[Bereavement and its clinical implications, conceptual developments and ways of supporting bereaved families]. / Le deuil et ses implications cliniques, évolutions conceptuelles et modalités de soutien des familles endeuillées.

Bereavement is a natural process whose scope has long been essentially social and collective before it was increasingly limited to the private sphere. In recent years, the redefinition of the various clinical manifestations of grief raises the question of diagnosis when it becomes a disorder and the question of whether or not adapted treatments are necessary in certain situations. We will place the bereavement process in a cultural and social perspective, before focusing on the centrality of rituals as a modality of support and resilience.

[Trauma, grief and culture in humanitarian work]. / Trauma, deuil et culture dans le travail humanitaire.

Based on a clinical case, this work aims to illustrate the multiple dimensions and modalities of psychological support in humanitarian work. It  also shows the importance and relevance of implementing a transcultural approach when dealing with complex trauma and traumatic bereavement among refugees and asylum seekers in an emergency context.

[Management of traumatic grief in adolescents in a psychotrauma group]. / Prise en charge du deuil traumatique chez l'adolescent dans un groupe psychotrauma.

The sudden loss of a parent during adolescence causes great psychological suffering in the young person as well as multiple reorganizations within the family unit. This traumatic mourning requires appropriate care that takes into consideration both the multiple and complex effects of this loss and the collective and ritual dimensions of mourning. Through two clinical cases, we will discuss the interest of a group care device to address these dimensions.

[Psychotherapy of traumatic grief in exiled patients]. / Psychothérapie du deuil traumatique chez les patients exilés.

After a presentation of the clinical speci-ficities of complex traumas in exiled patients, the psychotherapeutic issues and processes at work in the treatment of traumatic mourning are detailed through a clinical case. Emphasis is placed on the articulation and interface between the private and collective dimensions of grief.

Prevalence and determinants of post-traumatic stress disorder, anxiety and depression symptoms in street children survivors of the 2010 earthquake in Haiti, four years after.

Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD=2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.

Defense Profiles in Adaptation Process to Sport Competition and Their Relationships with Coping, Stress and Control.

The purpose of this study was to identify the potentially distinct defense profiles of athletes in order to provide insight into the complex associations that can exist between defenses and other important variables tied to performance in sports (e.g., coping, perceived stress and control) and to further our understanding of the complexity of the adaptation process in sports. Two hundred and ninety-six (N = 296) athletes participated in a naturalistic study that involved a highly stressful situation: a sports competition. Participants were assessed before and after the competition. Hierarchical cluster analysis and a series of MANOVAs with post hoc comparisons indicated two stable defense profiles (high and low defense profiles) of athletes both before and during sport competition. These profiles differed with regards to coping, stress and control. Athletes with high defense profiles reported higher levels of coping strategies, perceived stress and control than athletes with low defense profiles. This study confirmed that defenses are involved in the psychological adaptation process and that research and intervention should not be based only on coping, but rather must include defense mechanisms in order to improve our understanding of psychological adaptation in competitive sports.

Psychological experience of patients 3 months after a stay in the intensive care unit: A descriptive and qualitative study.

PURPOSE: The purpose was to describe psychological experiences of patients 3 months after a stay in the intensive care unit (ICU) using qualitative methods. METHODS: Twenty patients underwent clinical interview lasting 1 hour and completed the Impact of Event Scale-Revised and Hospital Anxiety and Depression questionnaires. All interviews were recorded and coded using thematic analysis. RESULTS: All patients (100%) reported that they could not remember their ICU stay; half reported confused memories (50%) or disorientation (50%). Negatives memories were also reported (20%-45%), namely, pain, distress, sleep difficulties, noise, fear, feeling of abandonment; 20% reported positive memories. At 3 months, for 10 (50%) of 20 patients, their ICU experience was characterized by anxiety; 3 (15%) of 20 presented posttraumatic stress disorder; 7 (35%) of 20 reported a feeling of well-being with positive life changes. Well-being seems to be associated with use of coping strategies, such as active coping, positive reframing, optimism, humor, acceptance, leisure activities, and family support. CONCLUSION: Our study highlights the need to investigate patients' memories of ICU and the coping strategies used by patients to improve their ICU experience. Our findings suggest that a systematic follow-up consultation after ICU discharge would be useful for monitoring of post-ICU psychological outcomes.

