Psychotic and Somatic Symptoms Are Frequent in Refugees With Posttraumatic Stress Disorder: A Narrative Review

OBJECTIVE

In 2021, 89.3 million refugees were vulnerable to posttraumatic stress disorder (PTSD) after exposure to multiple and repeated traumatic experiences. The recent war in Ukraine provoked 7 million refugees to flee their homes. Specific clinical presentations of PTSD in refugee populations may not be familiar to most physicians. The goal of this review is to describe the diagnosis and specific clinical features of PTSD in refugees.

METHODS

This narrative review of 263 articles explores 3 PTSD diagnoses that are frequently described in refugee populations and that have been observed in our clinical practices: complex PTSD, PTSD with psychotic symptoms, and PTSD with somatic symptoms.

RESULTS

While complex PTSD does not seem to be related to individuals' culture and origin, the other 2 diagnoses have been specifically described in refugee populations. PTSD with somatic manifestations appears to be the most frequently described and commonly acknowledged form in refugee populations, whereas PTSD with psychotic symptoms remains more controversial due to its clinical variability and association with comorbid disorders.

CONCLUSIONS

The difficulty of identifying PTSD with psychotic symptoms and PTSD with somatic symptoms in refugee populations may lead to misdiagnosis and explain the moderate effectiveness of care delivered to these populations. Appropriate diagnosis is essential to provide optimal psychiatric care to refugee populations.

Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks

BACKGROUND

Terrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors.

METHODS

Data were collected from a web-based survey of civilians 8-12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation.

RESULTS

Among the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were "did not feel the need", "it was not the right time to talk about it", and "not offered". For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims.

CONCLUSION

The organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.

The Relationship between Trauma and Attachment in Burundi's School-Aged Children

The exposure of children and adolescents to trauma is one of the most important public health challenges. These childhood experiences play a role in children's attachment patterns with their parents and peers. The objective of this study was to examine the relationship between exposure to trauma and the degree of attachment representations in school-aged children in Burundi. One hundred thirteen vulnerable children aged 7 to 12 years were recruited and referred by their teachers. We used an event list including the post-traumatic reaction index to measure their exposure to traumatic events and the People in My Life instrument to measure attachment representations. The results revealed that the children had experienced or witnessed at least one traumatic event. The results indicated that secure attachment representations were highest among children with their parents and lowest among children with their peers. The relationship between trauma experiences and children's attachment representations was significant with their parents and with their peers. Children's attachment representations with their parents and peers predicted their traumatic experiences. Future research should focus on how attachment relationships can facilitate counselors and clinicians in providing preventive psycho-education to adults and children to develop healthier functioning, through better knowledge of the complex interplay between traumas.

[Assessment of psychotrauma in children with early exposure to domestic violence]

The Paris Nord Regional Psychotrauma Center of the Avicenne Hospital, located in Bobigny, accommodates children and adolescents who have experienced potentially traumatic events. Based on a clinical situation of children born in a context of domestic violence, we will describe how the assessment device, through its therapeutic aim, allows to name the traumatic events suffered and to recognize their impact on the child's development.

PTSD and Partial PTSD among First Responders One and Five Years after the Paris Terror Attacks in November 2015

Following the Paris terror attacks in November 2015, a large number of first responders (FR) were mobilized and consequently were at risk of developing posttraumatic stress disorder (PTSD). Based on the ESPA 13 November survey, the objectives of this study were to 1) describe the prevalence of PTSD and partial PTSD in FR five years after the attacks, 2) describe the changes in PTSD and partial PTSD from one to five years after the attacks, and 3) examine factors associated with PTSD and partial PTSD five years after the attacks. Data were collected using an online questionnaire. PTSD and partial PTSD were measured using the Post-Traumatic Stress Disorder Checklist based on the DSM-5 (PCL-5). Gender, age, responder category, education level, exposure, mental health history, history of traumatic events, training, social support, concern about the COVID-19 epidemic, and somatic problems present after the attacks were all analyzed as potential factors associated with PTSD and partial PTSD using multinomial logistic regression. A total of 428 FR were included 5 years after the attacks, of which 258 had participated also 1 year after the attacks. Five years after the attacks, the prevalence of PTSD and partial PTSD were 8.6% and 22%, respectively. Presence of somatic problems after the attacks were associated with PTSD. Involvement in dangerous crime scenes was associated with a higher risk of partial PTSD. No awareness of psychological risks in the context of professional activity through specific training was associated with partial PTSD, in particular among participants aged 45 years or more. To mitigate PTSD for FR, monitoring mental health symptoms, providing mental health education, and providing treatment may be needed for several years after the attacks.

[Post-traumatic grief and the need for ritual in therapy]

This clinical history retraces the treatment of an Ivorian man presenting with a state of post-traumatic mourning following the assassination of his family ten years ago, in a context of crisis. The aim is to illustrate the need for flexibility in the therapeutic framework in this mourning process, which is complicated or even prevented by psychotraumatic symptoms and the absence of rituals. The transcultural approach initiates here a first evolution in the patient's symptomatology.

Mental Health Symptoms of University Students 15 Months After the Onset of the COVID-19 Pandemic in France

IMPORTANCE

The Conséquences de la pandémie de COVID-19 sur la santé mentale des étudiants (COSAMe) survey was conducted among university students in France during the COVID-19 pandemic and found that although there was a slight decrease in anxiety, depression, and stress between the first lockdown (T1) and 1 month after it ended (T2), the prevalence of suicidal ideation had increased between these periods and 1 in 5 students had probable posttraumatic stress disorder (PTSD) at T2. These results emphasize the need to explore the long-term consequences of the COVID-19 pandemic.

