Measuring Resilience in Adult Women Using the 10-Items Connor-Davidson Resilience Scale (CD-RISC). Role of Trauma Exposure and Anxiety Disorders

International audiencePURPOSE: Resilience is the ability of individuals to adapt positively in the face of trauma. Little is known, however, about lifetime factors affecting resilience. METHODS: We assessed the effects of psychiatric disorder and lifetime trauma history on the resilience self-evaluation using the Connor-Davidson Resilience Scale (CD-RISC-10) in a high-risk-women sample. Two hundred and thirty eight community-dwelling women, including 122 participants in a study of breast cancer survivors and 116 participants without previous history of cancer completed the CD-RISC-10. Lifetime psychiatric symptoms were assessed retrospectively using two standardized psychiatric examinations (Mini International Neuropsychiatric Interview and Watson's Post-Traumatic Stress Disorder Inventory). RESULTS: Multivariate logistic regression adjusted for age, education, trauma history, cancer, current psychiatric diagnoses, and psychoactive treatment indicated a negative association between current psychiatric disorder and high resilience compared to low resilience level (OR = 0.44, 95% CI [0.21-0.93]). This was related to anxiety and not mood disorder. A positive and independent association with a trauma history was also observed (OR = 3.18, 95% CI [1.44-7.01]). CONCLUSION: Self-evaluation of resilience is influenced by both current anxiety disorder and trauma history. The independent positive association between resilience and trauma exposure may indicate a "vaccination" effect. This finding need to be taken into account in future studies evaluating resilience in general or clinical populations

Traumatisme et santé mentale chez les jeunes majeurs isolés étrangers arrivés en France en tant que Mineurs Non-Accompagnés

International audienceObjectifs : La santé mentale des mineurs non accompagnés a été largement étudiée mais peu d’études se sont intéressées à leur devenir au sortir de la protection de l’enfance, souvent caractérisé par l’incertitude et l’angoisse quant à leur statut et droit de rester dans le pays d’accueil. Notre objectif était d'étudier auprès de cette population de jeunes majeurs isolés étrangers (JMIE) la prévalence des troubles psychiatriques courants à l’aide d’instruments de recherche standardisés et validés, et d’examiner les associations entre la présence de ces troubles et leur histoire traumatique.Méthodes : 110 JMIE (92,7% hommes, âge médian 19,7 ans [18,1-22,8]) de Chambéry, Montpellier et La Rochelle, ont participé à une étude transversale exploratoire. Le recrutement a été effectué par l’intermédiaire d’intervenants travaillant dans les centres d’accueil de l’Aide Sociale à l‘Enfance où ils avaient séjourné. Au cours d’un entretien en face à face, les troubles probables somatoformes, anxieux et dépressifs ont été évalués avec le Patient Health Questionnaire (PHQ ; score≥10) et le trouble de stress post-traumatique (TSPT) avec le PTSD Checklist for DSM-5 (PCL-5 ; score≥33). Les associations entre ces quatre troubles et le nombre et type d’évènements de vie traumatiques mesurés avec le Life Events Checklist (LEC-5) ont été analysées à l’aide de modèles de régression logistique, avec un seuil de significativité fixé à p≤0,0125 pour prendre en compte les comparaisons multiples.Résultats : 19,3% des JMIE présentaient des troubles somatoformes, 17,6% une anxiété, 28,7% une dépression et 20% un TSPT. Le nombre médian d’évènements traumatiques vécus personnellement sur les 15 types investigués était de 5 [min-max : 0-10]. Les plus fréquents étaient : exposition à la mort accidentelle d'un proche (67,8%), agression physique (66,1%), attaque à main armée (47,7%) et captivité (45,9%). Le nombre d'événements de vie traumatiques augmentait le risque de dépression (OR (95%CI) ajusté : 1,56 (1,25-1,96)), de TSPT (1,60 (1,23-2,08)), de troubles somatoformes (1,41 (1,10-1,82), avec, après correction pour comparaisons multiples, une tendance pour l'anxiété (1,33 (1,02-1,72)). L’agression physique était le type d’évènement associé positivement au plus grand nombre de troubles psychiatriques (p≤0,01, pour tous les troubles sauf l’anxiété), suivi par l’exposition comme témoin à mort violente (p≤0,01 pour la dépression et le TSPT) et par l’agression sexuelle (p=0,002 pour le TSPT).Conclusion : les JMIE présentaient une prévalence élevée de troubles psychiatriques, comparée à des valeurs normatives pour les catégories d’âge les plus proches. Malgré les difficultés à établir des comparaisons, les prévalences par catégorie diagnostique étaient proches de celles trouvés dans d’autres études de migrants, mineurs non accompagnés ou adultes. Nous avons mis en évidence un effet cumulatif du nombre d’évènements de vie traumatiques sur ces troubles, qui était robuste aux ajustements pour les facteurs de confusion potentiels. Nous avons aussi constaté une augmentation des troubles, en particulier le TSPT, avec des évènements de type interpersonnels (agressions) et violents. Une évaluation régulière des symptômes psychiatriques avec une prise en charge rapide et adaptée est préconisée, en vue des troubles potentiellement traumatiques vécus dans les pays d’accueil qui viendraient s’ajouter aux évènements subis avant et pendant le parcours migratoire

Association between uncertainty regarding right-to-stay and mental health in unaccompanied and separated migrant children (UASC) reaching adulthood: findings from France

