Occupational, academic, and personal determinants of wellbeing and psychological distress in residents: results of a survey in Lyon, France.

Introduction: The mental health of residents is a growing significant concern, particularly with respect to hospital and university training conditions. Our goal was to assess the professional, academic, and psychological determinants of the mental health status of all residents of the academy of Lyon, France. Materials and methods: The Health Barometer of Lyon Subdivision Residents (BASIL) is an initiative which consists in proposing a recurrent online survey to all residents in medicine, pharmacy, and dentistry, belonging to the Lyon subdivision. The first of these surveys was conducted from May to July 2022. Participants should complete a series of validated questionnaires, including the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and the Kessler Psychological Distress Scale (K6), respectively, and ad-hoc questions assessing their global health and hospital and academic working conditions. A Directed Acyclic Graph (DAG) analysis was conducted prior to multivariable analyses, to explore the determinants associated with low wellbeing (WEMWBS <43) and high psychological distress (K6 ≥ 13). Results: A total of 904 residents (response rate: 46.7%) participated in the survey. A low level of wellbeing was observed in 23% of participants, and was significantly associated to job strain (OR = 2.18; 95%CI = [1.32-3.60]), low social support (OR = 3.13; 95%CI = [2.05-4.78]) and the experience of very poor university teaching (OR = 2.51; 95%CI = [1.29-4.91]). A high level of psychological distress was identified for 13% of participants, and associated with low social support (OR = 2.41; 95%CI = [1.48-3.93]) and the experience of very poor university teaching (OR = 2.89, 95%CI = [1.16-7.21]). Conclusion: Hospital working conditions, social support, and the perception of teaching quality, were three major determinants of wellbeing and psychological distress among health profession residents. Demographic determinants, personal life and lifestyle habits were also associated. This supports a multilevel action in prevention programs aiming to enhance wellbeing and reduce mental distress in this specific population and local organizational specificities.

Changes over time in anxiety, depression, and stress symptoms among healthcare workers in French emergency departments during the first COVID-19 outbreak.

STUDY OBJECTIVE: Assess the changes in anxiety, depression, and stress levels over time and identify risk factors among healthcare workers in French emergency departments (EDs) during the first COVID-19 outbreak. METHOD: A prospective, multicenter study was conducted in 4 EDs and an emergency medical service (SAMU). During 3 months, participants completed fortnightly questionnaires to assess anxiety, depression, and stress using the Hospital Anxiety and Depression and the Chamoux-Simard scale. The changes in anxiety, depression, and stress levels over time were modelled by a linear mixed model including a period effect and a continuous time effect within periods. RESULTS: A total of 211 respondents (43.5 %) completed the survey at inclusion. There was a decrease in mean anxiety (from 7.33 to 5.05, p < 0.001), mean depression (from 4.16 to 3.05, p = 0.009), mean stress at work (from 41.2 to 30.2, p = 0.008), and mean stress at home (from 33.0 to 26.0, p = 0.031) at the beginning of each period. The mean anxiety level was higher for administrative staff (+0.53) and lower for paramedics (-0.61, p = 0.047) compared to physicians. The anxiety level increased with the number of day and night shifts (0.13/day, p < 0.001, 0.12/night, p = 0.025) as did stress at work (1.6/day, p < 0.001, 1.1/night, p = 0.007). Reassigned healthcare workers were at higher risk of stress particularly compared to SAMU workers (stress at work: p = 0.015, at home: p = 0.021, in life in general: p = 0.018). CONCLUSION: Although anxiety, depression, and stress decreased over time, anxiety was higher among physicians and administrative staff. Reassignment and working hours were identified as potential risk factors for mental health distress in EDs.

[Treatment of post-traumatic stress disorder]. / Prise en charge des troubles psychotraumatiques.

Treatment of post-traumatic stress disorder. Psychological traumas, whose cares are complex, need to be furthermore clarified since they recently became a major public health issue in the wake of the terrorists' attacks that struck France over the past three years. It is its temporality since the event which will determine the type of disorder which might appear thus its adequate processing treatment. In the short term, in the context of collective events or disasters, treatments of psychological suffering by the Medico-Psychological Units (CUMP) are very specific by combining sorting out and direct health care to the victims as well as indirect care such as crisis management. For the health practitioner, a precise knowledge of the disorders which might appear at the early stage, prior to the onset of PTSD, is mandatory. Likewise, approaching a patient with a high emotional load requires specific skills. This is about establishing a real therapeutic alliance with the patient, key factor to prevent a more embedded pathology. Medical treatments at this stage are yet sparsely codified. When pathology is confirmed, post-traumatic stress disorders together with the existence of potential comorbidity (depression, addiction, etc.) require specialized care. Targeted psychotherapies are the first-line treatments, often combined with medical treatments (SSRI antidepressants, for instance) depending on the symptom's seriousness. Sleep disorders, likely conditioning the pathology, will require heightened vigilance. In any case, medication should be adapted to the patient. Similarly, elements of relational approach, any advice, or other health lifestyle rules together with referral to more specific cares, should be individualised.