OBJECTIVES

To measure the prevalence of mental health symptoms among university students in France 15 months after the first lockdown (T3) and to identify factors associated with outcomes.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study reports data from the third measurement time of the repeated COSAMe survey, which took place from July 21 to August 31, 2021, through an online questionnaire sent to all French university students.

MAIN OUTCOMES AND MEASURES

The prevalence of suicidal thoughts, PTSD (PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] [PCL-5]), stress (Perceived Stress Scale), anxiety (State-Trait Anxiety Inventory), and depression (Beck Depression Inventory) at T3 were gender- and degree-standardized and compared with prevalence rates at T1 and T2. Multivariable logistic regression analyses identified risk factors.

RESULTS

A total of 44 898 students completed the questionnaires. They were mainly women (31 728 [70.7%]), and the median (IQR) age was 19 (18-21) years. Standardized prevalence rates of stress, anxiety, depression, suicidal thoughts, and PTSD were 20.6% (95% CI, 20.2%-21.0%), 23.7% (95% CI, 23.3%-24.1%), 15.4% (95% CI, 15.1%-15.8%), 13.8% (95% CI, 13.5%-14.2%), and 29.8% (95% CI, 29.4%-30.2%), respectively. Compared with the decreased prevalence rates at T2, there was an increase at T3 for stress (2.5% increase), anxiety (13.9% increase), and depression (22.2% increase). The prevalence of suicidal ideation continued to increase from T1 (10.6%) to T3 (13.8%), and the prevalence of probable PTSD increased from 1 in 5 students to 1 in 3 students between T2 and T3. Female and nonbinary participants; participants without children and living in an urban area; and those with financial difficulties, a chronic condition, psychiatric history, COVID-19 history, social isolation, and low perceived quality of information received were at risk of all poor outcomes at T3 (eg, stress among women: adjusted OR, 2.18; 95% CI, 2.05-2.31; suicidal thoughts among nonbinary respondents: adjusted OR, 5.09; 95% CI, 4.32-5.99; anxiety among students with children: adjusted OR, 0.68; 95% CI, 0.56-0.81; depression among students living in a rural area: adjusted OR, 0.80; 95% CI, 0.75-0.85).

CONCLUSIONS AND RELEVANCE

These results suggest severe long-lasting consequences associated with the pandemic on the mental health of students. Prevention and care access should be a priority.

Mental health impact and mental health care among first responders following the Paris terror attacks in November 2015

Introduction

During the evening of 13 November 2015, a terror attack occurred in France in the Paris area. Overall, 130 people were killed, 643 were injured and several thousands were psychologically impacted. Thousands of first responders (FRs), including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on FRs, and its associated factors 12 months after the 13 November 2015 terrorist attacks, as well as their engagement in mental health care and its associated factors.

Methods

FRs who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of Post Traumatic Stress Disorder (PTSD). PTSD and partial PTSD were measured using the PTSD checklist for DSM-5 (PCL-5) and depression with the hospital anxiety and depression (HAD) scale.

Results

Overall, 663 FRs were included in the analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers. Low educational level, social isolation, intervention on unsecured crime scenes and lack of training were associated with PTSD. Among FRs with PTSD, partial PTSD or depression, 38% sought mental health care. Mental health care engagement was associated with a history of mental health care, post-immediate support and the presence of PTSD, partial PTSD or depression.

Conclusions

Our results highlight that improving access to mental health care for FRs after terror attacks is needed. Efforts should be made before and after potentially traumatic events to ensure mental health education for FRs. Special attention should be given to FRs living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes.

[Together in the face of extreme violence: accompanying families after a traumatic event]

After a traumatic event, families can also be impacted at different levels and require post-immediate or longer-term care. The adaptation of these family care procedures carried out following the attacks of 2015-2016 in France, based on existing clinical arrangements, in a child psychiatry service associated with a medical-psychological emergency unit, is discussed via two clinical examples. These different modalities of follow-up, a family debriefing and a situation of mourning associated with a trauma insist on the necessity to consider the temporality of the follow-up, the use of different theoretical tools, as well as the importance given to rituals and family skills hard hit by the traumatic event.

Evolution in French University Students' Mental Health One Month After the First COVID-19 Related Quarantine: Results From the COSAMe Survey

INTRODUCTION

The COVID-19 related quarantine had negative psychological effects among University students. Evidence from previous epidemics suggests that negative psychological effects of quarantine measures can last or even worsen after the quarantine lift. The objective of this study was to assess the evolution of students' mental health and to identify factors associated with mental health outcomes 1 month after the lift of the lockdown.

MATERIALS AND METHODS

This repeated cross-sectional study collected data during the first quarantine in France (T1, N = 68,891) and 1 month after its lift (T2, N = 22,540), through an online questionnaire sent to all French University students. Using cross-sectional data, we estimated prevalence rates of suicidal thoughts, severe anxiety (State-Trait Anxiety Inventory, State subscale), depression (Beck Depression Inventory), and stress (Perceived Stress Scale) at T1 and T2. Using longitudinal data (N = 6,346), we identified risk factors of poor mental health outcomes among sociodemographic characteristics, precariousness indicators, health-related data, information on the social environment, and media consumption, adjusting for baseline mental health status.

RESULTS

We found lower prevalence rates of severe stress (21.7%), anxiety (22.1%), and depression (13·9%) one month after the quarantine compared to the quarantine period (24.8%, 27.5%, and 16.1%, respectively). The prevalence rate of suicidal thoughts increased from 11.4 to 13.2%. Regardless of the existence of symptoms during quarantine, four factors were systematically associated with poor mental health outcomes 1 month after the quarantine was lifted: female gender, a low feeling of integration before the quarantine period, a low quality of social ties during the quarantine, and a history of psychiatric follow-up.

CONCLUSIONS

The prevalence rates of severe stress, anxiety, and depression, although being lower than during the first lockdown, remained high after its lift. The prevalence rate of suicidal ideation increased. This stresses the need to consider the enduring psychological impact of the pandemic on students as a critical public health issue.

