The experience of parents in Ronald McDonald houses in France.

BACKGROUND: Ronald McDonald houses are located close to children's hospitals. They enable the hospitalized child to benefit from their family's presence, while helping the family to cope better with their child's hospital stay. This study aimed to describe the experience of parents staying in Ronald McDonald houses in France, identify their needs, and study the psychological impact of their child being in hospital. METHOD: This cross-sectional observational epidemiological study was conducted in 2016, using anonymous self-administered questionnaires offered to parents staying in one of the nine Ronald McDonald houses in France. The questionnaire had two sections: a general section about the hospitalized child, and a 62 questions section to be completed by each parent, including a Hospital Anxiety and Depression Scale (HADS). RESULTS: The participation rate was 62.9%: 71% of mothers completed the questionnaire (n = 320), and 54.7% of fathers did so (n = 246). They were the parents of 333 children (53.9% boys, 46.1% girls), under 1 year old (44.1%), hospitalized in the following three departments: intensive care (24%), pediatric oncology (23.1%), and neonatal care (20.1%). The mothers on average spent 11 h a day at their child's bedside, while the fathers spent 8 h 47 min. The parents tended to be employees or manual workers, and mostly lived together, with an average 2-h journey to hospital. They reported financial problems in 42.1% of cases, significant sleep deprivation (>90 min) in 73.2% of cases, and anxiety and depressive disorders: anxiety (59%) and depression (26%). There were some significant differences between the experiences of mothers and fathers: mothers lost out on their sleep and lost more appetite, and spent more time at their child's bedside, while the fathers encountered twice as many work-related difficulties (p<0.01). Additionally, their perception of the Ronald McDonald House was similar, as over 90% of them stated that this family accommodation allowed them to feel closer to their child and supported them in their role as parents. CONCLUSION: The parents of children in hospital were 6-8 times more anxious than the general population, while clinical symptoms of depression were twice as common as in the overall population. Despite this suffering linked to their child's illness, the parents rated highly the support provided by the Ronald McDonald House in helping them cope with their child's time in hospital.

[Mental Health and sexual orientation in adolescents in a school environment]. / Santé mentale des adolescents selon leur attirance sexuelle : enquête en milieu scolaire.

INTRODUCTION: Although homosexuality is a subject often addressed by the media, little is said about homosexuality in adolescents who are particularly affected by the question of sexual orientation. This work aims to study the mental health of adolescents who report being exclusively attracted to members of the same sex. We explore the evidence for an association between homosexuality and depression, suicide attempts, and consulting a psychiatrist or a psychologist. METHODS: We used data from the cross-sectional study "Adolescent Portraits - A Multicenter Epidemiological Survey in Schools in 2013" (CHU Fondation Vallée, Inserm CESP U1018). Data were gathered through the use of an anonymous, self-administered questionnaire (348 questions) given to students between the "4e" and "terminaleschool" years (comparable to the 8th and 12th grade in the U.S. education system) in three contrasting French geographical areas. The risk of depression was measured using the Adolescent Depression Rating Scale (ADRS). RESULTS: The results reflect the survey responses provided by 15,235 young people. Of these, 1.5 % reported only being attracted to members of the same sex (homosexual group). This group contained twice as many girls as boys. Students who did not report sexual attraction, who reported bisexual attraction, or who did not answer the question were excluded from the results (830 students). In the homosexual group, 24 % presented with depression versus 11.5 % of those attracted exclusively to members of the opposite sex (heterosexual group). There is also a significant difference between sexes: 13.2 % of boys in the homosexual group were depressed compared to 29.3 % of girls in the same group; 6.7 % of boys in the heterosexual group reported being depressed versus 16.1 % of girls in the same group. In the heterosexual group, 10.7 % of respondents reported having already made at least one suicide attempt versus 20.7 % of those in the homosexual group. There was a difference according to sex, since 6.3 % of boys in the heterosexual group had a history of attempted suicide versus 14.9 % of girls in the same group. This gap disappeared completely within the homosexual group, as 21.4 % of boys and 20.4 % of girls had already made at least one suicide attempt at the time of the survey. Depressed adolescents in the homosexual group also reported a higher number of previous suicide attempts than those in the heterosexual group (46.9 % versus 31.6 %). In terms of sex, 25.3 % of depressed boys in the heterosexual group made at least one suicide attempt versus 34.1 % of girls. In the homosexual group, 44.4 % of depressed boys reported having made at least one suicide attempt versus 47.5 % of depressed girls. Adolescents in the homosexual group were significantly more likely to report having consulted a psychiatrist or psychologist than those in the heterosexual group (14.6 % versus 6.5 %), regardless of sex (16.7 % versus 4.7 % for boys; 13.5 % versus 8.2 % for girls). This difference was also found among depressed subjects (26.0 % in the homosexual group versus 15.4 % in the heterosexual group). Sexual activity (having already had sex) was higher in the homosexual group than in the heterosexual group (53.7 % versus 37.5 %), and this difference remained significant after adjusting for age. Fifty percent of the sexually active homosexual respondents reported having engaged in sexual activity of a homosexual nature versus 0.7 % of sexually active heterosexual respondents. In the homosexual group, mental suffering appeared to be more severe among sexually active subjects, in terms of dark thoughts (64 % versus 46 %) and a prior history of attempted suicide (29.3 % versus 10 %), but not in terms of depression (27.9 % versus 18.9 %; NS). CONCLUSION: Young people who reported being exclusively attracted to members of the same sex presented a higher level of mental distress compared to those who reported being attracted to members of the opposite sex. This was especially the case for boys. These findings led to the identification of risk and protective factors that can inform the development of appropriate preventive measures.

