Impact de la pandemie COVID-19 sur la mortalite hospitaliere des patients schizophrenes pris en charge pour une affection autre que le COVID-19.

Introduction: L'impact de la priorisation des ressources lors de la pandemie COVID 19 sur la prise en charge des populations les plus vulnerables (non atteintes de COVID-19) comme les patients atteints de schizophrenie a ete peu documentee alors que des disparites de prise en charge de cette population avaient deja ete demontrees avant meme la pandemie. L'objectif de l'etude etait d'etablir si l'impact de la pandemie de COVID-19 sur la mortalite hospitaliere non-COVID-19 et l'acces aux soins hospitaliers differait entre les patients atteints de schizophrenie et ceux sans trouble mental severe. Methodes: A partir des donnees nationales du PMSI, nous avons selectionne toutes les hospitalisations aigues (MCO) non liees a la COVID-19 dans la periode pre-COVID-19 (du 15r mars 2019 au 31 decembre 2019) et COVID-19 (du 15r mars 2020 au 31 decembre 2020) et inclus les patients atteints de schizophrenie pour les apparier a des patients sans trouble mental severe (ratio 1:10) sur l'age et le sexe. En utilisant une approche de difference de la difference, nous avons realise des modeles de regression logistique multivaries avec ajustement sur differents facteurs. Resultats: Au total, 198 186 patients atteints de schizophrenie ont ete apparies avec 1 981 860 temoins. La mortalite hospitaliere a 90 jours chez les patients atteints de schizophrenie a augmente significativement plus par rapport aux temoins (+0,47 % versus +0,21 %;OR ajuste=1,18;p<0,001);le taux d'admission en reanimation a stagne pour les patients schizophrenes alors qu'il a augmente pour les temoins (0,00 % versus +,.85 %;ORajuste=0,93, p<0,001). Discussion/Conclusion: Ces resultats suggerent une plus grande deterioration de l'acces, de l'efficacite et de la securite des soins aigus non COVID-19 chez les patients atteints de schizophrenie par rapport aux patients sans troubles mentaux severes et soulignent l'importance de developper des strategies specifiques pour les patients vulnerables en prevision des futures urgences de sante publique. Mot-cles: Schizophrenia, Mental disorders, Psychiatry, Health services research, Public health, COVID-19 disparities. Declaration de liens d'interets: LB has received honoraria/has been a consultant for Lundbeck. P-ML has been a consultant and/or advisor to or has received honoraria from from Eli-Lilly, Janssen, Lundbeck, Otsuka and Teva, GF has received honoraria/has been a consultant for Lundbeck and Eisai. The other authors declare no competing interests.Copyright © 2023

Impact de la pandémie COVID-19 sur la mortalité hospitalière des patients schizophrènes pris en charge pour une affection autre que le COVID-19

Introduction L'impact de la priorisation des ressources lors de la pandémie COVID 19 sur la prise en charge des populations les plus vulnérables (non atteintes de COVID-19) comme les patients atteints de schizophrénie a été peu documentée alors que des disparités de prise en charge de cette population avaient déjà été démontrées avant même la pandémie. L'objectif de l'étude était d'établir si l'impact de la pandémie de COVID-19 sur la mortalité hospitalière non-COVID-19 et l'accès aux soins hospitaliers différait entre les patients atteints de schizophrénie et ceux sans trouble mental sévère. Méthodes A partir des données nationales du PMSI, nous avons sélectionné toutes les hospitalisations aiguës (MCO) non liées à la COVID-19 dans la période pré-COVID-19 (du 15r mars 2019 au 31 décembre 2019) et COVID-19 (du 15r mars 2020 au 31 décembre 2020) et inclus les patients atteints de schizophrénie pour les apparier à des patients sans trouble mental sévère (ratio 1:10) sur l'âge et le sexe. En utilisant une approche de différence de la différence, nous avons réalisé des modèles de régression logistique multivariés avec ajustement sur différents facteurs. Résultats Au total, 198 186 patients atteints de schizophrénie ont été appariés avec 1 981 860 témoins. La mortalité hospitalière à 90 jours chez les patients atteints de schizophrénie a augmenté significativement plus par rapport aux témoins (+0,47 % versus +0,21 %;OR ajusté=1,18;p<0,001);le taux d'admission en réanimation a stagné pour les patients schizophrènes alors qu'il a augmenté pour les témoins (0,00 % versus +,.85 %;ORajusté=0,93, p<0,001). Discussion/Conclusion Ces résultats suggèrent une plus grande détérioration de l'accès, de l'efficacité et de la sécurité des soins aigus non COVID-19 chez les patients atteints de schizophrénie par rapport aux patients sans troubles mentaux sévères et soulignent l'importance de développer des stratégies spécifiques pour les patients vulnérables en prévision des futures urgences de santé publique. Mot-clés Schizophrenia, Mental disorders, Psychiatry, Health services research, Public health, COVID-19 disparities. Déclaration de liens d'intérêts LB has received honoraria/has been a consultant for Lundbeck. P-ML has been a consultant and/or advisor to or has received honoraria from from Eli-Lilly, Janssen, Lundbeck, Otsuka and Teva, GF has received honoraria/has been a consultant for Lundbeck and Eisai. The other authors declare no competing interests.