Error in intensive care: psychological repercussions and defense mechanisms among health professionals.

OBJECTIVE: To identify the psychological repercussions of an error on professionals in intensive care and to understand their evolution. To identify the psychological defense mechanisms used by professionals to cope with error. DESIGN: Qualitative study with clinical interviews. We transcribed recordings and analysed the data using an interpretative phenomenological analysis. SETTING: Two ICUs in the teaching hospitals of Besançon and Dijon (France). SUBJECTS: Fourteen professionals in intensive care (20 physicians and 20 nurses). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We conducted 40 individual semistructured interviews. The participants were invited to speak about the experience of error in ICU. The interviews were transcribed and analyzed thematically by three experts. In the month following the error, the professionals described feelings of guilt (53.8%) and shame (42.5%). These feelings were associated with anxiety states with rumination (37.5%) and fear for the patient (23%); a loss of confidence (32.5%); an inability to verbalize one's error (22.5%); questioning oneself at a professional level (20%); and anger toward the team (15%). In the long term, the error remains fixed in memory for many of the subjects (80%); on one hand, for 72.5%, it was associated with an increase in vigilance and verifications in their professional practice, and on the other hand, for three professionals, it was associated with a loss of confidence. Finally, three professionals felt guilt which still persisted at the time of the interview. We also observed different defense mechanisms implemented by the professional to fight against the emotional load inherent in the error: verbalization (70%), developing skills and knowledge (43%), rejecting responsibility (32.5%), and avoidance (23%). We also observed a minimization (60%) of the error during the interviews. CONCLUSIONS: It is important to take into account the psychological experience of error and the defense mechanisms developed following an error because they appear to determine the professional's capacity to acknowledge and disclose his/her error and to learn from it.

Longitudinal study of alexithymia and multiple sclerosis.

OBJECTIVE: The aim of this study was to investigate the course of alexithymia and its relation with anxiety and depression in patients with multiple sclerosis (MS), over a period of 5 years. METHODS: Sixty-two MS patients were examined at two timepoints, 5 years apart, and they answered questionnaires collecting socio-demographic, medical, and psychological data (depression, anxiety, alexithymia). RESULTS: Our data show that emotional disorders remain stable over time in patients with MS, particularly as regards alexithymia and anxiety. Conversely, the rate of depression decreased between the two evaluations, falling from 40% to 26%. The two dimensions of alexithymia (i.e., difficulty describing and difficulty identifying feelings) were correlated with anxiety and depression, whereas the third component of alexithymia (externally oriented thinking) was independent, and was the only component to change over time, with a significant fall observed at 5 years. CONCLUSION: Alexithymia was associated with increased severity of anxiety and attack relapses.

Anxiety and subjective quality of life preoperatively and 4 months after reduction mammaplasty.

OBJECTIVE: The aim of this study was to evaluate the development of anxiety, psychological distress, and subjective quality of life on the basis of the criteria of satisfaction and expectations in a group of women who had undergone reduction mammaplasty for cosmetic reasons. METHOD: The population consisted of 20 women who had requested breast reduction treatment [mean age, 34.70 (+/-10.94)] for cosmetic reasons. After being informed of the purpose of the study and after giving their written consent, the subjects took part in a psychological examination conducted at two different times (T1, initial medical consultation; T2, 4 months after surgery). At each of these stages, the psychological evaluation consisted of a clinical interview and questionnaires: the Subjective Quality of Life Profile, State-Trait Anxiety Inventory, and the General Health Questionnaire. RESULTS: The results showed that the subjects improved significantly between T1 and T2 in terms of state anxiety (P=.04), trait anxiety (P=.002), sleeping disorders (P=.003), difficulty in enjoying their activities (P=.008), and a number of dimensions of subjective life quality: pain (P=.009), physical appearance (P=.003), social life (P=.03), and inner life (P=.03). The study showed that satisfaction with treatment was correlated with satisfaction with medical relations (P=.05) and medical information (P=.05) at T1 and with greater satisfaction with friendship relations (P=.05), sexual relations (P=.05), and inner life (P=.05) after the operation (P=.01). Conversely, a greater level of anxiety at T3 was correlated with reduced satisfaction with the surgical treatment (P=.05). CONCLUSION: This study demonstrates the importance of evaluating surgical and cosmetic treatment in terms of psychological dimensions and emphasizes the improvement in psychological well-being during the postoperative phase.

