Anxiété et dépression associées à la prise en charge de la COVID-19 chez les personnels de santé au Cameroun

ObjectiveThe COVID-19 pandemic has had a significant impact worldwide, at different levels. The literature consulted indicates that healthcare workers, who are the first to respond, are generally the ones who pay the highest price. The present study assesses the extent of anxious and depressive symptoms among these actors responding to COVID-19, in the context of Cameroon.MethodThe Hospital Anxiety and Depression Scale (HADS) was used to assess anxious and depressive symptoms. Data collection involved the use of a web questionnaire for this purpose through the Google Forms virtual platform. The questionnaire link was sent to professional groups spread throughout Cameroon's ten regions. A total of 331 health professionals were interviewed over the period from April 5 to 19, 2020.ResultThe results show a high rate of anxiety (41.8%) and depression (42.8%). There is a higher susceptibility to depression in young people (30-39 years). Fear of contamination and fear of death are modulators of depression and anxiety. The anxiety-depression comorbidity in the sample is 14.73%. The prevalence rates of major depressive disorder and adjustment disorder in the sample were 8.2% and 3.3%, respectively. The data presented confirm the trends recorded in the literature regarding the impact of fatal epidemics on the mental health of healthcare workers.DiscussionThe results indicate, as is the case with most of the work consulted in the literature, that the Covid 19 pandemic is significantly affecting the mental health of healthcare workers. This underlines the urgency of setting up a specialized aid and/or support system, in the context of the current pandemic, such as that of similar health crises. Such a device does not exist in Cameroon, where the mental health response remains weak.ConclusionThese results suggest that the healthcare staff involved in the response to COVID-19 in Cameroon are significantly affected in their mental health. This underlines the need for specialized psychological help for nursing staff.     

Répercussions psychologiques de la pandémie de COVID-19 chez les enfants et les adolescents et modalités de prise en charge

Children and adolescents were particularly affected by the psychological consequences of the COVID-19 health crisis. They were faced with multiple stressors such as repeated confinements, the use of masks, the disruption of daily routines, the lack of social interactions following the closure of schools and the cessation of extra-curricular activities. These adversities dramatically weakened their coping strategies and their resources. In this interview with Jean-Pierre Bouchard, Olivier Sorel, Juliane Tortes Saint-Jammes et Sandie Meillerais discuss the changes that have been implemented in their clinical practice for children in the context of the COVID-19 pandemic. Then, they will also identify, by using clinical examples, the procedures specifically used to develop, reinforce or reactivate the resources of children and adolescents during the therapy. Finally, they address the very notion of clinical support, with an emphasis on EMDR therapy and a family-centered approach.     

Chaleur,sport et santé. Partie 1 : Impact psychologique de la chaleur sur la santé des sportifs

The individual determinants of sports performance, whether physical, physiological or psychological, are the subject of a dense literature aiming to understand better what makes an athlete perform and how, through training, one can lead him or her to progress. In this search for performance, it very quickly became apparent that the environment could play an important role and some training programs now incorporate environmental conditions as one of several levers. Training at altitude or in a hot and humid environment are indeed avenues that have been successfully explored. But if the environment is used as a lever for training, it is because it places physiological and psychological constraints on the organism that require adaptations. Indeed, the human body, repeatedly exposed to exercise conditions that exceed its initial capacities, adapts. This is the fundamental principle of training. However, extreme environmental constraints such as high temperature, when not controlled, as is the case in competition, amplify the stress imposed on the body, and the athlete may, driven by his or her desire to win, go beyond his or her limits and expose himself or herself to significant health risks. This problem has recently become particularly salient with, on the one hand, global warming which is progressively raising the temperatures at which competitions are held, and on the other hand, the desire of certain emerging countries to offer major international competitions in environments which are sometimes particularly unsuitable for aerobic performance due to temperature and even hygrometry conditions which go well beyond the thermolysis capacities of the human organism during intense effort. If the components of sports performance (physical, physiological and psychological) are well documented in the scientific literature and fairly well taken into account by coaches and athletes, the thermal constraints in which training and competitions take place are much less considered, even though taking them into account is essential to perform without risk to health. The study of these constraints on psychological functioning is therefore a major issue. In this first part of the interview, Drs. Coudevylle, Collado and Sinnapah discuss the negative impact of the hot climate on psychological functioning (perceptions, cognition, affects) as well as on the associated risk of injury or accident.     

