ABSTRACT
Introduction: Since March 16, 2020, the date of the announcement of the first confinement in France in the context of the COVID-19 pandemic and health crisis, French residents have experienced a brutal and lasting disruption in their rhythms and habits. The health crisis has had a strong impact on the general population and especially on patients suffering from psychiatric disorders. The demand for mental health care has particularly heightened among young people, who seem to be the most affected by this crisis. In the first part of this article, we will describe the impact of the health crisis on the mental health of young people and on the attendance of psychiatric emergencies, with a review of French and international literature. In the second part, we will present a descriptive epidemiological study carried out in the largest French psychiatric emergency center. Methods and objective: Our sample included 9,771 young patients from 15 to 25 years old. The main objective of our study is to highlight the changes in the flow of consultations of patients aged 15 to 25 years during the first year of the health crisis, compared to the three previous years. We calculated and compared the proportion of the target population consulting between the period of the first year of the health crisis (COVID period) and the period encompassing the previous three years (pre-COVID period). We also compared different variables, between the 2,179 young people consulting during the first year of COVID-19 health crisis and the 7,592 young people during the three last years: age, sex, marital status, symptoms, environmental context and CIM-10 diagnoses. Result(s): We observed a significant increase in the proportion of patients aged 15 to 25 during the COVID period (n = 29.4% vs. 27.6%;P < 0,001). The patients during the COVID period were predominantly female. We have seen a significant increase in patients coming for consultations for anxiety (+4.3%;P < 0.001), sleep disorders (+2.8%;P < 0.001) and suicidal thoughts (+2.7%;P = 0.006) during the COVID period. During the first year of the health crisis, the target population consulted less for claustration, withdrawal or odd behavior. Family conflicts, traumatic events and other life events were more frequent. Schizophrenia, schizotypal and delusional disorders were less frequently diagnosed. Conclusion(s): The health crisis has had a considerable impact on the mental health of the youth population. The mental health of young people is a current subject of concern and a major public health issue. Data from the literature warns of the impact of the health crisis on the mental health of this population and the need for early treatment, even as the supply of psychiatric care is decreasing.Copyright © 2022 Elsevier Masson SAS
ABSTRACT
Mortality, morbidity, and childhood developmental challenges can all result fromadverse birth outcomes. In regard to these outcomes, the United States exhibits significant racial and socioeconomic inequities, and effective interventions targeting lowincome pregnant people are necessary. A recommendation for expanding home visiting programs has been provided with the hope of improving newborn andmaternal outcomes, and substantial federal funding is granted to these programs via theMaternal, Infant, and Early Childhood Home Visiting program. The Nurse-Family Partnership program is a nurse home visiting service targeting nulliparous low-income families during pregnancy and early childhood. The state of South Carolina's preterm birth rate in 2016 was the sixth highest in the United States, which motivated the state to offer program services to Medicaid-eligible nulliparous women through aMedicaid waiver. This study's objective was to determine effects of intensive nurse home visiting programs on the composite outcome of small for gestational age, low birth weight, preterm birth, and perinatal mortality. This randomized clinical trial assigned participants in a 2:1 ratio to either a control group or an intervention group, which was offered access to the program. The control group was offered a list of community-based resources available to them, and all participants received usual care for South Carolina. Inclusion criteria were nulliparous pregnancy of less than 28 weeks' gestation, income-eligible for Medicaid during pregnancy, and residence in a program-served county. Self-referral, or referral through schools, clinicians, and Medicaid led patients to 1 of 9 program-implementing sites. The intervention, which consisted of a prenatal and early childhood home visiting program, was carried out by nurses conducting home visits with participants from pregnancy through the first 2 years of the child's life. The nurses used activities tailored to the clients' strengths, preferences, and risks via educational tools, motivational interviews, goal setting related to prenatal health, health assessments, maternal life course, and child health and development. Utilization of health care was encouraged when needed, coupled with referrals to health and social services. Ideal visits ranged from weekly 60- to 90-minute sessions for 4 weeks following enrollment and then every other week leading up to delivery. Nurse training encouraged flexible support of clients for more or fewer visits as necessary, with services provided in both Spanish and English, with other translation options. Enrollment for the study began on April 1, 2016, but concerns for the COVID-19 pandemic led to a recruitment halt on March 17, 2020. However, 95% of the target recruitment goal had already occurred, and the remaining home visits were conducted via telehealth. A total of 3319 patients were eligible and opted for enrollment. Upon time of enrollment, 18% of participants were younger than 19 years, with 54.8% of them between 19 and 24 years old. Self-reported race and ethnicity statistics were reported as 55.2% non-Hispanic Black, and 22.4% had not completed high school. Body mass index of greater than 30 kg/m2 was present in 34.5%, and smoking 3 months before pregnancy was reported in 25.8% of participants. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
