of reporting UNMHC among people with MDS, regardless of the sex. Further studies are needed to increase knowledge about sex differences in regard of the consultation PCN for mental health reasons and UNMHC.

Keyphrases: Sexe, Primary-care nurse, Depression, Sex, Man, Woman, Unmet needs, Mental health.