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. 2026 Feb;16(2):e71260.
doi: 10.1002/brb3.71260.

Care Trajectories of People With Mood Disorders in Quebec Using a Sequence Analysis Method

Marc Henri N'Guessan  1 , Matea Belan  2   3   4 , Christian Roger Clav Kouakou  2   4 , Maude Laberge  5 , Thomas Gilbert Poder  4   6
Affiliations

Care Trajectories of People With Mood Disorders in Quebec Using a Sequence Analysis Method

Marc Henri N'Guessan et al. Brain Behav. 2026 Feb.

Abstract

Purpose: The analysis of care trajectories for chronic diseases has gained increasing importance, particularly for mental health conditions that are often neglected despite their alarming prevalence. This study aimed to identify and describe care trajectories of Quebec adults with self-reported mood disorders.

Method: We used data from the TorSaDE cohort, which links data from the Canadian Community Health Surveys (CCHS) with administrative data from Quebec's health insurance board Régie de l'assurance maladie du Québec (RAMQ) over a 21-year period (1996-2016). Sequence analysis (SA) was used for 4421 Quebec adults who self-reported mood disorders within a 7-year follow-up period.

Finding: SA revealed three distinct user groups: Low healthcare users (Type 1, n = 2714), moderate users with diverse services (Type 2, n = 1120), and moderate users with high psychiatric service use (Type 3, n = 587). Average healthcare costs over 7 years varied significantly between trajectory types, ranging from $94,434 for low users to $230,899 for moderate users.

Conclusion: Results show that the burden of mood disorders is unevenly distributed across care trajectories: a small vulnerable group accounts for a disproportionate share of specialized healthcare use, while the majority relies only marginally on the public system. These findings highlight the heterogeneity of patients with mood disorders and underscore the need for differentiated, profile-specific approaches to healthcare planning rather than uniform treatment strategies.

Keywords: care trajectories; health services utilization; healthcare planning; mood disorders; sequence analysis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Follow‐up period for defining care trajectories for sequence analysis.
FIGURE 2
FIGURE 2
Participant flow diagram.
FIGURE 3
FIGURE 3
Mean time spent (in months) per state.
FIGURE 4
FIGURE 4
Dendrogram of the sequences clustering.
FIGURE 5
FIGURE 5
Inertia jump plot.
FIGURE 6
FIGURE 6
Monthly distribution of respondents by type of contact with the health care system (states).
See this image and copyright information in PMC

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