Fabien Gilbert

Voice disorders and mental health in teachers: a cross-sectional nationwide study.

BackgroundTeachers, as professional voice users, are at particular risk of voice disorders. Among contributing factors, stress and psychological tension could play a role but epidemiological data on this problem are scarce. The aim of this study was to evaluate prevalence and cofactors of voice disorders among teachers in the French National Education system, with particular attention paid to the association between voice complaint and psychological status.MethodsThe source data come from an epidemiological postal survey on physical and mental health conducted in a sample of 20,099 adults (in activity or retired) selected at random from the health plan records of the national education system. Overall response rate was 53%. Of the 10,288 respondents, 3,940 were teachers in activity currently giving classes to students. In the sample of those with complete data (n = 3,646), variables associated with voice disorders were investigated using logistic regression models. Studied variables referred to demographic characteristics, socio-professional environment, psychological distress, mental health disorders (DSM-IV), and sick leave.ResultsOne in two female teachers reported voice disorders (50.0%) compared to one in four males (26.0%). Those who reported voice disorders presented higher level of psychological distress. Sex- and age-adjusted odds ratios [95% confidence interval] were respectively 1.8 [1.5-2.2] for major depressive episode, 1.7 [1.3-2.2] for general anxiety disorder, and 1.6 [1.2-2.2] for phobia. A significant association between voice disorders and sick leave was also demonstrated (1.5 [1.3-1.7]).ConclusionVoice disorders were frequent among French teachers. Associations with psychiatric disorders suggest that a situation may exist which is more complex than simple mechanical failure. Further longitudinal research is needed to clarify the comorbidity between voice and psychological disorders.

Individual and contextual covariates of burnout: a cross-sectional nationwide study of French teachers

BackgroundLimited information on the covariates of burnout syndrome in French teachers is available. The aim of this study was to evaluate the relative contributions of individual and contextual factors on the three burnout dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment.MethodsThe source data come from an epidemiological postal survey on physical and mental health conducted in 2005 among 20,099 education workers (in activity or retired) selected at random from the health plan records of the national education system. The response rate was 52.4%. Teachers in activity currently giving classes to students who participated in the survey (n = 3,940) were invited to complete a self-administered questionnaire including the Maslach Burnout Inventory. 2,558 teachers provided complete data (64.9%). Variables associated with high emotional exhaustion (highest quartile of score), high depersonalization (highest quartile), and reduced personal accomplishment (lowest quartile) were evaluated using multivariate logistic regression. Studied variables referred to demographic characteristics, socio-professional environment, job dissatisfaction, experienced difficulties at work, and teaching motivations.ResultsDifferent variables were associated with each burnout dimension. Female teachers were more susceptible to high emotional exhaustion and reduced personal accomplishment, whereas male teachers were more susceptible to high depersonalization. Elementary school teachers were more susceptible to high emotional exhaustion, but less susceptible to high depersonalization and reduced personal accomplishment than their higher school level counterparts. Experienced difficulties with pupils were associated with all three dimensions. A socio-economically underprivileged school neighbourhood was also related to high emotional exhaustion and high depersonalization.ConclusionPrograms to enhance teaching environment might be an interesting approach to try to prevent burnout. It would be useful to take the different dimensions into account in planning the intervention.

Child Overweight, Associated Psychopathology, and Social Functioning: A French School-based Survey in 6- to 11-year-old Children

The aim of this study was to estimate the prevalence of child overweight in a regional sample of primary school‐aged children, and to examine the relationships among child overweight, psychopathology, and social functioning. A cross‐sectional survey was conducted in 2004 in 100 primary schools of a large French region, with 2,341 children aged 6–11 randomly selected. Child weight and height, lifestyle variables (leisure‐time physical activity (LTPA), watching television (TV), playing video games), and socioeconomic characteristics were collected in parent‐administered questionnaires. Child psychopathology outcomes were assessed using child‐ and parent‐reported instruments (Dominic Interactive (DI) and Strengths and Difficulties Questionnaire (SDQ)). Overweight and obesity were estimated according to the International Obesity Task Force (IOTF) definition. Response rates to the parent questionnaire and DI were 57.4 and 95.1%, respectively. Final sample size was 1,030 children. According to the IOTF, 17.3% of the children were overweight, of whom 3.3% were obese. In univariate analysis, correlates of overweight were low parental education, low monthly income, Disadvantaged School Areas (DSAs), self‐reported generalized anxiety, parent‐reported conduct disorders, emotional problems, and peer difficulties. High monthly income was less frequently associated with overweight. In multivariate analysis, parent‐reported peer difficulties (odds ratio (OR) = 2.06; 95% confidence interval = 1.27–3.35) and DSAs (1.88; 1.03–3.44) were independent factors significantly associated with child overweight. There was a trend of being overweight with elevated TV times (P for trend = 0.02). The psychosocial burden of excess weight appears to be significant even in young children. Findings should be considered for preventing strategies and public health interventions. School‐based overweight prevention programs should be implemented first in disadvantaged areas together with information about weight stigmatization and discrimination.

