Le processus d'évaluation du risque de récidive en consensus : intérêts et limites

Introduction L’évaluation du risque de récidive est devenue centrale dans les missions dévolues aux experts judiciaires et nombre de recherches préconisent de réaliser cette évaluation en consensus afin de l’optimiser. Objectifs Cette étude vise à analyser : (a) si l’utilisation du consensus dans l’évaluation intégrée du risque est susceptible d’améliorer la validité prédictive par rapport à une évaluation individuelle et, (b) les mécanismes à l’œuvre dans le processus d’évaluation et de prise de décision en consensus. Méthode Cent soixante dossiers d’expertises psychiatriques pénales ont été évalués par deux évaluateurs indépendants, suivi d’un temps de consensus. L’analyse de la validité prédictive a été réalisée par des courbes ROC et une équation structurale sur une période de suivi de trois ans après la sortie de prison. L’analyse qualitative du processus a été réalisée par une analyse thématique de contenu sur l’ensemble des données. Résultats La méthode du consensus n’améliore pas la validité prédictive, mais elle permet de repérer les items qui suscitent le plus de difficultés de cotation et de désaccords, de mettre au travail les aspects subjectifs dans le processus d’évaluation et de faciliter les apprentissages et corrections mutuelles. Conclusion L’échange entre évaluateurs introduit de la rigueur et oblige à argumenter précisément les positions prises, mais il n’améliore pas le niveau de prédiction de la récidive qui apparaît davantage lié à l’outil utilisé et à la logique sommative des facteurs plutôt qu’aux modalités d’évaluation étudiées, seul ou en consensu

Retrospectively assessed trajectories of PTSD symptoms and their subsequent comorbidities

Background Dynamic trajectories of psychopathology, such as post-traumatic stress disorder (PTSD) provide a key to understanding human adjustment processes after trauma exposure. Recent studies have suggested more heterogeneous mental health outcomes than the initially identified four adjustment trajectories. To explore this heterogeneity, we investigated the after-trauma adjustment patterns of psychopathology based on retrospective lifetime data. This was first carried out on the PTSD symptoms (PTSS, including no symptoms, few symptoms, partial and full PTSD), and secondly together with their post-trauma comorbidities. Methods Data of trauma and the post-trauma mental disorders were collected for a large and randomly selected community sample, resulting in a N = 960 trauma-exposed subsample. Pattern recognition as carried out by latent class analysis (LCA) was implemented on this subsample. LCA was first exploited to identify the potential trajectory patterns of PTSS and next to explore the patterns of mental adjustments when additional post-trauma comorbid disorders, such as anxiety, mood and substance use disorders, were assessed. Results Four PTSS trajectory patterns were found, namely resilient, chronic, recovered, and delayed onset, consistent with findings from longitudinal PTSD studies. When post-trauma comorbidities were evaluated, other than the trajectory pattern of delayed onset which retained a low comorbidity profile, the other three split respectively and paired up with either low, moderate or high comorbidity profile. Conclusions Mental health outcomes after trauma exposure were considerably more complex than the four previously established adjustment trajectories. Here, we uncovered additional and more heterogeneous adjustment patterns comprised of PTSS trajectories and post-trauma comorbidity profiles

Backtracing persistent biomarker shifts to the age of onset: A novel procedure applied to men’s and women’s white blood cell counts in post-traumatic stress disorder

Background: Traumatic experiences tend to be preserved in altered biomarker profiles. These profiles can be traced back from cross-sectional data regarding the age of exposure. Consequently, the change across developmental stages, e.g. from childhood to adulthood, can also be reconstructed. This study introduces a backtrace procedure that is illustrated using white blood cell (WBC) counts in full / partial post-traumatic stress disorder (PTSD). The procedure was applied separately on men's and women's data to provide a replication of the analysis based on different subsamples. Methods: The analysis was carried out with data from the CoLaus|PsyCoLaus study (N = 5111, 2370 men and 2741 women, age range 35–88 years). It was restricted to traumatic experiences that occurred until the age of 35, i.e., the lower age limit of the sample. The WBC counts from up to two assessments were standardized, pooled and assigned to the reported age of trauma exposure. This resulted in age series for each marker, whereas the reference values were based on subjects who did not experience any trauma exposure. The backtrace procedure ascertained the peaks and troughs of the age series and determined the best-fitting critical age range surrounding each peak or trough based on the best p-value from simple t-tests. Results: In CoLaus|PsyCoLaus, 750 participants reported trauma exposure until the age of 35, and 86 (out of 329) men and 187 (out of 421) women thereof were coded with a full or partial PTSD. Full / partial PTSD after trauma exposure in childhood was characterized by increased WBC counts (lymphocytes, eosinophils – in women also neutrophils). This pattern was partly retained during adolescence, in men due to eosinophils counts and in women due to lymphocyte counts. For exposure in young adulthood, the deviations were in the negative direction – in men with decreased basophils, in women with decreased lymphocytes and monocytes. Conclusions: Summarizing, the backtrace approach revealed WBC profiles in PTSD that were specific to particular developmental age stages. The strongest persistent upregulation of the immune system related to trauma exposure was traceable to childhood / early adolescence both in men and in women. Further research will show which biomarkers are similarly suitable for backtracing as WBC counts. As in PTSD, the backtrace approach could also be applied to identifying persistent biomarker profiles in other mental disorders, as well as autoimmune and other chronic diseases