Children and Adolescents Psychological Distress Scale During COVID-19 Pandemic: Validation of a Psychometric Instrument (CONFEADO Study)

AIM AND OBJECT PURPOSE OF THE STUDY

In March 2020, the WHO declared a pandemic (COVID-19) due to the SARS-CoV-2 virus. In France, school closures and lockdowns were implemented. In this unprecedented context for French adolescents and children, the CONFEADO study surveyed children aged 9 to 18 years to assess their mental health, psychological distress, and resilience during and after the lockdown in relation to their living and housing conditions. To assess psychological distress, a psychometric tool (Children and Adolescent Psychological Distress Scale-CAPDS-10) was specifically designed for the research. This article presents the psychometric validity of the CAPDS-10.

METHODS

This cross-sectional study collected data from June 9 to September 14, 2020, from children and adolescents (9 to 18 years of age) via an online questionnaire after sending it to a large network of partners. Psychological distress, resilience, and trait anxiety were assessed using the CAPDS-10, the Child and Youth Resilience Measure (CYRM), and the State-Trait Anxiety Inventory for Children (STAIC). The CAPDS-10 measured perceived psychological distress in the most recent 2 weeks (primary endpoint). The predictive power of the CAPDS-10 was determined by statistical analysis. We proceeded to a confirmatory factor analysis to validate the scale at a clinical level. We carried out a psychometric validation with a step to verify the uni-dimensionality of the scale (PCA analysis) and the calculation of convergent and divergent validity, correlation coefficient between items and subscales, Cronbach's alpha for reliability, determination of a cut-off score for the AUROC index.

RESULTS

Three thousand and forty eight children and adolescents completed the CAPDS-10. Analysis confirmed a three-factor model (anxiety, depression, and aggressive behavior) (RMSEA = 0.072 [0.067; 0.077], CFI = 0.954), with a correlation coefficient between items >0.4. PCA analysis concluded that the scale is unidimensional. Reliability was satisfactory with Cronbach's alpha coefficients >0.7 (0.86). In addition, prediction was good with an AUROC index equal to 0.73 and a threshold score for severe distress greater than or equal to 19.

CONCLUSION

The CAPDS-10 measures psychological distress over the most recent 2-week period with good psychometric qualities. It could be used in crisis or prevention contexts in the general population or in clinical settings.

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.

Transcultural and familial factors in bilingualism and language transmission: A qualitative study of maternal representations of French-Maghrebi Arabic bilingual children

This qualitative exploratory study examined transcultural and familial factors involved in bilingualism and minority language transmission among French and Arabic-speaking children. Participants included 30 children aged 4 to 6 years, born in France, and their bilingual French-Maghrebi Arabic-speaking parents. Children's bilingual language profiles were assessed with the ELAL Scale for Maghrebi Arabic (minority language) and the Neel Scale for French (majority language). Mothers participated in qualitative interviews about cultural and language practices and representations. Interview contents were compared with the children's language profiles. Results indicated that parents closely associated the transmission of the Arabic language with their cultural heritage transmission. The parents of fluent bilinguals had a strong desire to transmit the minority language. Mothers of minority language dominant bilingual children reported little perception of change in their lives since migration. Half of the mothers of majority language dominant bilingual children reported relationship or emotional difficulties with their children. Four minority language transmission types were identified: direct parent-child transmission; indirect transmission through private classes; indirect transmission through visits to family in the parents' native countries; and alternative transmission by another family member. Direct parent-child transmission was most frequent among the fluent bilinguals. Families' processes of hybridity were related to language transmission and bilingual development of children. Parental cultural affiliations to native country were related to minority language transmission. Perception of change since migration and affiliation to host country may also play a role in harmonious bilingual development. Moreover, the quality of family relationships can affect minority language transmission.

Mental health care utilization by first responders after Paris attacks

Background

First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC).

Aims

This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris.

Methods

A web-based study was conducted 8–12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC.

Results

Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression.

Conclusions

Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.

Eating disorders and sexuality: A quantitative study in a French medically assisted procreation course

OBJECTIVE

Among medically assisted procreation (MAP) patients, the prevalence of eating disorders (ED), clinical or subclinical, current or past, is considerable. In addition to metabolic repercussions, the literature suggests that these patients present with more sexual dysfunction, leading to anxiety. This quantitative research on a population of women consulting a MAP department for unexplained or ovulatory infertility proposed to study the sexuality of this population by comparing the sexuality of patients suffering from or having suffered from an ED to the sexuality of the non-ED group.

METHOD

Patients (n = 61) filled out the Eating Disorder Examination Questionnaire (EDE-Q), the Brief Index of Sexual Functioning for Women (BISF-W), the ED Whole Life Research Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Kansas Marital Satisfaction Scale (KMSS).

RESULTS

We found a prevalence of 54% of ED, current or past. Even though these patients reported the same prevalence of sexual intercourse, they had significantly more physical problems (e.g., anorgasmia, vaginismus, headache) affecting their sexuality (p = .01) than the non-ED group, after adjusting for depression. Approximately 10% of the study population reported no intravaginal intercourse during the last month.

DISCUSSION

This study provides evidence for the existence of more sexual dysfunction in patients who have a fertility disorder and have ED or a history of ED. Future research should evaluate the results of psychological or sexological care that may be more suitable for the infertility of these patients.

Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study

BACKGROUND

The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack ('bystander exposure') who may or may not have provided care to attack victims subsequently, or as care providers to victims only ('professional exposure only'). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with 'professional exposure only', and to assess their use of psychological support resources.

METHOD

An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category ('bystanders to the attack'; 'professional exposure only'; 'unexposed'); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis.

