[Hazardous drinking in Parisian medical students]

A cross-sectional study: Nitrous oxide abuse in Parisian medical students

BACKGROUND AND OBJECTIVES

Nitrous oxide (N₂ O) has euphoric properties, which are associated with an alarming increasing misuse. A lack of data exists regarding medical students. The objectives are: (i) evaluate the prevalence of N₂ O use and N₂ O use disorder (NUD) among French medical students, (ii) assess whether education about addictions has an impact on consumption, (iii) draw up clinical profiles of N₂ O users with or without NUD, (iv) identify factors associated with use and NUD.

METHODS

A cross-sectional study among medical students at Université de Paris, using an online questionnaire.

RESULTS

Out of the 981 medical students (29% of the total medical students) who completed the questionnaire, 80% had used N₂ O. 19% had a mild use disorder, 4% moderate, and 1% severe. N₂ O use was significantly associated with the use of poppers (p < .0005), alcohol (p < .0005), and cocaine (p = .004). Factors significantly associated with NUD were alcohol use disorder (p = .017), male gender (p = .006), and being part of a student association (p = .0130).

DISCUSSION AND CONCLUSION

This survey shows a high prevalence of N₂ O use and NUD among medical students. It could be explained by the N₂ O pharmacokinetic profile or by a perception of "harmlessness." We also identified associated risk factors that may be useful to better identify and treat students seeking help.

SCIENTIFIC SIGNIFICANCE

This is the first study to evaluate the use of this product among medical students. The evaluation of factors impacting use and dependence is also new in this population, which is at risk of misuse of substances.

Hazardous drinking is associated with hypnotic consumption in medical students in the BOURBON nationwide study: psychological factors explored

France has been identified with one of the highest rates of hazardous drinking and hypnotic consumption in Western countries. Medical students have been identified at risk for hazardous drinking yet we lacked of national data on their hypnotic consumption and associated factors to guide public health policies. To determine the prevalence of hazardous drinking and dependence among French medical students and their association with psychotropic drug consumption and psychosocial factors. Medical students were recruited from 35 French universities of medicine through administration mailing lists and social networks, between December 13, 2016 and May 15, 2017. Hazardous drinking was defined by an Alcohol Use Disorder Identification Test (AUDIT) score ≥ 7 for men and ≥ 6 for women. 10,985 medical students with a mean aged of 21.8 years (± 3.3) were included, 32% of which were male. Overall, 3713 (34%) students reported hazardous drinking (41% for men vs. 31% for women) and 820 participants (8%) reported alcohol dependence (12% for men vs. 6% for women). In multivariate analyses, hazardous drinking was independently associated with age, male gender, hypnotic consumption, psychiatric follow-up, mourning, parents divorce, exposure to sexual and physical assault. Alcohol dependence was associated with male gender, tobacco and cannabis consumption, and sexual and physical assault. Second year was reported as the year at higher risk for increased alcohol consumption vs. decreased risk in first and fourth year. Hazardous drinking identified in one third of medical students is associated with hypnotic consumption and some psychological factors suggesting self-medication behavior that could be targeted by psychological interventions.

[Exposure to professional violence by young physicians in the hospital: MESSIAEN national study]

BACKGROUND

Hospital professional violence is defined as hostile and aggressive behavior exerted by health professionals on other health professionals. No quantitative study has been carried out to date on French hospital professional violence among young physicians, while recent qualitative studies have suggested a potential high frequency. The main objective was to determine the prevalence of exposure of young doctors to hospital violence. The secondary objective was to determine their characteristics and consequences as well as to determine if students and young physicians (resident and young MD) differed.

METHODS

The study was a national cross-sectional observational epidemiological study that included 4th-year medical students and young physicians (MD for less than 2 years). Thirty-seven French faculties of medicine were contacted for email recruitment of participants. Social networks were used to increase the visibility of the study. The questionnaire was developed after exhaustive review of the international literature dealing with professional violence in hospitals, its characteristics and its consequences in terms of mental health, addiction, personal and professional life. The report of these events was also explored.

