A qualitative evaluation of the use of Problem Management Plus (PM+) among Arabic-speaking migrants with psychological distress in France - The APEX study

ABSTRACTBackground: Feasibility studies with non-French speaking migrants in France are needed to inform appropriate adaptation of psychosocial intervention procedures.Objective: To test the WHO Problem Management Plus (PM+) intervention protocol for Arabic-speaking migrants in the Paris metropolitan region.Methods: Between 2019 and 2021 we recruited participants from three accommodation centres receiving asylum seekers or migrants experiencing social and economic difficulties. Participants experiencing psychological distress underwent five PM + sessions with trained helpers. Feasibility was evaluated through 15 interviews with 8 participants, 4 helpers, and 3 study supervisors. Interview topics covered PM + implementation in general and for each component. We also sought to understand problems with delivery and gathered suggestions for improvement. Data were analysed thematically using a deductive approach.Results: We found implementation of PM + to be feasible, with predominantly positive reactions from participants, helpers and study staff. All intervention components were considered beneficial, with breathing exercises considered easy to implement and often sustained. Selection of problems and strategies to address them were described as challenging to execute. Psychosocial support from and rapport with helpers and the use of the native language were considered key strengths of the programme. However, we observed the need for complementary or higher intensity psychological support in some cases. Findings also highlighted the importance of addressing distress among non-specialist helpers delivering PM + . Finally, local guidance to social resources were suggested to be added in the protocol.Conclusion: PM + was well-liked and feasible, with cultural adjustments and increased access to community resources for migrants needed.

Remote mental health care interventions during the COVID-19 pandemic: An umbrella review

Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.

Are we socially equally at risk of smoking during the COVID-19 pandemic? French data from 2009-2021

Background

Since 2020, the COVID-19 pandemic has greatly affected people including a significant increase in mental health difficulties. Cigarette smoking is found to be strongly associated with mental health conditions, which is why the pandemic might have influenced the secular decline in smoking rates observed over recent years. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic is found to exacerbate existing social inequalities and because this group was more likely to smoke before the pandemic. We examined the prevalence of smoking in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between educational level and interpersonal changes in tobacco consumption from 2018 to 2021.

Methods

The TEMPO cohort study included 1785 French adults followed between 1991 and 2021. With four assessments of smoking status available before and two after the onset of COVID-19, we estimated the smoking prevalence over time stratified by highest obtained diploma. We studied interpersonal change in smoking status between 2018 and 2021 among 148 smokers, using multinomial logistic regression.

Results

The prevalence of smokers was higher among those with low educational attainment compared with those with higher diploma at all timepoints. The difference between the two groups increased from 2020 to 2021 (4.8% to 9.4%). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018-2021 compared to low educated smokers (aOR=2.72 [1.26;5.89]).

Conclusions

Current findings showed a widening of the socioeconomic gap over time in smoking rates, which emphasizes the vulnerability of persons with low educational attainment to smoking, also during the pandemic.

Key messages

• The existing gap in smoking prevalence between lower and higher diploma groups has increased from 2020 to 2021, which may be a consequence of the COVID-19 pandemic.

• From 2018 to 2021, people with high school as highest qualification were less likely to decrease their tobacco use compared to higher educated people.

Smoking during pregnancy and children’s emotional and behavioural trajectories

Background

The nature of the relationship between maternal tobacco smoking during pregnancy and the occurrence of children's behavioural problems is still a matter of controversy. We tested this association using data collected among a sample of children followed from pregnancy to early adolescence (age 11.5 years), accounting for multiple parents’, children's and family characteristics.

Methods

Data come from 1424 mother-child pairs participating in the EDEN mother-child cohort set up in France. Using repeated measures (3, 5.5, 8 and 11.5 years) of the mother-reported Strengths and Difficulties Questionnaire, we estimated trajectories of children's emotional and behavioural difficulties. Two aspects of maternal smoking were studied: the timing and the level of use (cigarettes/day) during the first trimester of pregnancy. Multinomial regression models controlled for confounding factors including maternal mental health and socioeconomic characteristics using propensity scores with the overlap weighting technique.

Results

Contrary to bivariate analyses, in propensity score-controlled regression models, maternal smoking throughout pregnancy was no longer significantly associated with offspring emotional or behavioural difficulties. Maternal heavy smoking (≥10cigarettes/day) remained significantly associated with intermediate levels of overall emotional and behavioural difficulties (OR 1.64, 95%CI 1.04-2.58) and conduct problems (OR 3.05 95%CI 1.22-7.61), as well as with high levels of conduct problems symptoms (OR 2.82 95%CI 0.88-9.06) - although the latter did not reach statistical significance.

Conclusions

The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties appears to be largely explained by women's other characteristics. However, maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics.

Key messages

• The association between maternal smoking in pregnancy and offspring emotional and behavioural difficulties seem largely explained by the family's socio-demographic and behavioural characteristics.

• Maternal heavy smoking appears to be related to offspring behavioural difficulties beyond the role of confounding characteristics.

Early childcare type and child development at age 3.5 years, data from the French ELFE cohort

Background

Early childcare has been linked to child development in some countries. The aim of this study is to evaluate the impact of early childcare in the French context, where children can attend different types of childcare facilities prior to age 3 when they enter kindergarten, and development at age 3.5 years.

Methods

10,683 children from the ELFE French national birth cohort were classified into 4 groups depending on their main type of childcare between birth and age three: childminder (n = 5,014), centre-based childcare (n = 2,583), informal childcare (n = 777) and parents only (n = 2,465). Children's development was measured with the short form of the Child Development Inventory (CDI) via parents-reports at age 3.5 years. The CDI score was transformed into a Development Quotient (DQ) taking into account the child's age, and global developmental delay was defined as DQ < 90. Missing data was imputed by Fully Conditional Multiple Imputation with 10 imputations. Multinomial analyses were carried out adjusted by Inverse Probability Weighting based on Propensity Scores calculated using main selection and confounding variables.

Results

Compared to children who were cared for by parents only, children who were cared for by a childminder or in a centre-based childcare had a higher DQ (103.0 and 104.8 respectively) as well as a lower likelihood of global developmental delay (propensity-score weighted OR = 0.84, [95% CI 0.70-1.01] and propensity-score weighted OR = 0.54, [95% CI 0.44-0.66]) respectively.

