Mediating effect of sleep in the association between social media use and mental health among French adolescents during the COVID-19 sanitary crisis

OBJECTIVE/BACKGROUND

Social media use could have deleterious effects on mental health through short sleep duration and poor sleep quality among adolescents. This study aimed to investigate the mediating role of both sleep duration and sleep quality in the association between social media use and mental health among adolescents.

PATIENTS/METHODS

We used cross-sectional data collected from adolescents in the EXIST pilot project conducted during COVID-19 pandemic. Adolescents self-reported wellbeing (WEMWBS), anxiety and depression (HADS) as mental health outcomes. We used ad-hoc questionnaires to assess social media use during weekdays and weekend days, and sleep duration and quality. Mediation analyses were carried out following Baron and Kenny's method, using adjusted linear regression models.

RESULTS

A total of 340 adolescents (13.5 ± 0.6 years, 45.3 % girls) were included. Greater social media use, poorer sleep quality, and shorter sleep duration were associated with poorer mental health. Greater social media use was associated with poorer sleep quality only during the weekend days. The total effect of social media use during weekend days on anxiety (β = 2.54; 95%CI [-1.59; 6.68]) was significantly conveyed through sleep quality (β = 1.22; 95%CI [0.17; 2.62]; mediated proportion = 48.0 %) and duration (mediated proportion = 46.8 %). Mediated proportions ranged from 12.5 % to 20.6 % for wellbeing and depression. Mediating effects were not evident during weekdays.

CONCLUSIONS

Sleep duration and quality mediated the association between social media use and mental health among adolescents during weekend days but not weekdays. Our findings highlight the importance of promoting healthy social media habits, especially during periods of increased reliance on digital platforms, such as COVID-19 pandemic.

[The evolution of child psychiatry emergencies: Results and reflections from a Nancy University Hospital study]

INTRODUCTION

Mental illness is one of the most common causes of disability, morbidity and mortality in childhood. According to the scientific literature, the prevalence of mental health disorders is an estimated 10% to 20% in the USA and similar results are found in France. Although primordial, outpatient care often appears insufficient with inequalities in its geographical distribution and its accessibility. These past decades have been marked by an increase in consultations for mental disorders in pediatric emergency departments. Is this trend indicative of a "defect" in the healthcare organization? Identifying the root causes of this inflation in psychiatric consultations seems of paramount importance in the improvement of healthcare policies. In France and worldwide, only a few studies deal with this subject. That is why we proposed to observe the evolution of the number of consultations for mental health reasons in the pediatric emergency department of Nancy University Hospital and to detail their characteristics.

MATERIALS AND METHODS

Ancillary comparative and retrospective study (2003-2013) on minors having received a child psychiatry consultation within the pediatric emergency department of Nancy University Hospital.

RESULTS

The number of consultations for mental health reasons increased by 119% (97 in 2003; 212 in 2013), while consultations for pediatrics reasons remained stable over the period studied. Consultations mainly dealt with females representing 55.6% of consultations in 2003 and 63.7% in 2013. Mean age of consultants was stable: 13.9 years (standard deviation=3.3 years) in 2003; 14.1 (2.5) years in 2013. Family structure witnessed a three-fold increase in the single-parent model. Regarding consultation motives, behavioral disorders were significantly more represented in 2013: 27.7% (RR=1.7; 95% CI 1.0-2.8; P<0.05) versus 16.5%. As far as diagnosis is concerned (ICD-10), emotional and behavioral disorders increased to 35.9% from 12.6% (RR=2.8; IC95% 1.6-5.1; P=0.0001).

CONCLUSIONS

In France, as well as in other western countries, the number of visits in pediatric emergency departments for mental health reasons more than doubled over a 10-year span. This growth mostly concerned externalizing disorders as a motive for consultation. Causes for this increase are multifactorial and closely related to the prevalence of psychiatric disorders in children. Some studies showed that economic factors played a major role on mental illness during such a downturn as the financial crisis of 2007-2008. Unemployment caused by economic crises can weaken pediatric caregivers and therefore their patients. Evolution of family structure and value also explains this trend. These past decades, the two-parent model, relevant till the 1960s, has evolved to a point where single parents are more quickly overwhelmed. Family values are now focused on consensus rather than duty and hedonism has become a central value. Women are more involved in the working world which became for all a performance field. Several studies have shown that social settings where competitiveness is the norm breed externalized disorders in children by advocating short-term efficiency. Moreover, the widespread use of screens in households as well as early exposure impact the psychomotor development, decrease the amount of sleep and may be responsible for the occurrence of many psychiatric disorders. There are some epidemiological reasons too. In 1971, Omran introduced a concept called "epidemiological transition" explaining how mental health issues appeared in the limelight through to the decline of infectious and cardiovascular diseases. This phenomenon has already occurred in western countries which could explain the increase in the prevalence of psychiatric disorders. In Africa, there is evidence it may have already started. Beyond all these considerations, the increase in consultations for mental disorders in pediatric emergency departments can be explained by a change in care consumption habits. Going straight to the local emergency department, accessible on a 24/7 basis, is easier than waiting for an outpatient appointment and is also free for the have-nots lacking proper insurance coverage. Scarce resources in ambulatory care may also explain the increased recourse to emergency services. Several reports have shown a lack of child psychiatrists and their uneven geographical distribution. For example, in the US only a third of children with mental disorders receive proper care, a lack which doubled between 1997 and 2010. Despite the reason for this trend, it is important to propose a better fitting of the healthcare system to the population needs, and to improve prevention and early identification. All these changes require further collective reflection.

