Aspect traumatogène de l’exclusion sociale, une analyse enthnopsychanalytique

International audienceThis research explores the phenomenon of social exclusion into a complementarist approach using interviews with six people as a starting point. Thanks to a qualitative method based on the grounded theory, we carried out a comparative analysis of our material. The analysis helped to show the traumatogenic dimension of social exclusion. We used the concept of liminality from the cultural anthropologist Victor Turner, in order to describe the destabilizing aspect of this experience, but also its potential to provoque profound change. The traumatogenic dimension appears in each story, butsometimes it provoques a real “initiatory transformation”. In other cases it may lead to defensive psychic arrangements which are constructed on the basis of a splitting between the “sacred" and the “profane” and even really become traumatic.Cette recherche explore le phénomène d’exclusion sociale dans une approche complémentariste en partant d’entretiens effectués avec six personnes. Grâce à une méthode qualitative basée sur la grounded theory, nous avons réalisé une analyse comparative de différentes parties de notre matériel. Nous avons mis en évidence la dimension traumatogène de l’exclusion sociale. La notion de liminalité de l’anthropologue Victor Turner nous a permis de décrire le potentiel déstabilisant de cette expérience, tout autant que sa capacité de «métamorphose » : si la dimension traumatogène est présente dans chacun des récits, la situation d’exclusion sociale peut, dans certains cas, prendre la forme d’une véritable « transformation initiatique ». Pour d’autres, elle peut aussi amener à des aménagements défensifs construits sur un clivage entre le « sacré » et le « profane », ou encore devenir véritablement traumatique

Exposition aux facteurs de stress et impact psychosocial du tremblement de terre de Tohoku et de ses conséquences sur les Français présents au Japon en mars 2011 - Étude qualitative

The Great East Japan Earthquake and Tsunami of the 11 th of March 2011 was followed by a nuclear accident. This study aim to identify the exposure to stress, the psychosocial impact and information need of the French Nationals who were in Japan at this time as well as the care they were looking for. A qualitative study based on 10 semi-structured interviews of French nationals was carried out between June and October 2013. They were chosen among the French who answered to the registry launched by the InVS considering the importance of the event. The interviews were face to face (7 in France, 2 in Japan) except for one in Japan that was performed by videoconference.This study confirms the impact of this disaster on real life experience. Some interviewed relate anxious and thymic manifestations or impacts on personality that might lead to seek care, even two years after the events. Beyond stress factors usually linked to natural disaster, this study showed that the issue of information was considerable, in particular about nuclear contamination that makes the feeling of worrying long lasting. Living abroad is a specificity that modifies the experience of such extreme events. This experience influenced the life-course of the exposed. These results will be useful for future post-disaster epidemiological studies. They plaid also for registering involved people as well as preparing appropriate and sustained information and mental health screening which allows people to stay active in their choices and decisionsLe séisme survenu au Japon le 11 mars 2011 a entraîné un tsunami et un accident nucléaire. L’objectif de cette étude est de mieux connaître, pour les ressortissants français présents, les expositions aux facteurs de stress liés à ces événements, ainsi que l’impact psychosocial et les besoins d’information et de prise en charge qui en ont résulté.Une étude qualitative par entretiens semi-directifs a été réalisée auprès d’une dizaine de personnes sélectionnées parmi celles qui avaient répondu à l’enregistrement proposé par l’InVS. Les entretiens se sont déroulés entre juin et octobre 2013 en face à face (7 en France, 2 au Japon) ou par visioconférence pour une personne domiciliée au Japon. Les résultats confirment le vécu bouleversant de cette catastrophe multiple pouvant contribuer, parfois à distance de l’événement, à la survenue de manifestations anxieuses, thymiques ou des modifications de la personnalité qui peuvent nécessiter un recours aux soins. Les facteurs de stress classiquement identifiés en rapport avec les catastrophes naturelles sont retrouvés. La question de l’information a été centrale, notamment au sujet de la contamination radiologique suscitant une inquiétude prolongée. L’expatriation est une situation particulière qui modifie les modalités de vécu de tels événements. Cette expérience a sensiblement influencé ou précipité des décisions relatives à l’existence. Ces résultats vont être utilisés pour planifier les études épidémiologiques post-catastrophe. Ils confirment l'importance d'un enregistrement initial des personnes impliquées et d'une offre d’information et de dépistage adaptée et maintenue dans le long terme qui donne aux personnes exposées la possibilité de rester actives dans leurs choix et leurs décisions

Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo

ABSTRACT: BACKGROUND: Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo. METHODS: Women who attended the Médecins Sans Frontières program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville. RESULTS: The initial diagnosis according to DSM criteria showed a predominance of anxious disorders (54.1%) and acute stress disorders (24.6%). One to two years after the initial psychological care, 64 women were evaluated using the Trauma Screening Questionnaire (TSQ), the Global Assessment of Functioning scale (GAF) and an assessment scale to address medico-psychological care in emergencies (EUMP). Two patients (3.1%) met the needed criteria for PTSD diagnosis from the TSQ. Among the 56 women evaluated using GAF both as pre and post-test, global functioning was significantly improved by initial post-rape support (50 women (89.3%) had extreme or medium impairment at first post-rape evaluation, and 16 (28.6%) after psychological care; p = 0.04). When interviewed one to two years later, the benefit was fully maintained (16 women (28.6%) presenting extreme or medium impairment). CONCLUSION: We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings

Prospective study on a fast-track training in psychiatry for medical students: the psychiatric hat game

Abstract: Background: While medical students are losing interest in lectures in favor of other educational materials, many studies suggest the benefit of active learning, combined with gamified educational tools. The authors developed a psychiatric adaptation of the « Hat Game ». It was hypothesised that this game would increase both knowledge and motivation in medical students toward psychiatric semiology. The aim of the study was to assess the benefit of a Psychiatric Hat Game session for learning psychiatric symptoms in third-year medical students. Student performance was also evaluated at 3 months. Methods: This gamified fast-track training consists of two teams and each team has to guess as many psychiatric semiology terms as possible using different techniques (i.e. speech, mime). The study involved a pre- and post-evaluation of knowledge (Multiple Choice Questions) and a satisfaction survey. Baseline, post-immediate, and three-months scores were compared by using Friedman analysis for paired samples. Comparisons of mean scores at two different times were performed by using Wilcoxon test for paired samples. Results: One hundred and sixty-six students were proposed to take part in the study. Among them 129 completed the whole program (response rate = 77.7%). Mean scores measured at the three points in time were significantly different (p < 0.001, N = 129). Knowledge mean scores were significantly higher after the game than before (+ 28.6%, p < 0.001). Improvement was maintained 3 months after the game (+ 18.9%, p < 0.001). Satisfaction survey items highlighted that students enjoyed and would recommend this type of gamified training. Conclusions: The Psychiatric Hat Game improved knowledge of psychiatric semiology in medical students. Results suggest that it is a promising and efficient tool to playfully teach medical semiology, with transferable features, utility and acceptability from one medical field to another. This study contributes to the growing body of knowledge advocating for serious games and gamified training in medical education.Version of Recor

Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study

BACKGROUND: The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack ('bystander exposure') who may or may not have provided care to attack victims subsequently, or as care providers to victims only ('professional exposure only'). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with 'professional exposure only', and to assess their use of psychological support resources. METHOD: An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category ('bystanders to the attack'; 'professional exposure only'; 'unexposed'); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis. RESULTS: 804 staff members' questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were 'bystanders to the attack', 285 had 'professional exposure only'. The staff with 'professional exposure only' reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the 'professional exposure only' category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19-6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30-11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18-7.85; p = 0.022). Lastly, 70.6% of the staff with 'professional exposure only' with full PTSD did not seek psychological support. CONCLUSION: Despite a significant impact on mental health, few staff with 'professional exposure only' sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks. STUDY REGISTRATION: Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812-51)

Children and Adolescents Psychological Distress Scale During COVID-19 Pandemic: Validation of a Psychometric Instrument (CONFEADO Study)

AIM AND OBJECT PURPOSE OF THE STUDY: In March 2020, the WHO declared a pandemic (COVID-19) due to the SARS-CoV-2 virus. In France, school closures and lockdowns were implemented. In this unprecedented context for French adolescents and children, the CONFEADO study surveyed children aged 9 to 18 years to assess their mental health, psychological distress, and resilience during and after the lockdown in relation to their living and housing conditions. To assess psychological distress, a psychometric tool (Children and Adolescent Psychological Distress Scale-CAPDS-10) was specifically designed for the research. This article presents the psychometric validity of the CAPDS-10. METHODS: This cross-sectional study collected data from June 9 to September 14, 2020, from children and adolescents (9 to 18 years of age) via an online questionnaire after sending it to a large network of partners. Psychological distress, resilience, and trait anxiety were assessed using the CAPDS-10, the Child and Youth Resilience Measure (CYRM), and the State-Trait Anxiety Inventory for Children (STAIC). The CAPDS-10 measured perceived psychological distress in the most recent 2 weeks (primary endpoint). The predictive power of the CAPDS-10 was determined by statistical analysis. We proceeded to a confirmatory factor analysis to validate the scale at a clinical level. We carried out a psychometric validation with a step to verify the uni-dimensionality of the scale (PCA analysis) and the calculation of convergent and divergent validity, correlation coefficient between items and subscales, Cronbach's alpha for reliability, determination of a cut-off score for the AUROC index. RESULTS: Three thousand and forty eight children and adolescents completed the CAPDS-10. Analysis confirmed a three-factor model (anxiety, depression, and aggressive behavior) (RMSEA = 0.072 [0.067; 0.077], CFI = 0.954), with a correlation coefficient between items >0.4. PCA analysis concluded that the scale is unidimensional. Reliability was satisfactory with Cronbach's alpha coefficients >0.7 (0.86). In addition, prediction was good with an AUROC index equal to 0.73 and a threshold score for severe distress greater than or equal to 19. CONCLUSION: The CAPDS-10 measures psychological distress over the most recent 2-week period with good psychometric qualities. It could be used in crisis or prevention contexts in the general population or in clinical settings