Conclusions

In the French context, early centre-based childcare attendance is significantly associated with a lower risk of global child delay. Policies should make centre-based childcare more accessible to a broader number of children.

Key messages

• Early childcare type is linked to child development in France.

• Children in centre-based childhood had a lower likelihood of developmental delay compared to those looked after by parents only.

The role of substance use in the risk of not getting employed among young people: Prospective findings from the CONSTANCES cohort

Introduction

It remains unclear whether substance use in youth could be associated with a lower likelihood of accessing employment.

Objectives

To examine prospectively associations between substance use and the risk of not getting employed among young people.

Methods

From the French population-based CONSTANCES cohort, 2,873 students who never worked were included between 2012 and 2018 and followed-up for 2.7 years in average. Generalized estimating equations computed the odds of being unemployed versus employed according to substance use at baseline controlling for sociodemographic factors and depressive state. Tobacco use (smoking status and number of cigarettes), cannabis use frequency, and at-risk alcohol use according to the Alcohol Use Disorder Identification Test (total score >7) were introduced separately in the models.

Results

Tobacco use wasn’t significantly associated with employment. Cannabis use at least weekly, and at-risk alcohol use, were associated with increased odds of being unemployed (OR=1.85, 95%CI(1.29, 2.64)) and OR=1.34, 95%CI(1.04, 1.71)), respectively. Additional analyses on sub-scores of alcohol use suggested that the association was mainly driven by alcohol dependence rather than frequency of use.

Conclusions

Public health campaigns must target youth by advising them of the detrimental roles of regular cannabis use and at-risk alcohol use and their lower chances of getting employed.

Disclosure

No significant relationships.

Effect of Tobacco Cessation Aids on Smoking Cessation and Duration of Abstinence : a French Population-Based Study

Introduction

Although smoking prevalence has been decreasing worldwide, sustained tobacco cessation remains a challenging goal for many smokers. Nicotine replacement therapy (NRT) products remain among the most widespread type of cessation tobacco aids, along with the more recently introduced electronic cigarette, the efficiency of which is still a matter of debate in the public health community.

Objectives

This study aims to contribute to the ongoing discussion about effective ways of encouraging tobacco cessation and in particular evaluating the role of the two aforementioned tobacco cessation aids with regard to lasting smoking abstinence in real-life settings.

Methods

The study is based on the French 2017 Health Barometer, a cross-sectional survey conducted by Santé Publique France. Two distinct outcomes related to tobacco cessation were used: smoking status at 6 months follow-up (yes vs. no) and the duration of smoking abstinence. These two study outcomes were examined respectively among N1 = 2783 and N2 = 1824 participants. All results were weighted based on inclusion probability weights and controlled for propensity scores via overlap weighting (OW), which is appropriate when exposure groups are disparate.

Results

After adjusting on potential confounders, tobacco cessation at 6 months remains significantly associated with e-cigarette use (OR: 1.50 (1.12-1.99)) and e-cigarette use combined with NRT (OR:1.88 (1.15-3.07)). This association did not reach statistical significance in the long-term analysis, nor did the results of NRT use alone in both analyses.

Conclusions

Overall, while electronic cigarette use alone and combined with NRT is associated with an increase in the likelihood of smoking cessation, the long-term effects are probably limited.

Disclosure

No significant relationships.

Symptoms of anxiety/depression during the COVID-19 pandemic and associated lockdown in the community: longitudinal data from the TEMPO cohort in France

Introduction

The COVID-19 pandemic and associated preventive measures have an impact on the persons’ mental health, including increasing risk of symptoms of anxiety and depression in particular. Individual experiencing mental health difficulties in the past could be especially vulnerable during lockdown, however, few studies have tested this empirically considering preexisting mental health difficulties using longitudinal data.

Objectives

The objective of this study is to examine the longitudinal association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown due to the COVID-19 pandemic in a community sample.

Methods

Seven waves of data collection were implemented from March-May 2020. Generalized estimation equations models were used to estimate the association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown among 662 mid-aged individuals from the French TEMPO cohort.

Results

We found an elevated odds ratio of symptoms of anxiety/depression (OR=6.73 95% [CI=4.45–10.17]) among individuals experiencing such symptoms prior lockdown. Furthermore, the odds of symptoms of anxiety/depression during lockdown was elevated among women (OR=2.07 [95% CI=1.32–3.25]), subjects with low household income (OR=2.28 [1.29–4.01]) and persons who reported loneliness (OR=3.94 [2.47–6.28]).

Conclusions

This study demonstrates a strong relationship between preexisting symptoms of anxiety/depression and anxiety/ depression during the COVID-19 outbreak among mid-aged French adults. The findings underline the role of preexisting symptoms of anxiety/depression as a vulnerability factor of anxiety/depression during lockdown. Furthermore, the study shows that loneliness is independently associated with symptoms of anxious/depression, when controlling for prior anxiety/depression symptoms.

Disclosure

No significant relationships.

Non-participation to a longitudinal and interventional survey on the psychological impact of the COVID-19 pandemic among healthcare workers (PSYCOVER) in France

Introduction

We conducted a national longitudinal survey among healthcare workers in the context of the Covid-19 pandemic, (1) to assess mental health and (2) to describe the results of an intervention to improve capacity of resilience. Non-participation is rarely studied despite being an important methodological matter when performing studies on mental health.

Objectives

The study aims to describe and identify the factors associated with non-participation of healthcare workers to the intervention part of a national longitudinal study on the psychological impact of the COVID-19 pandemic.

Methods

Participants were recruited from April to October 2021 via an Internet link widely disseminated. Data collected include participant’ socio-demographic, occupational and working conditions, general health, professional burnout and mental health. The intervention proposed the use of tools for self-management of stress and resilience (PsySTART-Responder® and Anticipate.Plan.Deter™ program). A robust Poisson regression was used to identify factors associated with non-participation.

Results

Among 724 participants, 41% participated to the intervention part. Factors associated to non-participation to the intervention were to work with few or no COVID-19 patients, and low scores in the anxiety scale. Social determinants, occupational characteristics or general health were not associated with non-participation.

Conclusions

Our study provides a better understanding of the participation of healthcare workers that was not frequently studied. The results logically suggest lower participation among those with better mental health and not directly concerned with management of COVID-19 patients. Non-participation to the intervention was not associated with social factors, which is an argument in favour of using such a design/intervention in a socially heterogeneous population.

