Global Behaviors, Perceptions, and the Emergence of Social Norms at the Onset of the COVID-19 Pandemic.

We conducted a large-scale survey covering 58 countries and over 100,000 respondents between late March and early April 2020 to study beliefs and attitudes towards citizens' and governments' responses at the onset of the COVID-19 pandemic. Most respondents reported holding normative beliefs in support of COVID-19 containment measures, as well as high rates of adherence to these measures. They also believed that their government and their country's citizens were not doing enough and underestimated the degree to which others in their country supported strong behavioral and policy responses to the pandemic. Normative beliefs were strongly associated with adherence, as well as beliefs about others' and the government's response. Lockdowns were associated with greater optimism about others' and the government's response, and improvements in measures of perceived mental well-being; these effects tended to be larger for those with stronger normative beliefs. Our findings highlight how social norms can arise quickly and effectively to support cooperation at a global scale.

[Sociodemographic and mental health risk factors: Global and local conditions according to the Survey results "mental health in the general population" in 18 international locations]. / Facteurs de risque sociodémographiques et troubles mentaux : modèle global et spécificités locales, d'après les résultats de l'enquête « santé mentale en population générale ¼ dans 18 sites internationaux.

INTRODUCTION: Mental Health in General Population survey (MHGP) is a socio-anthropological and epidemiological multicentre research carried out by the WHO Collaborating Centre for Research and Training in Mental Health (Lille, France). It assessed the prevalence of major mental disorders in the general population with 15,747 people aged 18 years and above in 18 sites worldwide: 6 European sites, 4 sites in the Maghreb, 4 sites in the Indian Ocean, 2 sites in the Caribbean and two sites in the Pacific Ocean. OBJECTIVES: To assess the risk of the presence of at least one mental disorder in terms of sociodemographic factors (gender, age, marital status, family income, education level, professional activity, religious practice and social isolation) and location (zone [Europe, North Africa, Indian Ocean, Caribbean Islands and the Indian Ocean Islands] and "investigation site"). METHODOLOGY: Statistical analysis was performed using data collected in 18 international sites of the MHGP survey. Logistic regression was used to model the relationship between sociodemographic and geographic factors and the presence of at least one disorder (mood disorder, anxiety disorder, psychotic disorder, abuse or dependence on alcohol or drugs), evaluated with the Mini International Neuropsychiatric Interview (MINI) diagnostic questionnaire. RESULTS: The prevalence of mental disorders rates vary among 18 sites, ranging from 15.5 % (Andorra) to 60 % (Algiers). The adjusted global epidemiological model (18 cluster sites) confirms a decreased level of risk of at least a psychiatric pathology due to a favorable sociodemographic "profile": marital status (married), family income (higher), age group (60 years and above), educational level (university), gender (male), practice of religion (among believers), employment (exercised). Analysis at geographical situation's level confirms existence of sub socio-geo-demographic models differentiated by ranking and levels of variables' modalities. Classification of variables and their modalities is clearly differentiated not only between 5 zones, but also within each of them depending on the sites that comprise it. This produces differentiated models for each of the 18 survey sites. CONCLUSIONS: The impact of sociodemographic risk factors on mental health is confirmed regardless of World region. However, the implementation of action plans for the prevention of mental disorders requires a detailed understanding of people's needs in terms of the disorder's prevalence, nature and strength of risk factors, at regional and local levels. This observation provides incentives to develop this research axis in world francophone and Latin speaking areas. These epidemiological results can be refined thanks to the data collected in the MHGP surveys about each mental disorder and comorbid conditions, the recourse of populations to assistance or care, as well as results of the socio-anthropological axis.

[Discrimination perceived by people with a diagnosis of schizophrenic disorders. INternational study of DIscrimination and stiGma Outcomes (INDIGO): French results]. / La discrimination vécue par les personnes ayant reçu un diagnostic de troubles schizophréniques. Premiers résultats français de l'étude INDIGO.

