[Identification of factors associated with low access to psychiatric care. Concerning 516 psychiatric assessments carried out in the framework of the local medical committee of Martinique]. / Identification de facteurs associés à un faible recours aux soins spécialisés en psychiatrie. À propos de 516 cas d'expertises psychiatriques réalisées dans le cadre du Comité médical départemental de Martinique.

OBJECTIVE: Mental illness is noted for being in one of the first places in global burden of disease in terms of years lived with disability (YLDs). Notably, absences due to mental health problems greatly affect the world of work, and mental illness is one of the most economically important diseases. However, there is a high rate of those not seeking care in mental health, both in the general population but also in workers in private and public sectors with significant economic impacts. The aim of our study was to identify factors associated with low access to specialized psychiatric care among French Public Sector employees referred to a psychiatric expertise upon request from the Departmental Medical Board of Martinique (Comité médical départemental [CMD] de Martinique), between 2000 and 2013. METHODS: We carried out an observational and transversal study, analyzing sociodemographic and clinical data from psychiatric assessments done to help the CMD give notification on the medico-administrative situation of Public Sector employees, a large majority of whom had been on sick leave due to mental health for at least 6 months. The variable of interest - low access to psychiatric care - was defined as the absence of consultation at the time of the assessment provided by a psychiatrist since at least 12 months. Descriptive analyses were performed first, then univariate analysis using a non-adjusted binary logistic regression model, to identify factors associated with low access to psychiatric care. Finally, multivariate analyses using a binary logistic regression model were performed after excluding non-relevant factors (with significance level above 5%) during the univariate analysis. A significance threshold of 0.05 was adopted for all of the statistical analyses. RESULTS: We retrospectively analysed the records of 516 Public Sector employees. Two hundred and ninety-three subjects (57% of the population) had a low access to psychiatric care as part of their regular clinical follow-up, even the 81% who were identified has having had psychiatric antecedents (55% with 'mood disorders', and 17% with 'neurotic, stress-related and somatoform disorders'). Moreover, psychiatric expertise found a psychiatric diagnostic in 96 % of cases, mostly 'mood disorders', 'neurotic, stress-related and somatoform disorders' and 'personality disorders'. For mood disorders, clinical characteristics of episodes were defined as 'severe' or 'with psychotic symptoms' in many cases. Suicidal thoughts were found in 96 subjects (18%) during the expertise. Fewer than half of the subjects (43%) had a specialized psychiatric care (mostly subjects with 'mood disorders' and 'psychotic disorders') and 41% only had care by a general practitioner (mostly subjects with 'neurotic, stress-related and somatoform disorders'). In most of the cases, psychotropic drugs were insufficiently and inadequately prescribed. Using multivariate analysis, we found a significant association between low access to psychiatric care and: being masculine, having had more than two children, having had personal life events (in particular chronic somatic diseases), and having had no history of mental illness or of psychiatric hospitalization. It appears that chronic somatic diseases are frequently associated with psychiatric diseases, and the association worsens the prognosis of the two disorders. However, even if employees with mental disorders associated with chronic somatic diseases are unfit for work, many of them do not have access to mental health care and only have care by a general practitioner. CONCLUSION: More than half of French Public Sector employees referred to the Departmental Medical Board of Martinique for a medico-administrative decision relevant to sick leave due to mental diseases, had low access to specialized psychiatric care. By identifying barriers to care and reasons for not seeking specialized mental health care, we would be able to prevent disability claims and days off work (predicting malaise in the workplace and health-related limitations). Our results demonstrate the need to strengthen existing partnerships, and thus enhancing cooperation between public psychiatric sectors and primary healthcare players, facilitating access to mental healthcare and decreasing the stigma about mental disorders.

Prevalence of Mental Disorders in Martinique, French West Indies: A Community-based Epidemiological Study / Prevalencia de los trastornos mentales en Martinica, Antillas Francesas: un estudio epidemiológico comunitario

ABSTRACT Objective: This study aimed to estimate the prevalence of mental disorders in the population of Martinique, as part of the survey entitled 'Mental Health in the General Population - Images and Realities ' (Santé Mentale en Population Générale - Images et Réalités). The survey was a multicentre epidemiological study in the general population, conducted in mainland France and French overseas islands between 1997 and 2006, under the authority of the World Health Organization Collaborating Centre for Training and Research in Mental Health (Lille, France). Methods: The study took place in 2000. Participants aged 18 years or over were recruited in public places, using the quota sampling method, and interviewed using the Mini International Neuropsychiatric Interview. Results: A total of 900 participants (52.7% women) with a mean age of 43 years completed the survey. Lifetime prevalence of any mental disorder was 29%. Mood (15%) and anxiety disorders (17%) were the most frequent. The rate of suicide attempts was low (4.2% lifetime), while the frequency of suicidal thoughts was high (11% past month) and similar to the frequency in mainland France. Conclusion: Mental disorders, especially mood and anxiety disorders, were as frequent in Martinique as in mainland France. The lower rates of suicide attempts, in spite of high rates of suicidal thoughts, might deserve further investigation. Our results should strengthen the development of a system of diagnosis and care for these disorders, especially to prevent suicidal behaviours and reduce morbidity and mortality.