ABSTRACT
Depression is the most common psychiatric disorder in the general population, and emergency room visits for depression have been increasing for several years. In addition, the Covid-19 pandemic may lead to an explosion of psychiatric emergency room visits for this reason, with an overall prevalence of anxiety and depression that appears to be increasing since 2020. The Centre Psychiatrique d'Orientation et d'Accueil is a regional psychiatric emergency service located in Paris which records approximately 10,000 consultations per year. Among these consultations, the main symptoms are those of depression (depressive ideations, anxiety) and nearly 40 % are diagnosed with mood disorders, including depression. The management of the patient in the emergency room is based on a global evaluation, which should not be limited to the psychiatric interview. In the best case, and if compatible with the organization of the service, an initial evaluation by the nursing reception staff determines the context of the arrival of the patient, the reason and the degree of urgency of the consultation can thus be assessed from the outset. The request for care can come from the patient themself, but also from family and friends who are worried about a decline in the patient's previous condition. The consultation may also be triggered by the intervention of emergency services, particularly in the case of attempted suicide or agitation. The context of arrival, the environment, and the patient's entourage must be taken into account in order to achieve an optimal orientation. Particular attention must be paid to the first episodes (elimination of a differential diagnosis, screening for a possible bipolar disorder). The existence of an external causal factor or a comorbid personality disorder should not trivialize the consultation and lead to a faulty diagnosis of a characterized depressive episode. Drug treatment in the emergency room is usually symptomatic (anxiolytic treatment with benzodiazepines or neuroleptics, depending on the situation), and outpatient referral should always be preferred. Therapeutic adaptations can then be considered. The decision to hospitalize must always be justified, and consent for care must be rigorously evaluated. It is almost always necessary to take the patient's entourage into account as well as the potential support of the patient by the entourage. All these elements must be recorded in the file. Suicide risk assessment must be systematic for all patients consulting psychiatric emergencies, and the use of the RUD (Risk, Urgency, Dangerousness) grid can be useful. Any decision to release a patient with suicidal tendencies must be made strictly following certain conditions:a rapid psychiatric re-evaluation of the crisis, with for example the proposal of a post-emergency consultation, a supportive entourage, accepted symptomatic treatment. The registration of the suicidal patient in a monitoring system such as VigilanS can also be beneficial and reduce the risk of recidivism.
ABSTRACT
Introduction: Since March 16, 2020, the date of the announcement of the first confinement in France in the context of the COVID-19 pandemic and health crisis, French residents have experienced a brutal and lasting disruption in their rhythms and habits. The health crisis has had a strong impact on the general population and especially on patients suffering from psychiatric disorders. The demand for mental health care has particularly heightened among young people, who seem to be the most affected by this crisis. In the first part of this article, we will describe the impact of the health crisis on the mental health of young people and on the attendance of psychiatric emergencies, with a review of French and international literature. In the second part, we will present a descriptive epidemiological study carried out in the largest French psychiatric emergency center. Methods and objective: Our sample included 9,771 young patients from 15 to 25 years old. The main objective of our study is to highlight the changes in the flow of consultations of patients aged 15 to 25 years during the first year of the health crisis, compared to the three previous years. We calculated and compared the proportion of the target population consulting between the period of the first year of the health crisis (COVID period) and the period encompassing the previous three years (pre-COVID period). We also compared different variables, between the 2,179 young people consulting during the first year of COVID-19 health crisis and the 7,592 young people during the three last years: age, sex, marital status, symptoms, environmental context and CIM-10 diagnoses. Results: We observed a significant increase in the proportion of patients aged 15 to 25 during the COVID period (n = 29.4% vs. 27.6%;P < 0,001). The patients during the COVID period were predominantly female. We have seen a significant increase in patients coming for consultations for anxiety (+4.3%;P < 0.001), sleep disorders (+2.8%;P < 0.001) and suicidal thoughts (+2.7%;P = 0.006) during the COVID period. During the first year of the health crisis, the target population consulted less for claustration, withdrawal or odd behavior. Family conflicts, traumatic events and other life events were more frequent. Schizophrenia, schizotypal and delusional disorders were less frequently diagnosed. Conclusion: The health crisis has had a considerable impact on the mental health of the youth population. The mental health of young people is a current subject of concern and a major public health issue. Data from the literature warns of the impact of the health crisis on the mental health of this population and the need for early treatment, even as the supply of psychiatric care is decreasing. © 2022 Elsevier Masson SAS