Marie Choquet

Sexual Behavior Among Adolescents Reporting Chronic Conditions: A French National Survey

PURPOSE To compare sexual behavior in adolescents with a physical handicap or a chronic illness (HCI, n = 604) to a healthy group (HG, n = 7,332). METHODS Data drawn from a French national health survey carried out among 7,936 adolescents (mean age = 16.2 years) were used. A self-report questionnaire concerning health behavior, sexual behavior, and chronic illness was used in 136 public secondary schools. HCI and HG groups were compared on reported sexual behavior as well as on information (on sexuality, AIDS, and pregnancy) given by the parents. Logistic regression was performed for boys and girls to explore the relationship of health status (HCI or HG) to sexual intercourse, adjusted for sociodemographic variables. RESULTS Fifty-two percent of HCI boys and 38% of HCI girls reported sexual intercourse (vs. 42% of HG boys and 28% of HG girls). The HCI girls reported more often than HG girls changing partners, pregnancy, and use of oral contraceptives. The HCI boys reported more often than HG boys receiving information on sexuality from their parents. CONCLUSIONS French HCI adolescents were found to be at high risk for pregnancy and sexually transmitted diseases (STD).

Self-reported health and behavioral problems among adolescent victims of rape in France: Results of a cross-sectional survey☆

OBJECTIVES To measure the prevalence rate of rape among French adolescents; to analyze the associated health and behavioral problems; to analyze the use of the health care system by rape victims. METHOD A national representative sample of 8,140 students attending public secondary schools in France (grades 8 to 12) filled in a self-administered questionnaire (274 questions) on health and behavior problems (acceptance rate = 87%). Each rape victim in the sample (n = 61) was matched to two nonvictims (n = 122). RESULTS The reported prevalence rate of rape was .8% (.9% among girls, .6% among boys). For both boys and girls, there was a relationship between rape and current sleep difficulties, depressive symptoms, somatic complaints, tobacco consumption, and behavior problems (running away, violent behavior, stealing, and school absenteeism). Additional problems were associated for boy rape victims: attempted suicide, regular use of alcohol and of illicit drugs. Rape victims did consult health professionals, but the majority saw neither a mental health specialist nor a social worker. CONCLUSION The findings indicate that rape victims, especially boys, have more behavior problems and health problems than nonrape victims. Authors suggest that adolescents who have ran away from home, attempted suicide, or manifested violent behavior should be systematically asked about rape.

Phenomenology, Psychosocial Correlates, and Treatment Seeking in Major Depression and Dysthymia of Adolescence

OBJECTIVE To compare phenomenology, psychosocial correlates, and treatment seeking in DSM-Itt-R major depression and dysthymia among adolescents diagnosed as cases in a community-based study. METHOD A self-report questionnaire, including psychosocial data, life events, eating behaviors, depressive symptoms, substance use, pathological behaviors, and family and school functioning was administered to a nonselected sample (N = 3,287, 93.2% of targeted population) of adolescents aged 11 to 20 years from several Haute-Marne communities in France in 1988-1989. Subgroups of subjects (n = 205, 84.7% of eligible subjects) were interviewed with a structured diagnostic schedule, and adolescents with major depression (n = 49), dysthymia (n = 21) and controls (n = 135) were compared. RESULTS Nearly 30% of controls had at least one current symptom of depression. Patterns of affective symptoms were similar in major depression and dysthymia, but significant differences emerged in comorbid conditions (more anxiety disorders, suicidal behaviors, and alcohol intoxications associated with major depression) and stressor at onset (more severe in major depression). Experiences of loss during the prior 12 months were associated with both forms of affective disorder, while poor family relationships were specific correlates of dysthymia. In contrast, peer relationships and pathological behaviors did not differ between depressed subjects and controls. Although psychosocial functioning was significantly impaired in both groups of depressed adolescents, treatment seeking was limited to 34.7% for major depressive subjects and 23.8% for dysthymic subjects. CONCLUSION The results provide evidence that major depression and dysthymia in adolescence are equally severe but may have distinct patterns in associated factors. Despite free access to health care, the rate of treatment seeking for mood disorders in France is similar to that reported in U.S. studies.

Gender differences in symptoms of adolescents reporting sexual assault.

Abstract Sexual assault on children and adolescents has become a common topic of study, but there has been little research into the specific characteristics of the population of male victims. A national survey representative of school-age adolescents in France enabled us to study 465 adolescents reporting sexual assault (121 boys, 344 girls; mean age 15.4, SD 2.5 years). Girls were shown to be more frequently affected by certain medico-psychological symptoms: nightmares, multiple somatic complaints and some items concerning mood disorders. On the other hand, behavioural symptoms were much more frequently expressed in boys, in particular: repeated suicide attempts, running away, fits of violence and substance use. Boys presenting these symptoms should be questioned as a matter of routine concerning a history of sexual assault.

Eating disorders among adolescents in an unselected French population

As part of an epidemiological study concerning young people and their health, adolescents between the ages of 12–19 (n = 3288) were asked to fill out a questionnaire concerning their eating habits. Repeated eating binges, use of a strategy in order to control weight, preoccupation with body shape, and feelings of selfdepreciation following binges indicated the incidence of bulimia to be 0.7% (0.2% boys and 1.1% girls) according to DSM-III-R diagnostic criteria, and 1.3% (0.6% boys and 1.9% girls) according to DSM-III criteria. A larger group of subjects presenting eating disorders symptoms, although not necessarily all diagnostic criteria for bulimia, was identified and studied also. Somatic problems, fatigue, and difficulties in sleeping, as well as depressive symptoms appear more frequent within the group of those who present bulimic behaviors than in the group of those who do not.