Disclosure

No significant relationships.

Factors associated with suicidal ideation in the French nationwide EPICOV study

Introduction

The COVID-19 pandemic seems associated with a worsening in mental health issues as well as a widening of pre-existing social and health inequalities. Assessment of its impact on suicidal behavior might therefore be relevant.

Objectives

To assess factors associated with suicidal ideation in the general population, using data from the French nationwide Epicov study

Methods

In the nationally representative Epicov study, data on occurrence of suicidal ideation from November 2019 to November 2020 were available, including timing with respect to France’s lockdown periods. We studied the incidence of suicidal ideation among participants without a prior history of suicidal behavior, after May 11, 2020, when first COVID-19 related lockdown was suspended. Studied factors assessed sociodemographic and health status, including mental health, as well as COVID-19 related information such as symptom. Associations between selected factors and suicidal ideation were assessed in sex-stratified adjusted logistic regression models.

Results

In the Epicov study, prevalence of suicidal ideation was of 2,9%, as opposed to around 4% pre-pandemic. Among 48 702 female and 41 016 male participants, health or financial issues were associated with a higher incidence of suicidal ideation. Interestingly, Covid19-like symptoms were also associated with higher risk of suicidal ideation. While an impaired mental health has been observed in survivors of past pandemics, given the unprecedented context of the current pandemic, this association needs further investigation.

Conclusions

While the COVID-19 pandemic might have lowered suicidal ideation, it’s aftermaths may reverse the trend. To prevent this rise, identification of vulnerable groups is crucial to promote tailored public health strategies.

Disclosure

No significant relationships.

Increased risk of job strain and mental health among first and second-generation migrants in France

Background

Immigrants often have more difficult working conditions than natives in Europe, which could particularly expose them to psychosocial work factors and participate to a deteriorated mental health. This study aims to 1) describe the prevalence of job strain across origin and its determinants in France 2) verify whether the association between job strain and mental health hold across all population groups.

Methods

We used the national Conditions de travail-Risques Psychosociaux 2016 survey (N = 24, 640) which is representative of the active population in France. Mental health was measured by Generalized Anxiety Disorder (GAD-Mini). Among employed persons, we described the prevalence of job strain according to migratory status and by sex. Then we modelled the probability to be exposed to job strain with Poisson regressions. Finally we modelled the probability to have a Generalised Anxiety Disorder in each group of population with Poisson regressions.

Results

The prevalence of job strain was 44% among first-generation immigrants from Africa and 50% among second-generation immigrants (not EU, not Africa) vs 32% in the non-immigrant population, p < 0.0001)., with differentiated gender patterns. After adjustment on sociodemographic and occupational characteristics, women were more likely to be exposed to jobstrain [aIRR=1,30 [1,24;1,37]] as well as second-generation immigrants from Africa (aIRR=1,10 [1,00;1,21]). Job strain was associated with Generalised Anxiety Disorder in all groups of population.

Conclusions

Immigrants are more exposed to job strain in France and more research is needed to understand this increased risk. Additionally, job strain was associated with anxiety in all immigrant groups and could contribute to immigrants' deteriorated mental health.

Key messages

First and second generation immigrants are more exposed to job strain than non-immigrants in France. This increased risk is only partially explained by the type of jobs they hold.

Symptoms of emotional difficulties and hyperactivity/inattention among children during the COVID-19 epidemic and associated lockdown: data from the SAPRIS project

Background

COVID-19 limitation strategies led to widespread school closures around the world. The present study aims to provide a description of children's mental health and associated factors during the COVID-19 school closure in France.

Methods

We conducted a cross-sectional analysis in the SAPRIS study during the COVID-19 pandemic in France, relying on 2 ongoing national birth cohorts, ELFE and EPIPAGE 2. Using weighted multinomial logistic regression models, we estimated associations between children's mental health (i.e., hyperactivity/inattention and emotional symptoms; assessed by the Strengths and Difficulties Questionnaire), children's health behaviors, schooling, as well as sociodemographic and socioeconomic characteristics of children family.

Results

The sample consisted of 5702 children aged 8 - 9 years and 49.3% girls. Sleep disturbance and parents' dominant socio-professional category were associated with both hyperactivity-inattention (adjusted Odds Ratio (aOR)=2.10 95%Confidence Interval [1.85-2.38]; aOR=0.45 [0.33-0.61] respectively) and emotional symptoms and (aOR=6.33 [5.26-7.63]; aOR=0.62 [0.39-0.98] respectively). Specifically associated with hyperactivity/inattention were: male sex (aOR=2.51 [2.24-2.82]), presence of regular care and its pursuit during school closure (aOR=1.69 [1.33-2.15]), emotional symptoms (aOR=2.74 [2.23-3.37]), school situation (aOR=2.19 [1.69-2.82]), presence of tutoring and difficulties with it (aOR=2.56 [2.13-3.08]), type of housing (aOR=0.79 [0.70-0.89]). Factors associated with emotional symptoms were: presence of covid cases in the household (aOR=2.33 [1.92-2.82]), hyperactivity/inattention (aOR=2.94 [2.45-3.52]) and financial difficulties (aOR=1.71 [1.39-2.11]).

Conclusions

Policy makers need to balance pros and cons of closing schools, taking into consideration educational and psychological consequences for children and the various factors associated with mental health.

Management of work-related common mental disorders in general practice: a cross-sectional study

BACKGROUND

General practitioners (GPs) often manage individuals with work-related common mental disorders (CMD: depressive disorders, anxiety and alcohol abuse). However, little is known about the ways in which they proceed. The aim of this study is to analyze GPs' management and patterns of referral to other health professionals of patients with work-related CMD and associated factors.

METHOD

We used data from a cross-sectional study of 2027 working patients of 121 GPs in the Nord - Pas-de-Calais region in France (April - August 2014). Statistical analyses focused on patients with work-related CMD detected by the GP and examined the ways in which GPs managed these patients' symptoms. Associations between patient, work, GP and contextual characteristics and GPs' management were explored using modified Poisson regression models with robust variance.

RESULTS

Among the 533 patients with work-related CMD in the study, GPs provided psychosocial support to 88.0%, prescribed psychotropic treatment to 82.4% and put 50.7% on sick leave. Referral rates to mental health specialists and occupational physicians were respectively 39.8 and 26.1%. Several factors including patients' characteristics (occupational and sociodemographic), GPs' characteristics and environmental data were associated with the type of management used by the GP.

