Context: The shortage of child and adolescent psychiatrists in France affects access to early interventions and mental health services and impacts therapeutic practices and prescribing trends. This study aimed to describe factors associated with choosing child and adolescent psychiatry (CAP) as a career specialty and with assessing the level of attractiveness of this discipline and its predictors. Methods: We generated a self-report questionnaire using a modified two-step Delphi approach. The survey was conducted from January 13 to February 16, 2020, and targeted French child and adolescent psychiatrists or psychiatrists, mainly working with children and/or adolescents. We used a logistic regression model to assess the factors associated with the perception of CAP as attractive. A thematic qualitative analysis of the free comments section of the questionnaire was performed. Results: Of 863 doctors contacted by email, the response rate was 77.4% (668 respondents). Two-thirds of respondents were female and had an official specialization in CAP. One-third were aged between 31 and 40 years. The main reasons for choosing to specialize in CAP were interest in working with children (64.2%), interest in psychotherapy (52.8%), and influence of an internship in CAP during medical studies (46.0%), although only one-third of respondents actually did an internship. Over half of respondents (57.3%) identified personal factors as implicated in their choice of CAP, mainly personal psychotherapy (22.2%) and personal trauma (14.4%). Although only 58.4% of respondents perceived CAP as attractive, 97.8% had no regret about their choice, and 83.5% would make the same career choice today. A positive perception by respondents' surroundings for choosing CAP at the time of the choice was associated with a perception of CAP as currently attractive by respondents (odds ratio: 1.82; 95% confidence interval: 1.27-2.60; p = 0.001). Conclusion: CAP is in crisis and faces many challenges in France, with an urgent need to redress its demographics. Many child and adolescent psychiatrists do not regret their choice and would choose the same specialty today. To increase its attractiveness, better visibility during medical school, enhanced academic recognition, and increased remuneration seem promising.
BACKGROUND: Most adolescents consult their general practitioner (GP) for common reasons, somatic or administrative but many of them have hidden feelings of distress. OBJECTIVES: To assess the immediate impact of 'ordinary' consultations on feelings of distress among adolescents and to compare adolescents experiencing difficulties (D) to those with no difficulties (N). To analyse how accurately GPs assess the impact of their consultation on adolescents' feelings. METHODS: GPs were randomly selected from two non-contiguous French administrative areas between April and June 2006. Fifty-three GPs gave two questionnaires to the first 10 to 15 adolescents aged 12 to 20 seen in consultation. One questionnaire was issued before the consultation and the other one afterwards. Adolescents had to position themselves about different aspects of well-being and say where they would seek help if they had problems. A GP questionnaire assessed how well they estimated their impact on the adolescent's feeling of well-being. RESULTS: Six hundred and sixty-five adolescents were assessed. They reported feeling better about their health, being able to talk, having someone to talk to or to confide in and on feeling understood. The D group (n = 147) felt significantly better compared to the N group (n = 518). GPs tended to underestimate this improvement, especially regarding adolescents in the D group feeling better about their health. CONCLUSIONS: Consulting a GP generates increased well-being among adolescents, especially for those experiencing difficulties. GPs tend to underestimate the positive impact they may have. Further studies are needed to explore if this benefit is permanent over time.
Child Welfare , General Practice , Physician-Patient Relations , Psychology, Adolescent , Self Concept , Adolescent , Attitude of Health Personnel , Attitude to Health , Child , Female , Health Status , Humans , Male , Patient Acceptance of Health Care , Surveys and Questionnaires , Trust , Young Adult
BACKGROUND: Adolescents are frequently accompanied by a third party in consultation. Their stated reason for consulting is rarely psychological. However, many adolescents experience distress or impaired well-being that practitioners fail to detect. OBJECTIVES: To study the ability of adolescents to express personal concerns in general medicine consultations depending on if an accompanier is present and to explore perceptions of participants and how they evolved. METHODS: Six hundred and seventy-four adolescent consultations with 53 GPs were studied. The adolescents and any persons accompanying completed self-administered questionnaires before and after the consultation, the GPs only afterwards. Analyses compared responses before and after consultation and between participants. RESULTS: Six per cent of the adolescents were consulting for a psychological reason, but, among the others, 17% reported having personal concerns they would like to talk about. Among adolescents aged 14-17 years, those consulting alone more frequently reported personal worries but were more satisfied with the consultation than the others. A third party's presence did not appear to hinder expression for those that consulted accompanied. The representations of the third party and practitioner concerning the adolescent differed, although they tended to converge following the consultation: accompaniers overestimated the adolescents' well-being and freedom to talk, while GPs underestimated their well-being, readiness to confide and feelings of being understood. CONCLUSIONS: GPs could be more optimistic about adolescent consultations: their role is viewed more positively than they think, especially by adolescents consulting alone. The majority of adolescents wishing to say something do so, even when an accompanier is present.