[Behavior disorders in preschool children]. / Troubles du comportement de l'enfant d'âge préscolaire.

In child psychiatry, behaviour disorders in preschool children motivate frequently consultations. Indeed, from the nursery, young children, between 18months and 3years, present behaviours that alert the adults and disarm usually their parents. Unfortunately, this category of "catch-all" does not allow the childhood professionals to understand well the meaning of the disorder and to propose therapeutic strategies and/or educational properly adapted. This article offers an analysis of this psychopathological disorder, especially taking into account the nature of parent-child interaction during the different stages of development of this period.

[Parenting in 2008: between resignation and authoritarianism]. / Parentalité en 2008: entre démission et autoritarisme.

The contradictory media messages, even paradoxical, make many parents think that to have a child changes nothing in their lives. However, to grow, the baby requires initially that is established a narrow dependence between him and his/her parents, so that, in the second time, he can take his autonomy. With through its experiment clinical and a review of a certain number of media messages, the author shows how much certain adults are in lack of reference, which prevents them from correctly transmitting the limits essential to child education. The concept of "extimity" and the problems of the sexualisation of the culture are also approached. Lastly, media used by children (video games and internet) are analyzed. A strategy of parentality assistance is then proposed.

How physicians caring for adult patients presenting with a chronic mental illness take into account the difficulties experienced by the children of those patients: preliminary study.

AIMS: To study how physicians caring for adult patients presenting a chronic mental disturbance take account of the difficulties of their patients' children under 18. METHOD: Exploratory and qualitative study based on an in-depth study of interviews. STUDY POPULATION: Thirteen physiatrists or neurologists following brain-damaged patients and 12 psychiatrists following patients with chronic psychiatric disorders. RESULTS: In the two groups of physicians, diversified practices in catering for the issues of the patient's parenthood, child-parent relationships, and difficulties experienced by the child. The child's difficulties are not approached as such. For many of the physicians, representations of the parenting function, and of the child's needs and difficulties are not often used in work with the patient. Patient-centred care appears at odds with catering for the patient's children and their specific difficulties. The seriousness of the mental pathologies, their chronic nature, and the fact that they can affect the patient in his/her parental functioning and concerns, appear as factors in the reluctance of physicians. Other reasons are lack of familiarity with issues relating to childhood, and the feeling of encroaching on a private and intimate sphere. The representations of physicians with regard to parenthood, parent-child relations, and the needs and difficulties of children, are often not integrated into the corpus of knowledge. These issues are more often aspects of physicians' own experience. CONCLUSION: The conflict of values and the uneasiness of the physicians suggest the need for ethical reflection groups or Balint groups.

[Chronic disease and childhood: image of the body, psychic stakes and therapeutic alliance]. / Maladie chronique et enfance: image du corps, enjeux psychiques et alliance thérapeutique.

The child is an individual in constant development, dependent on his/her parents with whom he interacts everyday to open out, and in particular, to construct a dependable image of his body for growing up comfortably. Announcement of a disease, real traumatism for the whole family, upsets these exchanges and can often induce psychological difficulties masked by the therapeutic somatic stakes placed at the foreground of concerns of each one: child, parents and doctors. The child's stakes are construction of a good image of the body (basis of his own) which can be deteriorated by the disease whatever it is (chronic disease, with relapse or vital prognosis engaged). The family's stakes are the perception of the disease by the parents (distress, culpability, depression) and sibling's reactions (aggressiveness, identification with the sick child, masked depression, functional troubles). Doctor's stakes in the chronic disease is to obtain therapeutic alliance of the child and his family to allow the good progress of the treatments. In front of the chronic disease's reality, it is essential to establish and maintain a multidisciplinary follow up. The child's psychiatrist role will be to take care of the exchanges, and listening among the doctors, the patient and his family are favoured.