Disclosure of sexual abuse by adolescents treated in a psychiatry department.

OBJECTIVES: The aim of the study is to describe the population of adolescents who have disclosed sexual abuse to a health professional during their care in a psychiatric department. We also want to discuss the circumstances that enable adolescents to make this disclosure. METHODS: This single-center retrospective observational study is based on the mandatory reports (n=139) sent by a Paris adolescent psychiatry department between 2005 and 2021 after patients disclosed previous sexual abuse. R® (3.6.1) and RStudio® (1.2.5001) software were used for statistical analysis. RESULTS: Girls accounted for almost all the adolescents who disclosed (95.7%). First abuse occurred around the age of 12 years and was first disclosed to a health professional a mean of 3.5 years later; 66 (47.5%) patients were admitted for inpatient care during their follow-up. The most common diagnoses were depression, eating disorders, posttraumatic stress disorders, and other anxiety disorders. Before disclosing to a health professional, most of these adolescents had already talked about it, mainly to a family member (69.8%) or peers (24.7%). CONCLUSION: This is the first study in France on the reporting of sexual abuse after its disclosure by adolescents being treated in a psychiatry unit. Our results show that child sexual abuse is rarely reported and that health care professionals are far from being the first recipients of these disclosures. We recommend routine screening for sexual abuse in adolescent psychiatry units, improved training for staff receiving these disclosures, and consideration of how best to coordinate medical, social, and legal services for these adolescents.

[The therapeutic mediation device in the clinic of adolescent action]. / Le dispositif à médiations thérapeutiques dans la clinique de l'agir adolescent.

The pathologies of the adolescent act illustrate the overflow so characteristic of the "modernity" of a world in perpetual evolution. Through compulsive bodily symptoms that are as noisy as they are enigmatic (self-mutilation, suicide attempts, addictions, fast sex, eating disorders), adolescents are always in search of transitional and containing spaces, which are indispensable for symbolizing and calming destructuring intrapsychic conflicts. Therapeutic mediations, adapted to the different singularities, offer a space through which integration and subjectivation processes are possible.

[Photographing to advance, the use of photography in psychotherapy]. / Photographier pour avancer, l'utilisation de la photographie en psychothérapie.

The practice of the clinical psychologist in child psychiatry can be a perilous task. His balance, as precarious as it may be, lies in listening to and observing the patient, but also in the use of precious tools of which therapeutic mediations are a part. They allow to experiment a sensory-motor anchorage and bring a multidimensional vision necessary to the comprehension of the subject and his suffering. By creating an intermediary space between the I and the You, the outside and the inside, they determine a place where the psychotherapeutic work can take place.

A retrospective cohort study comparing the social, familial and clinical characteristics of adolescents admitted to a French Emergency Department in suicidal crisis before and during the COVID-19 pandemic.

The social turmoil resulting from the COVID19 pandemic has come with an increase in the incidence of suicidal crises among adolescents and in particular an increase of suicidal attempts in most Western societies. Monthly prevalence of suicidal attempts in adolescents was doubled or tripled during winter 2021 in France. This study proposes to describe the youths in suicidal crisis admitted to a French hospital during the pandemic according to their sociodemographic, familial, and clinical characteristics as well as to compare them to the adolescents who were presenting the same symptoms the years preceding the pandemic. A retrospective cohort of 332 participants was divided in two groups. The adolescents admitted during the pandemic were more frequently girls, with less familial and personal history of psychiatric care, less depressive disorders, and they were more frequently referred to psychological outpatient care than to psychiatric outpatient care. These results strengthen the hypothesis that the increase in adolescents' suicidal crisis could be an expression of the social suffering more than a result of an increase in adolescents' psychiatric disorders.

Gender in the Suicidal Experience: A Qualitative Study among Adolescents.