Psychometric properties of the Dominic Interactive in a large French sample.

Objectives: To examine the psychometric properties of the Dominic Interactive (DI) in school-aged children in a different cultural environment than Quebec. Methods: In a large French region, 100 schools and 25 children (aged 6 to 11 years) per school were randomly selected. Data were collected using self-administered questionnaires to children (DI), parents (sociodemographic characteristics, mental health services use), and teachers (child school achievement). DI psychometric properties were assessed by examining: the distribution of each DI diagnosis; comorbidity between diagnoses; alpha cœfficients measuring internal consistency; and correlates of psychopathologies with sociodemographic status and health care services use. Estimates of DI properties were compared with those from a sample of community children in Quebec. Results: Complete data were available for 1274 children (54.4%). The internal consistency of each DI diagnosis of the French version was reasonable, with Cronbachs alpha cœfficients ranging from 0.62 to 0.89. The psychometric properties and comorbidity were consistent with the version from Quebec. Conclusions: The satisfactory psychometric properties of the DI along with other demonstrated advantages of this instrument (children enjoy the activity, parents approve of it, and it is cost-effective) and its cultural adaptability support the consideration of the DI for epidemiologic studies in diverse cultures.

Respondents in an epidemiologic survey had fewer psychotropic prescriptions than nonrespondents: an insight into health-related selection bias using routine health insurance data

OBJECTIVES Using register-based insurance data, we aimed to evaluate health-related differences between respondents and nonrespondents in a mailed epidemiologic survey, with a particular focus on mental health. STUDY DESIGN AND SETTING In 2005, 19,406 adults covered by the national education system health insurance plan were sent a general health questionnaire including a significant part devoted to mental health. Of them, 52% responded. Using multivariable logistic regression models, we compared participants and nonparticipants on various sociodemographic characteristics, morbidity variables, and health care utilization indicators derived from the routine health insurance databases, regardless of response status. Mental health was appraised through the reimbursement of psychiatric services and the volume of psychotropic prescriptions received in 2004-05. RESULTS In addition to traditional sociodemographic covariates of participation, we observed that respondents used more medical services than nonrespondents (visits to general practitioners, dentists, and specialists other than psychiatrists) but essentially for somatic disorders, as they also were prescribed significantly fewer psychotropic drugs. CONCLUSION Response bias may impact estimation quality even in apparently sociodemographically homogeneous populations. Our results confirmed that persons with mental complaints are less likely to respond to a survey focused on their troubles and illustrate the risk of underestimation of psychiatric disease in population-based surveys.

Paradoxical increase of positive answers to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of decreasing alcohol consumption: results from two population-based surveys in Ile-de-France, 1991 and 2005.

AIMS To describe trends of responses to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of declining alcohol consumption, in a country with no temperance history. DESIGN Two random-sample surveys, conducted in 1991 and 2005, respectively. SETTING The adult population of Ile-de-France. PARTICIPANTS A total of 1183 subjects in 1991 and 5382 subjects in 2005. MEASUREMENTS Responses to CAGE questions, obtained by face-to-face interviews in 1991 and by telephone in 2005. RESULTS were standardized on the 2005 population structure. FINDINGS The proportion of subjects giving at least two positive answers has increased by 4.2 times; the biggest increase was observed for the Guilt question (4.8 times) and the smallest for the Eye-opener question (2.6 times). Several increases were higher for women than for men: 12.9 times versus 3.3 times for two or more positive answers, 9.8 times versus 3.8 times for the Guilt question. Increases did not vary consistently by age. CONCLUSION These paradoxical trends do not support the use of CAGE in general population surveys. They confirm previous reports suggesting that CAGE was sensitive to community temperance level. They might reflect the emergence of a temperance movement in France, with stronger impact among women. This movement might be responsible for the fall in alcohol consumption.

Self-reported peer victimization and child mental health: results of a cross-sectional survey among French primary school children.

