[Patterns of care and socio-professional categories derived from DIM (Department of Medical Information) data regarding MGEN psychiatric management]. / Modèles de soins et catégories socioprofessionnelles à partir des données recueillies par le DIM du dispositif psychiatrique de la MGEN.

The influence of social factors (demographics, work statute, profession) on patterns of care like psychotropic drugs prescription, psychotherapeutic treatment or hospitalisation was studied on the population receiving care within the MGEN (a semiprivate health insurance system for the teaching related professions, the largest in France). This was possible by the use of a three year data bank (1992, 1993, 1994) where out and inpatients care were systematically recorded along some socio-demographics data in a rather detailed manner if provided within the system. The present study concerns 6,453 patients selected on the most frequent ICD 9 diagnoses as registered by the psychiatrist in charge of the patient: schizophrenia (acute, simple and persistent): 18.5% of the sample, manic-depressive psychosis 7.7%, and neurotic disorders (depressive disorders 38.3%, anxiety disorders 27% and mixed disorders 8.2%). For most of these diagnoses, hospitalization rates vary according the profession of the patient: teachers suffering from schizophrenia (simple) have higher rate of hospitalization than others professions; on the reverse university teachers and managers have the lowest rates of hospitalization for neurotic disorders. Duration of stay is rather identical within profession for psychotic disorders but again there are difference for neurotic disorders: blue collar workers, managers and university teachers have the lowest duration. Number of outpatients acts and provision of psychotherapeutic treatment either individual or group therapy show some variations between professions. Number of psychotropic drugs do not vary according profession but there is difference between men and women suffering from depressive disorders (2.97 for men, 2.72 for women). Neuroleptics are prescribed at the same rate but depot neuroleptics are prescribed mainly to blue collars workers, clerks and whose who are teaching technical matters; this applies only to men. These results are discussed according the context of the MGEN psychiatric health system.

Mental health and use of care in people receiving a French social benefit.

BACKGROUND: This paper presents and epidemiological survey of 300 adults randomly sampled among the Parisian population and 207 randomly sampled recipients of a social benefit. The RMI (Revenu Minimal d'Insertion) provides a regular minimal income to any person with resources below a certain level. It is not targeted at people with mental health problems. METHODS: The subjects were evaluated by trained interviewers using collateral information provided by an informant, together with CIDIS, a simplified version of the CIDI, covering: somatisation, panic attack, phobias, generalised anxiety, major depression and alcohol and illegal drug abuse (DSM-III-R and ICD-10 classifications). RESULTS: The response rate was 79% for the Parisian sample and 75% for the RMI recipients. As expected, the sociodemographic composition of the two groups adjusted for age differed considerably: RMI recipients were likely to be unemployed and single or divorced. The collateral information showed that psychoses of all types were more frequent among RMI recipients (4.2% vs 1.2%, P < 0.02). There were large differences in rates for substance abuse and dependence, antisocial personality and lifetime depressive disorders, but no difference for mental deficiency. This corresponded partly with the direct CIDIS measure: male RMI recipients suffered significantly more from severe depression than male Parisian controls: 16.7% compared to 3.4% (P < 0.01 lifetime) and from drug and alcohol abuse or dependency disorders. Depressed RMI recipients made less use of available medical care for their depression than Parisians controls, mainly because RMI recipients did not consult psychiatrists, whereas controls did (21%, P < 0.0001). On average, the duration of depressive episodes is longer in RMI recipients, especially in women. CONCLUSION: The high rate of psychiatric disorders and poor access to resources in RMI recipients have implications for the health system. Care would be improved if social workers administering the benefit were better trained to recognise psychiatric problems, and able to link their clients with (particularly) primary care services.

Symptom distress and frequency of life events.

A study of the frequency of life events was conducted in a group of subjects selected from the general population over a period of 9 months. Four assessments were made, using an events questionnaire and the Psychiatric Symptom Index (PSI), at 3-monthly intervals. The results show a significant relationship (maintained over time) between PSI score and the number of upsetting events, but no significant relationship between PSI score and non-upsetting events. These observations are interpreted as follows: the higher frequency of upsetting life events is secondary to the previous psychological pattern of subjects.

[Medico-psychological exploration of the professional experience of teachers]. / Exploration médico-psychologique du vécu professionnel de l'enseignant.

From A. Abraham's questionnaire exploring the professional Self of teachers, we determined, after standardisation with a french group of teachers, a much shorter bipolar satisfaction-dissatisfaction scale. Next, we compared the results between the israëli and the french teachers, then between a group of so called normal teachers and a group of teachers suffering from various mental troubles. We noted with satisfaction the close relations between the results of the test and the clinical opinions. This helps much in coping with teachers' psychotherapy and rehabilitation. Several examples and a bibliography are given.