CONCLUSION

Our study emphasizes the major and often lonesome role of the GP in the management of patients with work-related CMDs. Better knowledge of the way GPs manage those patients could help GPs in their practice, improve patients care and be a starting point to implement a more collaborative care approach.

High Work Demands and Depression: The Moderating Role of the Serotonin Transporter Gene (5-HTT) and Work Control

Background:

High work demands (i.e. a heavy workload, tight time pressures, conflicting work tasks) put individuals at high risk of depression. Our aim was to test whether the relationship between high work demands and depression is moderated by genetic vulnerability to depression and by work control.

Methods:

Participants are members of the Dunedin Study, a 1972-73 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (96% response rate). This analysis included all participants who were employed at age 32. Depression was measured using the Diagnostic Interview Schedule. Work demands and work control were assessed in an interview. Genetic vulnerability to stress was ascertained by the serotonin transporter gene (5-HTT).

Results:

Among individuals exposed to high work demands, symptoms of depression were significantly higher among those who carried two short alleles of the 5-HTT gene (‘s/s’ group) than among ‘l’ carriers (interaction between 5-HTT gene and work demands: β=4.22, se=1.86, p=0.02). However, this gene-environment interaction was only present among those individuals who had low control over their work (interaction between 5-HTT gene and high work demands: β: 7.21, se: 2.73, p=0.009), not among those who had high work control (interaction between 5-HTT gene and high work demands: β: 1.32, se: 2.53, p=0.60).

Conclusion:

Pending replication, the serotonin transporter gene appears to moderate the effects of high work demands on symptoms of depression. This gene-environment interaction is attenuated by high work control.

Dépression maternelle : facteurs de risque, conséquences sur le développement des enfants et interventions de prévention

La dépression maternelle en période périnatale est fréquente et peut avoir des répercussions négatives sur le développement des enfants. La prévention de la dépression chez les femmes qui ont des enfants en bas âge est donc un objectif de santé publique prioritaire. Ceci exige une bonne connaissance des facteurs associés à la dépression maternelle, des conséquences sur le développement des enfants, et des mesures préventives pouvant être efficaces. Cette session thématique abordera chacun de ces trois axes à partir de résultats récents d’études épidémiologiques et d’intervention menées en France (ELFE, EDEN, CAPEDP). Les facteurs associés à la dépression maternelle au cours de la grossesse et en post-partum, ainsi que l’accès à des interventions de prévention qui visent à prévenir les difficultés psychologiques des mères, telles que l’entretien prénatal précoce et les cours de préparation à la parentalité, ont pu être étudiés à partir des données de la cohorte ELFE, une étude représentative au niveau national. Les résultats montrent notamment que les femmes qui ont une situation sociale défavorisée ont des niveaux élevés de difficultés psychologiques, alors que ce sont celles qui bénéficient le moins des interventions de prévention. L’impact en termes de difficultés comportementales ou développementales chez les enfants a pu être étudié à partir des données de la cohorte EDEN montrant l’importance de différentes trajectoires longitudinales de dépression maternelle vis-à-vis du développement émotionnel, comportemental et cognitif des enfants jusqu’à 6 ans. Enfin, la faisabilité et l’efficacité d’interventions de prévention de la dépression maternelle seront discutées à partir des résultats de l’étude CAPEDP, un programme de visites à domicile chez des familles en situation difficile.

Prenatal Psychological Distress and Access to Mental Health Care in the ELFE Cohort

Background:

Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.

Methods:

We used data from the French cohort Étude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.

Results:

Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.

Limitations:

Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.

Conclusions:

Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.

Dépression maternelle et développement de l’enfant : résultats de la cohorte EDEN

Un des facteurs de risque systématiquement lié à la survenue précoce et importante de problèmes sociaux, affectifs et cognitifs durant la petite enfance est la psychopathologie parentale et particulièrement maternelle. En effet, les enfants dont la mère souffre de dépression ont environ deux à trois fois plus souvent des difficultés précoces, et qui peuvent prédire la survenue de problèmes psychiatriques avérés ultérieurement. À partir des données longitudinales de la cohorte EDEN, des groupes de trajectoires latentes de dépression maternelle seront identifiées au sein de la population d’étude. Ensuite, ces trajectoires seront mises en relation avec les difficultés émotionnelles et de comportement et le développement cognitif chez l’enfant en utilisant des analyses de régression linéaire multivariée, en tenant compte de covariables pertinentes. Nous avons identifié cinq trajectoires de dépression maternelle au sein de la cohorte EDEN : 60,2 % des mères n’avaient pas de symptômes dépressifs ; 4,7 % avaient des symptômes dépressifs élevés seulement pendant la grossesse ; 4,9 % avaient des symptômes dépressifs élevés 3–5 ans après la naissance de l’enfant ; 25,2 % avaient des symptômes dépressifs de niveau intermédiaire persistants et 5,0 % avaient des symptômes dépressifs de niveau élevé persistants. La dépression maternelle est liée à des problèmes émotionnels et comportementaux des enfants, en particulier si elle est persistante. De même, on a trouvé que le développement cognitif des enfants, tel que mesuré par le QI, suit la même tendance. À l’âge de 5,5 ans, les enfants de mères ayant des symptômes dépressifs élevés et persistants montrent des scores de QI verbal, QI de performance et QI total réduits par rapport aux enfants de mères jamais déprimés. Les résultats de ces recherches montrent que la dépression maternelle chronique a un impact sur le développement cognitif et émotionnel de l’enfant, même quand les symptômes dépressifs sont d’un niveau intermédiaire.

Free access to nicotine substitutes and e-cigarette for tobacco cessation: STOP a pilot intervention

Background

Smoking rates in France are high, and present a substantial socio-economic gradient. Smokers with low socio-economic position (SEP) may be more dependent on nicotine, and have more financial difficulties to buy nicotine substitutes. Tailored approaches are therefore needed.

Methods

STOP (Sevrage Tabagique à l’aide d’Outils dédiés selon la Préférence) is an ongoing pilot study, examining the acceptability of a smoking cessation intervention. Smokers with low SEP are recruited in six healthcare centres in Greater Paris area by health professionals and are offered substitute(s) of their choice for 4 weeks. Participants can choose between different types of nicotine substitutes (NS; patches, inhalers, etc.) and/or an e-cigarette delivered free of charge. The acceptability of this approach is examined in patients and doctors, using a mixed-method approach.