RESULTS

In total, 2003 participants have been included. More than nine out of ten participants were exposed to hospital violence at least once and nearly 42% to moral harassment as defined by the French law. This violence does not differ between the students and the residents/young MDs, suggesting that working time in the hospital does not seem to affect this risk. Nearly 80 % of interns and young MDs reported working more than the legal time. The perpetrators of violence include in almost all cases at least one man, often a senior doctor, but students reported the presence of at least one woman among the perpetrators in ¾ of cases. The victims are as often men as women. Compared to the undergraduate medical students, residents and young MDs more frequently reported poor outcomes on their mental health, addictive behavior, personal and professional lives. The majority of victims reported the event to a peer but fewer than 10% to the head of the department, a professor or an instance that could have acted. In almost all cases, participants reported the continuation of abusive behavior after the event. In total, 42% of students think that this is simple part of medical studies that they must endure.

CONCLUSION

These results suggest the need to develop specific information and prevention programs for professional hospital violence in France.

[Addictive behaviors: Clinical facts]

Malgré les fréquentes comorbidités psychiatriques, le trouble de l’usage de substance doit être appréhendé comme une pathologie autonome par ses déterminants, sa sémiologie et ses modalités évolutives spontanées ou sous traitement. De multiples produits de synthèse sont désormais accessibles via internet : associé à la créativité des chimistes cela a participé à l’émergence de pratiques inédites allant du chemsex au purple drank. Les conduites addictives résultent d’un ensemble de facteurs individuels (vulnérabilités biologique et psychique) et contextuels (disponibilité et banalisation du toxique dans l’environnement). Les pathologies mentales autres sont des facteurs de vulnérabilité à la pathologie addictive, tout comme les conduites addictives peuvent révéler une pathologie émotionnelle ou psychotique. Le médecin se doit d’entendre l’impuissance du malade face au besoin irrépressible de consommer (craving) et proposer une thérapeutique qui peut être chimique (y compris traitement de substitution) et psychologique. Dans la majorité des cas, un accompagnement social s’impose pour corriger les effets désocialisants du trouble de l’usage de substances ou des comportements addictifs.

First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs

BACKGROUND

First year exams are a major source of stress amongst first-year medical students.

OBJECTIVE

To explore antidepressant and anxiolytic consumption and addictive behavior of medical students before and after exams.

METHODS

Medical students of the 35 French medical schools were recruited through mailing lists and social networks between December 2016 and May 2017 and completed online Internet anonymized questionnaires.

RESULTS

Overall, 4345 medical students were included (3051 first year vs. 1294 second year). In multivariate analyses, compared to those in the first year of medicine, second year students were found to have lower anxiolytic (adjusted odd ratio (aOR)=0.56, p = 0.01) and antidepressant consumption (aOR=0.21, p<0.0001) but higher psychiatric follow-up (aOR=1.95, p<0.0001) after adjustment for age, gender and relationship status. Whilst second year students reported slightly higher quality of life (especially for mental health), they also reported more daily tobacco smoking (aOR=1.78, p<0.0001), more cannabis use disorders (aOR=2.37, p<0.0001), hazardous drinking (aOR=3.61, p<0.0001), and alcohol dependence (aOR=3.66, p<0.0001). Second year medical students reported fewer difficulties relating to studying in comparison to first year students (aOR=0.60, p<0.0001) yet they reported a higher rate of recreational drugs use with a variety of reasons including self-treatment of anxiety; disinhibition and to copy their peers (all p<0.05).

LIMITS

These results should be confirmed by longitudinal studies.

CONCLUSION

First year medical students who are faced with challenges relating to studying consume more antidepressants and anxiolytics, whilst second year students have a higher consumption of recreational drugs for a range of reasons. This suggests that the first two years at medical school are an important contributor to adverse mental health and therefore present a window of opportunity for preventative intervention.

Psychiatric and psychological follow-up of undergraduate and postgraduate medical students: Prevalence and associated factors. Results from the national BOURBON study

BACKGROUND

Physicians are at risk of burnout, anxiety and depression. Prevention is needed from the beginning of the medical studies to detect early poor mental health outcomes.

OBJECTIVE

To determine the prevalence and associated of psychiatric or psychological follow-up in a national sample of undergraduate and postgraduate medical students (UPMS).

METHODS

UPMS of the 35 French Medicine faculties were recruited through mailing lists and social networks between December 2016 and May 2017 and fulfilled Internet anonymised questionnaires.

