The psychopathological repercussions on patients faced with pain: A focus on endometriosis.

OBJECTIVES: Endometriosis is a chronic and progressive gynecological disease that affects 1 to 2 out of 10 women of childbearing age in France. The objective of this research was to understand the factors determining the quality of life of the patients who experience significant pain symptoms (75%), distinguished by the extent and depth of the lesions. The second objective was to evaluate the psychological repercussions of this pain. We will therefore assess the various psychological processes involved in explaining quality of life. METHOD: In total, 1039 women aged 18-55 years completed a self-administered questionnaire, assessing different types of pain and intensity, body image (BIS), self-esteem (Rosenberg), anxiety-depressive symptomatology (HAD), and quality of life (SF-36). Socio-biographical and medical characteristics of the patients were also assessed. RESULTS: Analyses of variance showed that patients with chronic pain had lower self-esteem and body image, more anxiety-depressive symptoms, and a poorer quality of life than women with cyclic pain and those without pain. Regression analyses showed that the determinants of physical and mental quality of life differed significantly according to the type of pain experienced. CONCLUSION: The consequences of the pain associated with endometriosis reveal multiple problems that can be considered from a new perspective. Although psychological disorders can be a response to pain phenomena they can also contribute to their increase. This is where the challenge lies in providing comprehensive care.

The level of education is associated with an anxiety-depressive state among men and women - findings from France during the first quarter of the COVID-19 pandemic.

CONTEXT: It is widely recognised that the COVID-19 pandemic has negatively impacted individuals' mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively. METHOD: Data are from 32,581 individuals representative of the French population who responded to the weekly survey "Baromètre COVID-19" between April 7th and May 31st 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and COVID-19 contexts to assess the relationship between education and anxiety-depressive state. RESULTS: In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (ßVocational certificate/qualification = 0.16 [0.04; 0.27]; ßNo diploma = 0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (ßBaccalaureate = 0.37 [0.25; 0.49]; ßVocational certificate/qualification = 0.41 [0.28; 0.54]; ßNo diploma = 0.8 [0.49; 1.12]). For both men and women, economic, health, and COVID-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women. CONCLUSION: In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.