Results

So far, 30 smokers have been included in our study, 20% chose e-cigarettes, 36% chose NS, 36% chose both, and 2 participants (8%) chose neither. More than half of participants quit smoking (66%) at one week after inclusion, with 11 reporting tobacco abstinence out of 16 participants followed for 4 weeks. The average number of cigarettes smoked decreased from 15(sd = 10) at inclusion to 8.5 (sd = 5) among those who didn’t quit at four week. In qualitative interviews, one of the facilitators highlighted by health professionals was the perceived “met need” of smokers with low SEP when given free quitting aids without upfront-payment. One of the reported obstacles is the difficulty in scheduling consecutive follow-up meetings in short time.

Discussion

It is feasible to implement a smoking cessation programme aimed at smokers with low SEP, and embedded in the healthcare system. If proven effective, this intervention could contribute to decreasing social inequalities with regard to tobacco use. Recruitment in a randomised controlled multicentre trial based on this pilot study will start at the end of 2019.

Key messages

It is feasible to put in place a smoking cessation intervention among socially-disadvantaged in healthcare centres. Free access to nicotine substitutes and e-cigarettes could be a promising smoking cessation intervention among smokers with low socio-economic position.

Out of country tobacco purchases decrease despite a price increase and plain packaging in France

Background

The introduction of new anti-tobacco measures in France (plain tobacco packaging, higher prices) might encourage smokers to buy their tobacco from other sources than tobacco shops. We examine whether these measures increased the likelihood of smokers purchasing tobacco abroad, depending on their driving distance from the border of a neighboring country with lower tobacco prices.

Methods

DePICT is a two-wave cross sectional national telephone survey examining the French population tobacco-related perceptions and behaviors before and after the introduction of the new measures in 2017. Smokers were asked whether they bought tobacco from abroad in the last 12 months. Shortest driving distances to neighboring countries’ border were calculated using Google Maps (<100 Km, 100-200 Km, 200-300 Km, >300 Km and Ile-de-France (IDF)). Data was weighted to be representative of the population living in France. Multivariate regressions, adjusted on socio-demographic characteristics as well as substance use behaviors, were carried out.

Results

Compared to smokers living at more than 300 Km from a border, those living near a border, and in IDF were significantly more likely to have bought tobacco from abroad (<100 Km: ORadjusted = 3.98; 100-200 Km: ORadjusted = 2.04; 200-300 Km: ORadjusted = 1.47; IDF: ORadjusted = 1.32). Smokers in wave 2 (n = 929) were significantly less likely than those in wave 1 (n = 1238) to have bought tobacco abroad (ORadjusted = 0.81 [95% CI: 0.69-0.96]). It was mainly smokers who were in a driving distances of 100-200 Km, and 200-300 Km who were significantly less likely to buy abroad across the 2 waves (respectively ORadjusted = 0.56 [95% CI: 0.34-0.92] and ORadjusted = 0.50 [95% CI: 0.27-0.92]). Supplementary analyses showed that it was mainly for men and smokers born in France that the decrease was significant.

Conclusions

Our results suggest that the new anti-tobacco measures did not increase out of country tobacco purchases by smokers.

Key messages

The introduction of new anti-smoking measures (increase in price, plain tobacco packaging) did not increase the likelihood of smokers purchasing tobacco from abroad. It was mainly male smokers and smokers born in France that had a decreased likelihood of purchasing tobacco from abroad after the introduction of new anti-tobacco measures.

Electronic cigarette use and smoking reduction – longitudinal data from CONSTANCES cohort study

Aims

Electronic cigarettes are often used by smokers to stop smoking and former smokers to prevent relapse. We examined whether electronic cigarette use lead to smoking reduction and cessation among smokers, and relapse among former smokers.

Design and Settings

The CONSTANCES cohort, France (2012 - ongoing).

Measurements

Among smokers (N = 5,400, average follow-up of 23.4 months), mixed regression models were used to examine whether electronic cigarette use was linked to a decrease in the number of cigarettes smoked per day and Poisson regression models with sandwich variance estimators were used to test smoking cessation. In parallel, Cox proportional hazards regression models were used to examine the relationship between electronic cigarettes use and smoking relapse among former smokers who stopped smoking since 2010 (N = 2,025, average follow-up of 22.1 months), year in which electronic cigarettes were introduced in France. All statistical analyses were adjusted for socio-demographic characteristics, duration of follow-up, and smoking characteristics.

Findings

There was a significantly higher decrease in the number of cigarettes smoked/day among smokers who used electronic cigarettes (decrease of 4.4 cigarettes/day) compared to those who did not (decrease of 2.7 cigarettes/day), as well as a higher relative risk of smoking cessation (adjusted RR: 1.67 [95% CI: 1.51-1.84]). At the same time, among former smokers, EC use was associated with an increase in the rate of smoking relapse (adjusted HR = 1.70 [95% CI: 1.25-2.30]).

Conclusions

After a follow-up of approximately 2 years, electronic cigarettes use among smokers was associated to a decrease in smoking level and an increase in smoking cessation attempts but among former smokers it was associated to a higher risk of smoking relapse.

Key messages

Among smokers, electronic cigarette use was associated to smoking reduction and smoking cessation. Among former smokers who quit smoking since 2010, electronic cigarette use was associated to a higher likelihood of relapse.

Social inequalities of postpartum depression: the mediating role of social support during pregnancy

Introduction

A disadvantaged socioeconomic position (SEP), as well as insufficient social support during pregnancy (SSP) increase the probability of subsequent postpartum depression (PPD). The aim of this study was to quantify the part of social inequalities in PPD due to insufficient SSP and in particular assess the impact relative to women’s migrant status.

Methods

The sample included 15,000 women from the nationally representative French ELFE birth cohort study. Depressive symptoms were assessed at two months postpartum by the EPDS. SEP was constructed as a latent factor explaining educational level, occupational grade, employment during pregnancy, household income and financial difficulties. SSP was characterized by informal support (partner perceived support, frequency of quarrels and paternal leave) and formal support (early prenatal psychosocial risk assessment and antenatal classes’ attendance). Causal mediation analyses between SEP, dimensions of SSP and PPD were conducted and stratified on migrant status (categorized as native French, first or second generation migrant or immigrant).