Association of Gender with Clinical Expression, Quality of Life, Disability, and Depression and Anxiety in Patients with Systemic Sclerosis

OBJECTIVES: To assess the association of gender with clinical expression, health-related quality of life (HRQoL), disability, and self-reported symptoms of depression and anxiety in patients with systemic sclerosis (SSc). METHODS: SSc patients fulfilling the American College of Rheumatology and/or the Leroy and Medsger criteria were assessed for clinical symptoms, disability, HRQoL, self-reported symptoms of depression and anxiety by specific measurement scales. RESULTS: Overall, 381 SSc patients (62 males) were included. Mean age and disease duration at the time of evaluation were 55.9 (13.3) and 9.5 (7.8) years, respectively. One-hundred-and-forty-nine (40.4%) patients had diffuse cutaneous SSc (dcSSc). On bivariate analysis, differences were observed between males and females for clinical symptoms and self-reported symptoms of depression and anxiety, however without reaching statistical significance. Indeed, a trend was found for higher body mass index (BMI) (25.0 [4.1] vs 23.0 [4.5], p = 0.013), more frequent dcSSc, echocardiography systolic pulmonary artery pressure >35 mmHg and interstitial lung disease in males than females (54.8% vs 37.2%, p = 0.010; 24.2% vs 10.5%, p = 0.003; and 54.8% vs 41.2%, p = 0.048, respectively), whereas calcinosis and self-reported anxiety symptoms tended to be more frequent in females than males (36.0% vs 21.4%, p = 0.036, and 62.3% vs 43.5%, p = 0.006, respectively). On multivariate analysis, BMI, echocardiography PAP>35 mmHg, and anxiety were the variables most closely associated with gender. CONCLUSIONS: In SSc patients, male gender tends to be associated with diffuse disease and female gender with calcinosis and self-reported symptoms of anxiety. Disease-associated disability and HRQoL were similar in both groups

Les enfants endeuillés par le COVID. Interview: Interview par Véronique Duqueroy

SIte d'information médicale en ligne. https://francais.medscape.com/voirarticle/3607097#vp_

Effroi et métamorphose. Psychothérapie transculturelle des névroses traumatiques en situation d’impasse thérapeutique

We describe and analyze a psychotherapeutic groupal transcultural setting conceived in order to take care of the migrant patients who present traumatic neuroses when in a situation of therapeutic dead end. After having analyzed the concept of fright in its metapsychological, mythological and transcultural aspects, we propose the analysis of four psychotherapies, first in a longitudinal way, and then in a thematic way. We clarify both the factors of resistance to the psychotherapy and the factors of therapeutic efficiency. It allows us to emphasize the heuristic value of the fright’s concept in a transcultural context. We analyse fright’s transcultural semiology. We suggest understanding traumatic neuroses resisting to the care as situations of “dead ended” metamorphosis caused by fright. A first psychotherapeutic phase working on psychic and cultural containers is necessary before work on the psychic œdipian conflictuality can be started. We hypothesize that an internal containing defect linked to premature experiences having affected the Ego does preexist in those patients. We put emphasize on the relevance of transcultural group psychotherapy setting for both clinical care and research.Nous décrivons et analysons un dispositif psychothérapeutique groupal transculturel conçu pour prendre en charge des patients migrants présentant des névroses traumatiques en situation d’impasse thérapeutique. Après avoir analysé le concept d’effroi dans ses aspects métapsychologiques, mythologiques et transculturels, nous proposons l’analyse de quatre psychothérapies de manière longitudinale puis de manière thématique. Nous précisons les facteurs de résistance aux soins et les facteurs d’efficacité thérapeutique. Cela nous permet de souligner la valeur heuristique du concept d’effroi en situation transculturelle. Nous précisons sa sémiologie transculturelle et nous proposons de comprendre les névroses traumatiques résistant aux soins comme des situations d’impasse de la métamorphose imposée par l’expérience de l’effroi. Une phase de travail psychothérapeutique portant sur les contenants psychiques et culturels est nécessaire avant que ne puisse être entrepris un travail psychothérapeutique portant sur la conflictualité psychique œdipienne. Nous faisons l’hypothèse qu’un défaut de contenance interne lié à des expériences précoces ayant affecté le Moi préexiste chez ces patients. Nous soulignons la pertinence du dispositif psychothérapeutique groupal transculturel pour le soin et la recherche

Traumatisme, mémoire, amnésie : le regard d’un clinicien

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