Communications

Les états dépressifs de la post-adolescence. Résultats d’une enquête menée chez 1521 étudiants de l’université de Poitiers

Cet article présente la validation française de l’Inventaire de Beck Depression Inventory-Fast Screen (BDI-FS) sur un échantillon d’étudiants.

Une étude transversale a été menée sur 473 étudiants de l’Université de Caen Normandie.

Le Beck Depression Inventory-Fast Screen-France (BDI-FS-Fr) obtient une bonne sensibilité, spécificité et une bonne valeur prédictive positive et négative, un coefficient de Yule très fort et une aire sous la courbe satisfaisante. Il a une très bonne validité de structure interne : une analyse factorielle exploratoire a dégagé un facteur expliquant 40,21 % de la variance totale du BDI-FS-Fr, et il présente une consistance interne satisfaisante (0,74). Le BDI-FS-Fr a une très bonne validité de structure externe (validité de construit : validité convergente et divergente ; p < 0,001) et validité discriminante (p < 0,001), et validité concomitante (p < 0,001). Le coefficient de fidélité pair-impair est à 0,73 (p < 0,001). La fidélité test-retest est de 0,82 (p < 0,001).

La version française du BDI-FS possède des propriétés psychométriques très favorables. Elle est valide pour auto-évaluer la dépression, son intensité et son évolution, et elle est un bon complément au BDI pour les étudiants. Le BDI-FS-Fr présente ainsi de très bonnes qualités psychométriques et constitue un outil utile pour les chercheurs et les praticiens.

Depression is a public health problem and constitutes the most frequently psychic manifestation observed among students. Its prevalence is much higher (30%) than in the other populations. Depression among students can have negative impacts on their social, relational situation and significantly impact their quality of life. Depression is misdiagnosed, misdetected and thus mistreated. In clinical practice at the University, the clinician finds difficulty in correctly diagnosing depression comorbidity including depression with a physical illness and/or somatic problems. It underestimates or overestimates depression (false negative diagnosis or false positive diagnosis). The difficulties of diagnosing depression and overlap with the physical symptoms of the disease are the challenges for the clinician to differentiate if certain symptoms are related to depression or physical illness. Thus, the difficulty in detecting and/or diagnosing depression can lead to false diagnoses of depression. So to avoid the false diagnosis of depression in the university context or in the disease, we must take into account the cognitions of depression. The BDI-FS, self-assessment scale to detect depression, considers these cognitions and therefore avoids the false diagnosis of depression in the presence of problems (such as a physical illness or somatic problems) and properly detects the depression.

This article presents the French validation of the Beck Depression Inventory-Fast Screen (BDI-FS Inventory) on a sample of students.

A cross-sectional study was conducted on 473 students of the University of Caen Normandy.

The Beck Depression Inventory-Fast Screen-France (BDI-FS-Fr) gets a good sensitivity, specificity and good positive and negative predictive value, a coefficient of Yule very strong and area under the curve satisfactory. He has a very good internal validity of structure: an exploratory factor analysis identified a factor that explains 40.21% of the total variance of the BDI-FS-Fr, and he has a satisfactory internal consistency (0.74). The BDI-FS-Fr has a very good external validity of structure (construct validity: convergent and divergent validity; P < 0.001) and discriminate validity (P < 0.001), and concurrent validity (P < 0.001). The split-half reliability (odd-even) was 0.73 (P < 0.001). The test-retest reliability was 0.82 (P < 0.001). Regarding clinical practice in the University, clinicians can use a simple questionnaire include 7 items (Beck Depression Inventory-Fast Screen-French: BDI-FS-Fr) to assess depression avoiding false diagnosis of depression in the University. The BDI-FS-Fr only evaluates the non-somatic symptoms (cognitive) rather than physical symptoms (somatic), which may overlap with problems due to the university or physical illness and depression may overlap. The BDI-FS-Fr only includes items the BDI-II that are related to the direct psychological experience of depression. Thus, the key strength of the BDI-FS-Fr is that it prevents symptoms of physical illness (e.g., weight loss, difficulty concentrating) from confounding the psychodiagnostic picture. The BDI-FS-Fr also allows us to evaluate the two diagnoses DSM-IV-TR (the main symptoms of depression: sadness and anhedonia). It also allows us to observe and assess the risk of suicide in people (ex. students and patients) by observing the items 2 (pessimism) and 7 (thoughts or desires of suicide) that are considered suicidal risk indicators. The BDI-FS is a diagnostic tool that minimizes the risk of giving falsely high estimates of depression in subjects focusing on the cognitive symptoms of depression. For pre-cited reasons, the clinicians can use the BDI-FS-Fr among students to diagnose their depression and assess their risk for suicide without false negative or false positive diagnosis.

