POVERTY AND MENTAL HEALTH: WHAT SHOULD WE KNOW AS MENTAL HEALTH PROFESSIONALS?

Background: Social inequality as a social and economic phenomenon has become an issue of common interest in Europe and other societies worldwide, mainly after the recent global financial and economic crisis that occurred in 2008. The increasing gap observed between socioeconomically advantaged and disadvantaged people has caused intensive debates in politics, social sciences and in the field of public health. Today, poverty is considered as a major variable adversely influencing health. In this paper we will discuss the link between poverty and mental health. Subjects and methods: We conducted a literature search focusing on three main objectives: (I) to investigate the definition of “poverty”; (II) to determine the association between poverty and major mental health problems; and (III) to discuss the extent to which poverty could be both a cause and a consequence of mental health. Results: We identified a total of 142relevant papers, published between 1995 and 2014, only 32 were retained. Main findings are summarised in this paper. Conclusion: Poverty can be considered as a risk factor for mental illness. Yet the relation between poverty and mental health is complex, without direct causation, and bidirectional. As poverty has severe consequences not only on health but also on the whole society, combating poverty should be placed high on the political agenda

“PLEASE ADMIRE ME!” WHEN HEALTHCARE PROVIDERS\u27 POSITIVE STEREOTYPES OF ASYLUM SEEKER PATIENTS CONTRIBUTE TO BETTER CONTINUITY OF CARE

Background: Among asylum seekers (AS), mental health conditions are highly prevalent. However this population group has poor access to adequate services and frequently incurs discontinuity of mental healthcare. Many factors explain discontinuity of mental healthcare for asylum seekers. The aim of this study is to evaluate if facilitation of care for AS decreases healthcare provider stereotypes of this population and improves their continuity of care. Subjects and methods: General practitioners (GPs) and mental health professionals (MHPs) were invited to participate in a vignette study, presenting an AS patient manifesting post-traumatic stress symptoms. We randomly manipulated the context of the clinical vignette to create two experimental conditions: facilitated care versus non-facilitated care. In each condition, we measured participants’ stereotypes and continuity of care. Results: There was a significant effect of participant’s type of stereotypes on continuity of care (F=2.87, p=0.035). However, we found no effect of condition (facilitated vs. non facilitated care) on stereotypes (F=0.11, p=0.95), nor on continuity of care (F=0.35, p=0.55). Furthermore, there was a significant effect of profession (GPs vs MHPs) on continuity of care (F=11.43, p=0.001). Participants’ number of consultations per week (F=10.33, p=0.002) and their gender (F=3.69, p=0.030) both have a significant effect on continuity of care. Conclusion: Among healthcare providers, we found that “admiration” stereotypes were associated more with continuity of care. Paradoxically, continuity of mental healthcare was better among GPs compared to MHPs. Thus, improvement of continuity of mental healthcare for AS among MHPs should be investigated in further studies

RELAXATION AND IMPACT ON THE MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL: INTEREST OF GROUP PSYCHOEDUCATION FOR STRESS MANAGEMENT IN THE CONTEXT OF LIAISON PSYCHIATRY WITHIN A GENERAL HOSPITAL

Background: In this article we propose a model for caring for a group focusing on psychoeducation for stress management and learning relaxation designed for patients experiencing somatization and who were recruited during organic medicine consultations. We are developing an interest for this kind of group from a clinical and practical point of view and have sought to demonstrate the impact that this kind of care can have on health representations among these patients through using the MHLC (Multidimensional Health Locus of Control) questionnaire. Subject and methods: Participants in the stress management and relaxation groups completed the questionnaire at the beginning of the first session and at the end of the second and last session. We collected 94 usable questionnaires between January 2008 and December 2014 and processed the data using Student’s t-test on paired samples. Results: The results tend to demonstrate that psychoeducation for stress management and relaxation reduces internality scores in patients with high scores and the opposite for patients whose internality scores are low. Discussion: Our research protocol does not enable us to distinguish between the respective influences of the psychoeducation group and the relaxation group. Conclusion: The psychoeducation groups for stress management and relaxation have an impact on health representations in patients experiencing somatization who would not have spontaneously sought out psychiatric consultations

REVIEW OF DISPARITIES IN THE MENTAL HEALTH CARE OF ETHNIC MINORITY PATIENTS

Background: Due to demographic changes, Western societies are increasingly multicultural and diverse. These changes lead to the issue of the equity of care for all groups of society, particularly for ethnic minorities. Within the context of medicine, it has been proven that doctors are sensitive to patient ethnicity, and that this in turn affects doctors’ decision-making and the quality of their relationship with the patient. This leads to reduced access and quality of care for ethnic minority patients, which in turn magnifies ethnic inequalities in health care. Little is known about the extent of this issue within the specific field of mental health care. Methods: We conducted a literature search within three online databases, focusing on two main questions: (I) What are the main types of disparity observed in the provision of mental health care for ethnic minority patients? and (II) How do mental health care providers contribute to disparities in the mental health status of ethnic minority patients? Results: We identified a total of 164 articles relevant to our research questions, published between 1989 and 2013. Of these, only 29 were retained. The main findings are summarised in this paper. Conclusion: Mental health care providers should be constantly aware of potential bias due to patient ethnicity and of the potential impact of this bias on the process of care if they want to act in the best interests of patients and avoid contributing to mental health disparities. The contribution of mental health care providers to these disparities is only one aspect of this complex social issue