RESULTS

Overall, 10,985 UPMS were included in the present study (2165 (19.7%) postgraduate, 31.6% males, mean aged 21.8 years). Overall, 1345 (12.2%) were followed-up by a psychiatrist and/or a psychologist, 20.5% of them were regular anxiolytic consumers and 17.2% of them were regular antidepressant consumers. In multivariate analyses, being followed-up by a psychiatrist and/or psychologist was associated with older age (aOR = 1.2[1.2-1.2], p < 0.0001), female gender (aOR = 0.5[0.5-0.7], p < 0.0001), current alcohol use disorder (aOR = 1.3[1.3-1.5], p < 0.0001), higher anxiolytic (aOR = 3.1[2.5-3.7],p < 0.0001) and antidepressant (aOR = 11.7[7.6-18.0],p < 0.0001) consumption, and with lower self-reported general health, social functioning and mental health quality of life (all aORs = 0.9, all p < 0.05). The UPMS followed-up by psychiatrist and/or psychologist reported to have been more frequently exposed to sexual assault (5.1% vs. 0.9%, aOR = 2.5[1.3-4.7], p < 0.0001), domestic violence (3.3% vs. 0.8% aOR = 2.1[1.2-4.0], p = 0.01) and parents divorce (11% vs. 6.4%, aOR = 1.5[1.2-1.9], p = 0.001). Students followed-up by a psychiatrist and/or psychologist reported more frequently to seek alleviating anxiety (aOR 1.9[1.6-2.3], p < 0.0001), depression (aOR 1.7[1.3-2.1],p < 0.0001), coping with studies difficulties (aOR 1.5[1.2-1.8],p < 0.0001), experiencing more stress at hospital (aOR = 2.3[1.6-3.5],p < 0.001) and more burnout syndrome (aOR = 1.4[1.1-1.8], p = 0.03).

CONCLUSIONS

Around 12% of UPMS are followed-up by a psychiatrist and/or a psychologist. These students reported higher antidepressant and anxiolytic consumption, psychic suffering and altered quality of life, associated with professional pressure and personal issues. Public health programs should be developed to help these students through their studies to prevent later mental /addictive issues and professional suffering. Improving UPMS mental health may also improve the later quality of care of their patients and global stress at hospital.

Psychiatry: A discipline at specific risk of mental health issues and addictive behavior? Results from the national BOURBON study

BACKGROUND

Physicians are at risk for burnout, anxiety and depression.

OBJECTIVE

To explore the self-reported mental health status, substance use behavior and motives of a national sample of interns in psychiatry compared to other specialties.

METHODS

Interns of the 35 French Medicine faculties were recruited through mailing lists and social networks between December 2016 and May 2018 and fulfilled internet anonymized questionnaires.

RESULTS

Overall, 2165 interns (302 interns in psychiatry and 1863 in other specialties) mean aged 25.9 years (±2.8), 35% males were included in the present study. In multivariate analyses, interns in psychiatry were found to have higher rates of current tobacco smoking (aOR = 1.9 [1.4-2.5], p < 0.001), alcohol use disorder (aOR = 1.5 [1.2-2.0], p = 0.001), cannabis use disorder (aOR = 2.7 [1.8-4.2], p < 0.001)). They were more frequently followed by a psychiatrist and/ or a psychologist (aOR = 2.5 1.9-3.3], p < 0.001), they consumed more often antidepressants (aOR = 3.8 [2.2-6.6], p < 0.001) and anxiolytic (aOR = 1.8[1.2-2.8]; p = 0.006). They reported to have been more frequently exposed to sexual assault (aOR = 2.2 [1.1-4.8], p = 0.04) and physical assault (aOR = 1.9[1.3-2.9], p = 0.002), and to have lower vitality (β = 3.5 [0.6-6.4], p = 0.02). Interns in psychiatry reported to have more often experienced ecstasy (aOR = 1.6 [1.2-2.3], p = 0.004), mushrooms (aOR = 1.5 [1.1-2.2], p = 0.04), amphetamines (aOR = 1.9 [1.2-3.1], p = 0.009) and LSD (aOR = 1.8 [1.1-3.1], p = 0.04). Beyond classical motives for this consumption (party, group effect), interns in psychiatry reported to seek more frequently disinhibition (aOR = 1.7 [1.3-2.2], p < 0.001), dealing with anxiety (aOR = 1.7 [1.3-2.3], p = 0.001), and to seek both stimulant (aOR = 1.4 [1.1-1.9], p = 0.04) and sedative effects (aOR = 1.9[1.3-2.7], p = 0.001).

CONCLUSIONS

Interns in psychiatry are more exposed to violence during medical studies, they report lower vitality and increased substance use behavior. Their motives for consumption suggest mental health problems associated with increased engagement in psychotherapy and self-medication of antidepressant/anxiolytic. This population should be targeted as a specific vulnerable population among interns in medicine to prevent ulterior bad health outcomes.