Risk factors for burnout and depression in healthcare workers: The national AMADEUS study protocol.

CONTEXT: Burnout is an international phenomenon defined as a state of professional exhaustion. It can lead to depression and have major economic and organizational impacts. Previous studies of healthcare professionals in France have focused on physicians, but none to date have explored other healthcare professions. OBJECTIVES: The main objective of our study is to determine the prevalence of burnout among healthcare workers. The secondary objectives are to explore the associations of burnout with professional and psycho-social factors and the risk of depression, professional harassment, sexual harassment, sexual-orientation based discrimination, consumption of antidepressants, anxiolytics and also the lifestyle of the individual: smoking, alcohol consumption, coffee consumption, physical activity and sleep quality. MATERIALS AND METHODS: The survey will take the form of a voluntary and anonymous online questionnaire carried out on the FramaForm1® platform and will be disseminated via social networks, professional networks and mailings. STUDY POPULATION: Senior doctors, interns, directors of care, nurses, head nurses and senior head nurses, physiotherapists and occupational therapists, dieticians, radiology technicians, laboratory technicians, psychologists, nurses' aides, auxiliary nurses and midwives will be included. COLLECTED DATA: Burnout will be measured with the Maslach Inventory burnout (MBI) questionnaire, work environment with the Karasek questionnaire and anxiety, depression risk with the Center for Epidemiologic Studies- Depression (CES-D), physical activity with the Global Physical Activity Questionnaire (GPAQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). ETHICS: This protocol has been accepted by the ethical committee (IRB n°C08/21.01.06.93911, CNIL). EXPECTED RESULTS: Based on international studies, we expect a high rate of burnout with disparities according to profession, socio-demographic data, seniority and type of service. We also expect a significant rate of untreated depression. This study will provide evidence for policy makers to implement collective strategies to reduce burnout and depression in the different populations studied.

[Real-life data and Covid-19: The third avenue of reseach]. / Données de vie réelle et Covid-19 : la troisième voie.

The analysis of real-life data from hospital information systems could make possible to decide on the efficacy and safety of Covid-19 treatments by avoiding the pitfalls of preliminary studies and randomized clinical trials. The different drugs tested in current clinical trials are already widely prescribed to patients by doctors in hospitals, and can therefore be immediately analysed according to validated methodological standards.

Increased in-hospital mortality from COVID-19 in patients with schizophrenia.

BACKGROUND: There is limited information describing the presenting characteristics and outcomes of patients with schizophrenia (SCZ) requiring hospitalization for coronavirus disease 2019 (COVID-19). AIMS: We aimed to compare the clinical characteristics and outcomes of COVID-19 SCZ patients with those of non-SCZ patients. METHOD: This was a case-control study of COVID-19 patients admitted to 4 AP-HM/AMU acute care hospitals in Marseille, southern France. COVID-19 infection was confirmed by a positive result on polymerase chain reaction testing of a nasopharyngeal sample and/or on chest computed scan among patients requiring hospital admission. The primary outcome was in-hospital mortality. The secondary outcome was intensive care unit (ICU) admission. RESULTS: A total of 1092 patients were included. The overall in-hospital mortality rate was 9.0%. The SCZ patients had an increased mortality compared to the non-SCZ patients (26.7% vs. 8.7%, P=0.039), which was confirmed by the multivariable analysis after adjustment for age, sex, smoking status, obesity and comorbidity (adjusted odds ratio 4.36 [95% CI: 1.09-17.44]; P=0.038). In contrast, the SCZ patients were not more frequently admitted to the ICU than the non-SCZ patients. Importantly, the SCZ patients were mostly institutionalized (63.6%, 100% of those who died), and they were more likely to have cancers and respiratory comorbidities. CONCLUSIONS: This study suggests that SCZ is not overrepresented among COVID-19 hospitalized patients, but SCZ is associated with excess COVID-19 mortality, confirming the existence of health disparities described in other somatic diseases.