Results

A disadvantaged SEP and a lack of informal SSP during pregnancy were both associated with an increased risk for postpartum depressive symptoms and a disadvantaged SEP was positively associated with lack of SSP. In immigrant women, a larger proportion of social inequalities in PPD could be attributed to lack of SSP, in comparison to native French women (17.5% vs. 8.8%).

Conclusions

Both disadvantaged SEP and SSP are risk factors for PPD. We found evidence that disadvantaged women’s increased risk for PPD can partly be attributed to limited social support.

Key messages

PPD in disadvantaged groups, especially in migrant women, could possibly be prevented early in pregnancy by increasing support from partner and larger family. Access to social support health care systems directed towards pregnant women remains low for women with a disadvantaged SEP, especially in migrant women.

Maternal immigrant status and signs of neurodevelopmental problems in early childhood

Background

A growing body of evidence suggests that children of immigrants may have increased risks of neurodevelopmental disorders. However, evidence based on parent report and on very young children is lacking. We therefore investigated the association between maternal immigrant status and early signs of neurodevelopmental problems in a population-based sample of two-year-old children using standardized parent-report instruments.

Methods

We used data from the French representative ELFE birth cohort, initiated in 2011. The study sample included 9,900 children of non-immigrant French, 1,403 children of 2nd, and 1,171 children of 1st generation immigrant women followed-up to age two years. Neurodevelopment was assessed using the Modified Checklist for Autism in Toddlers (M-CHAT) and an adaptation of the MacArthur-Bates Communicative Development Inventories (MB-CDI).

Results

In fully adjusted linear regression models, maternal immigrant status was positively associated with M-CHAT scores, with stronger associations in children of 1st (β-coefficient: 0.19; 95% CI 0.08-0.29) than 2nd generation immigrants (0.09; 0.01-0.17). This association was especially strong among children of 1st generation immigrant mothers native of North Africa (vs. non-immigrant French: 0.33; 0.16-0.49) or French-speaking Sub-Saharan Africa (0.26; 0.07-0.45). MB-CDI scores were lowest among children of 1st generation immigrant mothers, particularly from mostly non-francophone regions. Children of 1st generation immigrant mothers were most likely to have simultaneously low MB-CDI and high M-CHAT scores.

Conclusions

Our findings suggest that maternal immigrant status is associated with higher risks of early signs of neurodevelopmental difficulties, with strong variations according to maternal region of origin. Standardized screening instruments may aid the early detection and treatment of these difficulties, helping to address inequalities in neurodevelopmental health in children of immigrants.

Key messages

Children of immigrant mothers in a population-based sample appear to have elevated neurodevelopmental risks, as assessed by maternal report. This is in line with evidence from clinical samples. We found strong variations according to maternal region of origin, with the highest risks in children of 1st generation immigrant mothers from North Africa and French-speaking Sub-Saharan Africa.

Verbal victimisation and mental health of sexual minority adults in France

Objectives

Sexual minority individuals face minority stress, and specific discrimination and abuse that might increase their risk of having mental health problems. We examine associations between sexual orientation, experienced violence in the past year, and mental health outcomes in a representative sample of French adults aged 18 to 75 years.

Methods

Analyses were based on the “Health Barometer” (Baromètre Santé) a nationally representative, cross-sectional survey which recruited 25,198 adults in 2017. Data were weighted to be representative of the French adult population. Four mental health outcomes occurring in the preceding year or currently were examined: a) current depressive symptoms, b) having experienced a major depressive episode, c) suicidal ideation, and d) suicide attempt. We conducted mediation analysis using the counterfactual approach to evaluate the contribution that verbal violence victimisation experience in the preceding year has in the association between sexual orientation and mental health outcomes.

Results

Sexual minority adults were more likely to experience verbal violence in the last year compared to heterosexual individuals (22% vs 11.4%). They were also more likely to have experienced each of the four mental health outcomes. Verbal victimisation in the preceding was found to significantly mediate the association between sexual orientation and mental health outcome with mediated proportions varying between 15 to 22%.

Discussion

Initiatives that aim to structurally reduce stigma and victimisation against sexual minority individuals, but also improve social support and resilience, could have a significant impact on their mental health and well-being.

Key messages

Sexual minority adults are more likely to experience verbal violence, and mental health problems. Verbal victimisation partly explains the increased risk of having mental health problems among sexual minority individuals.

Work intensity in men and work-related emotional demands in women are associated with increased suicidality among persons attending primary care

BACKGROUND

A large proportion of persons died by suicide are employed at the time of death and work-related factors partly contribute to suicide risk. Our aim was to examine the association between multiple aspects of work organization and suicidal ideation in a study conducted in primary care.

METHODS

Data came from a study of 2027 working patients attending a GP representative of patients in the Nord Pas-de-Calais region in France (April-August 2014). Suicidality was assessed using the MINI (Mini International Neuropsychiatric Interview). Six emergent worked-related factors were explored (work intensity, emotional demands, autonomy, social relationships at work, conflict of values, insecurity of work). Several covariates were considered: patient's and GP's characteristics, and area-level data (material and social deprivation, psychiatrist and GPs' density, suicide attempts and suicide rates).

RESULTS

8.0% of participants reported suicidal ideation in the preceding month (7.5% of men and 8.6% of women, p = .03). In multivariate analyses adjusted for covariates, suicidality was significantly associated with work intensity (OR = 1.65; 95%CI [1.18-2.31]) in men and with work-related emotional demands (OR = 1.35; 95%CI [1.01-1.80]) in women. Area-level data were not associated.

LIMITATIONS

Our cross-sectional study cannot assess the direction of the relationships under study.

CONCLUSION

Our results emphasise a central role for GPs in suicide prevention among workers and highlight the importance of work-related factors with regard to suicidality in primary care.

Early Childcare and Trajectories of Behavioral Difficulties in Children: The EDEN Mother–Child Cohort Study

Background

There is no consensus of the relationship between early childcare and later psychological development.

Methods

We studied 1428 children participating in the French EDEN cohort. Childcare was reported prospectively between ages 4 months and 3 years: childminder, collective care, informal care. Children's behavior was assessed by mother-reported strength and difficulty questionnaire (SDQ) scores at ages 3.5, 5.5 and 8 years. Trajectories of children's behavioral difficulties (emotional difficulties, behavioral problems, peer-relations difficulties, symptoms of hyperactivity and inattention, prosocial behavior) were identified using group-based trajectory modelling (PROC TRAJ, SAS). To control for selection and confounding factors, we used propensity scores based on over 30 covariates, included in multinomial regression models as inverse probability weights of exposure.