BACKGROUND: Teenaged boys die more often than girls by suicide, although they report fewer suicide attempts and seek less care. The aim of this work is to explore the subjective experience of adolescent suicidal behavior to determine the aspects that are common to adolescent girls and boys and those that are specific to one gender. METHOD: The study included 22 adolescents receiving care for suicidal behavior. The semi-structured interviews were analyzed according to the methods of Interpretative Phenomenological Analysis. RESULTS: Three themes of experience emerged: the experience of suffering, connection to others, and courage. The individual and interpersonal dimensions highlight feelings that they are not understood by others and are isolated. Young boys experience relationship difficulties more as rejection, and young girls describe a fear of being abandoned, for which they feel responsible. Boys and girls have different definitions of courage: boys sometimes appear to value the courage to risk death, while girls perceived risk-and therefore courage-in seeking help. DISCUSSION: Specific prevention programs must focus on the perception of care and its representations. By positioning the experience of adolescents as expertise, these programs would thus better respond to the expectations and the reluctance of this audience. Gender attitudes that are harmful to the use of care can be addressed and worked on. By separating the reception of care from the demeaning representation common among teens, these can be linked to a notion of shared vulnerability and interdependence and enable earlier recourse to treatment.

The Cultural Hybridization of Mothering in French Prison Nurseries: A Qualitative Study.

In France, women can be incarcerated during pregnancy and can keep their babies with them in prison up to the age of 18 months. The small number of nurseries in France and their unequal geographic distribution as well as the high percentage of foreign prisoners often result in women's isolation from their usual cultural environment. Family members and cultural community play a crucial role in the process of mothering. The aim of this study is to explore through these mothers' narratives how they experience the cultural aspects of this process in the prison environment. We conducted semi-structured interviews to collect the experience of 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. Four different themes emerged: prison: repression of cultural practices, prison: a culture of its own, loss of traditional culture, and cultural hybridization. The specific environmental architecture and operating rules in prison nurseries may induce acute repression regarding cultural ways of mothering. Considering both cultural permeability specific to the peripartum period during which women tend to more easily embrace cultural aspects from their environment, and family distance which restrains cultural transmission, these mothers gather multiple factors of vulnerability for full prisonization, as a form of forced assimilation to prison culture. But a sort of specific hybrid prison culture around motherhood seems to emerge instead, in a process similar to creolization.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study.

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.

Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents.

The Coronavirus Disease 2019 (COVID-19) pandemic catalysed an abrupt explosion in the use telepsychiatry for the delivery of mental health services. We aimed to explore the experience of telemedicine use during this period among adolescent outpatients and inpatients and their parents. This qualitative study took place in a French adolescent medicine and psychiatry department during the first lockdown. Data collection by purposive sampling continued until we reached theoretical sufficiency. The interviews were analysed by applying Interpretative Phenomenological Analysis which is based on an iterative, inductive process. It included 20 participants: 10 adolescents and 10 parents. The analysis showed three themes: (1) facilitators of a switch from face-to-face to tele-consultation: (a) the context of health emergency, (b) the integration of parents in the treatment, (c) the choice between telephone or video consultation; (2) distance from the therapist's gaze and its consequences: (a) an obstacle to decrypting clinical nonverbal communication, (b) effectiveness depends on the severity of the adolescent's symptoms, (c) and on the previous quality of the therapeutic relationship; (3) awareness of the value of the face-to-face therapeutic space. In the post-COVID era, practitioners would benefit from combining both approaches, face-to-face and remote, based on the quality of the therapeutic alliance, the pathology, the parents' availability for in-person participation, and the patient's age. Future quantitative research will also be necessary to establish the extent to which the experiences described by the participants in this study reflect those of a broader population.

[A patient education program for adolescents with anorexia nervosa]. / Un programme d'éducation thérapeutique pour adolescents souffrant d'anorexie mentale.

Patient education program (PEP) aims to help the patient acquire the skills necessary to manage a chronic disease. A multidisciplinary TPE program for adolescents with anorexia nervosa was developed in a daycare hospital setting. This qualitative study, exploring the experience of the caregivers involved in this program, reports the benefits but more so the difficulties linked to the clinical specificities of anorexia nervosa, as well as the numerous requirements, constraints and necessary adjustments linked to this innovative practice.

Barriers and Expectations of Adolescents Regarding the Identification and Management of Their Psychoactive Substance Use by Their General Practitioner.

