[Psychosocial factors associated to depressive episodes with hospitalization in women: a case-control study]. / Facteurs psychosociaux associés à des épisodes dépressifs avec hospitalisation chez des femmes: étude cas-témoins.

UNLABELLED: The part played by psychosocial factors has frequently been studied in mental disorders whether as protective factors or as vulnerability factors, using variously adequate methods. A large body of research has shown that poor social support or poor self-esteem or presence of stressful life events could play a large part in triggering disorders. The importance of socioeconomic factors in mental illness is so great that such factors (unemployment, insecurity in employment, homelessness, lower social classes, low income) skew the studies in which they are not considered. In this study, in order to take into account these methodological problems, the study of psychosocial factors was undertaken in a standardized clinical manner and on a relatively socially privileged population. METHODS: Two homogeneous samples for several variables, using a case-control approach have been formed. A group of hospitalized women for "neurotic" depressive disorders, aged 30-50 (n=59) was systematically recruited in a psychiatric hospital located in the Paris area depending on MGEN (Mutuelle Générale de l'Education Nationale). The control group (n=76) was recruited among the 75 000 individuals in the Paris area registered as members of MGEN. A large group of women received a physical and mental health questionnaire for initial screening, the CIDIS (Composite Diagnostic Interview Simplified), by post. Among the 395 women that did not show mental disorders, a group of 90 was examined a second time using a more discriminating tool: the SCAN (Schedule for Clinical Assessment in Neuropsychiatry). In fine, the control group was based on 76 women that did not show and had never shown any mental disorders. To assess neurotic mental disorders in a clinical standardized manner, the SCAN (Schedule for Clinical Assessment in Neuropsychiatry) was used for inpatients. Scores were processed by CATEGO software which enables subjects to be classified according to the ICD-10 system. Events and difficulties experienced by subjects were recorded using the LEDS (Life Events and Difficulties Schedule). The clinicians that interviewed subjects and collected date were trained beforehand by Harris. The Brown and Haris methodology was used to rate subjects' responses and to classify events and difficulties. To assess and measure self-esteem and social support two check-lists elaborated and implemented by Pearlin were used. Means were compared using Student t test and frequencies using the c2 method (Yates'correction or Fisher exact test when necessary) to analyse independent associated factors. A multivariate logistic analysis was performed to identify significant variables. The association between factors and mental pathology studied was expressed with an odds ratio (OR) with the 95% confidence interval. RESULTS: Compared to the control group, the hospitalized patients reported higher levels of exposure to six factors: practising an intermediate profession (p=0.051), living alone (OR=4, 38); low self-esteem (OR=40, 96); low social support (OR=6, 46); having experienced at least one severe event (OR=2,45), at least one difficulty lasting 6 Months or more (OR=25, 57) and at least one provoking agent (a severe event or a major difficulty) (OR=3,49). These six variables were considered as potential associated factors to "neurotic depressive disorders" and thus entered into a logistic regression analysis. From these six variables, four may be considered as psychosocial associated factors in "neurotic depressive disorders": poor self-esteem is the highest risk factor (OR=71,43), and having experienced at least one difficulty (OR=15,75). Having poor social support and having experienced one or more "provoking agents" (one severe event or one major difficulty lasting 24 Months or more) correspond to approximatively OR=3. DISCUSSION: Following this study, four psychosocial associated factors in depressive episodes can be considered as being risk factors for "neurotic depressive disorders". In the literature psychosocial factors are frequently considered to be factors that possess a certain independence. This idea is discussed in the full article.

Psycho-social determinants for psychiatric hospitalisation for neurotic disorders in women--a case-control study.

BACKGROUND: Much has been written about the determinants of psychiatric hospitalisation, chiefly for psychotic patients in an emergency. This paper reports the results of a comparative study between in-patients and pathological subjects from the general population. The aim of this work is to evidence the psycho-social determinants of hospitalisation in a psychiatric department for neurotic disorders. METHODS: This study was conducted on a socially fairly privileged population which was, therefore, also fairly homogeneous. The subjects from the two groups were assessed clinically using standardised instruments both for diagnosis (SCAN) and for psycho-social variables (Stressful Life Events: LEDS; Social Support and Self-esteem: Pearlin checklist; care itinerary). RESULTS: Following the analysis of frequency and a multivariate logistic regression analysis, four risk factors for hospitalisation for neurotic disorders were evidenced, including: severity of neurotic disorders, taking a long time to consult a specialist after first onset of anxiety disorders, poor social support, and having experienced one or more provoking agents (Brown and Harris methodology) in the year previous to hospitalisation. CONCLUSION: The severity of the mental pathology is largely responsible for hospitalisation in neurotic patients as it is in psychotic patients, but it is not the only determinant for hospitalisation.