La santé du sommeil en psychiatrie : à la croisée de la physiologie et de la santé publique

The concept, and analysis, of sleep can often open the door to new health studies and strategies in psychiatry. Sleep is indeed a physiological and behavioral function essential to mental health. First, we need to screen and treat comorbid sleep disorders in persons with mental disorders. A sleep disorder is a pathological condition related to a sleep dysfunction that interferes with an individual's health. Scales can be used to help screen for sleep disorders in persons with a mental disorder. In return, psychiatry, through its attention to mental symptomatology, can provide important elements to better detect, delineate, and define sleep disorders. Second, we need to assess sleep alterations and a person's sleep health related to mental disorders. Indeed, the absence of a comorbid sleep disorder is not necessarily associated with good sleep health in persons with a mental disorder. The mental disorder may indeed impact sleep through a common pathophysiology, but also through non-optimal sleep behaviors for health. Scales can be used to assess sleep health in persons with a mental disorder. The implementation of preventive measures targeting sleep as a modifiable behavior in psychiatry is also necessary. In return, psychiatry, with its attention to behavior, can provide important elements for the development of integrative models to predict the relationship between sleep health and mental health, and propose an iterative approach between behavioral change models and pathophysiological models of mental disorders and sleep disorders, and can also design prevention strategies that improve sleep health that will have a real impact on mental health.     

Réflexions sur le « contact » et le « regard » en clinique psychiatrique

GoalsThis article explores the semiological value of contact and of the gaze in clinical practices. It questions the subjectivity involved in the caregiver/patient relationship and in nosography.MethodologyThe authors examine the place of the gaze based on writings of 19th-century alienists. Then, they question the clinician's subjective experience–through the concepts of “sentiment” (Binswanger, Minkowski) and “praecox Gefühl” (Rümke) from the accounts of early stages of the clinical encounter.ResultsThe gaze plays a specific role in the early stages of the clinical encounter, especially in the landscape of schizophrenia. A draft classification of different types of gazes (off-center gaze, white gaze, ecstatic gaze, black gaze) is proposed, then nuanced.DiscussionAny attempt to classify the gaze leads to the deconstruction of any fixed typology. The gaze resists verbalization and even meaning, and in this, belongs to the dimension of anguish, an essential affect in a practice that does not seek to do away with relationship.ConclusionAt a time of increasing research in “eye movement abnormalities” in schizophrenia, it seems essential to renew our interest in the relational and therefore subjective–dimension as a specificity in clinical psychiatry. The gaze, then, would be this area without a place, this primary area of contact where relationship begins… or not.     

Impact psychologique de la pandémie de la COVID-19 : comparaison entre des Français métropolitains et de l’île de La Réunion