The French version of the BDI-FS has very favourable psychometric properties. It is valid for self-assess depression, its intensity and its evolution, and it is a good complement to BDI for students. The BDI-FS-Fr thus has very good psychometric properties and is a useful tool for researchers and practitioners.

La première année commune des études de santé (PACES) est une année difficile en raison du concours et d’un contexte compétitif qui met à rude épreuve la santé des étudiants. Dans le cadre de la réforme des études de santé (rentrée 2010) qui réunit les quatre filières (médecine, odontologie, maïeutique et pharmacie), un nouveau programme a été proposé en laissant la possibilité aux étudiants de choisir plusieurs concours. Cette réforme qui permet à l’étudiant de redéfinir ses choix est apparue comme un nouveau facteur de stress que nous avons voulu évaluer tout en ciblant notre intérêt sur les conséquences physiques et psychologiques de la santé des étudiants et sur leur qualité de vie. Au cours de l’année universitaire de PACES de 2011–2012, la qualité de vie, le stress et la santé physique et psychologique des étudiants ont été évalués en début et en fin d’année. Les résultats de cette cohorte composée de plus de 1000 étudiants ont montré une qualité de vie des étudiants bien dégradée, comparée à d’autres filières, un stress spécifique élevé et des conséquences tant physiques que psychologiques qui nécessitent de développer des actions préventives auprès de ces jeunes populations qui sont des soignants en devenir.

The first year of health sciences studies is a challenging time given the many changes in: learning, work habits, autonomy acquisition, new responsibilities, and establishing a break between educational and psychosocial activities (Lahire, 1997). Experiencing so many changes requires time to adjust and development of coping resources. This is why student health has become an important issue for the authorities responsible for this aspect of campus life. These authorities have been particularly affected by recent revelations concerning the living conditions and difficulties that students encounter during their studies. In Europe (Belghith et al., 2011), and more specifically in France (Belghith et al., 2011; Lafay et al., 2003), several health reports point out the physical, psychological and financial difficulties that students are experiencing, all of which portend a complicated future perspective. Regarding students in health sciences studies specifically, some Anglo-Saxon research highlights reports of high levels of anxiety and depression disorders along with suicidal ideation manifested by medical students (Schwenk et al., 2010; Garnier, 2010). The results suggest that future doctors could be predisposed to depression and that their overall health profile would not be comparable to a general age-comparable population (Rosenthal, 2005). Little research has been carried out in France where the first year of health sciences studies (known as PACES) is a common year for different healthcare professions (doctors, dentists, physical therapists, midwives). The present study was conducted with a sample of students from this population. The first year of PACES is widely acknowledged to be a difficult year because of competition between students that can severely impact their health. As part of a proposed health sciences studies reform (September 2010), a new program has been developed allowing students the opportunity to choose more than one career objective (as noted above, doctors, dentists, physical therapists, midwives). This reform is presented as a potential stress factor. In this study, both the way the students perceive and experience the first year of PACES, as well as the impact on their quality of life, physical, and psychological health were evaluated with the objective to propose possible prevention and intervention strategies.

University of Nantes PACES students (academic year 2011–2012) were asked to participate in this longitudinal study composed of two separate evaluations at six months interval. Nine hundred and thirty-six students completed questionnaires directly on the university website at time 1 and 657 at time 2, six months later. Information about their living conditions were collected (general and academic information, practical aspects of academic, social support, and their physical health) along with a generic quality of life questionnaire the SF-36 (Leplege et al., 1998, 2001), a specific questionnaire on perceived student stress [the Freshman Stress Questionnaire (Boujut and Bruchon-Schweitzer, 2009)], an index of psychosomatic symptoms, SCL-90 (Laugaa, 2004) and the level of anxiety and depression with the HAD (Lépine, 1986). Regarding student quality of life, on a analogical scale rated from 1 to 7 (from ‘poor’ to ‘very good’), students expressed an average quality of life of 4.0 (±1.3). Similarly, all dimensions of the SF-36 demonstrated declining scores between September and March and were consistently lower than the threshold scores particularly for the physical and psychological limitation dimensions. Concerning stress, on a scale rated from 1 to 7 (low to high), students expressed an average perceived stress of 4.7 (±1.4); this was expressed at exam times as well 4.5 (±1.6) and 4.0 with regards to competition (±1.3), respectively. They also expressed a greater stress in all domains explored by the survey except for the stress linked to isolation. As for anxiety and depressive symptoms, the results obtained by the HAD showed that 56% of the students in September and 60% in March reported high levels of anxious symptoms; and 64% of students in September and 70% in March reported high levels of depressive symptoms. Finally, an increase of somatic complaints perceived during the year as the competition approached with for main symptoms of headaches, pains of back and muscle, diffuse pains and symptoms specific to stress (digestive, cardiac, respiratory) was observed.