General Practice/statistics & numerical data , Physician-Patient Relations , Third-Party Consent , Adolescent , Female , Humans , Male , Patient Satisfaction , Psychology, Adolescent , Surveys and Questionnaires , Young Adult
Accidents among adolescents and young adults are a public health issue, and present two main characteristics: a strong association with sporting activities, and frequent recurrence. Sports accidents are generally relatively benign, but they show a marked tendency to recur Young people engaging in sporting activities do not generally exhibit psychological traits different from the general population. In contrast, the other types of accident, and particularly domestic and traffic accidents, appear to have specific features: they are often more serious, but above all they are associated with psychopathologic features, including depression, anxiety, disorders due to life events, and thrill-seeking These psychopathological features are strongly associated with recurrence. The authors describe a simple self-administered questionnaire (ECARR) designed to assess the risk of accident recurrence in this population.
Accidents/statistics & numerical data , Accident Prevention , Adolescent , Child , Emergency Service, Hospital , Female , France/epidemiology , Humans , Male , Risk Assessment , Risk Factors , Sex Distribution , Young Adult
OBJECTIVE: This study aimed at assessing the frequency of adolescents'ill-being beyond their complaint during a general practitioner's (GP) consultation, analyzing the progression of their feeling during an ordinary consultation, comparing it to the physician's feeling and checking whether this feeling could correlate a short and specific training received by the physician. METHOD: 53 physicians were divided into 2 groups: 29 physicians experienced with adolescents and 24 control physicians from a non-adjacent department. 665 consultations involving adolescents aged 12-20 years were analyzed using 2 questionnaires filled in by adolescents before and after the consultation as well as a questionnaire filled in by physicians at the end of the consultation. RESULTS: Among adolescents consulting for "non-psychological" complaints, one out of six acknowledged having other problems. Sixty percent of them considered talking about these problems during the consultation. During a single GP's consultation, the adolescents'sensation of feeling good about themselves, being understood and listened to significantly improved. However, such an improvement did not depend on the physician's experience in adolescents. Nevertheless, experienced physicians are more circumspect than control physicians regarding the level of well-being felt or put forward by adolescents. CONCLUSION: The study reveals that a short awareness program is sufficient to sustainably draw general practitioners' attention on teenagers' disquiet, but insufficient to induce an improvement of teenagers' feeling, which is anyhow recorded during a consultation. Measuring an impact on teenagers requires a probably more thorough training for physicians and a longer-term analysis by teenagers.
Physician-Patient Relations , Surveys and Questionnaires , Adolescent , Child , Humans , Young Adult
The prescription of a psychotropic drugs to an adolescent is a high-risk prescription that raises numerous issues, imposing a rigorous evaluation of the expected benefit compared with the results that could be obtained by another approach, and the risk of interference with the spontaneous changes inherent to the process of adolescence. If sedatives, anxiolytics and psychostimulants are proscribed, it is possible in the case of absolute necessity, to prescribe neuroleptics and antidepressants. In this case, the medications should be prescribed in efficacious doses, should be the object of negotiation with the adolescent and his parents, and must never be prescribed at the first consultation nor, in any case, consist of the sole therapeutic intervention. It imposes a regular follow-up of the adolescent to assess compliance and to detect possible suicidal ideation.
Adolescent , Drug Prescriptions , Psychotropic Drugs , Humans
Psychiatric emergencies in adolescents, apart from difficulties also found in adults, present specific difficulties linked to psychological characteristics of this period of life and to importance of familial interactions. "Real" emergencies or situations felt to be emergencies, they all need that we take time for serious assessment. Drugs and hospitalization are possible responses but must be challenged with much care. After some general aspects of these emergencies, we detail the most frequent clinical situations.
Adolescent Psychiatry , Emergency Services, Psychiatric , Adolescent , Drug Therapy , Family Relations , Hospitalization , Humans
Adolescent psychiatry is a new discipline implied in mental health and individual health as suicide attempts, substance abuse and drug addiction, anxiety disorders, mood disorders, eating disorders.... This disorders appears at this age and often continue with the adult. Adolescent psychiatry is an original practice with young people in development which had to learn the self-care. This work is an illustration of this point of view.
Adolescent Behavior , Adolescent Psychiatry , Adolescent , Anxiety Disorders , Feeding and Eating Disorders , Female , Humans , Male , Mood Disorders , Substance-Related Disorders , Suicide, Attempted
Three to 4% of parents are regularly battered by their children, at the adolescence. Before the appears of violence, there is an escalation of pathologic interaction between parents and child. Comorbidity is usual: problem behavior, impairments in school functionning, antisocial disorders, etc.... Sometimes violence seems to appear at the adolescence in families without any problem. Very often there are many family conflicts and discrepancy between parents about education of their children. Prevention is the better treatment with an early intervention as soon as possible.
Domestic Violence , Parent-Child Relations , Adolescent , Child , Humans , Psychology, Adolescent