AIMS: General practitioners (GPs), who are the most frequently consulted health professionals by adolescents, play a key role in screening for psychoactive substance (PAS) use. The purpose of our study was to determine the barriers and expectations of adolescents regarding the identification and management of their PAS use by their general practitioner. METHODS: Descriptive, cross-sectional study of a population of adolescents aged 12 to 17 years, followed up in general practice in France. Adolescents were recruited from general practice offices by open-access questionnaires. An opaque box was provided to ensure the anonymity of the adolescents. RESULTS: A total of 277 adolescents were included: 155 girls, mean age 14.5 ± 1.7 years, 113 adolescents (41%) had used a PAS at least once in the past 12 months. Alcohol was the most used PAS, followed by tobacco and cannabis. Three groups were identified: the nonusers group (n = 134); the group of moderate users (n = 71); the group of users at risk of substance abuse or misusing (n = 38). Regardless of group, adolescents felt that their GP was attentive, responsive, competent, understanding, and took the time to ask the appropriate questions in their role. The at-risk group was less confident and less comfortable, and they felt more judged and more afraid of the GP telling their parents. Despite this, the at-risk group was the most willing to talk to their GP about their PAS. Almost half of the adolescents surveyed found it useful to use a questionnaire to discuss PAS. CONCLUSIONS: Reminding each consultation of the principles of the relationship of trust and confidentiality while maintaining an empathetic attitude would make it easier for GPs to remove adolescents' inhibitions about communicating about their PAS use.

The experience of anaesthesiology care providers in temporary intensive care units during the COVID-19 pandemic in France: a qualitative study.

BACKGROUND: During the COVID-19 pandemic, care providers (CPs) worldwide grappled with the extraordinary number of severely ill patients with high fatality rates. The objective of this study is to explore the experience of anaesthesiology CPs in temporary intensive care units during the COVID-19 pandemic's first wave. METHODS: CPs were interviewed at a university hospital in Paris, France. We conducted a qualitative study using interpretative phenomenological analysis. RESULTS: Fifteen participants were included (five nurses, three nurse managers, and seven physicians). The analysis uncovered four themes: 1. Overworked care providers in an intensive care unit under pressure; 2. The disrupted relationship among patients, their families, and end-of-life care; 3. Short-term coping strategies; 4. A long-term transformative experience for care providers. DISCUSSION: The COVID-19 pandemic has drained CPs physically and emotionally. Infection control protocols, lack of knowledge about this new disease, the establishment of open-space care settings, and the disruption of relationships have posed ethical dilemmas, leading CPs to question the meaning of their profession, and their future professional involvement. CPs at both an individual and institutional level employed numerous coping strategies, relying on a strong team spirit and a reinforced sense of duty. Nevertheless, after the end of the first wave, participants described the long-lasting psychological impact of this experience and frustration at the lack of recognition from their institutions and from policymakers. This study can inform institutional interventions and public health policy to support CPs during and after such a crisis to ensure their well-being and high standards of care.

Subjective Experience of Antidepressant Prescription Among Adolescents With Anorexia Nervosa.

Introduction: Major depressive disorder is considered the most common comorbidity of anorexianervosa in adolescence. Some evidence argues against antidepressant use in this population. Moreover, the fear of being threatened with autonomy and of becoming dependent specific to this adolescent population and at the very core of the anorexic disease, make the proposal of such a treatment difficult to accept. This qualitative research aimed to explore the perspectives of view of adolescents with anorexia nervosa about antidepressants. Methods: We conducted interviews with adolescents suffering from anorexia nervosa who had been treated with an antidepressant agent during their inpatient or outpatient care at Cochin Hospital. Adolescents were chosen by convenience sampling. Both verbal and written questions were asked to elicit their lived experiences. Interpretative Phenomenological Analysis was used to examine the data. Results: Fifteen adolescents (13 girls and two boys) were interviewed. We have reached total data saturation. The analysis found two meta-themes, each with two separate themes. (I) Reactions to the proposal of antidepressant with (i) an opposition phase (about the existence of depressive symptoms and about negative preconceptions) and (ii) need to share with family and other teenagers. (II) Reactions to antidepressant use with (iii) ambivalence and an initial perception of coercion, and (iv) effects of antidepressants (psychological effects, effects on the body and on anorexia nervosa and effects perceived through the eyes of others). Discussion: Despite positive effects, ambivalence toward the treatment remained present throughout the interviews: these adolescents still worry greatly about loss of control and weight gain. Depression as comorbidity seems to be entangled in the denial of disease, cognitive distortion and acquired fearlessness specific to AN. Its existence in adolescence can uncover transgenerational issues, sometimes previously hidden. An orodispersible/drinkable form of antidepressants would facilitate adherence to treatment in this specific population. The intervention of a "patient-expert" could reduce adolescents' anxiety about loss of control. A latency period seems necessary to allow them to understand the prescription at their own level and in the complexity of their anorexic illness.