REVIEW OF DISPARITIES IN THE MENTAL HEALTH CARE OF ETHNIC MINORITY PATIENTS

Background: Due to demographic changes, Western societies are increasingly multicultural and diverse. These changes lead to the issue of the equity of care for all groups of society, particularly for ethnic minorities. Within the context of medicine, it has been proven that doctors are sensitive to patient ethnicity, and that this in turn affects doctors’ decision-making and the quality of their relationship with the patient. This leads to reduced access and quality of care for ethnic minority patients, which in turn magnifies ethnic inequalities in health care. Little is known about the extent of this issue within the specific field of mental health care. Methods: We conducted a literature search within three online databases, focusing on two main questions: (I) What are the main types of disparity observed in the provision of mental health care for ethnic minority patients? and (II) How do mental health care providers contribute to disparities in the mental health status of ethnic minority patients? Results: We identified a total of 164 articles relevant to our research questions, published between 1989 and 2013. Of these, only 29 were retained. The main findings are summarised in this paper. Conclusion: Mental health care providers should be constantly aware of potential bias due to patient ethnicity and of the potential impact of this bias on the process of care if they want to act in the best interests of patients and avoid contributing to mental health disparities. The contribution of mental health care providers to these disparities is only one aspect of this complex social issue

Discrimination dans la consultation médicale interethnique de médecine générale ?

Fighting against health inequalities has become a major issue of public health. These strike more heavily certain population groups, such as migrants and ethnic minorities. Recent literature has shown that doctors can sometimes discriminate against patients based on their ethnicity, strengthening health inequalities. The original point of this thesis is to try to clarify the issue of health inequalities, by focusing on what is at the heart of inter-ethnic medical consultation. Our empirical findings confirm that the ethnicity of a patient is sufficient to cause differentiated medical care. Our thesis points out that the micro level of analysis of what is at stake in the heart of the doctor-patient relationship offers new research perspectives for understanding the genesis of health inequalities, and thus fight against them. Our work equally highlights the importance of university education for the doctor-patient relationship in the context of quality medical care.Lutter contre les inégalités de santé est devenu un enjeu majeur de la santé publique. Celles-ci frappent plus lourdement certains groupes de la population, tels que les migrants et les minorités ethniques. Récemment la littérature a mis en évidence que les médecins peuvent parfois discriminer les patients sur base de leur ethnicité, renforçant ainsi les inégalités de santé. L’originalité de cette thèse est de tenter d’éclairer la problématique des inégalités de santé, en s’intéressant à ce qui se joue au cœur de la consultation médicale interethnique. Notre partie empirique confirme que l’ethnicité d’un patient suffit à entraîner une prise en charge médicale différenciée. Notre thèse souligne que le niveau d’analyse micro de ce qui se joue au cœur de la relation médecin-patient offre de nouvelles perspectives de recherche pour mieux comprendre la genèse des inégalités de santé et ainsi lutter contre ces dernières. Notre travail rappelle également l’importance d’un enseignement universitaire de la relation médecin-patient, dans l’optique d’une médecine de qualité.(SP - Sciences de la santé publique) -- UCL, 201

How should psychiatrists and general physician communicate to increase patients' perception of continuity of care after their hospitalization for alcohol withdrawal?

BACKGROUND: There are medico-psycho-social indications to apprehend the alcohol use disorder (AUD) as a chronic problem for which a continuous care is necessary. The perception of continuity of care is also associated with positive outcomes on the patient's health. Communication between caregivers is essential to maintain a good continual care. In order to put patients back into the center of care, we asked them the question: "why should the psychiatric department (PD) and general physicians (GP) should communicate about AUD patients"? SUBJECTS AND METHODS: After a week of hospitalization for alcoholic withdrawal, we used a qualitative approach with 4 open questions to explore AUD patients' point of view (N=17) about the best way of communication between psychiatrists and GP to improve care continuity. The data collection was carried out in the psychiatric department of the University Hospital of Mont-Godinne, Belgium. RESULTS: AUD patients consider that the GP is the first line actor that will be consulted after hospitalization and have a privileged relationship with him. These arguments justify him being informed. Concerning these patients, communication is useful to have a continuous treatment and project care, for purposes of symptoms' evolution follow-up and so as to help the GP to understand them better to follow the evolution of symptoms and to help the GP to understand them better. CONCLUSION: From AUD patients' point of view, communication between psychiatric department and the GP is useful for a perspective of continuity of care at discharge from the hospital. This communication seems to be at the service of the GP and his patient rather than for the psychiatrist himself. Mainly because of the GP's role as a privileged first-line care, but also thanks to the specific relationship relating him to his patient

Pour une approche psychosomatique des algies pelviennes : de la douleur à la souffrance ... sexuelle

À partir d’une revue de la littérature et de leur expérience clinique, les auteurs mettent en évidence la complexité des processus douloureux et leurs interactions avec la fonction sexuelle. Ils proposent des pistes pour une approche thérapeutique psychosomatique intégrée à des éléments de sexothérapie