Jean-Luc Roelandt

Background: The population of French Guiana is young, poor, and multicultural. We thus hypothesized that the epidemiology of depression and its care may differ from that in mainland France. We took the opportunity of the Mental Health in the General Population survey to estimate the overall prevalence of depression in the general population and its prevalence in different sociodemographic subgroups using the MINI interview. Methods: The cross-sectional survey was conducted 881 persons aged > 17 years were interviewed and analyzed. Results: There were 151 current depressive episodes setting the prevalence at 17.1% (95% confidence interval = 14.8–19.8%). For recurrent depression, the prevalence was 7.9% (95% confidence interval = 6.3–9.9%). The prevalence of current depression was independently greater among younger age groups than those aged 65 or more (age ≤ 25 years (aPR = 4.4 (95% CI = 1.5–12.3), p = 0.004); age 26–35 years (aPR = 3.3 (95% CI = 1.2–9), p = 0.01) persons who did not complete primary education (aPR = 1.9 (95% CI = 1–3.5), p = 0.04), those who earned less than EUR 840 (aPR = 2 (95% CI = 1.1–3.8), p = 0.04), and those who were separated or divorced relative to those married or in a couple (aPR = 2.2 (95% CI = 1.1–4.5), p = 0.02). For recurrent depressive episodes, multiple Poisson regression found that younger age categories relative to those aged > 65 years ≤ 25 years (aPR = 9.9 (95% CI = 1.1–85.9), p = 0.04), those aged 26–35 years (aPR = 9.3 (95% CI = 1.1–78.9), p = 0.04), and female sex (aPR = 2.04 (95% CI = 1.2–3.4), p = 0.007) were independently associated with the outcome. Conclusions: Depression is more frequent in French Guiana than in mainland France and is strongly associated with youth and poverty.

La recherche RPSY vise à explorer les liens entre pratiques de soins, notamment l’usage de la contrainte (isolement, contention), risques psychosociaux (RPS) et santé mentale au travail des soignant·e·s de psychiatrie adulte dans huit établissements publics de santé mentale (EPSM). Les critiques dont la démarche participative et le protocole de recherche proposés ont été l’objet sont révélatrices des débats et controverses entourant la production de connaissances sur la santé mentale au travail, entre approches compréhensives versus objectivistes. Une manière d’en tenir compte a été d’engager une étude préliminaire afin de questionner le sens de l’engagement des établissements dans cette recherche, leurs motivations et les attentes. C’est l’objet de cet article qui se propose d’analyser les enjeux institutionnels soulevés par cette recherche. L’analyse des entretiens réalisés permet de mettre en lumière les difficultés, les limites et les enjeux d’une politique de prévention des RPS, particulièrement sensible au sein des établissements, source de tensions et divisions entre les partenaires sociaux et les directions, témoignant d’une difficile coopération susceptible d’en affaiblir la portée.

Resumen. Representaciones sociales del "loco", del "enfermo mental" y del "depresivo" en los territorios franceses de ultramar y en la Francia occidental. La encuesta "Salud mental en la población general : imágenes y realidad" se realizó en Francia y en 8 sitios de ultramar en tres continentes, en los departamentos, regiones y colectividades francesas de ultramar (Guayana, Martinica, Guadalupe, Reunión, Mayotte, Polinesia Francesa y dos sitios en Nueva Caledonia), a partir de muestras representativas de la población general. Los individuos respondieron a cuatro cuestionarios: uno socioantropológico, otro epidemiológico, otro sobre el uso de la asistencia sanitaria y otro sociodemográfico. El foco de atención de este artículo se centró en las representaciones sociales del "Loco" , el "Enfermo mental" y el "Deprimido". Si bien los territorios de ultramar son claramente diferentes en términos sociodemográficos, epidemiológicos, psiquiátricos, las representaciones sociales del "Loco" y del "Enfermo mental" siguen siendo muy similares entre los sitios y con la Francia occidental. En cambio, existen claras diferencias con la Francia metropolitana en cuanto al concepto de recuperación, de exclusión y, sobre todo, de

En accord avec les préconisations de l'OMS et ses propres valeurs, le CCOMS a inclus les usagers et les aidants dans sa participation à la révision de la CIM L'article décrit la mise en place de cette démarche participative et illustre comment elle a contribué à faire évoluer la conception de différents diagnostics. Une première action a soutenu la dépsychiatrisation de la transidentité par un changement de nom et un transfert vers une nouvelle catégorie « santé sexuelle », maintenant un accès aux soins tout en réduisant la stigmatisation. Une deuxième action s'est centrée sur le vocabulaire utilisé dans la CIM. Un projet international centré sur les diagnostics d'« épisode dépressif » et de « schizophrénie » confirme d'abord le caractère stigmatisant de l'étiquette « schizophrénie » et montre que le vocabulaire utilisé dans la CIM est souvent incompris des usagers et des aidants. Ces travaux se prolongent par une réflexion autour du diagnostic même de « schizophrénie ». La position du CCOMS est d'aller au-delà d'un simple changement de nom pour déconstruire ce concept à forte charge stigmatisante dont la validité scientifique est grandement contestée.

People with severe mental illness (PSMI) have a shorter life expectancy and are more likely to have cardiovascular disease than the general population. Patients, carers, psychiatric professionals and primary care providers can all play a role in increasing PSMI physical health. The present qualitative exploratory study aimed to explore the views of these four populations as part of the multi-phase COPsyCAT project, whose objective is to build and test a cardiovascular risk prevention programme for PSMI. Overall, 107 people participated in the study’s 16 focus groups, which were transcribed and analysed in a thematic analysis. With a view to building the health promotion programme, major themes identified in the corpus were translated into a list of needs as follows: communication, information, training and support. Results show that it is essential to improve communication between all the different stakeholders in mental health. The greatest challenge facing this programme will be to adapt it to the needs and expectations of PSMI while facilitating work between the various mental health stakeholders. Simple and inexpensive actions could be taken to improve the cardiovascular health of PSMI and will be experimented with during the programme’s feasibility study which will start in September 2022.