ObjectivesThe COVID-19 pandemic raised a lot of anxiety around the world. France is composed of several overseas territories with major cultural differences but also with a different exposure to the COVID-19. Reunion Island is the most populated overseas French department, but few researches have focused on this population. Therefore, the main objective was to explore and compare the impact of the COVID-19 pandemic (perceived stress, risk and fear of being infected, severity, lockdown respect, perceived stress, quality of life, quality of relationship, loneliness, resilience) during the lockdown among residents of metropolitan France and of Reunion Island.Material and methodsA sample of 347 participants, aged from 18 to 78 (M = 37.90; DS = 13.20) replied to a questionnaire posted online during the last ten days of the lockdown in France. The sample is divided into 227 metropolitans (M = 38.24 DS = 13.41; 13.2% of men) and 120 residents of Reunion Island (M = 37.26; DS = 12.81; 31.7% of men). Resilience, loneliness and perceived stress have been assessed using validating scales while specific items have been created to assess COVID-19 impacts.ResultsThe majority of the total sample has been little exposed to the COVID-19, but the estimated severity was high throughout the sample. Several significant differences have been observed between overseas and metropolitans. The latter, who were more exposed, were more respectful of lockdown measures and felt more concerned about being contaminated. They also had different professional activities (work at home, stop working) since the lockdown than did the overseas sample. Non-significant higher scores of resilience and quality of life during the lockdown contrast in the overseas sample, who estimated risk, fear and severity similarly. In correlational analyses, many relationships were significant only in one sample. For example, in metropolitans the higher the loneliness, the higher the severity. In the other sample, the higher the perceived stress, the higher the respect of lockdown measures, while more metropolitans felt lonely the more they respected these measures. Regressional analysis showed different predictive variables of the scores of perceived stress and fear of being contaminated. In metropolitans, stress was explained by COVID-19 related variables (fear, severity, respect), loneliness and negatively by resilience and quality of life while in the other sample it was explained by fear of being infected and negatively by resilience. Fear of being infected was explained by risk and stress in the overseas, but also by quality of life in the metropolitan sample.ConclusionsThis study brings new data on the important psychosocial impact of the COVID-19 pandemic on two French samples. Observed differences highlight a higher fear of being infected among the metropolitans who were generally more exposed. Overseas from La Réunion did not feel more spared by this risk, despite the limited number of cases since the appearance of the first case in March 11th and the end of the lockdown in May 11th. Despite exposure, our results could be explained by several cultural differences such as way of life or beliefs. Overseas life in Reunion Island might bring more resilience and less loneliness given the particular familial, social and religious functioning. Given the limits of this study and the lack of similar comparisons, more work could highlight the protective factors of these populations.     

Étude CONFAMI : effets du confinement durant l’épidémie de la COVID-19 sur la vie des enfants et leur famille

ObjectivesThe aim of this study is to understand the changes within families during confinement motivated by the COVID-19 pandemic and to explore the psycho-emotional experiences of children and their parents in this new situation. Confinement necessarily induced significant changes in daily family routines, particularly for work, education, leisure and social activities. In the more vulnerable pediatric population, several authors have warned of the need to consider the impact of lockdown measures during COVID-19 on the psychological impact and well-being.MethodThis is an anonymous online survey with methodology combining quantitative and qualitative analyses. The questions targeted several themes such as life context, emotional experience and the impact on daily habits in children and adolescents, as perceived by parents. Participants are adults and parents of at least one child. They were recruited through social media and email.ResultsA total of 439 parents responded to the questionnaire. The families generally stayed in their usual place of residence and managed to adapt well. On average, the children's level of worry (as estimated by parents) was lower than the level of worry parents attributed to themselves. For the majority, the parents did not observe any change, the psychological state of the children and adolescents was generally stable, but for those who experienced more negative emotions than usual, it was an increase in boredom, irritability and anger. A decrease in the quality of sleep was also observed by a third of the respondents. On the other hand, an increase in autonomy was noted. Regarding the quality of family cohabitation, an important result showed that confinement had improved family relationships for 41% parents but at the expense of usual social ties inducing a feeling of deprivation. Indeed, the participants evoke a lack of “social link” and “social contact with friends”. Lack became synonymous with absence, a feeling of loneliness and separation.ConclusionOur results confirm European and international data collected in children in countries where strict lockdown measures have been applied. Despite the negative emotions felt in some children, confinement has helped develop new resources in most families. Families seem to have been successful in maintaining a stable and secure routine which has certainly been a protective factor against anxiety. Some reported factors, such as bonding, could be protective factors and constitute good leads in interventions to be offered to children and their families.     

Obésité et bypass gastrique,impact sur la qualité de vie et le risque suicidaire : revue de la littérature