Differential metabolization of the impact of life events on subjects hospitalized for depressive and anxiety disorders: case-control study.

BACKGROUND: The study of the relationship between life events and mental illness has progressed considerably over the last 30 years. Practically all mental disorders have been explored using a variety of methods of variable value. The results are in favor of the existence of a temporal link between life events and illness. The part played by life events is the most pronounced in triggering depressive disorders and attempted suicide. Many aspects of this relationship have been explored, but the ability to metabolize the event impact over time has never been studied. This paper reports the results of a longitudinal study. Its objective is to make a comparative study of the ability to metabolize event impacts in depressive in-patients and controls. METHODS: The investigation was designed as a longitudinal, clinical, case-control study constructed on in-patients with depressive and anxiety disorders (n=25) and healthy controls from the community (n=28). The absence or presence of mental pathology was assessed using the SCAN, events and event-impacts were reported by subjects from a list of events constructed from the LEDS framework. RESULTS: The results show that the ability to metabolize the event-impact is positively linked to the mental health status of subjects, and that the first self-assessment of the event-impact has a good predictive capacity on the progression of this score a few months later and then 15-18 months later both in in-patients and in controls.

First-time hospitalisation for depressive and/or anxiety disorders and severe life events.

BACKGROUND: It has been suggested that the impact of antecedent life events differs between first and subsequent episodes of depressive or anxiety disorders. METHOD: We used the Bedford College methodology to determine the presence of severe events and/or major difficulties in two different groups of patients hospitalised for neurotic disorders, and in a control group of healthy subjects from the general population. RESULTS: The experience of severe events and/or major difficulties was significantly higher in patients being hospitalised for the first time than in patients who had been hospitalised several times, or in the control group. This difference was observed for female patients only. CONCLUSIONS: Two hypotheses are put forward as an explanation of these results.

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.

[Organization and achievement of a training for ICD-10 rating. The experience of La Verrière Psychiatric Hospital]. / Mise en place d'une formation à la CIM-10. L'expérience du CHS de La Verrière.

Referring to an International Classification of Mental Health and Behavioural Disorders is a way for psychiatrists to use a common language. The publication of the ICD-10 Chapter V made this possible. A note from the French Ministry of Health (14 January 1993) made official the use of the ICD-10th Revision in order to complete the psychiatric sector patient files. During 1992, in the La Verrière Psychiatric Hospital, all doctors, psychologists and nurses get trained in the use of the ICD-10. Twelve video inpatient cases were rated and discussed following the ICD-10 criteria. This paper reports on this experience.

[Psychological disorders encountered during the post-transplantation period of bone marrow]. / Troubles psychologiques rencontrés pendant la période postgreffe de moelle osseuse.

Psychological issues encountered during the procedure of a bone marrow transplantation (BMT) have already been described. Anxiety, depressive behaviour and anger are reactions usually observed. For inpatients, the psychological status seems to follow the somatic status. Among patients with a kidney transplant, some authors have observed psychological problems related to the patient's impression of acquiring some of the donor's characteristics through the graft. Little is known about psychological issues following bone marrow transplantation, which requires a donor in the case of allogeneic transplantation. Thirty-nine patients (12 auto, 27 allogeneic) are included in this study. Patients had been undergoing BMT for six to eighteen months at the time of the study. All patients were in complete remission of their disease. To conduct our study, we used interviews, a rating scale of depression and anxiety, vocabulary testing, and a Rotter's scale. The patients were not suffering specifically from depression or anxiety. After BMT, they experienced both objective and subjective changes in their way of life. The majority appear to be well adapted to their new situation, and some patients have received some benefit from their experience. For a minority, the transplantation was disruptive. Psychological problems encountered in such cases were related to the personality and personal history of the patients. After an allogeneic BMT, some patients approached, by means of a complaint or a joke, the theme of transformation induced by the transplanted marrow. This suggests that psychological integration of an allogeneic marrow transplant is a complex procedure. The various components of this elaboration could be studied further by using more sophisticated means to analyse interviews.