Ten years psychosocial outcomes among adolescents following suicide attempts - early recurrence and psychosocial outcomes

OBJECTIVES

A suicide attempt (SA) is a major risk factor of recurrent SA in adolescence and may be associated with psychological or social problems in the future. REPEATERS is a longitudinal study which examines the long-term psychosocial outcome of adolescents following attempted suicide. It focuses on the impact of early recurrence (i.e., within the first year of the index SA) - data which is, in fact, poorly documented.

METHODS

Ten years after the index SA, a self-reporting questionnaire was sent to all adolescents who had attempted suicide and were followed up by the CHRU (Regional University Hospital Centre) de Nancy, France, between 1994 and 2003 and their parents. The purpose of this questionnaire was to assess psychosocial outcomes. Data concerning SA were collected retrospectively.

RESULTS

After ten years, 146 of the 309 adolescents who had attempted suicide and were participating in the study had responded: 90% lived with a partner and 41% had children. The mean (SD) current emotional life of suicide attempt survivors scored 7.3 (2.3) on a scale of 0 to 10. Compared to the general population of the same age, responders felt more depressed than their peers (29% vs. less than 8% of males and 20% of females), had more suicidal thoughts (14% vs. 5%), and had more SAs (27% vs. 0.3%). Moreover, the risk of recurrence over the ten year period was associated with suicide recurrence in the first year after the index SA (odds ratio [OR]=2.3; 95% confidence interval [CI]=1.1-4.9) and with a lower level of education at ten years (OR=0.37; 95% CI=0.19-0.45).

CONCLUSIONS

Although a favorable outcome was reported ten years after the event for the majority of adolescents who had attempted suicide, some with a lower level of education were nevertheless at increased risk of recurrence and depression. Post-intervention strategies are therefore essential in order to evaluate risk factors which may persist if not taken into consideration.

[Psychopathological consequences of confinement]

The psychological effects of isolation have already been described in the literature (polar expeditions, submarines, prison). Nevertheless, the scale of confinement implemented during the COVID-19 pandemic is unprecedented. In addition to reviewing the published studies, we need to anticipate the psychological problems that could arise during or at a distance from confinement. We have gone beyond the COVID-19 literature in order to examine the implications of the known consequences of confinement, like boredom, social isolation, stress, or sleep deprivation. Anxiety, post-traumatic stress disorder, depression, suicidal or addictive behaviours, domestic violence are described effects of confinement, but the mechanisms of emergence of these disorders and their interrelationships remain to be studied. For example, what are the mechanisms of emergence of post-traumatic stress disorders in the context of confinement? We also remind the reader of points of vigilance to be kept in mind with regard to eating disorders and hallucinations. Hallucinations are curiously ignored in the literature on confinement, whereas a vast literature links social isolation and hallucinations. Due to the broad psychopathological consequences, we have to look for these various symptoms to manage them. We quickly summarize the diagnostic and therapeutic approaches already in place, such as telemedicine, which is undergoing rapid development during the COVID-19 crisis.