Brain injured patients versus multiple trauma patients: some neurobehavioral and psychopathological aspects.

BACKGROUND: The study aims to describe the neurobehavioral and psychopathological disorders in road crash victims with cerebral lesions compared with multiple trauma sufferers with no brain damage. METHODS: This study compares the neuropsychological and psychopathological developments of two groups of road crash victims (25 severe brain injuries (SBI) and 25 multiple traumas (MULT)) on the basis of the Neurobehavioral Scale, the SCL 90-R and the State/Trait Anxiety Scale. RESULTS: On the basis of the Neurobehavioral Scale, it was clear that the SBI patients suffered from significantly more disorders of type factor 1 (self-appraisal and flexible thinking), factor II (withdrawal), factor III (mood swings, irritability, disinhibition, excitement), factor IV (attention, slower motor responses, and mental fatigue), factor V (articulatory problems, problems of oral expression, and oral comprehension) and nonfactored disorders (exaggerated somatic concerns). On the SCL 90-R scale, we observed a higher level of obsessive symptoms in the SBI patients, whereas there was no significant difference between the two groups on the State/Trait Anxiety Scale. Unexpected results indicated that the multiple trauma patients suffered from memory troubles (60%), concept disorganization (32%), loss of initiative (36%), irritability (52%), unusual thought content (40%), mood swings (40%), attention difficulties (24%), suspiciousness (48%), and feelings of guilt (36%). CONCLUSION: Even though multiple trauma sufferers do not receive a psychologic assessment of their cerebral functioning, and do not benefit from any rehabilitation, they exhibit neurobehavioral and psychopathological disorders which need to be taken into account when designing rehabilitation programs. This study points toward new therapeutic methods for the treatment of multiple trauma sufferers.

Effects of an informational CD-ROM on anxiety and knowledge before aesthetic surgery: a randomised trial.

This trial aimed to assess the value of visual information by CD ROM before aesthetic breast reduction or abdominoplasty. All included patients were given an information leaflet about the procedure and completed a Spielberger state-trait anxiety inventory (STAI form Y-1) questionnaire to assess situational anxiety. The patient was then randomly assigned to watch or not to watch an informational CD ROM. The day before surgery the patient completed a second anxiety questionnaire and a knowledge questionnaire. Eighty patients were included, 40 were assigned the CD ROM and 40 no CD ROM. Patients who watched the CD ROM were significantly less anxious than those who did not (Mean STAI 45 [38.2-46.3] vs 55 [49.9-63.8]). Furthermore they also scored higher in the knowledge questionnaire as far as the purpose and the procedural details of the surgery were concerned. However, no statistical difference of knowledge regarding the potential complications of the procedure was found.

Emotional factors and subjective quality of life in subjects with spinal cord injuries.

OBJECTIVE: To compare depression, subjective perception of quality of life, and social support in patients with spinal cord injuries 4 yr or more after trauma vs. controls. DESIGN: The Rorschach inkblot method, the Diagnostic Interview Schedule Self-Administered, the Progressive Matrix 38, the Social Support Appraisals, and the Subjective Quality of Life Profile were used to assess 33 patients with spinal cord injuries and 33 matched controls. RESULTS: No significant difference was observed for levels of general intelligence and depressive disorders. Subjects with spinal cord injuries assessed the general subjective quality of life as satisfactory, with exceptions for sexuality, physical condition, leisure activities, and holidays. A high degree of satisfaction with medical staff and inward life was observed. Social support was perceived as positive. However, they presented emotional distress, deteriorating perceptions, extreme preoccupation with their bodies, and diffuse anxiety. CONCLUSION: Although quality of life as evaluated by the persons concerned was good, areas of their lives remained unsatisfactory and a source of mental suffering. The next stage would study the factors involved and the means needed to help these subjects improve these aspects of life.