In the last few years, the flourishing number of surgery for morbid obesity induces a growing interest in the short, medium and long-term consequences of the operative procedures. Both massive overweight and its surgical treatment such as gastric bypass can influence the mental health of patients and have an impact on their risk of suicide and suicide rates. Indeed, the suicide rate after the surgical treatment of obesity is increased; although medical literature is prolific on the subject of quality of life after gastric bypass surgery, less is known about the causes of postoperative suicide. There are few theories that allow discussion or hypothesis making and among these none can explain alone the excess of preventable deaths. This raises many questions about the management of candidates for gastric bypass: Is it possible to improve preoperative screening of patient's compliance? Should psychiatric follow-up become compulsory after surgery? It appears obvious from the current literature that suicide rates are higher among gastric bypass patients than the general population. It is reasonable to assume that this finding is related to the psychological difficulties experienced by patients, the impact on their quality of life and social functioning, on emotional and on a professional level. The intervention and massive weight loss can often destabilize an already precarious balance. It seems necessary to strengthen the psychiatric treatment of candidates for bariatric surgery and discuss the value of mandatory postoperative follow-up, as well as to promote patient compliance. Bariatric surgery patients with a history of psychiatric comorbidities should benefit from strict preoperative consultations and appropriate medication in order to rigorously balance their condition before surgery. Postoperative measures should include monitoring of high-risk populations such as patients with psychiatric comorbidity, as well as considering couple psychotherapy or support groups for patients and their relatives.     

Améliorer la participation et le vécu des proches de personnes atteintes de schizophrénie dans le parcours de soins en santé mentale

ObjectivesSchizophrenia is a long-term, stigmatized disease which often leads to social impairment, unemployment and isolation, with heavy negative social and psychological consequences both on patients and their families. Close relatives’ perceptions of the illness have an impact on their mood, and then on the course of the patient's disease itself. In this context, our objective is to evaluate the perceptions of French close relatives of people with schizophrenia or schizophrenia spectrum disorders, about the disease itself, as well as their experience within the mental healthcare system.MethodsOur population is constituted of close relatives of people experiencing schizophrenia or schizophrenia spectrum disorders, recruited through an active patient and families association. We used a French translation of a standardized questionnaire, the Brief Illness Perception Questionnaire, as well as an extensive semi-structured interview assessing the experience of the mental healthcare system (diagnosis divulgation, information about disease and treatment, family psychoeducation, hospitalization experience, and access to health professionals). Some questions in the last were open-ended questions, which allowed us to gather detailed and personal responses, in order to be able to illustrate our quantitative findings with brief clinical cases.ResultsAmong the 27 close relatives included in our research, results to the standardized questionnaires show threatening perceptions of the disease, in particular regarding the probable duration of the disease and the frequency of symptoms. In our study, a better access to diagnosis is associated with a shorter perceived probable duration of the disease, while an easier communication with healthcare professionals (in particular nurses) is associated with the perception of a better efficiency of the treatment. Family psychoeducation seems to be associated with the perception of less frequent symptoms. When the patient lives independently or is older, close relatives of our sample perceive a higher risk of chronicity of the disease. Our results tend to confirm the available literature on the subject of information towards families in psychiatric services: indeed, studies, especially in the field of nursing research, have shown that families tend to feel excluded from care processes and from useful information exchanges about the patient's illness. Our study also confirms the fact that family psychoeducation seems to reduce the frequency of present symptoms in the patient as perceived by the close relative. This effect could be caused by a better understanding of the real symptoms or by an enhancement of the family mood and functioning. Even if the patient's hospitalization was a difficult or very difficult experience for close relatives, it showed no relationship with their illness negative perceptions. Sociodemographic variables of the patient, such as age or the fact of living in an independent household, were associated in our research with the close relatives’ view of a higher potential chronicity of the illness; this could be explained by a different stage of acceptation of the illness when compared to close relatives taking care of a younger or still dependent patient.ConclusionsOur results plead for further research on a larger and less homogeneous sample. Confirming our findings could help build useful recommendations leading to better integrated families who currently seem to feel relatively isolated and exclused in the healthcare process, despite the strategic role they could play and despite the many recommendations of public health policies in that matter. Efforts should continue to be made to reach the goal of a better inclusion of families and close relatives of people experiencing schizophrenia or schizophrenia spectrum disorders, in particular in the field of information and communication with health professionals, both areas which seem to have a potential effect on close relatives’ illness negative perceptions. Family psychoeducation deserves more attention and should be more systematically proposed to French families with an easier and free access.     