A family with acquired and inherited blue-yellow axis.

The pedigree of a family with a blue-yellow axis in the Farnsworth 100-Hue is reported. The fact that a blue-yellow axis corresponds to an inherited defect in 6 subjects and to an acquired defect in 1 subject is discussed. Methodological conditions necessary for making the differential diagnosis between an inherited and an acquired blue-yellow defect are recalled.

[Life events, risk factor or risk indicator?]. / L'évènement, un facteur ou un marqueur de risque?

The english language literature relating life stressful events and mental disorders is twenty years old. A review of works published allows to draw the conclusion that there is a relevant link between these two parameters. Results of four studies, we have carried out, show that the significance of life events is more important than the volume of events in explaining the subject vulnerability as well as in predicting high risk.

[Life events and breast cancer. Initial results of a comparative study dealing with 100 cases and their control]. / Evènements de la vie et cancer du sein. Premiers résultats d'une étude comparative portant sur 100 cas et leurs témoins.

The authors present the first results of a case-control study relative to the importance of life events in the 5 years which precede the clinical apparition of breast cancer. This study has examined a group of 100 women of french origin, aged from 45 to 65 years and carriers of a breast cancer which had been diagnosed less than a year ago, as well as their controls matched according to age. If the total number of events is similar in the two groups, there appears a negative peak of social desirability events in the two years preceding the diagnosis of cancer. The quantification of event impact by the subjects shows a greater vulnerability in women with cancer.

[Existential events and depression. Comparative study of several types of depressed patients]. / Evénements existentiels et dépression une étude comparative de plusieurs types de déprimés.

The aim of the present study was to investigate the relationship between the occurrence of life events and depression with a special emphasis on their impact (assessed through a 0-100 point scale) on psychopathological risk. In order to assess this influence, three groups of 50 depressed patients and three groups of 50 controls filled up a 53 items life stressfull events schedule. Results show that the way in which life events were construed is more relevant than their actual number in explaining the subject vulnerability as well as in predicting high risk subjects.

[Existential events and psychopathology]. / Evénements existentiels et psychopathologie.

The stream of works in the English-language literature relating life stressful events and mental disorders is fifteen years old. In spite of differences in methodology and conceptualization, a review of works published in French and in English allows to draw the conclusion that there is a significant link between these two parameters. This is clearly established for the suicidal cases and the relapses of neurotic depression. A significant link does not signify, systematically a principle of causality.

[Epidemiologic study of psychic morbidity in a group of future teachers]. / Etude épidemiologique de la morbidité psychique d'un groupe de futures enseignantes.

An epidemiological study of prevalence of psychopathology in a sample of students on secondary-school teachers training is presented and compared with that of a control group (N = 118). This study is based on standardized clinical interviews of the subjects which were in turn evaluated blind, by a psychiatrist. The main interest of the study was to investigate the psychopathological tendencies of future teachers which the practice of the teaching profession may tend to highlight. The results of the comparative study show that: 1. the incidence of psychopathological instability and its evolution across the four year period studied here are high across all groups. This general finding leads us to assume that to a certain limited degree, psychopathological manifestations in the post-adolescent period (18-25 ans) has prognostic value; 2. the differentiating factor between the two groups lies in the evolution of the psychopathological symptoms. In the group of future teachers, an increase in pathology across the four year period can be observed while the pathology in the control group virtually diminished. An attempt to explain this phenomena is made in terms of several differential situational factors characterizing the two groups.

[Mental disorders and professional determinants. Study of the time relationship between the beginning of professional life and the first disorder in teachers]. / Troubles mentaux et determinants professionnels. Etude de la relation temporelle entre débuts professionnels et premiers troubles chez des enseignantes.

Analysis of the temporal relation between the beginning of mental illness and the beginning of professional life, according to a comparative anamnestic method applied to a group of teachers (N. = 94) and a matching control group of psychiatric paired out-patients (N. = 95). The results show that the distribution of illness prior to professional activity is linked with the diagnostic category and not with professional determinants, psychosis proving to be more impairing than neurosis. A high-risk age group for first incidence of psychotic disease was found.