INTRODUCTION: The INDIGO study (INternational study of DIscrimination and stiGma Outcomes) aims at assessing the impact of schizophrenic disorders diagnosis on privacy, social and professional life, in terms of discrimination. In the general population, and even among health and social professionals, erroneous negative stereotypes (double personality, dangerosity) lead to high social distance. And this has an impact on various parts of daily life: employment, housing, compliance, self-esteem… About a tenth of the adult population suffers from mental disorders at any one time. These disorders now account for about 12% of the global impact of disability, and this will rise to 15% by the year 2020. People living with schizophrenia, for example, experience reduced social participation, whilst public images of mental illness and social reactions add a dimension of suffering, which has been described as a "second illness". Stigmatizing attitudes and discriminatory behavior among the general population against people with severe mental illness are common in all countries. Globally, little is known of effective interventions against stigma. It is clear that the negative effects of stigma can act as formidable barriers to active recovery. METHODOLOGY: The INDIGO study intends to establish detailed international data on how stigma and discrimination affect the lives of people with a diagnosis of schizophrenia. The first aim of the INDIGO study is to conduct qualitative and quantitative interviews with 25 people with a diagnosis of schizophrenia in each participating site, to elicit information on how the condition affects their everyday lives, with a focus upon sites in Europe. The second is to gather data for all participating countries on the laws, policies and regulations which set a clear distinction between people with a diagnosis of mental illness and others, to establish an international profile of such discrimination. A new scale (Discrimination and Stigma Scale [DISC]), used in a face-to-face setting was developed. Interviewers asked service users to comment on how far their mental disorder has affected key areas of their lives, including work, marriage and partnerships, housing, leisure, and religious activities. For country-level information, staff at each national site gathered the best available data on whether special legal, policy or administrative arrangements are made for people with a diagnosis of mental illness. These items included, for example, information on access to insurance, financial services, driving licenses, voting, jury service, or travel visas. The INDIGO study is conducted within the framework of the WPA global program to fight stigma and discrimination because of schizophrenia. French interviews occurred in two sites (Lille and Nice) on a sample of 25 patients. RESULTS: First, expressed disadvantages are high for several items (all relations, work and training, housing). In addition, we wish to highlight three specific points: almost half of the participants (46%) suffer from not being respected because of contacts with services, 88% of them felt rejected by people who know their diagnosis, and 76% hide/conceal their diagnosis. Positive experienced discrimination was rare. Two thirds of participants anticipated discrimination for job seeking and close personal relationships, sometimes with no experienced discrimination. CONCLUSIONS: This study, one of the rare in France adopting the point of view of a stigmatized group, revealed the numerous impacts of a diagnosis of schizophrenic disorders on everyday life. Comparisons between French and international results confirmed that the situation is not different in France, and even highlighted the extent of the stigmatization in the country.

["Mental Health in the General Population: images and realities (MHGP)": methodology of the study]. / "Santé Mentale en Population Générale : Images et Réalités (Smpg)" : Présentation de La méthodologie d'enquête.

