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.

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.

[Exposure to professional violence by young physicians in the hospital: MESSIAEN national study]. / Exposition aux violences professionnelles à l'hôpital chez les jeunes médecins : l'étude nationale MESSIAEN.

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.

Determinants of disability among the elderly population in a rural south Indian community: the need to study local issues and contexts.

BACKGROUND: Disability among the elderly is a cause of significant burden. There is dearth of relevant research from low- and middle-income countries. We aimed to establish the nature and factors associated with disability among the elderly in a rural south Indian community. METHODS: We recruited 1000 participants aged over 65 years from Kaniyambadi block, Vellore, India. We assessed their disability status, sociodemographic profile, psychiatric morbidity, cognitive functioning and anthropometrics using the following structured instruments: WHO Disability Assessment Scale II, Geriatric Mental State, Community Screening Instrument for Dementia, and Neuropsychiatric Inventory. We employed appropriate multivariate statistics to study the factors associated with a higher level of disability and to determine the population attributable fractions for various modifiable risk factors. RESULTS: Advanced age, illiteracy, hunger, poor nutrition, arthritis, hearing impairment, gastro-intestinal and respiratory diseases, dementia and travel costs to primary health facilities increased the risk of disability significantly. Hypertension, diabetes and depression were not associated with disability. Modifiable social determinants and medical diseases together contributed to disability in this population. CONCLUSION: Locally relevant social determinants combine with prevalent medical diseases to produce the disability burden among elderly. There is a need to focus on local contexts and modifiable risk factors to design locally appropriate public health policies and interventions.

Solid-state reduction of iron in olivine-planetary and meteoritic evolution.

Iron-nickel metallic particles have been reported in meteorites1 and lunar2-5 and terrestrial6,7 rocks. The origin of these metallic particles is not unique as they may be formed by (1) condensation from a primordial solar nebula8; (2) crystallization from a melt; and (3) subsolidus reduction reactions under low oxygen or sulphur fugacity. We report here an electron microscopy study of the solid-state microstructural development in olivine single crystals (Fo92) in which half of the iron has been reduced to the metallic state by a gas-solid interaction in the temperature range 950-1,500 °C. The reaction, Fo92→Fo96+metallic Fe(Ni in solid solution)+pyroxene, begins with a homogeneous transformation involving fine-scale metallic precipitates resembling Guinier-Preston zones9. The microstructure develops by the growth of the first-formed precipitates during an Ostwald ripening process9 in which the precipitates located in the dislocation sub-boundaries develop in preference to precipitates in the subgrains. On the other hand, pyroxene is first observed to nucleate heterogeneously at pre-existing dislocations and its coarsening rate is more than an order-of-magnitude faster than that of the metallic phase. Besides the textural similarity of the observed microstructures with that reported for some of the lunar materials2, these results have important implications for the physical models of accretion of terrestrial planets, planetesimals and meteorites10, especially with respect to the distribution of siderophile elements. The rate of reaction observed here places constraints on models for the formation of the Earth's core by segregation of a metallic phase with or without reduction.

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 1st 2019 and June 31st 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.

Sexual harassment exposure and impaired mental health in medical students. The MESSIAEN national study.

BACKGROUND: A previous national study has suggested that around 20% of French working women reported sexual harassment (SH) at work but we lack of data in medical students of French hospitals to guide prevention programs. OBJECTIVES: To determine SH prevalence in a national sample of French medical students and to validate a theoretical model explaining SH causes and its impact of mental health. METHODS: The study is a cross-sectional observational epidemiological national study. SH was defined according to the French legal definition. We further explored other discriminations and their potential association with impaired mental health in medical students. Mental health was assessed by Hamilton Anxiety & Depression scale, psychotropic drug consumption and psychotherapy follow-up. A Structured Equation Modeling was carried out to confirm our theoretical model. RESULTS: 2003 participants were recruited. SH was reported by 15.7% of the participants (19.8% of women and 5.2% of men). The SEM model showed good fit (RMSEA=0.024, CFI=0.90, TLI=0.87, WRMR=1.165). SH was associated with risk factors such as feminine gender and surgical and anesthesiology specialties. SH was also associated with exposure to discriminations based on the specialty choice and sexual orientation. SH was associated with impaired mental health. CONCLUSION: French medical student women reported similar rates of SH than other working women, suggesting that SH prevention programs are needed in French hospitals. Surgery and anesthesiology should be targeted in priority. The prevention programs should also target other discriminations and should be evaluated in terms of potential mental health improvement.

Alternative methods for determining the electrical conductivity of core samples.

Electrode configurations are described that can be used in measuring the electrical conductivity of a core sample and that do not require access to the core end faces. The use of these configurations eliminates the need for machining the core ends for placement of end electrodes. This is because the conductivity in the cases described is relatively insensitive to the length of the sample. We validated the measurement technique by comparing mathematical models with actual measurements that were made perpendicular and paralled to the core axis of granite samples.

National suicide rates and mental health system indicators: an ecological study of 191 countries.

PURPOSE: The relative contributions of psychiatric morbidity and psychosocial stress to suicide, and the efficacy of mental health systems in reducing population suicide rates, are currently unclear. This study, therefore, aimed to investigate whether national suicide rates are associated with their corresponding mental health system indicators. METHODS: Relevant data were retrieved from the following sources: the World Health Organization, the United Nations Statistics Division and the Central Intelligence Agency World Fact book. Suicide rates of 191 countries were compared with their mental health system indicators using an ecological study design and multivariate non-parametric robust regression models. RESULTS: Significant positive correlations between suicide rates and mental health system indicators (p<0.001) were documented. After adjusting for the effects of major macroeconomic indices using multivariate analyses, numbers of psychiatrists (p=0.006) and mental health beds (p<0.001) were significantly positively associated with population suicide rates. CONCLUSIONS: Countries with better psychiatric services experience higher suicide rates. Although these associations should be interpreted with caution, as the issues are complex, we suggest that population-based public health strategies may have greater impact on national suicide rates than curative mental health services for individuals.