RESULTS

804 staff members' questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were 'bystanders to the attack', 285 had 'professional exposure only'. The staff with 'professional exposure only' reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the 'professional exposure only' category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19-6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30-11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18-7.85; p = 0.022). Lastly, 70.6% of the staff with 'professional exposure only' with full PTSD did not seek psychological support.

CONCLUSION

Despite a significant impact on mental health, few staff with 'professional exposure only' sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks.

STUDY REGISTRATION

Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812-51).

[Age at diagnosis of Autism Spectrum Disorder depending on ethno-cultural background or migratory status: A systematic literature review]

INTRODUCTION

The early identification and access to health care of toddlers with autism spectrum disorder (ASD) - or at risk of developing it - is a crucial public health issue, as care and intervention may be more effective in younger children in order to improve their development and prognosis. However, there are still disparities in identification and health care access for children with ASD despite better screening methods. Given that misdiagnosis and delayed diagnosis are often due to the cultural gap between clinician and patient in some psychiatric disorders such as depression or schizophrenia, we examined this question concerning ASD and wondered to what extent ethno-cultural or migratory status might have an impact on the age at which a child is diagnosed. The only published review looking for independent factors influencing age of diagnosis concludes that the factors that have been proved to play a role are: socioeconomic status; symptom severity; level of parental concern, and family interactions with the health and education systems prior to diagnosis. The impact of ethno-cultural or migratory status is less clear. And yet, all these factors may be interconnected: migrants have on average a lower socioeconomic status, minorities don't have the same access to health care, and cultural background can have an influence on what is expected of a child's development and health. In order to try and clarify this issue and to analyze the way in which the international literature approaches the subject, we carried out a systematic review.

METHOD

Six databases were interrogated: Pubmed, Embase, Psychinfo, WebOfScience, Cochrane and Cinahl using the key words "ASD", "pervasive developmental disorder", "diagnosis", "age", "migrant", "ethnicity", "cross cultural". We narrowed neither the period of time not selected the articles by their method, as our objective was to collect the entirety of the articles written on the subject. We completed this review by including the pertinent references made in the articles.

RESULTS

Twenty articles were included, all epidemiological and observational, about children diagnosed in specialized centers. Published between 2002 and 2019, they cover a 20-year research period, between 1992 and 2016. The methods are disparate: the diagnosis criteria used are from DSM IV, IV TR and ICD; data originate from medical records, phone or internet surveys, and Medicaid healthcare claims. Comparison of the age at diagnosis is the principal objective for only thirteen studies; statistical data analyses vary, especially concerning adjustments. Seventy-five percent of the articles originate from North America where the compared populations are defined by ethnic and racial categories that are not used in some other countries, notably in Europe. Only five explore the link between migratory status and age at diagnosis. The research results concerning the impact of ethnicity are contradictory, while those concerning migratory status seem to indicate that migrant children are likely to be diagnosed later. But the articles and their methods being too heterogeneous, it was difficult to make a meta-analysis and impossible to reach a scientific conclusion.

CONCLUSION

Nevertheless, this review highlights the existence of a lot of confounding factors and raises many issues. It shows that the United States produces most of the studies whose conclusions cannot be generalized because of the particular history and organization of this country. In Europe, where belonging to minority groups is thought to be through migratory status, studies are rare. There is an urgent need for new research in order to clarify the connection between migratory status and socioeconomic factors, to precisely define the independent variables influencing diagnosis -such as access to healthcare- and finally to explore the possibility of different symptomatic expressions depending on cultural backgrounds. This review falls within studies currently carried out by the psychiatric service at Avicenne hospital in Bobigny, France about ASD in a transcultural context.

[Psychological care for the children of jihadists: modalities and challenges]

Since March 2017, minors returning from the terrorist groups' operation areas benefit from a medical and psychological assessment by referral centres throughout France. At the Avicenne hospital in Bobigny (AP-HP, 93), a team assesses the children of jihadists who land at Paris-Roissy-Charles-de-Gaulle airport. This evaluation raises unprecedented clinical questions and confronts professionals with challenges related to the history of these children and the context of their return.

Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris

Background

The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD).

Methods

Santé publique France conducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use.

Results

Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps.

Conclusion

Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.

Prospective study on a fast-track training in psychiatry for medical students: the psychiatric hat game

BACKGROUND

While medical students are losing interest in lectures in favor of other educational materials, many studies suggest the benefit of active learning, combined with gamified educational tools. The authors developed a psychiatric adaptation of the « Hat Game ». It was hypothesised that this game would increase both knowledge and motivation in medical students toward psychiatric semiology. The aim of the study was to assess the benefit of a Psychiatric Hat Game session for learning psychiatric symptoms in third-year medical students. Student performance was also evaluated at 3 months.

METHODS

This gamified fast-track training consists of two teams and each team has to guess as many psychiatric semiology terms as possible using different techniques (i.e. speech, mime). The study involved a pre- and post-evaluation of knowledge (Multiple Choice Questions) and a satisfaction survey. Baseline, post-immediate, and three-months scores were compared by using Friedman analysis for paired samples. Comparisons of mean scores at two different times were performed by using Wilcoxon test for paired samples.

RESULTS

One hundred and sixty-six students were proposed to take part in the study. Among them 129 completed the whole program (response rate = 77.7%). Mean scores measured at the three points in time were significantly different (p < 0.001, N = 129). Knowledge mean scores were significantly higher after the game than before (+ 28.6%, p < 0.001). Improvement was maintained 3 months after the game (+ 18.9%, p < 0.001). Satisfaction survey items highlighted that students enjoyed and would recommend this type of gamified training.

CONCLUSIONS

The Psychiatric Hat Game improved knowledge of psychiatric semiology in medical students. Results suggest that it is a promising and efficient tool to playfully teach medical semiology, with transferable features, utility and acceptability from one medical field to another. This study contributes to the growing body of knowledge advocating for serious games and gamified training in medical education.

Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic

IMPORTANCE

The coronavirus disease 2019 (COVID-19) pandemic and quarantine measures have raised concerns regarding their psychological effects on populations. Among the general population, university students appear to be particularly susceptible to experiencing mental health problems.

OBJECTIVES

To measure the prevalence of self-reported mental health symptoms, to identify associated factors, and to assess care seeking among university students who experienced the COVID-19 quarantine in France.

DESIGN, SETTING, AND PARTICIPANTS

This survey study collected data from April 17 to May 4, 2020, from 69 054 students living in France during the COVID-19 quarantine. All French universities were asked to send an email to their students asking them to complete an online questionnaire. The targeted population was approximately 1 600 000 students.

EXPOSURE

Living in France during the COVID-19 quarantine.

MAIN OUTCOMES AND MEASURES

The rates of self-reported suicidal thoughts, severe distress, stress, anxiety, and depression were assessed using the 22-item Impact of Events Scale-Revised, the 10-item Perceived Stress Scale, the 20-item State-Trait Anxiety Inventory (State subscale), and the 13-item Beck Depression Inventory, respectively. Covariates were sociodemographic characteristics, precariousness indicators (ie, loss of income or poor quality housing), health-related data, information on the social environment, and media consumption. Data pertaining to care seeking were also collected. Multivariable logistic regression analyses were performed to identify risk factors.

RESULTS

A total of 69 054 students completed the survey (response rate, 4.3%). The median (interquartile range) age was 20 (18-22) years. The sample was mainly composed of women (50 251 [72.8%]) and first-year students (32 424 [47.0%]). The prevalence of suicidal thoughts, severe distress, high level of perceived stress, severe depression, and high level of anxiety were 11.4% (7891 students), 22.4% (15 463 students), 24.7% (17 093 students), 16.1% (11 133 students), and 27.5% (18 970 students), respectively, with 29 564 students (42.8%) reporting at least 1 outcome, among whom 3675 (12.4%) reported seeing a health professional. Among risk factors identified, reporting at least 1 mental health outcome was associated with female gender (odds ratio [OR], 2.10; 95% CI, 2.02-2.19; P < .001) or nonbinary gender (OR, 3.57; 95% CI, 2.99-4.27; P < .001), precariousness (loss of income: OR, 1.28; 95% CI, 1.22-1.33; P < .001; low-quality housing: OR, 2.30; 95% CI, 2.06-2.57; P < .001), history of psychiatric follow-up (OR, 3.28; 95% CI, 3.09-3.48; P < .001), symptoms compatible with COVID-19 (OR, 1.55; 95% CI, 1.49-1.61; P < .001), social isolation (weak sense of integration: OR, 3.63; 95% CI, 3.35-3.92; P < .001; low quality of social relations: OR, 2.62; 95% CI, 2.49-2.75; P < .001), and low quality of the information received (OR, 1.56; 95% CI, 1.49-1.64; P < .001).

CONCLUSIONS AND RELEVANCE

The results of this survey study suggest a high prevalence of mental health issues among students who experienced quarantine, underlining the need to reinforce prevention, surveillance, and access to care.

[Suicidal behaviors in migrant youths: Male experiences]

OBJECTIVES

Suicide is the second leading cause of death among adolescents. Boys are more affected than girls, although they report fewer suicide attempts and rely less on care. Few studies have examined the experience of suicidal thoughts and behavior among young boys. In order to improve their health care, it is necessary to consider the socio-cultural aspects and the construction of the meaning given by adolescent boys to suicidal behaviors in France.

METHOD

This is a qualitative, complementary and inductive study. All teens included have presented suicidal thoughts in the months preceding the inclusion. The existence of self-mutilation and/or suicidal act is sought but is not included within the criteria of inclusion, the various contexts will enrich the data. Semi-structured interviews are transcribed and analyzed by the Interpretative Phenomenological Analysis.

RESULTS

Ten adolescents between 14 and 20 years old were included in the study. Three axes of experience emerge: the relationship to oneself, the relationship to the other, the relationship to death. Some themes are common to experiences of both boys and girls, others are more specific to the boys' experience. The inner struggle, testing one's limits and an isolating unspeakable are thus common, highlighting the difficulty for adolescents to mentalize and verbalize emotions and feelings. Difficulties in connecting with others, and feelings of loneliness and isolation, are at the core of the participants' experience. However, the experience of boys appears specific in the difficulty to represent the irreversibility of death which can lead to suicidal behavior without direct intentionality. The narrative of suicidal acts, in its formulation, is quite different from that of young girls. One can assume that the difficulty of expressing suffering could lead young boys to develop a discourse that overshadows the question of their death, or in contrast magnifies it in a rewarding stage from which they pride themselves. The fear of being isolated or rejected seems almost insurmountable for the boys interviewed. The fear of the judgment of peers or the family is mixed with the imperative to face the problem by oneself and reinforces the feeling of isolation in a retroactive loop. The story of the suicidal act can take a positive and enriching tone in the participant's stories. This only applies to adolescents with a history of suicidal gesture. The experience of acting out and its consequences seems to be integrated by the adolescent as elements which participate to a certain extent to the construction of their identity. This ameliorative feature can be compared to the hegemonic social models of masculinity. The sociological notion of gender identity makes it possible to think of this construction in a dynamic way and to propose adaptations of the caregivers' attitude during the first interviews with a suicidal teenager. During the first meetings, the caregiver should explore the adolescent's representations of the suicidal crisis in a neutral, self-interested, and unbiased way, including when the representations are disturbing or shocking for the caregiver. For example, when the patient values or glorifies suicidal behavior or when care is experienced as a sign of weakness and vulnerability. Respect of these proposals can indeed support weakened narcissistic foundations and favor encounter and alliance. This can only be done with the conviction that these representations are not frozen, but in construction, and that they can be secondarily mobilized in the therapeutic relationship. For that purpose, a work of elaboration on the representations of the masculinity will be able to lead the young person to reconsider his perception of care and suicidal behaviors. Reflexivity on the part of the caregiver about his own representations of masculinity seems necessary.