International audiencePurpose: There is substantial evidence suggesting high levels of mental health problems in unaccompanied and separated children (UASC). However, there is less focus on the first years of adulthood characterised by increased vulnerability and fear of deportation. We aim to describe the mental health of UASC on reaching adulthood, and how this is affected by uncertainty regarding their right-to-stay in France. Methods: 110 youth aged 18-22 were recruited via child protection reception centres. We administered the Patient Health Questionnaire somatic (PHQ-15), anxiety (GAD-7) and depression (PHQ-9) modules, the Post-Traumatic Stress Disorder Checklist (PCL-5) and Connor-Davidson Resilience Scale (CD-RISC-10). Logistic regression analysis was performed with the dependent variable, a secure (versus uncertain) situation defined as (i) detaining a residence permit and being in school, apprenticeship or salaried job, or (ii) waiting for residence permit whilst occupying a salaried job. Results: Of the sample, 18.4% reached criteria (score≥10) for probable somatic disorder, 17.6% for anxiety and 28.7% for depression; 41.8% were in an uncertain situation. Uncertainty was associated with higher anxiety ((OR per Interquartile range (95%CI), 1.77 (1.05-2.98)) and post-traumatic stress symptoms (2.05 (1.06-4.00)), lower resilience (0.50 (0.27-0.91)), and participants rating their anxiety (p=0.02) and depressive symptoms (p=0.003) as more severe since reaching adulthood.Conclusions: Our findings suggest uncertainty regarding right-to-stay is associated with increased mental health symptoms, specifically anxiety and trauma-induced stress, thereby highlighting the vulnerability of UASC in their first years of adulthood. This calls for greater support during this transition period with regular symptom monitoring for timely psychological interventions

Onset and relapse of psychiatric disorders following early breast cancer: a case-control study.: Mental health of primary breast cancer survivors

International audienceOBJECTIVE: Our objective is to evaluate the mental status of primary early breast cancer survivors according to DSM-IV criteria, distinguishing new psychiatric diagnosis, which started after the cancer diagnosis from relapse. METHODS: A comparative study of 144 breast cancer survivors and 125 women without previous history of cancer was carried out. Neuropsychiatric symptomatology was assessed retrospectively using standardized psychiatric examinations (Mini International Neuropsychiatric Interview, Watson's Post-Traumatic Stress Disorder Inventory) over three successive periods, 'before cancer' (from childhood to 3 years before the interview), 'around the cancer event' (the last 3 years including the time of diagnosis and treatment), and 'currently' (the last 2 weeks). RESULTS: Increased rates of anxiety and mood disorders were observed following a diagnosis of breast cancer compared with controls (generalized anxiety disorder (GAD) and major depressive disorder (MDD); 10.4 vs 1.6% and 19.4 vs 8.8%, respectively). The cancer disease promoted the development of dysthymia (n=4 new cases/6 two-year prevalent cases) and PTSD (7/7) and the re-emergence of MDD (n=21 relapses/28 three-year prevalent cases) and GAD (10/15). No improvement in serious mood disorders such as MDD (16.0 vs 7.2%) and dysthymia (4.2 vs 0%) was reported at the time of interview, more than 1.75 years (median time) after the cancer surgery, the prevalence being 2-4 times greater in breast cancer survivors than in controls. CONCLUSION: Despite significant advances in treatment, a diagnosis of breast cancer is highly associated with various forms of psychopathology, regardless of psychiatric history, with symptoms persisting after treatment. These results may assist clinicians in planning mental healthcare for women with breast cancer

Health Service Utilisation, Detection Rates by Family Practitioners, and Management of Patients with Common Mental Disorders in French Family Practice

International audienceOBJECTIVE:Provide up-to-date detection rates for common mental disorders (CMD) and examine patient service-use since the Preferred Doctor scheme was introduced to France in 2005, with patients encouraged to register with and consult a family practitioner (FP) of their choice.METHODS:Study of 1133 consecutive patients consulting 38 FPs in the Montpellier region, replicating a study performed before the scheme. Patients in the waiting room completed the self-report Patient Health Questionnaire (PHQ) and Client Service-Receipt Inventory with questions on registration with a Preferred Doctor and doctor-shopping. CMD was defined as reaching PHQ criteria for depression, somatoform, panic or anxiety disorder. For each patient, FPs completed a questionnaire capturing psychiatric caseness.RESULTS:81.2% of patients were seeing their Preferred Doctor on the survey-day. Of those with a CMD, 52.6% were detected by the FP. This increased with CMD severity and comorbidity. Detected cases were more likely to be consulting their Preferred Doctor (84.7% versus 79.4% for non-detected cases, p = 0.05) rather than another FP. They declared more visits to psychiatrists (17.2% versus 6.7%, p = 0.002). There was no association with consultation frequency or doctor-shopping, which both declined between the two studies.CONCLUSION:The CMD detection rate is relatively high, with no increase compared to our previous study, despite a decline in doctor-shopping. An explanation is the same high proportion of patients visiting their usual FP on the survey-day at both periods, suggesting a limited impact of the scheme on care continuity. FP action taken highlights the importance of improving detection for providing care to patients with CMDs

Association between socio-demographic characteristics and resilience level.

<p>Note: Resilience scores are classified in three categories: CD-RISC score ≤23 (R1),23< CD-RISC ≤29(R2) and CD-RISC score >29 (R3).</p

Women's resilience as a function of lifetime trauma and current psychiatric disorder.

<p>Women's resilience as a function of lifetime trauma and current psychiatric disorder.</p

Multivariate Logistic Regression Analyses of Factors associated with the Level of Resilience.

<p>Resilience scores are classified in three categories: CD-RISC score ≤23 (R1), 23< CD-RISC ≤29 (R2) and CD-RISC score >29 (R3).</p