Migrant adolescents' experience of depression as they, their parents, and their health-care professionals describe it: a systematic review and qualitative meta-synthesis.

Migrant youth are vulnerable and face a risk of internalised disorders such as depression. This qualitative meta-synthesis explores migrant adolescents' experience of depression. 14 studies (7 qualitative studies and 7 case reports) were selected after a systematic search of PubMed, Embase, Scopus and PsycInfo. Their quality was assessed with the Critical Appraisal Tool (CASP) for qualitative studies and the Joanna Briggs Institute (JBI) checklist for case reports. The analysis identified six themes describing the experience of depression among migrant adolescents: (1) the vulnerability factors underlying depressive distress, before, during and after migration; (2) the subjective experience of depression, combining symptoms associated with a form of depression common in the West with symptoms more common in other cultures; (3) two types of aetiological hypotheses to make sense of their distress; (4) attitudes adopted in response to distress; (5) experience of care, especially reasons discouraging investment in care; and (6) impairment of identity construction by breaks in cultural transmission and intergenerational conflicts. The threat of losing their connections both at the interpersonal (connection to family, peers and community) and intrapsychic levels (construction of identity) is inherently linked to migrant adolescents' experience of depression. We propose to adapt Brandenberger's 3C model (communication, continuity of care, and confidence) for the care of young migrants to promote a therapeutic alliance, foster construction of a coherent bicultural identity, and support the family.

Becoming a transcultural psychotherapist: Qualitative study of the experience of professionals in training in a transcultural psychotherapy group.

Transcultural psychotherapy is an original therapeutic technique designed to respond to difficulties encountered in psychiatric treatment for migrants. Today, this psychotherapy is formalized and it is in use at numerous sites in France and internationally. An increasing number of professionals are seeking training in this method. We sought to explore the experiences of these trainees, at their entry in the group and during their training. This qualitative study used focus groups to interview trainees participating in a transcultural psychotherapy training group. The thematic analysis generated two domains of experience: the emotional and personal experience within the transcultural group, including the private feelings of the trainee-participants, their initial difficulties, and the changes in these feelings; and their perception of this specific type of care, that is, their perspectives on transcultural psychotherapy and its most original aspects. Based on the narratives of trainees in this program, we conclude that becoming a transcultural psychotherapist involves a process not only of cultural decentering but also of professional decentering. This decentering cannot be learned theoretically: it must be experienced, for a long enough time to become imbued with it and to allow oneself to modify one's practices. After sufficient time in the group, the trainees succeed in extricating themselves, little by little, from their ethnocentric vision of psychotherapy, and come to tolerate and then integrate new ways of doing and thinking.

Adolescent attendance at transcultural psychotherapy: a retrospective cohort study.

Migrant adolescents in therapy for psychological problems are at risk of poor attendance or even of dropping out. Transcultural psychotherapy has been developed in France to take cultural diversity into account in psychological treatment and to deal with the specific difficulties encountered in the psychotherapeutic treatment of this population. This study aims to assess adolescents' attendance rates to this form of psychotherapy and to explore the association of these rates with demographic, cultural, and clinical variables. We conducted a retrospective clinical cohort study of 148 adolescents aged from 11 to 20 years treated between 2008 and 2018 at two transcultural psychotherapy centers in Paris. Statistical analyses tested demographic, cultural, and clinical hypotheses. The main result was the high attendance rate at transcultural psychotherapy sessions among adolescents (77.8%). Attendance rates were not associated with age, gender, family size, generation of migration, or cultural area of origin, but were significantly linked to support in therapy, specifically, the presence at the first transcultural psychotherapy session of the first-line therapist, an interpreter, or both. Transcultural psychotherapy appears to be an effective method for addressing the complex symptoms experienced by migrant adolescents. Better attendance at sessions is statistically significantly associated with factors favoring a therapeutic alliance, specifically, the presence of the first-line therapist or an interpreter in TPT sessions and the existence of support from a social worker. The holistic approach of transcultural psychotherapy to adolescent care may explain the high attendance rates observed.

