[Psychological barriers to professional inclusion of people with mental disabilities]

Permanent unfitness for work and mental disorders: a multicentric cross-sectional study of 2,788 unfit employees

In France, Mental Disorders (MD) are the second most common medical cause of unfitness-for-work notices. The main objective is to describe the MD causing permanent medically unfitness at the workstation. A cross-sectional multicenter survey was conducted among employees followed by 323 physicians from occupational health services of the South of France in 2017. The MD responsible for unfitness for the job were coded according to the ICD-10 nomenclature and their occupational origin was estimated by each physician. On 359,966 employees screened, 2,788 were unfitted. Among the 2,779 unfitness cases which were analysed, 985 were unfitted for MD. The incidence rate of unfitness for MD was 2.78 unfit per 1,000 employees followed. Representing 36.8% (985 cases) of all grounds for unfitness, MD were estimated to be work-related in 614 (63.6%) of cases. The main MD were 449 (45.6%) cases of major depressive episodes, 227 (23.0%) anxiety disorders and 131 (13.3%) recurrent depressive disorders. Their occupational origin was mentioned in 296 (67.3%), 168 (74.7%), 62 (49.6%) cases and the link with a Burnout (BO) in 166 (38.3%), 61 (27.9%) and 41 (34.2%) cases respectively among 364 all pathologies reported to a BO. Unfitness for MD was more common among women (ORa = 1.79 95% CI [1.50-2.13]), working in trade, transport, accommodation and catering (ORa = 1.47 95% CI [1.04-2.09]) and increase with age (ORa = 4.24 95% CI [2.73-6.60] for over 55). Major depressive episodes represent the MD most frequently responsible for unfitness and the most related to occupational origin.

As if it weren't hard enough already: Breaking down hiring discrimination following burnout

Hiring discrimination towards (former) burnout patients has been extensively documented in the literature. To tackle this problem, it is important to understand the underlying mechanisms of such unequal hiring opportunities. Therefore, we conducted a vignette experiment with 425 genuine recruiters and jointly tested the potential stigma against job candidates with a history of burnout that were mentioned earlier in the literature. We found candidates revealing a history of burnout elicit perceptions of requiring work adaptations, likely having more unpleasant collaborations with others as well as diminished health, autonomy, ability to work under pressure, leadership capacity, manageability, and learning ability, when compared to candidates with a comparable gap in working history due to physical injury. Led by perceptions of a reduced ability to work under pressure, the tested perceptions jointly explained over 90 % of the effect of revealing burnout on the probability of being invited to a job interview. In addition, the negative effect on interview probability of revealing burnout was stronger when the job vacancy required higher stress tolerance. In contrast, the negative impact of revealing burnout on interview probability appeared weaker when recruiters were women and when recruiters had previously had personal encounters with burnout.

The abbreviation "PWE" may carry a negative connotation compared with the labels "person with epilepsy" and "epileptic"

PURPOSE

Ways of labeling a person with epilepsy (PWE) may have an impact on public position towards affected persons. This study analyzed college students position changes, influenced by three different labels of PWE.

METHODS

Observational, descriptive, cross-sectional study. Students of three schools answered one of three questionnaires whose content changed in the labeling form: person with epilepsy, epileptic or PWE. Proportions were compared with Chi square test or Fisher's exact test to explore considering age, gender, religion practicing, socioeconomic status, knowing an affected person and by faculty.

RESULTS

A total of 273 questionnaires were included were distributed in medicine 133 (48.7 %), engineering 108 (39.6 %) and law 32 (11.7 %) schools. Labeling type distribution was person with epilepsy 94 (34.4 %), epileptic 93 (34.1 %) and PWE 86 (31.5 %. No statistical differences were found according the labels person with epilepsy and epileptic. The abbreviation PWE had statistical significant connotation in aspects of academic achievement p = 0,007, selecting a PWE in your work team p = 0,009, self control p < 0,000, being dangerous p < 0,000 and having any disturbance in thought or behavior p = 0,05. Religion practicing, socioeconomic status and knowing a person with epilepsy did not impact in attitude related to labeling. Engineering and law students expressed their concern in employability.

CONCLUSION

The abbreviation PWE may have negative connotations when used in written questionnaires. No differences were found with the labels person with epilepsy and epileptic in college students. More studies are needed to explore the stigmatizing or destigmatizing effects of labeling a person with epilepsy on different populations.

Représentations du « trouble psychique » et adéquation à l’emploi perçue par des employeurs du milieu ordinaire de travail en France

Le processus de stigmatisation est un des principaux freins à l’emploi des personnes présentant des troubles psychiques. Sonder les représentations de l’employeur est un premier indicateur de la compréhension générale des processus psychologiques qui le guident dans le recrutement de ce type de public. La présente étude vise à identifier les représentations d’employeurs vis-à-vis du « trouble psychique » en général et au travail, et des prérequis pour l’embauche afin de comprendre les processus psychologiques qui conduisent à l’exclusion professionnelle des personnes en situation de handicap psychique.