Prise en charge des troubles psychotraumatiques. Les traumatismes psychiques sont un enjeu de santé publique, leur prise en charge est complexe et mérite d'être précisée, particulièrement dans le contexte actuel des attentats survenus en France ces trois dernières années. La temporalité depuis l'événement conditionne le type de trouble et donc les modalités de traitement. Dans l'immédiat, dans le contexte de l'événement collectif, la prise en charge par les cellules d'urgence médico-psychologique (CUMP) est très spécialisée en associant au tri et soins directs aux victimes, des soins indirects sous forme de gestion de la crise. Pour le praticien, une connaissance précise des troubles dans la phase précoce, avant la survenue d'un trouble de stress post-traumatique, est impérative. De même, aborder un sujet ayant une charge émotionnelle forte nécessite un savoir-faire particulier. Il s'agit d'établir avec le sujet une véritable alliance thérapeutique, facteur essentiel de prévention d'une pathologie plus enkystée. Les traitements médicamenteux à cette phase sont encore peu codifiés. Lorsque la pathologie est avérée, le trouble de stress post-traumatique et l'existence d'une éventuelle comorbidité (dépression, addiction, etc.) nécessitent des soins spécialisés. Les psychothérapies ciblées sont le traitement de première intention, très souvent associées à un traitement médicamenteux (antidépresseur de type inhibiteur sélectif de la recapture de la sérotonine, par exemple), en fonction de la gravité des symptômes. Les troubles du sommeil, conditionnant probablement la pathologie, nécessitent une vigilance particulière. Quoi qu'il en soit, toute médication doit être adaptée au sujet. De même que doivent être individualisés les éléments d'approche relationnelle, tout conseil et autres règles d'hygiène de vie ainsi que l'orientation vers un soin spécialisé.

[What's the post-traumatic stress disorder (PTSD)?] / Qu'est-ce que le trouble de stress post-traumatique ?

What's the post-traumatic stress disorder? Post-traumatic stress disorder (PTSD) is a major public health problem by virtue of its frequency, chronicity and the disability it generates in daily life. PTSD has been known since Antiquity and explored by military psychiatrists and early psychoanalysts, but today more than ever it is a topical issue because of the large number of events such as terrorist attacks or meteorological disasters that occurred lately in France and outside the country. This disorder is characterized by four main dimensions: reexperiencing, avoidance, hyperarousal, and cognitive and mood disturbances. Sleep is very often disrupted and comorbidity is common. The suicidal risk is also frequent. PTSD can affect anybody even though a number of individual risk factors have been identified, such as gender, socio-economic status and psychiatric or traumatic history, with a special focus on peri-traumatic dissociation. As we know, this disorder is the result of exceptional events but is can also be the consequence of more "daily" events which general practitioners are often the first to be consulted for. Despite an apparent "popularization" of the symptoms by greater media coverage, this specific disorder is still poorly understood in its definition and in routine medical practice.

Qu'est-ce que le trouble de stress post-traumatique ? Le trouble de stress post-traumatique est un réel problème de santé publique en raison de sa fréquence, de sa chronicité et du handicap généré au quotidien. Connu depuis l'Antiquité, exploré par les psychiatres militaires et les premiers psychanalystes, il est aujourd'hui plus que jamais d'actualité du fait des événements de grande ampleur (terrorismes, catastrophes météorologiques…) survenus en France, et hors territoire, ces derniers temps. Ce trouble est caractérisé par quatre dimensions principales qui sont l'intrusion, l'évitement, l'hypervigilance, les perturbations cognitives et de l'humeur. Le sommeil est très souvent altéré et la comorbidité fréquente. Le risque suicidaire est également élevé. Le trouble de stress post-traumatique touche une population « tout-venant ¼ même si ont été identifiés un certain nombre de facteurs de risque, comme le sexe, le niveau socio-économique, les antécédents psychiatriques ou traumatiques, etc., avec une place particulière de la dissociation péritraumatique. Les événements à caractère exceptionnel ne doivent pas faire oublier que le quotidien reste aussi un grand pourvoyeur de cette pathologie et que les médecins généralistes sont souvent les premiers consultés. Malgré une apparente « vulgarisation ¼ des symptômes par une plus grande médiatisation, ce trouble spécifique reste encore mal connu dans sa définition et mal appréhendé en pratique médicale courante.