Psychosocial factors associated with help-seeking behavior among depressive adolescents

A group of 3,287 French school pupils between the age of 12 to 20 years, of whom 14.4% had sought consultation for depression, were investigated in order to analyse the factors related to the type of medical help obtained. Multivariate analyses showed that severe emotional distress alone did not explain the help-seeking behavior. Thus, among those adolescents with the same anxio-depressive level, girls, older adolescents, adolescents with parents living apart, with health worries, and adolescents often absent from school more often sought help for depression. Socioeconomic status, however, did not correlate with a higher level of consultation for depression. Adolescents attending medical services for depression had a higher consultation rate, for any reason, with general practitioners and with school nurses, in whom they confided more often than their counterparts. Nonmedical professionals also seemed to contribute to accessing to medical help for depression. Overall, those who consulted for depression, in very limited numbers turned to mental health services (8.4%).

Predictive factors of chronic Post-Traumatic Stress Disorder in rape victims

This study aimed to investigate the psychological disorders following rape as well as the course of Post-Traumatic Stress Disorder (PTSD), and to determine clinical factors predictive of chronic PTSD. Seventy-three rape victims were observed in a systematic follow-up study over 1 year following rape using structured interview schedules. The frequency of PTSD was massive. The early disorders predicting PTSD 1 year after rape included somatoform and dissociative disorders, agoraphobia and specific phobias as well as depressive and gender identity disorders and alcohol abuse. Through stepwise logistic regressions, the following were found to be good models of prediction of chronic PTSD 1 year after rape: for the characteristics of the traumas, intrafamily rape, being physically assaulted outside rape, and added physical violence during rape; for the early psychological and behavioural attitudes, low self-esteem, permanent feelings of emptiness and running away; and for early mental disorders, agoraphobia and depressive disorders. Finally, among all these predictive factors, added physical violence during rape, low self-esteem, permanent feelings of emptiness and agoraphobia were shown to constitute a strong model of predictors. People presenting features such as the predictive factors of chronic PTSD found in the study should be asked about a history of rape and symptoms of PTSD.

Women's Roles and Women's Drinking: A Comparative Study in Four European Countries.

The present study analyzes the influence of role combinations on heavy drinking in four European countries: Finland, France, Germany, and Switzerland. Data sets come from nationally representative surveys. A growing number of studies have investigated the influence of social roles on alcohol consumption. Different theories such as role accumulation, role overload, and role deprivation aim to explain the association between roles and poor mental health, including heavy alcohol consumption. The results show that roles and role combinations influence heavy drinking differently in each country. The findings also indicate that the social position of women in a country is strongly connected to the differing associations between specific role combinations and heavy drinking across countries. No single role theory can be applied cross‐culturally. Large‐scale surveys are needed to test statistically the association between role combinations and heavy drinking.

First positive reactions to cannabis constitute a priority risk factor for cannabis dependence

AIM To assess the association between first reactions to cannabis and the risk of cannabis dependence. DESIGN A cross-sectional population-based assessment in 2007. SETTING A campus in a French region (Champagne-Ardennes). PARTICIPANTS A total of 1472 participants aged 18-21 years who reported at least one life-time cannabis consumption, of 3056 students who were screened initially [the Susceptibility Addiction Gene Environment (SAGE) study]. MEASUREMENTS Positive and negative effects of first cannabis consumptions, present cannabis dependence and related risk factors were assessed through questionnaires. FINDINGS   The effects of first cannabis consumptions were associated dose-dependently with cannabis dependence at age 18-21 years, both according to the transversal approach of the SAGE study and to the prospective cohort of the Christchurch Health and Development Study (CHDS) assessed at the age of 25 years. Participants of the SAGE study who reported five positive effects of their first cannabis consumption had odds of life-time cannabis dependence that were 28.7 (95% confidence interval: 14.6-56.5) higher than those who reported no positive effects. This association remains significant after controlling for potentially confounding factors, including individual and familial variables. CONCLUSIONS This study suggests an association between positive reactions to first cannabis uses and risk of life-time cannabis dependence, this variable having a central role among, and through, other risk factors.

What are the characteristics of adolescent hospitalized suicide attempters

Abstract.Aim:To study the specificity of hospitalized adolescent suicide attempters.Method:Among a national sample of students (n = 11,718, mean age = 16.6 years) studied in 1999, 9.2% (n = 1078) made at least one suicide attempt during their life (SA); 21.9% (n = 234) of them were hospitalized (HSA). We identified the risk factors (family, school, behavioral and psychological) of SA and HSA by comparing (by gender) a) suicide attempters to non-suicide attempters and b) hospitalized suicide attempters to non-hospitalized suicide attempters.Results:Both for girls and boys, the risk factors for SA varied. However, certain risk factors, particularly depressive mood, low self-esteem and poor parent-child relationships, were not associated with hospitalization. Hospitalized suicide attempters had more personal and social problems. But there is an important difference according to gender: in boys, hospitalization is related to physical fighting (OR = 2.2) and offences (OR = 3.4), in girls to running away (OR = 1.7), consumption of illegal drugs other than cannabis (OR = 2.0), having a living standard outside average (OR = 2.0) and going to a private school (OR = 1.7).Conclusion:Suicide attempters with problem behavior are more at risk of being hospitalized than others. However, the difference between hospitalized and non-hospitalized subjects was smaller than expected.