Quand le téléphone ne chauffe pas : les hotlines psy en situation de pandémie

In Switzerland and elsewhere, many psychological support hotlines were set up during the acute phase of the COVID-19 pandemic. Specialists in psychological first aid, in charge of developing and managing these hotlines, had to face an unknown situation, very different from the disasters for which they prepare themselves. Since the pandemic and the associated physical distancing were a potential threat to social cohesion, one could make the hypothesis that, by setting up hotlines, these professionals sought to reintroduce a form of proximity and to care for and cultivate the social connections among people. The pressure, feelings of emergency, anxious anticipation and expectation of the political authorities and the population may have favoured the development of these structures. Other factors certainly also played a role, such as the need to be useful and to exist as professional, or the need to act in order to reduce anxiety related to the pandemic. Altogether, these hotlines were little used, and their usefulness may be questioned. Similar phenomena have been observed – especially in the sanitary domain – with a multiplication of new offers, not always adjusted to specific identified needs, while health care services were on the same time under-used. Our observations plead against emergency responses in crisis situations and for reflecting on the measures to be put in place rather than to “act” them.     

Traumatisme et résilience associés à la pandémie de la COVID-19 dans les villes de Bafoussam et de Dschang au Cameroun

IntroductionThe emergence of the Covid-19 pandemic in Cameroon, as in Africa and around the world, was marked by a suddenness and unpredictability that fascinated the imagination. The considerable psychic and social repercussions of the pandemic mobilized a significant anguish of death. The sudden onset of the pandemic was followed by spectacular, high-profile deaths that fascinated the imagination, listing it in the order of traumatic events, provoking reactions of astonishment, flight and avoidance.GoalThe objective of this study is to determine the symptomatology of post-traumatic stress disorder, as well as the resilience, associated with the Covid-19 pandemic in the Western Region of Cameroon.MethodologyThe research was carried out following the model of general population mental health surveys. The availability of area frames (sampling) made it possible to opt for probabilistic calculations. First and second year master's students in clinical psychology from Dschang University were involved in data collection. They benefited from a two-day seminar on data collection techniques in the general population. The calculated sample size is 384 households. The anticipated response rate, set at 90%, made it possible to increase robustness and to anticipate a total sample of 424 households, spread over 3 districts of Bafoussam and Dschang, according to the choice previously made. The study followed the ethical provisions of the Helsinki Protocol. The data collection tools used are: the Impact of Event Scale-Revised and the Connor-Davidson Resilience Scale.Results409 subjects were recruited, representing a completion rate of 106.5%. 70.7% of subjects exhibited symptoms of PTSD. These symptoms are more often mild (40.9%) or moderate (25.6%). Women are more affected (73.7%) by PTSD than men (67.9%). In addition to sex and age, area of residence and marital status, appear to be significantly associated with symptoms of PTSD: subjects under 35 years of age have a significantly higher prevalence rate than those over 35; the rate of PTSD is significantly higher in subjects living in urban areas than in those living in rural areas; single subjects are more affected by PTSD (40.1%) than married subjects (26.7%). The average score recorded on the CD-RISC is 64.3, the standard deviation is 15.3 and the coefficient of variation is 24%. This average falls into the second quartile of the distribution, indicating average resilience. CD-RISC scores are not affected by gender, age, marital status, level of education, or occupational status. These characteristics are therefore not factors of resilience.ConclusionThe Covid-19 pandemic has had a psychological impact in Cameroon which has made it a major psychosocial stressor. More than 6 in 10 people have symptoms of PTSD. But this symptomatology is often weak or moderate, testifying to an effective resilience, to balance the traumatic effects of the pandemic.     

L’électroconvulsivothérapie en période périnatale : représentations des professionnels de santé mentale