Simulation médicale en psychiatrie

L’exercice de la psychiatrie n’est pas un exercice médical instrumental mais repose pour une grande part sur l’action directe des soignants. De ce fait, son enseignement ne peut pas être exclusivement théorique mais doit également reposer sur l’expérience vécue. Celle-ci peut reposer sur la simulation médicale permet de se forger une expérience clinique sans mettre en danger de patient. Elle est par exemple employée pour l’enseignement de la réanimation cardiovasculaire ou encore en gynécologie-obstétrique. La Haute Autorité de santé recommande l’emploi de la simulation médicale pour l’enseignement de toutes les disciplines cliniques, psychiatrie inclue. Mais, si la littérature retrouve un usage de cette technique dans différents pays, le rapport Granry et Moll a récemment souligné qu’elle était encore peu employée dans l’enseignement psychiatrique en France. Nous nous sommes interrogés sur la pertinence et l’usage de ce type d’outil dans l’enseignement de la technique d’entretien psychiatrique. Nous proposons de décrire une expérience d’enseignement par simulation ayant eu lieu de 2012 à 2014 au centre universitaire d’enseignement par simulation médicale à Nancy. Cette expérience était destinée à un public d’internes en psychiatrie et portait sur une situation clinique d’urgence. L’objectif principal était de valider l’intérêt de l’enseignement par simulation pour les techniques d’entretien psychiatrique. Nous avons également évalué la pertinence d’outils de mesure de l’efficacité de l’investigation. Cette expérience a mis en avant l’intérêt majeur des étudiants en psychiatrie pour ce type d’enseignement. Elle a également permis de valider un outil d’évaluation de l’efficacité de l’investigation objectif et pertinent. Si l’enseignement par simulation montre son intérêt, il requiert des conditions matérielles très spécifiques que nous discutons ici. Par ailleurs, il s’applique prioritairement à certaines compétences ciblées. Sur la base de cette expérience, un programme structuré d’enseignement par simulation a été développé pour le début d’internat à Nancy.

Quantifying efficacy of investigation during a simulated psychiatric interview

INTRODUCTION

Simulation is a very promising educational tool. It provides medical students with clinical experience without jeopardizing patients' health. This tool can be implemented in psychiatry training in order to develop interview and specific assessment skills which is why the Université de Lorraine relies increasingly on simulation in teaching psychiatry to its residents. However, there are few objective indicators in that field that make it possible to assess learners. This study aims to assess the relevance of a quantitative measure for objectivising the investigation efficiency by psychiatry residents of a suicidal risk during a simulated psychiatric interview.

METHODS

A simulation exercise was offered to 20 psychiatric trainees from the Université de Lorraine. Their mission was to identify relevant information for assessing and guiding a standardized patient with suicidal risk during a psychiatric interview. The key judgemental criterion was the I²/Q ratio which corresponds to the squared number of relevant items collected by the interviewer divided by the number of questions. When dealing with emergency cases it is indeed important to collect as many key items in as little time as possible. This score was assessed by two examiners based on the analysis of filmed interviews.

RESULTS

The mean I²/Q ratio was 1.13 (SEM±0.2) and ranged between 0.25 and 2.86. Statistical analysis showed a positive correlation between I²/Q ratio and students' clinical experience (R=0.46, P=0.04). The interclass correlation coefficient (ICC) of the I²/Q ratio between the two examiners was 0.94.

CONCLUSION

I²/Q ratio may provide a consistent quantitative measure of a student's efficiency in assessing suicidal risk. Further research is now needed to evaluate its consistency in other clinical cases.

[Relevance and experience of surveillance and brief contact intervention systems in preventing reattempts of suicide among children and adolescents]

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.

Étude dimensionnelle des phases précoces des troubles affectifs et de la schizophrénie – Étude rétrospective comparative à propos de 100 cas

Objectif

Comparer rétrospectivement la clinique de l’enfance et de l’adolescence d’une population d’adultes schizophrènes avec celle d’adultes bipolaires, afin de mettre en évidence des manifestations prémorbides et des prodromes plus spécifiques à l’une ou l’autre des pathologies.

Méthode

Divers symptômes ont été recueillis dans les anciens dossiers pédopsychiatriques de 50 patients schizophrènes et de 50 patients bipolaires, grâce à une grille de recueil réalisée et évaluée par les auteurs. Ces symptômes ont ensuite été comparés entre les deux populations.

Résultats

La clinique de l’enfance du groupe schizophrène est marquée par un plus grand nombre de symptômes cognitifs tels qu’un Quotient Intellectuel bas, des troubles logicomathématiques, un retard de langage et des troubles de la concentration. L’énurésie et l’encoprésie semblent également plus spécifiques d’une évolution vers une schizophrénie par rapport à un trouble du spectre bipolaire. La clinique de l’adolescence du groupe schizophrène est marquée par un plus grand repli social, un quotient intellectuel bas et des troubles logicomathématiques. Les symptômes négatifs et positifs (éléments évoquant une discordance, bizarreries du comportement et des propos) sont des prodromes assez spécifiques de la schizophrénie par rapport aux troubles bipolaires. Les fluctuations thymiques constitueraient le seul symptôme réellement spécifique d’une évolution vers un trouble du spectre bipolaire par rapport à une schizophrénie.

Conclusion

Les phases prémorbide et prodromique de la schizophrénie se caractérisent par des symptômes psychocomportementaux qualitativement et quantitativement plus sévères que celle des troubles du spectre bipolaire.

En outre, les troubles bipolaires et la schizophrénie semblent précédés, à l’adolescence, d’une phase prodromique constituée de symptômes déjà évocateurs de ceux caractérisant la pathologie à l’âge adulte mais dans une expression atténuée. Ceci marquant une continuité entre l’adolescence et l’âge adulte.