This study aimed to articulate the roles of social support and coping strategies in the relation between childhood maltreatment (CM) and subsequent major depressive disorder (MDD) with a comprehensive exploration of potential factors in a longitudinal community-based cohort. Parallel and serial mediation analyses were applied to estimate the direct effect (DE) (from CM to MDD) and indirect effects (from CM to MDD through social support and coping strategies, simultaneously and sequentially). Sociodemographic characteristics and genetic predispositions of MDD were considered in the modeling process. A total of 902 participants were included in the analyses. CM was significantly associated with MDD (DE coefficient (β) = 0.015, 95% confidence interval (CI) = 0.002∼0.028). This relation was partially mediated by social support (indirect β = 0.004, 95% CI = 0.0001∼0.008) and negative coping (indirect β = 0.013, 95% CI = 0.008∼0.020), respectively. Social support, positive coping, and negative coping also influenced each other and collectively mediated the association between CM and MDD. This study provides robust evidence that although CM has a detrimental effect on later-on MDD, social support and coping strategies could be viable solutions to minimize the risk of MDD. Intervention and prevention programs should primarily focus on weakening negative coping strategies, then strengthening social support and positive coping strategies.

Little is known about the views of rural family physicians (FPs) regarding collaborative care models for patients with dementia. The study aims were to explore FPs’ views regarding this issue, their role in providing dementia care, and the implications of providing dementia care in a rural setting. This study employed an exploratory qualitative design with a sample of 15 FPs. All rural FPs indicated acceptance of collaborative models. The main disadvantages of practicing rural were accessing urban-based health care and related services and a shortage of local health care resources. The primary benefit of practicing rural was FPs’ social proximity to patients, families, and some health care workers. Rural FPs provided care for patients with dementia that took into account the emotional and practical needs of caregivers and families. FPs described positive and negative implications of rural dementia care, and all were receptive to models of care that included other health care professionals.

The physical and social environments are recognized as important therapeutic tools in the care of nursing home residents with dementia, yet little is known about the environments of rural nursing homes. This study was conducted in one rural health authority (16,000 km 2) in the province of Saskatchewan. Long-term institutional care was provided in seven small (15 to 35 beds), publicly funded nursing homes, none of which had separate dementia special care units (SCUs). The Physical Environmental Assessment Protocol (PEAP) was used to evaluate the facilities on nine key dimensions of dementia care environments. Facilities were most supportive in provision of privacy and least supportive on maximizing awareness and orientation. Focus groups were conducted with registered nurses, nursing aides, and activity workers. Staff caregivers identified six special needs of residents with dementia that were difficult to meet in the nursing homes, two of which were related to the physical environment (safety and a calm, quiet environment) and four of which were related to the social environment (meaningful activity and one-to-one contact, opportunity to use remaining abilities, flexible policy, and knowledgeable caregivers who enjoy working with persons with dementia). Staff suggested separate dementia SCUs as one approach to managing dementia care but also identified challenges in creating dementia units in small rural facilities. Results provide support for conceptual models of dementia care settings that emphasize the interaction of organizational, social, and physical factors.

This paper examines a comprehensive set of data on the prevalence and correlates of psychological distress in a sample of 1038 adolescent students in a major urban area of a Canadian prairie province. About 27% of the students reported 6 or more symptoms of psychological distress on the GHQ-30. The frequency of symptoms varied with age, grade level and average marks, with sex being the most significant variation. ‘Anxiety’ and ‘social dysfunction’ were the most frequent symptom dimensions reported. More detailed analysis of possible predictors of mental health showed that the nature and quality of family life strongly affected adolescent mental health. Adolescents' positive evaluation of their school atmosphere and peer group life and their locus of control orientation also positively influenced their psychological well-being.