INTRODUCTION: Mental Health is a Public Health issue, however, access to relevant treatment often does not meet the population needs. Patients, their relatives, as well as Mental Health professionals are still victims of a high stigmatization process. Whatever the countries and the cultural settings, public beliefs and attitudes towards mental illness (insanity) and mentally ills (insane people) play a major role in the ranking of priorities given to Mental Health national prevention and care policies. This paper presents the methodology of the research-action entitled "Mental Health in General Population: images and realities (MHGP)" carried out by the World Health Organisation Collaborative Centre (Lille, France) and the Direction of research, studies, assessment and statistics (Drees) of the French Ministry of Health, in a sample of 36 000 French subjects over 18 years old, between 1999 and 2003. OBJECTIVES: The MHGP Survey is an international multisite study aimed at: Describing, in the general population, the representations attached to insanity, mental illness and depression, and the related care; Assessing the prevalence of major psychiatric disorders in the general population; Rising awareness about Mental Health issues among various social groups: social workers, local elected, care professionals, by including them in the research-action procedure; Promoting the development of Community Psychiatry, following WHO main Guidelines. METHODS: About 900 individuals were recruited in 47 centres in metropolitan France between 1999 and 2003 according to the following criteria: i) informed consent to take part in the study, ii) age over 18 yrs, iii) not residing in a care institution and not homeless. Subjects were selected by quota sampling stratified by age, gender, educational and occupational level with the general population of the general population of the centre as sampling frame. The quotas were defined on the basis of the 1999 national population census. The data was collected by 1700 nursing students using a 50-item structured questionnaire administered in face-to-face interviews; mean length 40 minutes. The interviewers received a special 3-day training course. The assessment included a specially developed questionnaire enabling description of representations of insane, mentally ill and depressed individuals; the Mini International Neuro-psychiatric Interview (Sheehan and Lecrubier); a specific questionnaire on care consumption in case of positive MINI diagnosis and a sociodemographic questionnaire. In each centre, a team of supervisors (psychiatric staff) coordinated the interviews and the data collection; the local elected and the social and care networks were given information about the research and the results. The results of the local study were systematically presented to the general population, the local elected and the social and care professionals. Prevalence rates of mental disorders are very similar to those observed in other studies. Results on social representations and public beliefs in general population can compare with the international data available. MHGP research-action remains the first study of this scale on the topic of Mental Health in France, combining representations and prevalences description. It allowed the development of anti-stigma actions at a national and local level.

[Representations of insanity, mental illness and depression in general population in France]. / Représentations sociales du "fou", du "malade mental" et du "dépressif" en population générale en France.

OBJECTIVES: The aim of this study was to describe the representations of insane, mentally ill and depressive persons, in a representative sample from the French General Population. METHODS: Data were derived from the multicentric survey "Mental Health in the General Population: images and realities", carried out in 47 French public sites between 1999 and 2003. A face-to-face questionnaire was used to interview a representative sample of French metropolitan subjects, aged 18 and over, non-institutionalized and homeless. These subjects were recruited using quota sampling for age, sex, socioprofessional and education levels, according to data from the 1999 national French population census. Representations of insane, mentally ill and depressive persons were explored by a specific questionnaire with open and semi-open questions. Psychiatric diagnoses were identified using the Mini International Neuropsychiatric Interview (MINI). A national database was then constituted by pooling data from all sites, weighted for age, sex, level of education, socioprofessional level and work status to be representative of the French general population. RESULTS: Of the 36,000 individuals included in this study, over 75% associated the words "insane" and "mentally ill" with violent and dangerous behaviours and the term "depressive" with sadness, isolation and suicide. Young people, those with higher education and higher income level more frequently associated dangerous behaviours with mental illness rather than with insanity. The study shows that the general population draws a clear line between the representation of insane and mentally ill on one hand, and depressive on the other hand. Insane and mentally people are described as abnormal, irresponsible, unconscious, socially excluded, far from being curable, and to be cured against their will by psychotropic drugs and psychiatric hospitalisation. Whereas the depressive is perceived as a more familiar character, suffering, curable, who can be cured with psychotropic drugs and social support, but not to be hospitalized. CONCLUSION: This study highlights the overwhelming representations of insanity and mental illness in the French general population. As those stereotypes strongly affect access to care and behaviours toward psychiatric patients, the results show the need to think over the best way to fight against stigma and discrimination, in order to reduce psychiatric patients' social exclusion.

[Dangerous states and mental health disorders: perceptions and reality]. / Etats dangereux et troubles psychiques : images et réalités.