RESUMEN Objetivo: Este estudio tuvo por objeto estimar la prevalencia de los trastornos mentales en la población de Martinica, como parte de la encuesta intitulada 'Salud Mental en la Población General - Imágenes y Realidades ' (Santé mentale at Population Générale - Images et Réalités). La encuesta fue un estudio epidemiológico multicéntrico en la población general, realizado en Francia continental y en las islas francesas de ultramar entre 1997 y 2006, bajo la autoridad del Centro de Colaboración de la Organización Mundial de la Salud para la Formación y la Investigación de la Salud Mental (Lille, Francia). Métodos: El estudio tuvo lugar en el año 2000. Los participantes mayores de 18 años fueron reclutados en lugares públicos, utilizando el método de muestreo por cuotas, y entrevistados usando la Mini Entrevista Neuropsiquiátrica Internacional. Resultados: Un total de 900 participantes (52.7% mujeres) con edad promedio de 43 años completó la encuesta. La prevalencia de por vida de cualquier trastorno mental fue de 29%. Los estados de ánimo (15%) y los trastornos de ansiedad (17%) fueron los más frecuentes. La tasa de intentos de suicidio fue baja (4.2% por tiempo de vida), mientras que la frecuencia de los pensamientos suicidas fue alta (11% el mes pasado) y similar a la frecuencia en la Francia continental. Conclusión: Los trastornos mentales, especialmente los estados de ánimo y los trastornos de ansiedad, eran tan frecuentes en Martinica como en la Francia continental. Las tasas más bajas de intentos de suicidio, a pesar de los altos índices de pensamientos suicidas, podrían merecer investigación adicional. Nuestros resultados deben fortalecer el desarrollo de un sistema de diagnóstico y cuidado para estos trastornos, especialmente para prevenir comportamientos suicidas y reducir la morbilidad y la mortalidad.

Mental health of jail inmates within the prison of Ducos, Martinique - a cross-sectional descriptive study.

BACKGROUND: Prisoners' sociocultural backgrounds and prison environments have an influence on detainees' psychopathology; complex judicial and public policies are also to be taken into account in the dynamics of that environment. Scientific literature shows a wide range prison inmates' profiles across the world. However, very little data about the mental health of Caribbean jail inmates has been published. Martinique is a French overseas administrative district in the Caribbean, with a population of about 400,000 inhabitants. Its only prison is located in the city of Ducos. Our study proposes a description of the psychiatric characteristics of jail inmates in Martinique with epidemiological tools. Its objectives are to highlight their specific features and compare them to mainland France's jail population. METHODS: The initial study was a multicenter cross-sectional survey conducted in 18 French prisons. The selection was done using a two-stage stratified sampling strategy. For the purpose of our study, two groups were defined and compared: the detainees from the prison of Ducos (n=100) were compared to inmates from mainland France (n=698). Current psychiatric diagnoses were rigorously collected, through clinical and semi-structured interviews. We conducted a multiple logistic regression for each assessed mental disorder. Each prisoner gave us his oral and written informed consent. RESULTS: In terms of sociodemographic characteristics, we found more children per prisoner in the Martinican group and a better educational status in the mainland France group. The inmates from Martinique had significantly more adverse experiences in their childhood and the length of incarceration at the time of the interview was longer in the Martinique sample. Major depressive disorders (aOR=0.51; 95% CI=0.26-0.95) and psychotic disorders (aOR=0.24; 95% CI=0.08-0.57) were significantly less frequent in the Martinique sample. The data concerning substance-related disorders showed significant differences in bivariate analysis but this link was no longer statistically significant in the multiple logistic regression analysis. CONCLUSION: Even if imprisonment conditions are extremely tough, the inmates carry the heavy burden of difficult family histories, and the use of cannabis seems to be a major problem, it appears that Martinique's jail inmates have lower rates of mental illness than their counterparts from mainland France. We think this could be due to the benefit of greater proximity to their relatives and a united community, both which may contribute to lower prevalence of mental disorders.