Results

Compared to children in informal care, those who were cared for by a childminder or in collective care were less likely to have peer problems (respectively, ORs for the intermediate level trajectory = 0.67 [95% IC: 0.47–0.95] and 0.49 [95% IC: 0.34–0.72]; ORs for the high level trajectory = 0.47 [0.27–0.82] and 0.33 [0.17–0.62]). Collective care was also associated with a reduced likelihood of intermediate (OR = 0.71 [0.52–0.98]) and high trajectories of hyperactivity and inattention (OR = 0.50 [0.35–0.81]), intermediate (OR = 0.58 [0.39–0.88]) and high trajectories of emotional symptoms (OR = 0.54 [0.32–0.92]) and intermediate (OR = 0.72 [0.51–1.01]) and high behavioral problems trajectories (OR = 0.54 [0.34–0.85]).

Conclusion

Childcare attendance prior to school entry – particularly collective childcare – may have beneficial effects for children's psychological development and peer relations.

Disclosure of interest

The author has not supplied his declaration of competing interest.

Emotional and behavioral difficulties in children growing up homeless in Paris. Results of the ENFAMS survey

PURPOSE

Children growing up in homeless families are disproportionately more likely to experience health and psychological problems. Our objective was to describe social, environmental, individual and family characteristics associated with emotional and behavioral difficulties among homeless children living in the Paris region.

METHODS

Face-to-face interviews with a representative sample of homeless families were conducted by bilingual psychologists and interviewers between January and May 2013 (n=343 children ages 4-13 years). Mothers reported children's emotional and behavioral difficulties (Strength and Difficulties Questionnaire [SDQ]), family socio-demographic characteristics, residential mobility, and parents' and children's physical and mental health. Children were interviewed regarding their perception of their living arrangements, friendships and school experiences. We studied children's SDQ total score in a linear regression framework.

RESULTS

Homeless children had higher SDQ total scores than children in the general population of France, (mean total score=11.3 vs 8.9, P<0,001). In multivariate analyses, children's difficulties were associated with parents' region of birth (beta=1.74 for Sub-Saharan Africa, beta=0.60 for Eastern Europe, beta=3.22 for other countries, P=0.020), residential mobility (beta=0.22, P=0.012), children's health (beta=3.49, P<0.001) and overweight (beta=2.14, P=0.007), the child's sleeping habits (beta=2.82, P=0.002), the mother's suicide risk (beta=4.13, P<0.001), the child's dislike of the family's accommodation (beta=3.59, P<0.001) and the child's experience of bullying (beta=3.21, P=0.002).

CONCLUSIONS

Children growing up homeless experience high levels of psychological difficulties which can put them at risk for poor mental health and educational outcomes long-term. Access to appropriate screening and medical care for this vulnerable yet underserved group are greatly needed.

Les facteurs associés à la dépression post-partum dans la cohorte Étude Longitudinale Française depuis l’Enfance (ELFE)

La plupart des travaux ne considèrent pas les interrelations potentielles entre les différents facteurs de risque reconnus de troubles émotionnels maternels périnataux. L’Étude Longitudinale Française depuis l’Enfance (ELFE) a permis d’interroger l1 643 mères sur leur santé mentale périnatale (contrat ANR-DSSA, 2012). Les facteurs influençant indépendamment l’existence de difficultés psychologiques durant la grossesse et l’accès aux mesures de dépistage et de prévention anténatales (entretien prénatal précoce [EPP] ; préparation à la naissance et à la parentalité [PNP]) ont été étudiés par des régressions multivariées. Des analyses en équations structurelles ont ensuite permis de tester les relations directes et indirectes entre 9 groupes de facteurs de risque (niveau socioéconomique, soutien anténatal, soutien postnatal, accompagnement à la parentalité, complications obstétricales, facteurs psychologiques maternels, santé physique du bébé, comportements maternels envers le bébé et capacités d’autorégulation du bébé) et l’intensité des symptômes dépressifs postnataux évalués par l’Edingburgh Postnatal Depression Scale , selon un modèle multifactoriel inspiré du modèle théorique de Milgrom et al. . Douze pour cent des femmes rapportaient des difficultés psychologiques anténatales (plus fréquentes en cas de niveau économique bas, consommation d’alcool/tabac, grossesse non planifiée, déclaration tardive, multiparité, grossesse compliquée) . Les femmes primipares, nées en France, de niveau éducatif élevé, en situation d’emploi, ou déclarant des difficultés psychologiques avaient plus souvent bénéficié de l’EPP et de la PNP . Les mères jeunes, bénéficiant de la CMU, ambivalentes quant à leur grossesse, ayant moins de 7 visites prénatales et des complications obstétricales suivaient, elles, moins fréquemment une PNP . Enfin, le soutien anténatal et les capacités d’autorégulation du bébé avaient des effets directs sur l’intensité de la symptomatologie dépressive à 2 mois post-partum, et le niveau socioéconomique, les problèmes de santé du bébé et la compréhension maternelle des pleurs avaient eux des effets indirects. L’impact prépondérant de facteurs anténatals et liés au bébé orientent vers des pistes originales de recherche et d’adaptation de la prévention des difficultés psychologiques périnatales maternelles au population socioéconomiquement vulnérables.

Facteurs cliniques et sociaux associés à la prescription de médicaments ciblant le TDA/H dans la cohorte québécoise ELDEQ

Contexte

L’influence de la comorbidité psychiatrique et de l’environnement social sur la prescription médicamenteuse du trouble déficit de l’attention/hyperactivité (TDA/H) reste mal comprise.

Objectif

Évaluer l’effet des facteurs comportementaux et sociaux sur la prescription de médicaments ciblant le TDA/H.

Méthodes

Les données de la cohorte de naissance Étude Longitudinale du Développement des Enfants du Québec (ELDEQ) ont été analysées par des modèles de survie avec variables dépendantes du temps. L’échantillon (n = 1920) a été évalué de l’âge de 5 mois à 10 ans. Des mesures des symptômes psychiatriques de l’enfant et des variables de l’environnement social étaient disponibles pendant tout le suivi de la cohorte et ont permis d’étudier les facteurs comportementaux et sociaux associés à la prescription de médicaments ciblant le TDA/H.