Image of Madness was always strongly linked with the notion of "dangerousness", provoking fear and social exclusion, despite the evolution of psychiatric practices and organisation, and the emphasis on user's rights respect. Mediatization and politicization of this issue through news item combining crime and mental illness, reinforce and spread out this perception. This paper presents a review of the litterature on social perceptions associating "dangerousness", "Insanity" and "mental illness", available data about the link between "dangerous states" and "psychiatric disorders", as well as the notion of "dangerousness" and the assessment of "dangerous state" of people suffering or not from psychiatric disorders. MAPPING OF SOCIAL REPRESENTATIONS: The French Survey "Mental Health in General Population: Images and Realities (MHGP)" was carried out between 1999 and 2003, on a representative sample of 36.000 individuals over 18 years old. It aims at describing the social representations of the population about "insanity/insane" and "mental illness/mentally ill". The results show that about 75% of the people interviewed link "insanity" or "mental illness" with "criminal or violent acts". Young people and those with a high level of education more frequently categorize violent and dangerous behaviours in the field of Mental illness rather than in that of madness. CORRELATION BETWEEN DANGEROUS STATE AND PSYCHIATRIC DISORDERS: in the scientific literature, all experts reject the hypothesis of a direct link between violence and mental disorder. Besides, 2 tendencies appear in their conclusions: on one hand, some studies establish a significative link between violence and severe mental illness, compared with the general population. On the other hand, results show that 87 to 97% of des aggressors are not mentally ills. Therefore, the absence of scientific consensus feeds the confusion and reinforce the link of causality between psychiatric disorders and violence. OFFICIAL FIGURES BY THE MINISTRY OF JUSTICE: according to the French Ministry of Justice, there is a lack of significative data in general population, that would allow the accurate evaluation of the proportion of authors of crimes and offences presenting a "dangerous state", either of criminological order or related to a psychiatric disorder. FROM "DANGEROUSNESS" TO "DANGEROUS STATE": the vagueness of the notion of "dangerousness" aggravates the confusion and reinforce the negative social representations attached to subjects labelled as "mentally ills". A way to alleviate this stigmatisation would be to stop using the word "dangerous", and rather use those of "dangerous states". Assessment of dangerous states is complex and needs to take into account several heterogeneous factors (circumstances of acting, social and family environment...). Besides, it is not a linear process for a given individual. Those risk factors of "dangerous state" lead to the construction of evaluation or prediction scales, which limits lay in the biaises of over or under predictive value. The overestimation of dangerousness is harmful, not only to individuals wrongly considered as "dangerous", but also to the society which, driven by safety concerns, agrees on the implementation of inaccurate measures. A FEW TRACKS FOR REMEDIATION: the representations linking "mental illness" and "dangerousness" are the major vectors of stigma, and deeply anchored in the collective popular imagination. They are shared by all population categories, with no distinction of age, gender, professional status or level of education. To overcome those prejudices, one has to carefully study their basis, their criteria, document them with statistical data, look for consistency and scientific rigour, in the terminology as well as in the methodology. Moreover, one has to encourage exchanges about this topic, between users, relatives, carers, local elected, politicians, media and health professional.

[Patient and their relatives' satisfaction regarding a home-based crisis intervention provided by a mobile crisis team]. / Evaluation de la satisfaction des patients et de leurs proches vis-à-vis d'une prise en charge de crise ambulatoire par un service mobile d'urgence et de post-urgence psychiatrique.

The goal of this survey was to evaluate the patients and their relatives' satisfaction with a home-based crisis intervention provided by a psychiatric mobile crisis team (Equipe Rapide d'Intervention de Crise, hôpital Charcot, Plaisir). We were particularly interested in measuring satisfaction with telephone response time, team mobility, patient welcome, family consultations, information given to patients and the number of caregivers. We designed a questionnaire that included 24 closed questions and 2 open-ended questions. Replies were collected over the telephone by an outside psychologist with no prior knowledge of the patients. The inclusion criteria were the following: the patient had to have received a home-based crisis intervention from the mobile crisis team and to have received at least two follow-up consultations. The response rate was 95%, from 81 relatives and 73 patients. The results show a high level of overall satisfaction, with satisfaction levels at over 90% for some of the questions. High satisfaction was due to the human and professional approach of staff - their listening skills and competence - the 24-hour availability of the telephone service, the fast intervention of the team, the team mobility, and the systematic involvement of relatives as part of the program. Low satisfaction was due to the high number of caregivers, the short length of programs, the patient referral process to outpatient services, the lack of information on medication and patients' illness and the sad appearance of the building. These results lead us to improve some aspects of our service or at least to explain our services more fully to clients. More generally, these results encourage us to listen more attentively to patients' opinions on how they experience their psychiatric care.

