Repeated bullying at the workplace in medical students and young doctors: the MESSIAEN national study

Despite clues indicating high Bullying at the Work Place (BWP) rates in French hospitals, there has been no quantitative study so far. To determine the prevalence of repeated BWP in a national sample of French young physicians; its risk factors, and the mental health consequences of BWP. The study is a cross-sectional observational epidemiological national study addressed to young physicians. The online internet anonymous questionnaire was elaborated according to previous studies exploring BWP. In addition, we explored the quality of initial training. BWP was defined according to the French legal definition. Mental health was assessed by Hamilton Anxiety and Depression scale, psychotropic drug consumption and psychotherapy follow-up. A Structured Equation Modeling (SEM) was carried out to confirm our theoretical model. 2003 participants of the 37 French medical faculties were included. At least one history of BWP was identified in 41.7% of the participants. The SEM model showed good fit (RMSEA = 0.025, CFI = 0.93, TLI = 0.92, WRMR = 1.285). In the SEM model, BWP was associated with age and number of monthly night shifts and weekly worked hours. Obstetric gynecology, psychiatry, surgery, and medical specialties and low-quality initial training were associated with higher risk of BWP. BWP was associated with increased anxiety and depressive symptoms, daily antidepressant and anxiolytic consumption, and psychotherapy follow-up. Decreasing worked hours and night shifts and improving the quality of the initial training may help preventing BWP among medical students and young physicians. Obstetric gynecology, surgical and medical specialties, and psychiatry should be targeted with a focus on developing prevention programs.

Anxiety and depression in young physicians: Prevalence and associated factors. The MESSIAEN national study

BACKGROUND

Physicians are at risk of anxiety and depression.

OBJECTIVES

To determine the prevalence of anxiety and depression in a national sample of young physicians and their associated factors.

METHODS

The study is a cross-sectional observational epidemiological national study. An online anonymous questionnaire was administered to the young physicians of all French medical faculties. Anxiety and depression were assessed with the Hamilton Anxiety & Depression scale subscores for anxiety and depression. Psychotropic drug consumption, psychotherapy follow-up and other variables were self-declared.

RESULTS

Of the 2003 study participants, 32.3% reported a current anxiety disorder and 8.7% a current major depressive disorder according to their HAD scores and less than one on five of them was followed-up in psychotherapy or treated by antidepressant. Moral harassment, a bad quality of initial formation regarding dealing with disease and alcohol consumption were all associated with respectively anxiety disorder and major depression in multivariate analyses. Medical vocation was specifically associated with decreased major depression while being woman and increased coffee consumption were specifically associated with increased anxiety disorders.

CONCLUSION

Almost one third of medical students reported anxiety disorder or major depression and less than one on five received the recommended treatment (psychotherapy or antidepressant). The prevention and treatment of psychiatric disorders should be improved in this population. Moral harassment exposure, alcohol and coffee consumptions, bad quality of initial formation regarding dealing with disease have been identified as modifiable factors associated with poor mental health. Despite the absence of causal associations, these results yield some clues to guide future mental health prevention strategies in this population.

[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.

Sexual-orientation based discrimination is associated with anxiety and depression in young physicians. A national study

INTRODUCTION

The professional risk factors for depression and anxiety are underexplored in young physicians. While there has been increasing research on the mental health and well-being of lesbian, gay and bisexual patients, few studies have examined the mental health and well-being of lesbian, gay and bisexual young physicians.

OBJECTIVE

The objective of the present study was to determine the prevalence of Sexual Orientation-Based Discrimination (SOBD) in French young physicians and if SOBD was associated with increased anxiety and depression in this population.

METHOD

This national study is a cross-sectional observational epidemiological national study. The participants were recruited between April 1^st 2019 and June 31^st 2019. One question with binary answer was asked on SOBD. Mental health was assessed by Hamilton Anxiety & Depression scales.

RESULTS

On the 2003 participants, 148 (7%) reported SOBD exposure, 647 (32%) current anxiety disorders and 174 (9%) a current major depressive disorder according to their HAD score. SOBD was almost twice more frequently reported in participants with anxiety disorder and major depression (respectively 10%,vs 6% and 12% vs. 7%, p<0.05). In the first model of multivariate analyses, current anxiety disorder was significantly associated with being woman (adjusted odds ratio aOR=1.688, 95%CI 1.350-2.110, p<0.001) and SOBD (aOR=1.729, 95%CI 1.226-2.440, p=0.002). In the second model of multivariate analyses, current major depression was significantly associated with only SOBD (aOR=1.748, 95%CI 1.057-2.888, p=0.029).

CONCLUSION

SOBD has been associated with increased rates of anxiety disorder and major depression in young physicians and should be targeted in mental health prevention programs.

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.

The potential for adaptation in a natural Daphnia magna population: broad and narrow-sense heritability of net reproductive rate under Cd stress at two temperatures

The existence of genetic variability is a key element of the adaptive potential of a natural population to stress. In this study we estimated the additive and non-additive components of the genetic variability of net reproductive rate (R(0)) in a natural Daphnia magna population exposed to Cd stress at two different temperatures. To this end, life-table experiments were conducted with 20 parental and 39 offspring clonal lineages following a 2 × 2 design with Cd concentration (control vs. 3.7 μg Cd/L) and temperature (20 vs. 24 °C) as factors. Offspring lineages were obtained through inter-clonal crossing of the different parental lineages. The population mean, additive and non-additive genetic components of variation in each treatment were estimated by fitting an Animal Model to the observed R(0) values using restricted maximum likelihood estimation. From those estimates broad-sense heritabilities (H(2)), narrow-sense heritabilities (h(2)), total (CV(G)) and additive genetic coefficients of variation (CV(A)) of R(0) were calculated. The exposure to Cd imposed a considerable level of stress to the population, as shown by the fact that the population mean of R(0) exposed to Cd was significantly lower than in the control at the corresponding temperature, i.e. by 23 % at 20 °C and by 88 % at 24 °C. The latter difference indicates that increasing temperature increased the stress level imposed by Cd. The H² and CV(G) were significantly greater than 0 in all treatments, suggesting that there is a considerable degree of genetic determination of R(0) in this population and that clonal selection could rapidly lead to increasing population mean fitness under all investigated conditions. More specifically, the H² was 0.392 at 20 °C+Cd and 0.563 at 24 °C+Cd; the CV(G) was 30.0 % at 20 °C+Cd and was significantly higher (147.6 %) in the 24 °C+Cd treatment. Significant values of h(2) (= 0.23) and CV(A) (= 89.7 %) were only found in the 24 °C+Cd treatment, suggesting that the ability to produce more offspring under this stressful condition may be inherited across sexual generations. In contrast, in the less stressful 20 °C+Cd treatment the h(2) (0.06) and CV(A) (7.0 %) were very low and not significantly higher than zero. Collectively our data indicate that both the asexual and sexual reproduction phases in cyclic parthenogenetic D. magna populations may play a role in the long-term adaptive potential of Daphnia populations to chemical stress (with Cd as the current example) and that environmental variables which influence the stress level of that chemical may influence this adaptive potential (with temperature as current example).