Objectives: To estimate the prevalence of peer victimization among primary school-aged children, to identify mental health and social correlates, and to assess health care services use. Methods: One hundred schools and 25 children (6–11 years old) per school were randomly selected in a large French region. Data were collected using standardized self-administered questionnaires to parents (Strengths and Difficulties Questionnaire) and children (Dominic Interactive). Three drawings depicting situations of victimization were added to the 91 standard questions of the Dominic Interactive. The categories of victimization considered were as follows: bullied, assaulted not scared, and scared not assaulted (categories mutually exclusive). Results: Complete data were available for 1,274 children (54.4%). The prevalence of bullied children, assaulted not scared, and scared not assaulted was 21.0%, 19.6%, and 19.7%, respectively. Bullied children were characterized by their vulnerability: young age (6–8 yr) and chronic illness. The main correlates were self-reported symptoms of anxiety, major depressive disorder, and parent-reported peer relationship difficulties. Victimization was not associated with higher access to mental health services (odds ratio = 1.0; 95% confidence interval = 0.5–2.1). Except for children who suffered chronic illness, access to physicians was less frequent for bullied children (odds ratio = 0.3; 95% confidence interval = 0.2–0.7). Conclusion: Peer victimization was frequent in schools, even in primary schools. Our findings highlight the need for public health interventions in schools and the role of physicians in detecting children at risk.

Lifetime risk of suicidal behaviors and communication to a health professional about suicidal ideation. Results from a large survey of the French adult population.

BACKGROUND There is presently a lack of information on the role of healthcare in suicidal ideation in adults. AIMS To assess the frequencies, patterns, and factors associated with the communication of suicidal ideation toward a health professional. METHODS Participants stem from a French cross-sectional survey of 22,133 randomly selected adults. Lifetime suicidal behaviors and 12-month mental disorder patterns were assessed using the short form of the Composite International Diagnostic Interview. Participants with suicidal ideation were asked whether they had talked about it and, if they had, to whom. RESULTS Around 20% of people with suicidal ideation had talked about this distress to a health professional. It was more frequent for people with more severe suicidal behaviors (plan or a prior attempt), among women, those aged 30 or more, those suffering from major depressive episode, panic disorder, or drug use disorder. Above all, it was more frequent among those who had also talked to friends or relatives. CONCLUSIONS Prevention strategies that encourage suicidal persons to seek help for their distress, whoever that is, may be the more important strategies to develop.

Comparing mental health of francophones in Canada, france, and belgium: 12-month and lifetime rates of mental health service use (part 2)

Objectives: To compare 12-month and lifetime service use for common mental disorders in 4 francophone subsamples using data from national mental health surveys in Canada, Quebec, France, and Belgium. This is the second article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations. Methods: Comparable World Mental Health-Composite International Diagnostic Interviews (WMH-CIDI) were administered to representative samples of adults (aged 18 years and older) in Canada during 2002 and in France and Belgium from 2001 to 2003. Two groups of francophone adults in Canada, in Quebec (n = 7571) and outside Quebec (n = 500), and respondents in Belgium (n = 389) and France (n = 1436) completed the French version of the population survey. Prevalence rates of common mental health service use were examined for major depressive episodes and specific anxiety disorders (that is, agoraphobia, social phobia, and panic disorder). Results: Overall, most francophones with mental disorders do not seek treatment. Canadians consulted more mental health professionals than their European counterparts, with the exception of psychiatrists. Conclusions: Patterns of service use are similar among francophone populations. Variations that exist may be accounted for by differences in health care resources, health care systems, and health insurance coverage.

0273 Teachers’ well-being at work and quality of life: any differences according to years of experience?

Objectives In a context of ageing workforce, this study aimed to evaluate, among teachers, differences of work and general well-being according to years of experience, and to suggest recommendations. Methods In the population-based postal survey ”Teacher’s Quality of Life” (MGEN Foundation/Ministry of education), 2320 primary and secondary teachers were asked about their well-being at work (professional experience satisfaction, teaching experience evolution over the past five years, three dimensions of the Maslach Burnout Inventory) and general well-being (quality of life, perceived health, four scores of the WHOQOL-BREF questionnaire). These indicators were analysed in multivariate regression models adjusted on sociodemographic and occupational factors, according to the categories of years of experience:≤5, 6–29,≥30. Results Compared to more experienced teachers, early-career teachers had less favourable work conditions and a lower environmental health score (−3 points 95%IC=[(−5.1)-(−1.0)]; p=0.005). Senior teachers were more likely than mid-career teachers to judge their work as becoming ”more and more difficult” (OR=2.6 [2.0–3.4], p<0.001). They also tended to show more burnout symptomatology. They were less satisfied with their quality of life (OR=0.7 [0.5–0.9]; p=0.009) and their health (OR=0.7 [0.5–0.9]; p=0.002), especially from a physical and social relationship’s point of view (−5.4 points [(−7.1)-(−3.8)]; p<0.001 and −3.0 points [(−4.8)-(−1.3)]; p=0.001 respectively). Conclusion This study adds further evidence towards the hypothesis of a decrease in teachers’ well-being at the end of their career, and supports the interest of carrying out targeted support and preventive actions. Attention should also be paid to early-career teachers who may face particularly difficult work conditions.