CONCLUSION

Therapeutic management must explore and respect the adolescent's representations of masculinity and then mobilize them to bring the young person to reconsider his perception of care and suicidal behavior.

Post-Traumatic Stress Disorder in Homeless Migrant Mothers of the Paris Region Shelters

Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study’s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03; 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20; 2.76), and residential instability (PR = 1.93 95% CI 1.27; 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group.

A discursividade evangélica e alguns de seus efeitos: laço social, psicopatologia e impasses teóricos e transferenciais

Discutimos neste artigo a presença do discurso evangélico entre pacientes de serviços de saúde mental e de atenção psicossocial, nas características de tal fenômeno religioso e de suas possibilidades de transformar a vida de sujeitos, famílias e grupos ao ligá-los a uma modalidade bastante peculiar de discursividade religiosa. Como viemos pesquisando essas questões na França e no Brasil, propomos duas vinhetas clínicas (de um caso acompanhado em cada um desses países) para pensar sobre o tipo de transformação subjetiva e psíquica que esse laço religioso provoca, em como ele afeta o enlace transferencial e nas dificuldades que o mesmo pode provocar para profissionais que atuam sobre a subjetividade. Para isso, levantamos alguns dos pontos nodais das leituras psicanalíticas sobre religião e religiosidade, naquilo que aparece da coisa religiosa na gênese da vida psíquica, no sujeito, nos grupos, na cultura e na política.

Under-Age Children Returning From Jihadist Group Operation Areas: How Can We Make a Diagnosis and Construct a Narrative With a Fragmentary Anamnesis?

INTRODUCTION

Since 2011, the French government estimates that about 500 French children have been born in or taken by their parents to areas where terrorist operations prevail. Since May 2017, 75 children who returned to France have benefited from a dedicated health care system.

METHOD

This article is the result of clinical interviews conducted with 53 patients evaluated and taken care of at Avicenne Hospital in Bobigny. To our knowledge, no studies have been published on this subject.

RESULTS

A total of 32 evaluations have been completed, all of which indicated the need for care for these children. Of these children, 64% are under 5 years old, and 59% were born in France. Their clinical profiles are heterogeneous and fluctuate with time.

DISCUSSION

The multiple adverse events experienced by these children and the uniqueness of children born to families suspected by authorities of having participated in activities related to terrorism make this situation unprecedented. How can we make a diagnosis of PTSD without the help of a precise anamnesis? How can we help these children form a structuring narrative that avoids the pitfalls inherent to generalized fascination?

Non-participation and attrition in a longitudinal study of civilians exposed to the January 2015 terrorist attacks in Paris, France

BACKGROUND

Non-participation and attrition are rarely studied despite being important methodological issues when performing post-disaster studies. A longitudinal survey of civilians exposed to the January 2015 terrorist attacks in Paris, France, was conducted 6 (Wave 1) and 18 months (Wave 2) after the attacks. We described non-participation in Wave 1 and determined the factors associated with attrition in Wave 2.

METHODS

Multivariate logistic regression models were used to compare participants in both waves with those who participated in the first wave only. Analyses were performed taking the following factors into account: socio-demographic characteristics, exposure to terror, peri-traumatic reactions, psychological support, perceived social support, impact on work, social and family life, and mental health disorders. Characteristics of new participants in Wave 2 were compared with participants in both waves using a chi-square test.

RESULTS

Of the 390 persons who were eligible to participate in the survey, 190 participated in Wave 1 (participation rate: 49%). The most frequently reported reason for non-participation was to avoid being reminded of the painful event (32%, n = 34/105). In Wave 2, 67 were lost to follow-up, 141 people participated, of whom 123 participated in Wave 1 (re-participation rate: 65%) and 18 were new. Attrition in Wave 2 was associated with socio-demographic characteristics (age, French origin) and location during the attacks, but not with terror exposure or mental health disorders. Compared with those who participated in both waves, new participants declared less social and psychological support since the attacks.

CONCLUSIONS

Attrition at 6 months was not associated with exposure to terror or mental health disorders, which indicates that any bias in future analyses on IMPACTS on mental health outcomes will be limited. Our findings suggest the importance of adapting similar surveys for people of foreign origin and of improving strategies to avoid attrition of younger people, for example by using social media, peers, and the educational environment. The present study also revealed that a high level of exposure to terror and a lack of social and psychological support after a terrorist event could impede individuals' participation in similar surveys in the short term.

Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015

During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.

Psychological follow-up and its perception in civilians involved in the January 2015 terrorist attack in Paris, France

Background

A terrorist attack occurred in Paris in January 2015 against the staffs of the Charlie Hebdo magazine and a kosher grocery. This study examined the psychological follow-up and the non-satisfaction of the people civilians involved in the terrorist attacks.

Methods

The IMPACTS survey, an open cohort study of civilians involved in the terrorist attacks was conducted 6-10 (wave 1) and 18-22 months (wave 2) after the attacks. Psychologists interviewed in face-to-face 190 civilians in wave 1 and 123 of them participate to the wave 2. A questionnaire was used to collect data on socio-demographic characteristics, exposure level, social support, psychological support and perception, impact on work and social functioning, and mental health disorders.