Background: Schizophrenia diagnosis is associated with special communication difficulties between clinicians, service users and caregivers, which may hinder the therapeutic alliance, treatment compliance, and rehabilitation. A clinically useful psychiatric nosology should improve communication between all final users. Aim: To evaluate the accessibility (vs. difficulty), acceptability (vs. related negative feelings) and adequacy (i.e. correspondence with the patient’s experience) of the terms proposed for ICD-11 schizophrenia diagnostic guidelines, according to 15 persons with a schizophrenia diagnosis and 15 caregivers of individuals with schizophrenia. Result: The ICD-11 terms that were most accessible for service users and caregivers were those most commonly experienced by patients (such as delusions and hallucinations). However, many less frequent features were not understood by a high percentage of participants, and most terms had negative connotations for both service users and caregivers, including the label for the “schizophrenia” disorder. Specific suggestions of more neutral, colloquial terms were proposed by participants. Discussion: The jargon in the current psychiatric classifications for schizophrenia has little heuristic value for service users and their caregivers in terms of accessibility or acceptability, highlighting the need for nosological systems’ co-development with experts by experience to change language that is confusing or unacceptable to them.

Background: For ICD-11, the WHO emphasized the clinical utility of communication and the need to involve service users and carers in the revision process. Aims: The objective was to assess whether medical vocabulary was accessible, which kinds of feelings it activated, whether and how users and carers would like to rephrase terms, and whether they used diagnosis to talk about mental health experiences. Method: An innovative protocol focused on two diagnoses (depressive episode and schizophrenia) was implemented in 15 different countries. The same issues were discussed with users and carers: understanding, feelings, rephrasing, and communication. Results: Most participants reported understanding the diagnoses, but associated them with negative feelings. While the negativity of “depressive episode” mostly came from the concept itself, that of “schizophrenia” was largely based on its social impact and stigmatization associated with “mental illness”. When rephrasing “depressive episode”, a majority kept the root “depress*”, and suppressed the temporal dimension or renamed it. Almost no one suggested a reformulation based on “schizophrenia”. Finally, when communicating, no one used the phrase “depressive episode”. Some participants used words based on “depress”, but no one mentioned “episode”. Very few used “schizophrenia”. Conclusion: Data revealed a gap between concepts and emotional and cognitive experiences. Both professional and experiential language and knowledge have to be considered as complementary. Consequently, the ICD should be co-constructed by professionals, service users, and carers. It should take the emotional component of language, and the diversity of linguistic and cultural contexts, into account.

Background: Persons with a diagnosis of severe mental illness have a life expectancy that is 20 years lower than the general population, and they are disproportionately affected by cardiovascular disorders. Improving the management of cardiovascular risk is one of the main challenges for the public health system. In the care pathway of persons with a diagnosis of severe mental illness, a better understanding of limiting and facilitating factors is required. The objective was to include persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals in the creation and evaluation (feasibility) of a health promotion program designed to improve cardiovascular risk management through empowerment. Methods: This study combines a mixed methodology with qualitative and quantitative components. A multicenter prospective qualitative study was conducted in seven mental health units in France and was coordinated by a steering committee composed of persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals. Results: This health promotion program must enable persons with a diagnosis of severe mental illness to assert their right to self-determination and to exercise greater control over their lives, beyond their diagnosis and care. Following a preliminary feasibility study, the effectiveness of this new tool will be evaluated using a randomized controlled trial in a second study. Conclusions: The findings can be used by health organizations as a starting point for developing new and improved services for persons with a diagnosis of severe mental illness. Trial registration Clinical Trials Gov NCT03689296. Date registered September 28, 2018

Inpatient care accounts for the majority of mental health care costs and is not always beneficial. It can indeed have detrimental consequences if not used appropriately, and is unpopular among patients. As a consequence, its reduction is supported by international recommendations. Varying rates of psychiatric inpatient admissions therefore deserve to draw attention of researchers, clinicians and policy makers alike as such variations can challenge quality, equity and efficiency of care. In this context, our objectives were first to describe variations in psychiatric inpatient admission rates across the whole territory of mainland France, and second to identify their association with characteristics of the supply of care, which can be targeted by dedicated health policies. Our study was carried out in French psychiatric sectors’ catchment areas for the year 2012. Inpatient admission rates per 100,000 adult inhabitants were calculated using data from the national psychiatric discharge database. Their variations were described numerically and graphically. We then carried out a negative binomial regression to identify characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) which were associated with these variations while adjusting our analysis for other relevant factors, in particular epidemiological differences. Considerable variations in inpatient admission rates were observed between psychiatric sectors’ catchment areas and were widespread on the French territory. Institutional characteristics of the hospital to which each sector was linked (private non-profit status, specialisation in psychiatry and participation to teaching activities and to emergency care) were associated with inpatient admission rates. Similarly, an increase in the availability of community-based private psychiatrists was associated with a decrease in the inpatient admission rate while an increase in the capacity of housing institutions for disabled individuals was associated with an increase in this rate. Our results advocate for a homogenous repartition of health and social care for mental disorders in lines with the health needs of the population served. This should apply particularly to community-based private psychiatrists, whose heterogeneity of repartition has often been underscored.