The Process of Becoming a Mother in French Prison Nurseries: A Qualitative Study.

BACKGROUND: Many variables can influence the process of motherhood, including environmental precarity and personal adversity. One about which little is known is the impact of incarceration on women during or after pregnancy. In France, pregnant women or those with children up to 18 months old can be incarcerated with their child in specific units called nurseries. We sought to explore incarcerated women's experience of motherhood in prison environments and its potential consequences on the construction of their identity as mothers. METHOD: We conducted semi-structured interviews to collect the experience of the process of motherhood among 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. RESULTS: Four different themes emerged: prison conflates their status as inmates and as mothers; it limits their freedom as mothers; it disrupts their family structure; and motherhood may help distinguish them from other inmates. CONCLUSION: Incarceration of pregnant women or young mothers in prison nurseries might disrupt the process involved in becoming mothers, causing their identities as prisoners to englobe their identities as mothers and resulting in inappropriate parenting support by prison staff. A professional specialized in peripartum issues should help each woman disentangle her identity as inmate and mother and enable her placement at the facility best adapted to her individual needs as a mother. In any case, if prison must continue to be possible, it must always be a last alternative for women with young children.

Perspective changes through transcultural mediation training: A qualitative study of trainees, instructors, and experts.

To deal with cultural misunderstandings in health care due to increased migration, the Babel Centre-a training and mediation center-developed "transcultural mediation": a service meant to help health-care professionals encountering difficulties with migrant patients and their families. One of the center's health-care professionals, trained as a mediator, and a cultural broker jointly conduct the mediation session. In 2017, the center initiated a specialized training program to teach health-care professionals the skills needed to serve as transcultural mediators. We conducted a study to evaluate, through the trainees' and instructors' subjective experiences, the quality of this innovative training. We used semi-structured interviews and focus groups to question seven trainees, three instructors, and three experts in transcultural psychology at different stages of the 10-month program (before, at midpoint, and afterwards). We used Interpretative Phenomenological Analysis to explore the data. The themes are organized around the central concept of the transmission of knowledge from instructors to trainees and vice versa. Trainees were globally satisfied with this program by its end but did not feel able to lead a mediation by then, due to insufficient anthropology knowledge and practical training. Training in transcultural mediation resembles that for resolving situational problems. It cannot be taught by an approach based on reasoning by the inverse problem method, used for teaching medical sciences. Pedagogical tools more suited to problem solving, such as role-playing or use of senior-assisted mediations, should be used to improve the quality of this training.

Incarcerated mothers' views of their children's experience: A qualitative study in French nurseries.

CONTEXT: In France, young children of incarcerated women live with their mothers in prison in specific units called nurseries, up to the age of 18 months. Only a few studies have examined the impact of this environment on these children. This study sought to explore through mothers' narratives how they perceive their children to experience this environment and how it affects their development. METHOD: We used semistructured interviews to collect the perceptions of 25 mothers about their children's experience of daily life in 12 different prison nurseries in France. Interpretative phenomenological analysis was used to explore the data. RESULTS: According to mothers, prison is a sensorially aggressive environment for children that may impair the children's sensory abilities. The children's and mothers' emotional perceptions of anger, sadness, insecurity and imprisonment intertwine. Prison is home for these children, which leads them to establish strong bonds with this inside world-prison staff, other inmates-but to develop reluctances and concern about exploring the outside world. CONCLUSION: The prison's sensorial environment may overlay the sensorial environment created by the mother, interfering with early mother-child interactions and leading to emotional misattunement. The gap between what the mother and the child each feel to be their home, and the social group they feel they belong to, causes pain to the mothers. This could alter their mandate of being a protective shield that could reduce the traumatic potential of the carceral environment on their babies. These mothers' sentences must be reconsidered for the sake of their children.

[Professional representation of chronic idiopathic musculoskeletal pain in adolescents]. / Représentation des professionnels face aux douleurs musculo-squelettiques chroniques idiopathiques de l'adolescent.

Chronic idiopathic musculoskeletal pain is common in adolescence, and its impact is sometimes severe. The diagnostic process, which consists of eliminating other etiologies, can be long, complex, and at risk of medical nomadism. Specialists rely on many clinical elements to orient themselves. The care pathway and the subjective feeling of the professional are valuable diagnostic elements.