Results

In wave 1 (N = 190), 24% of participants had initiated a regular follow-up with a psychologist or a psychiatrist. Reasons of non-follow-up were: they had refused because they did not feel the need or they did not want to talk about it (60%), it was not suggested to them (30%), or they have already had a follow-up before (12%). In wave 2 (N = 123), 25% had a regular follow-up with a psychologist/psychiatrist since the events, 22.0% had had a follow-up but not anymore in wave 2, 15% did not have a follow-up in wave 1 but they had in wave 2 and 38.2% never had. Psychological aid from professionals for resilience has not been appropriate for 32% of the participants at 6 months and for 39% at 18 months. In both waves, non-satisfaction of follow-up was more frequent among witnesses than with those who were directly exposed.

Conclusions

Six months after the January 2015 terrorist attacks in Paris, among the participants without psychological follow-up, it was not offered to nearly a third of participants. In order to enhance resilience, psychological aid should also be provided to those who have not been directly exposed.

Main message

Psychological follow-up should be provided to all civilians in short and long-term.

Psychological support in short term after the January 2015 terrorist attack in Paris, France

Background

A terrorist attack occurred in Paris in January 2015 against the staffs of the Charlie Hebdo magazine and a kosher grocery. This study examined psychological support given to the people directly exposed, witnesses and close relatives of those who were injured, hostages or died.

Methods

The IMPACTS survey was an open cohort lead in 2 waves (6 and 18 months after the events). Psychologists interviewed in face-to-face 190 civilians in wave 1. A questionnaire was used to collect data on socio-demographic characteristics, exposure level, psychological and social support, impact on work and social functioning, and mental health disorders.

Results

Among the 190 participants in wave 1, 24.3% did not receive psychological support neither in 48 hours, between 2 and 7 days, and after 1 week. Among those who had received support, they had a contact in average with 3 institutions or associations. Within the 48 hours, psychological support was mainly provided by Medico-psychological emergency unit (CUMP) (45.2%). Between 2 and 7 days, CUMP (42.6%) and a Parisian hospital in specialized care unit for trauma (44.6%) had mainly offered psychological support. One week after events, psychological support was mainly provided by consultation in specialized care unit for trauma (41.4%) or in ambulatory (27.6%). Lack of psychological support was more frequent among men, unemployed, and witnesses (versus those who were directly exposed).

Conclusions

This study suggests offering psychological support to the whole population that have been potentially impacted, and also for those who had not been directly threatened. Long-term psychological follow-up of the most affected ones remains an objective to consolidate initial care.

Main message: Psychological follow-up should be provided not only to threatened people but also to the most vulnerable people (unemployed).

The benefits of mindfulness-based interventions on burnout among health professionals: A systematic review

OBJECTIVE

Healthcare professional burnout affects performance and has a negative impact on healthcare as a whole. Mindfulness-based Interventions (MIs), developed over the last 30 years, are increasingly used by healthcare professionals to reduce the risk of burnout. Yet the impact of MIs on burnout remains to be clarified. This review aimed to summarize and evaluate the existing literature on the potential benefits of MIs to minimize burnout risk.

METHODS

We conducted a systematic review of the literature, reporting according to the PRISMA standards. PubMed, Psychinfo, Web of Science and Science Direct databases were screened for original articles. Articles in English assessing an MI in combination with burnout measures were included up to September 2018.

RESULTS

Thirty-four articles were included. Only four randomised controlled trials concluded to burnout improvement after several weeks of MIs (11,8%). In the remaining five randomised controlled trials, results did not reach statistical significance. Of the four controlled, non-randomised studies, three showed significant improvements on burnout. Twenty-one studies did not report a controlled trial design. Overall the results appeared to be widely heterogeneous and several methodological concerns arose from the review.

CONCLUSION

This review shows the overall insufficient level of evidence offered by the literature assessing the effects of MIs on burnout in health professional populations. However, some studies have reported promising results and future research should address methodological issues and define more precise contexts of interventions and target populations that could benefit from MIs.

Health outcomes of the July 14, 2016 Nice terror attack among hospital-based professionals and students: the « ECHOS de Nice » health survey protocol

BACKGROUND

The terror attack of July 14, 2016, in Nice, France, resulted in 86 deaths, including children, and several hundred wounded, with a major psychological impact on the population. Hospital staff had to cope with exceptional circumstances which made them vulnerable to detrimental effects on their own health. This paper describes the method that was selected for the survey entitled "ECHOS de Nice 14 Juillet" which aimed to assess the impact of the attack on the psychological, psycho-traumatic and somatic health condition of the Nice University and Lenval hospital staff who were directly or indirectly exposed to the attack, and also to describe the support and care facilities they were offered.

METHOD

ECHOS de Nice 14 juillet is an observational, cross-sectional, multicentre study focusing on all the hospital staff and students of both institutions, i.e. 10,100 persons in June 2017. A web-based questionnaire based on the model developed by Santé Publique France (IMPACTS and ESPA 13 novembre 2015) was adapted to the contexts of the healthcare professionals and students employed in these healthcare institutions in Nice and published on line from June 21 to October 30, 2017. The paper describes the tools that were used to meet the aims of the study, i.e. identification of exposure categories ('civilian' exposure for those present during the attack and/or 'professional' exposure); indicators of psychological impact (anxiety, depression, burnout, compassion fatigue, suicidal states, tobacco and alcohol use, self-medications), psycho-traumatic and somatic impact; professional and social impact. Lastly, awareness of availability and use of psychological support and care-follow-up facilities by professionals were investigated. Respondents could include extensive qualitative comments on the various themes explored in the questionnaire, with text analysis complementing that of quantitative data.

DISCUSSION

The benefits and limitations of the selected methodology are discussed, in view of contributing useful information to help anticipate and manage health issues among hospital staff who have been victims of traumatic events.