An ecologic study of geographical variation in multiple sclerosis risk in central Sardinia, Italy.

We carried out an ecological study in the most archaic area of Sardinia to obtain a reliable estimate of the prevalence of multiple sclerosis (MS) and to investigate the geographical variation in the prevalence across the 100 administrative communes. To estimate the area-specific prevalence rate, we adopted a Bayesian approach that makes it possible to filter out the random variation from the estimates and to obtain a map that reflects the true geographical variation in MS prevalence. 428 resident cases were identified by the case register, including 69 multiplex families. The overall prevalence was 157 per 100,000 inhabitants. The Bayesian area-specific prevalence ranged from 143 to 262/100,000. The high prevalence and its moderate geographical variation in a genetically homogeneous population, as well as the high number of multiplex families observed in the communes with the highest prevalence, could be interpreted as representing a high susceptibility of the population to MS.

Impact of early pelvic floor rehabilitation after transurethral resection of the prostate.

We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters, urinary incontinence, post-micturition dribbling, and quality of life in patients after transurethral prostatectomy (TURP). Fifty-eight consecutive patients who were selected to undergo TURP for benign prostatic hyperplasia (BPH) were admitted into the study: 28 were randomly assigned to a control group (A), 30 formed the investigational group (B) during an initial visit conducted before surgery. In group B patients, perineal exercises were demonstrated in detail, and tested for their correct use via simultaneous rectal and abdominal examination. After the removal of the urethral catheter, these patients were instructed to perform pelvic floor muscle exercises at home and were evaluated before the exercises and at weekly intervals postoperatively. The American Urological Association Symptom Score improved significantly after TURP in both groups. The average quality of life score improved more significantly in group B after TURP, from 5.5 to 1.5 (P < 0.001). The grade of muscle contraction strength after 4 weeks of PME increased from 2.8 to 3.8 in group B (P < 0.01); it was unchanged in the group A. The number of patients with incontinence episodes and post-micturition dribbling was significantly lower in the group B at weeks 1, 2, and 3 (P < 0.01). Our results show that pelvic floor muscle re-education produces a quicker improvement of urinary symptoms and of quality of life in patients after TURP. Its early practice reduces urinary incontinence and post-micturition dribbling in the first postoperative weeks. The exercises are simple and easy to perform in the clinical setting and at home, and therefore should be recommended to all cooperative patients after TURP.

[Psychometric properties of a new instrument for evaluating quality of life, the WHOQOL-26, in a population of patients with neuromuscular diseases]. / Propriétés psychométriques d'un nouvel instrument d'évaluation de la qualité de vie, le WHOQOL-26, à partir d'une population de malades neuro-musculaires.

This study describes the principal psychometric properties of the French version of the WHOQOL-26, a short version (26 questions) of the WHOQOL-100, which are World Health Organization instruments for evaluation of quality of life (QOL) which include four dimensions (physical, psychological, environmental, social relations). The use of this tool with psychiatric patients is discussed. Collection of data was performed during a national inquiry on persons with neuromuscular disorders. The population included 2,102 subjects (mean age 42.9 +/- 15 years). Ten different clinical entities were represented, which differed in the type of lesion of the motor unit, the permanence and localization of the loss of muscle strength, the progression of the respiratory deficit, the moment of its occurrence and seriousness of prognosis. This questionnaire was well-adapted to the study population (weak effect of extremes) and was well-accepted (only 5% non-responses). Compared with the long version, homogeneity is less pronounced, but remains acceptable (the item-scale correlation is superior to 0.40 for 66.7% of some items), which is the same as the reliability (Cronbach's alpha coefficient always over 0.65). The sensitivity in relation to the diagnosis is verified for all four dimensions (p = 0.05). The concurrent validity, studied using general QOL evaluation scores, satisfaction with health, and the importance of repercussions of incapacities on daily life was also globally demonstrated (p < 0.0001).