IntroductionPsychiatric disorders are common in peripartum and are associated with adverse outcomes for mother and fetus. Electroconvulsive therapy (ECT) is one of the most effective and safe options to treat severe mental illness, including during the perinatal period. Nevertheless, it remains underutilized during this period, possibly due to negative representations. Research has been carried out on the representations and attitudes of caregivers towards ECT, but the specificities of these attitudes during peripartum have not been explored.ObjectivesWe aimed to assess the attitudes towards ECT during the peripartum among psychiatrists, nurses, social workers and psychologists. The primary objective was to compare the score of favorability for ECT during peripartum according to the profession. The secondary objective was to highlight other factors involved in the favorability for ECT in peripartum.MethodsWe investigated mental health professionals’ attitudes sending by e-mail an anonymous questionnaire in five hospitals in France. The questionnaire was composed of demographic details, one scale about the attitudes towards ECT (the Questionnaire on Attitudes and Knowledge of ECT (QuAKE)) used in several studies; in this questionnaire, a specific part for perinatal period has been added for our study, both using a Likert scale. The completion time for this online questionnaire was approximately 5 to 7 minutes. A score of favorability for ECT in general and in peripartum was established for each participant. These scores represented the percentage of positive responses to favorable items and of negative responses to unfavorable items towards ECT. Comparison of the QuAKE answers with a sample of English caregivers in 2001 has been determined with χ² tests. A Bonferroni correction was applied due to the large number of tests performed. Factors involved in the favorability for ECT have been studied with Pearson correlation, Kruskall-Wallis and Wilcoxon tests.ResultsTwo hundred and twenty one professionals (80 psychiatrists, 78 nurses, 19 social workers and 44 psychologists) were included in the study. Their answers to the QuAKE questionnaire were comparable or more favorable to ECT than the English sample answered in 2001. The perinatal part of questionnaire had a good internal consistency (Cronbach coefficient: 0,91). Participants were less favorable to ECT in perinatal period (favorability score: 44.2) than in general (63.6). They more often responded « uncertain » to the perinatal questionnaire (44,9 % against 18.4 % for the ECT in general; W = 19931,5; P < 0,001). The favorability for ECT in general and during peripartum were statistically associated with profession (psychiatrists were more favorable), specific training and experience in ECT. Gender, perinatal specialization, age, and the number of years in professional service were not associated with favorability for ECT in general and during peripartum in this study.ConclusionsIn this study, we have found that profession, training and experience in ECT are linked to the attitudes towards ECT, including in the perinatal period. It is necessary to inform professionals about the possibility of prescribing ECT in the perinatal period by training them in the specificities of pregnancy.     

Efficacité de l’éducation thérapeutique du patient (ETP) sur l’évolution virologique des patients vivant avec le VIH/SIDA : cas de cinq centres de santé en Côte d’Ivoire

BackgroundThe objective of this work was to present the methodological approach to therapeutic education in five health centers in Côte d’Ivoire and its impact on the virological evolution of patients enrolled in this process.MethodsThis study involved a cohort of 739 adult patients with unsuppressed viral load over the period from January to March 2019. The variables studied were the sex of the patients, the number of therapeutic education sessions performed, the viral status and the virological evolution that whether or not it is favorable based on the 1 log decrease in the last viral load after therapeutic education.ResultsThe results obtained presented therapeutic education on these sites as an elaborate process in which the patient himself is a major player in the management of his disease and its adaptation to it; his way of life and that of his loved ones. However, only 136 patients or 18 % of this cohort actually benefited from therapeutic education. 51 % of them experienced a difference in viral status from patients with non-suppressed viral load to patients with suppressed viral load. Based on the 1-log decrease in the last viral load, these results showed that 60 % of patients who participate in therapeutic education experience a positive significant virological evolution. The Chi-square independence test showed no dependence on the sex of the patients, the number of sessions with viral status.ConclusionThis study has shown the importance of therapeutic education in the care of patients living with HIV and its necessary and essential consideration for achieving the UNAIDS 90-90-90 goals.     

L’approche méditative de concentration au sein des prises en charge thérapeutiques et son impact sur la santé mentale : une revue de la littérature sur des essais cliniques contrôlés et randomisés

Research on meditation in the field of complementary and alternative therapies is increasingly important. Indeed, many works highlight the beneficial effects in terms of physical and mental health of meditation. Within the framework of the two main directions of meditation techniques (concentration and mindfulness), we will focus in this study on concentration meditation (mantra and transcendental meditation). After having framed the notion at a theoretical level, we will develop a review of the literature (randomized, before/after comparison) on this form of practice by precisely targeting transcendent and mantra meditation as well as other forms using only concentration in order to highlight the therapeutic effects of this approach on mental health and to emphasize its effectiveness. However, we will remain cautious about issuing hasty conclusions on the systematic beneficial effects of this practice by highlighting the importance of the methodological limitations that we find in this work for the past 40 years by proposing avenues for improvement.