Hematopoietic stem cell transplantation in children with sickle cell anemia: The parents' experience

Genoidentical HSCT is currently the only curative treatment for SCA, preventing further vascular complications in high-risk children. Studies on the psychological implications of HSCT for recipient, sibling donor, and the rest of the family have been limited in SCA. This study enrolled ten families and used semi-structured interviews to explore the parents' experience at three time points: first before transplantation, then 3 months later, and 1 year later. Three themes emerged from the results: (a) the presence of anxiety, experienced throughout the process, and alleviated by coping strategies (positive thinking, family support, praying); (b) the ability to remain parents to recipient and other family members, despite apprehension and feelings of helplessness, reinforced by the mobilization of important resources at the individual/family levels; (c) the ability to acknowledge the opportunity for their child to be cured of the disease, despite feelings of guilt toward families without a donor, or their own families back home. Overall, the parental experience with HSCT is complex, involving intra-psychic, familial, cultural, religious, and existential factors. Thus, it is important for medical teams to be cognizant of these issues in order to provide the best support to families during the HSCT process.

[Not Available]

MIGRATION JOURNEY OF AN UNACCOMPANIED MINOR AND HIS DESTINY IN FRANCE.: Among migrants, unaccompanied minors are rendered particularly vulnerable by their journey, the trauma endured and their solitude. Once they have been confirmed as minors, they remain under the care of child protection services. The adolescent children's home in Bobigny, Casita, provides psychological trauma consultations for these young people. This article focuses on the journey of a 16-year-old who arrived in France less than two years ago.

[The infant faced with the loss of a parent]

Bereavement in an infant constitutes a complex process with a distinct temporality. It is closely linked to family bereavement. Based on a clinical example, it is possible to detail the necessary stages as well as the difficulties to take into account during this very specific ordeal which the sudden loss of a parent represents.

Improving the mental health system for trauma victims in France

France has a rich history of exposure to large-scale traumas such as wars, disasters and terrorist attacks, and psychiatric teams specialized in emergency interventions for mass trauma have been created across the territory. However, no public resources are dedicated for long-term interventions or for individual trauma cases. This letter describes how a government supported model of care has been created and implemented in 2019. A national centre for resources and resilience (CN2R) and 10 regional ambulatory services specializing in psychotraumatology were created with the aim of improving public mental health-care delivery while providing a comprehensive suite of services for trauma victims from the most immediate to longer-term considerations.

[The place of the native language in speech therapy]

A high number of children consulting a speech therapist for a language disorder have in common the direct or indirect experience of migration and therefore find themselves in a context of plurilingualism. A dedicated group, called Mélimémo, has been set up for children in such situations. It enables their linguistic and cultural diversity to be integrated into the speech therapy.

Healthcare provision and the psychological, somatic and social impact on people involved in the terror attacks in January 2015 in Paris: cohort study

BACKGROUND

Terrorist attacks occurred in Paris in January 2015. Aims To assess the mental health impact and the access to psychomedical care of people exposed to the attacks.

METHOD

We implemented an open-cohort design 6 and 18 months after the attacks. Exposed civilians and rescue workers were included according to the exposure criteria A for post-traumatic stress disorder (PTSD) in DSM-5. A face-to-face questionnaire conducted by trained psychologists was used to collect sociodemographic characteristics, exposure level, scores on psychometric scales, an international neuropsychiatric interview and access to care.

RESULTS

Six months after the attacks, 18% of civilians reported symptoms of PTSD, 31% had anxiety disorders and 11% depression. Among rescue workers, 3% reported symptoms of PTSD and 14% anxiety disorders. During the 48 h following the attacks, 53.2% of civilian had access to psychomedical care v. 35% of rescue and police staff.

CONCLUSIONS

We found severe psychological consequences, even in people who were less exposed. Declaration of interest None.

Early psychological impact of Paris terrorist attacks on healthcare emergency staff: A cross-sectional study

BACKGROUND

The terrorist attacks in Paris and Saint Denis on November 13, 2015 were an unprecedented traumatic event in France. It was an especially distressing ordeal for the healthcare personnel involved in the care of the victims. The aim of this study was to estimate the effect of direct participation in the rescue on posttraumatic stress disorder (PTSD) symptoms among these workers.

METHODS

Less than a month later, 613 healthcare providers (professionals and paraprofessionals) from three hospitals in the Paris suburbs were asked to complete an anonymous questionnaire. A multivariable Poisson model estimated the effect of participating onsite in the rescue (exposure variable) on the number of PTSD symptoms measured by the Trauma Screening Questionnaire (TSQ; outcome variable), adjusted for covariates.

RESULTS

Two hundred thirty-three providers completed the assessment (38% response rate), 130 participated directly in the rescue (56%). Participation was associated with a higher number of symptoms of PTSD (RR = 1.34, P = .002) than for nonparticipants. Female gender (RR = 1.39, P < .001) and basic (vs. advanced or intermediate) life-saving training (RR = 1.42, P = .004) were also associated with more PTSD symptoms. Participants in the rescue were at 2.76 times more risk of a probable PTSD diagnosis (OR = 2.76, P = .037), defined as reporting at least six PTSD symptoms. Sensitivity analyses using propensity score matching supported the robustness of our findings.

CONCLUSIONS

Healthcare providers directly involved in the rescue of the victims of the Paris and Saint Denis attacks reported a significantly higher psychological impact, defined by PTSD symptoms, than those not directly involved.

[Trauma-related disorders in children]

Trauma-related disorders in children. The discovery of posttraumatic stress disorder (PTSD) in children is a recent finding. Nowadays we know that young age does not protect from traumatism. However, PTSD will display differently according to age. Epidemiology shows that PTSD is a less frequent occurrence than being exposed to traumatic events, but that certain groups may be more likely to be affected. A chronic course of the disorder is always possible and can interfere with every aspect of the child's development. Even if parents minimize the disorder, practitioners should carefully examine the signs of PTSD after the trauma and repeat this examination several times in the first few weeks.