Résultats

De l’âge de 3,5 ans à 10 ans, 0,2 à 8,6 % des enfants de l’échantillon ont été exposés à des médicaments ciblant le TDA/H. L’hyperactivité-inattention était le facteur le plus fortement associé à cette exposition (hazard ratio [HR] = 2,75, IC95 % 2,35–3,22). Parmi les variables sociales étudiées, un bas niveau éducatif maternel augmentait le risque d’usage de médicament (HR = 2,09, IC95 % 1,38–3,18) alors que le statut d’immigrant diminuait ce risque (HR = 0,40, IC95 % 0,17–0,92).

Conclusions

Au-delà des symptômes du TDA/H, la probabilité de recevoir un traitement pour le TDA/H était influencée par des variables sociales et non par d’autres variables cliniques ou par les pratiques parentales. Ces résultats soulignent la nécessité d’améliorer les interventions globales du TDA/H, notamment les interventions psychoéducatives.

Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France

BACKGROUND

Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors.

METHOD

Mothers (N = 1807) from the EDEN mother-child birth cohort study based in France (2003-2011) were followed from 24-28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership.

RESULTS

Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy.

CONCLUSIONS

Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.

Maternal tobacco smoking in pregnancy and children's socio-emotional development at age 5: The EDEN mother-child birth cohort study

BACKGROUND

There is debate as to whether maternal tobacco use in pregnancy is related to offspring behaviour later on. We tested this association examining multiple aspects of children's behaviour at age 5 and accounting for parental smoking outside of pregnancy, as well as child and family characteristics.

METHODS

Data come from a prospective community based birth cohort study (EDEN; n=1113 families in France followed since pregnancy in 2003-2005 until the child's 5th birthday). Maternal tobacco use in pregnancy was self-reported. Children's socio-emotional development (emotional symptoms, conduct problems, symptoms of hyperactivity/inattention, peer relationship problems, prosocial behaviour) was assessed by mothers using the Strengths and Difficulties Questionnaire (SDQ) at age 5 years. Logistic regression analyses controlled for Inverse Probability Weights (IPW) of maternal tobacco use calculated based on study center, children's characteristics (sex, premature birth, low birth weight, breastfeeding), maternal characteristics (age at the child's birth, psychological difficulties and alcohol use in pregnancy, post-pregnancy depression, and smoking), paternal smoking in and post-pregnancy, parental educational attainment, family income, parental separation, and maternal negative life events.

RESULTS

Maternal smoking in pregnancy only predicted children's high symptoms of hyperactivity/inattention (sex and study center-adjusted ORs: maternal smoking in the 1st trimester: 1.95, 95%CI: 1.13-3.38; maternal smoking throughout pregnancy: OR=2.11, 95%CI: 1.36-3.27). In IPW-controlled regression models, only children of mothers who smoked throughout pregnancy had significantly elevated levels of hyperactivity/inattention (OR=2.20, 95%CI: 1.21-4.00).

CONCLUSIONS

Maternal tobacco smoking in pregnancy may contribute directly or through epigenetic mechanisms to children's symptoms of hyperactivity/inattention.

Excess non-psychiatric hospitalizations among employees with mental disorders: a 10-year prospective study of the GAZEL cohort

OBJECTIVE

To examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders.

METHOD

In a cohort of 15,811 employees, aged 35-50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up.

RESULTS

After controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR=1.20 (95%, 1.14-1.26)], as well as hospitalization due to MI [IRR=1.44 (95%, 1.12-1.85)]. For stroke, the IRR did not reach statistical significance [IRR=1.37 (95%, 0.95-1.99)] and there was no association with cancer [IRR=1.01 (95%, 0.86-1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder).

CONCLUSION

In this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations.

Attempted and completed suicide in primary care: not what we expected?

BACKGROUND

General Practitioners (GPs) play a central role in suicide prevention. This study aims to compare the characteristics of individuals who attempt suicide to those who complete suicide in a same primary care setting.

METHODS

We compared the characteristics and GP's management of all patients with attempted (N=498, SA) or completed suicide (N=141, SC) reported to the GPs'French Sentinelles surveillance system (2009-2013).

RESULTS

Compared to patients who attempted suicide, those who completed suicide were more likely to be male, older and to have used a more lethal method; for men they were less likely to have a history of previous suicide attempt and prior contacts with their GP. In terms of GPs' management, we found no differences between the SA and SC groups in the identification of psychological difficulties and in the care, but GPs were more likely to provide psychological support to the SA group. During the last consultation, the SC group expressed suicidal ideas more frequently than the SA group (26.7% vs. 14.8%, p<0.01), only for women.

LIMITATIONS

The network may have missed cases and selected more serious SA.

CONCLUSIONS

Individuals who commit suicide differ from those who attempt suicide in terms of demographic characteristics and by sex, of history of suicide attempt, previous contact and expressed suicidal ideas. We show that GPs do not act more intensively with patients who will commit suicide, as if they do not foresee them. Current prevention programs particularly in primary care should be tailored.

Characterization of the fast GABAergic inhibitory action of etifoxine during spinal nociceptive processing in male rats

Etifoxine (EFX) is a non-benzodiazepine anxiolytic which potentiate GABAA receptor (GABAAR) function directly or indirectly via the production of 3α-reduced neurosteroids. The later effect is now recognized to account for the long-term reduction of pain symptoms in various neuropathic and inflammatory pain models. In the present study, we characterized the acute antinociceptive properties of EFX during spinal pain processing in naive and monoarthritic rats using in vivo electrophysiology. The topical application of EFX on lumbar spinal cord segment, at concentrations higher than 30 μM, reduced the excitability of wide dynamic range neurons receiving non-nociceptive and nociceptive inputs. Windup discharge resulting from the repetitive stimulation of the peripheral receptive field, and recognized as a short-term plastic process seen in central nociceptive sensitization, was significantly inhibited by EFX at these concentrations. In good agreement, mechanical nociceptive thresholds were also significantly increased following an acute intrathecal injection of EFX. The acute modulatory properties of EFX on spinal pain processing were never seen in the simultaneous presence of bicuculline. This result further confirmed EFX antinociception to result from the potentiation of spinal GABAA receptor function.