Vingt-neuf entretiens semi-directifs ont été menés auprès d’employeurs d’organisations implantées sur le territoire français et soumises à l’obligation d’emploi de travailleurs handicapés (OETH). Les résultats montrent des représentations du trouble psychique très péjoratives axées sur la déviance sociale (non-conformité à la norme sociale) et le préjudice que ces personnes constitueraient pour la société tout entière à cause des perturbations de l’interaction sociale et du fardeau qu’induirait le trouble psychique pour l’entourage et particulièrement pour le milieu de travail. L’analyse des prérequis pour l’embauche de personnes en situation de handicap psychique montre à quel point ces représentations sont des freins au recrutement principalement liés à un manque d’adéquation perçue à l’emploi.

Des perspectives de recherche et d’actions visant l’apprentissage et le perfectionnement des pratiques de recrutement et d’intégration en milieu de travail sont proposées pour accompagner les acteurs des organisations dans ce type d’inclusion.

Les accompagnants à l’insertion professionnelle en milieu ordinaire pour les personnes en situation de handicap psychique au sein des ESAT de transition Messidor

Les dispositifs d’aide à la réinsertion professionnelle des personnes souffrant de troubles psychiques sont peu étudiés en France bien que la littérature spécialisée souligne que ces dispositifs sont clés pour favoriser l’insertion en milieu ordinaire. Les objectifs de cette recherche étaient de décrire les rôles, tâches et compétences des conseillers d’insertion et des responsables d’unité de production qui accompagnent ce public vers le milieu ordinaire au sein des ESAT de transition Messidor. Une méthodologie qualitative a été retenue : 24 entretiens individuels et 7 groupes de discussion ont été menés auprès des deux types de professionnels de ces structures. Les résultats ont permis de définir la fonction de chaque accompagnant et une liste de 110 compétences pour les conseillers d’insertion et de 155 compétences pour les responsables de production. Ce binôme d’accompagnants complémentaires apporte un soutien à l’insertion en favorisant un changement de regard sur soi. Le conseiller d’insertion accompagne chaque travailleur à construire et réaliser un projet d’insertion, tout en assurant la liaison entre différents partenaires externes de la collectivité (ex. employeurs, équipe soignante). En parallèle, au quotidien, le responsable de production assure une formation dans un métier, propose des défis à relever, ce qui contribue à restaurer l’estime de soi professionnelle des personnes, facteur clé pour l’insertion en milieu ordinaire. Les implications cliniques de cette recherche concernent le recrutement, la formation et la supervision des personnels accompagnant vers l’emploi.

Vocational Counselors in France: Comparison to Competencies of Employment Specialists Working in Canadian IPS Programs

Supported employment programs are evidence-based practices to help people with severe mental illness to obtain competitive employment. The competencies of employment specialists working in these programs are key elements related to work integration. In France, the Messidor Association, a prevocational organisation, has developed a practice with similarities to supported employment and is beginning to develop supported employment programs in their context. The objective of this quantitative study was to evaluate the Messidor vocational counselors' competencies using the Behaviors, Attitudes and Knowledge in Employment Specialists' scale by comparing their results to those of employment specialists working in IPS programs in Canada. Descriptive analyses and a MANOVA highlighted similarities between French and Canadian counselors such as the same importance given to the working alliance with clients and the development of relationships with different stakeholders (e.g., employers). Skills that should be developed in vocational counselors in France include those related to rapid job search and dealing with stigma. In addition, clinical implications are suggested to ensure the development of vocational counselors' competencies in France.

Factors associated with problematic drug use among psychiatric outpatients

Objective

to examine the factors associated with problematic drug use among psychiatric outpatients.

Method

a cross-sectional study was carried out in two mental health services. Eligible individuals were patients of these mental health services, who used them within the data collection period. Instruments: standardized questionnaire with sociodemographic, social network, social harm, and clinical information; Alcohol, Smoking and Substance Involvement Screening Test; Barratt Impulsiveness Scale; Holmes and Rahe Stress Scale. Statistical analysis was performed using parametric statistics considering a significance level of p ≤ 0.05. Study participants were 243 patients, with 53.9% of these presenting problematic drug use.

Results

the most important independent predictors of problematic drug use were marital status (OR = 0.491), religious practice (OR = 0.449), satisfaction with financial situation (OR = 0.469), having suffered discrimination (OR = 3.821) and practicing sports activities in previous 12 months (OR = 2.25).

Conclusion

the variables found to be predictors were those related to the social context of the patient, there, it is recommended that mental health services valorize psychosocial actions, seeking to know the social support network of patients, their modes of socialization, their financial needs, and their experiences of life and suffering.