These preliminary results highlight the intensity of stress inherent to the competitive context. While a possible motivator, this stress can also have consequences in the short, medium, and longer term on the psychological and physical quality of life of certain students made vulnerable by this first university experience. It is crucial to identify those in difficulty and to develop a preventative approach through training and workshops for stress management and emotional regulation very early in a health sciences program. For students who do not succeed in this first year, it is also important to consider ways to help them to advance in other programs.

L’entrée dans une grande école, avec les nombreux changements occasionnés, peut être considérée comme une situation potentiellement stressante. Nous avons donc souhaité identifier les difficultés rencontrées par les étudiants inscrits en première année et leurs éventuelles répercussions sur leur santé et leur qualité de vie. Les résultats obtenus montrent que les tracas les plus fréquents et les plus gênants sont liés à la réussite dans les études (examens), à la gestion du temps (ne pas avoir le temps de faire ce que l’on voudrait faire), aux relations interpersonnelles (éloignement d’un être cher) et à la santé (sommeil et réveil) avec des répercussions non négligeables sur leur santé et leur qualité de vie. En effet, les résultats soulignent l’existence de corrélations entre non seulement les tracas quotidiens et la détresse psychologique, mais également entre les tracas quotidiens et la qualité de vie.

Keeping in mind that gaining access to the first year of French “grandes écoles” is a potential stressful situation, we have studied the daily hassles during the first six months of adaptation to “grandes écoles” life. The results show that the most frequent and most intense hassles are related to success in their studies (exams), time management (lack of time to do what they want to do), interpersonal relationships (separation from a loved one) and health (sleep and wake-up). In addition, the higher the levels of students’ hassles, the higher their emotional distress and the lower their quality of life. These results are discussed with reference to the literature on the subject.

This study aims to identify the daily hassles of students enrolled in the first year of the prestigious French “grandes écoles” and to assess the relationship between these hassles and their perceived mental health and quality of life.

Data were collected from 169 first-year students in these schools during the first semester of studies.

Daily hassles were evaluated using a specific scale for students. Mental health and quality of life were evaluated by using the GHQ-12 and the WHOQOL-26.

The results show that the most frequent and most intense hassles are related to success in their studies (exams), time management (lack of time to do what they want to do), interpersonal relationships (separation from a loved one) and health (sleep and wake-up). In addition, the higher the levels of students’ hassles, the higher their emotional distress and the lower their quality of life. These results are discussed with reference to the literature on the subject.

These results suggest that daily hassles were associated with a specific period of life and had a significant effect on the students’ mental health.

Although the diagnosis and treatment of depressive disorders are important public health issues in adolescents, epidemiological data in this population are scarce.

The aims of this study were to estimate the 12-month prevalence rates of depressive disorders among ninth grade pupils in French schools, and to identify the sociodemographic correlates.

The data were collected through a national cross-sectional study conducted among ninth grade pupils in France in 2003–2004. Depressive disorders were assessed using a self-administered questionnaire derived from the standardised Composite International Diagnosis Interview–Short Form (CIDI–SF).

A total of 7110 teenagers (mean age 15.1 years) were included. Of these, 9.6% (95% CI 8.6–10.6) reported symptoms corresponding to at least one major depressive episode (MDE) over the past 12 months. Three correlates were independently associated with a higher prevalence of 12-month MDE: being a female (adjusted odds ratio 3.0; 95% CI 2.4–3.8), being greater or equal to 16 years old (aOR = 2.2; 95% CI 1.0–5.0) and living alone with one's mother (aOR = 1.7; 95% CI 1.3–2.4) or with one's mother and her spouse (aORa = 1.4; 95% CI 1.0–2.1).

The high prevalence of depressive disorders in French adolescents is thoroughly discussed. The needs for developing mental health surveillance, comprehensive prevention and care programs for this population are crucial.

Bien que le diagnostic et la prise en charge de la dépression dans la population adolescente soient parmi les priorités de santé publique, il existe peu de données épidémiologiques concernant cette population.

Les objectifs de cette étude étaient d’estimer la prévalence des troubles dépressifs chez des collégiens en classe de troisième et d’identifier les principales variables sociodémographiques associées à ces troubles.

Les données ont été recueillies en classe de troisième au cours du cycle triennal d’enquêtes en milieu scolaire, en 2003–2004. Les troubles dépressifs ont été évalués selon la classification du DSM-IV, à l’aide d’un auto-questionnaire issu d’un outil standardisé, le Composite International Diagnosis Interview–Short Form (CIDI–SF).

L’échantillon national comprenait 7110 élèves âgés de 15,1 ans en moyenne. Parmi les adolescents interrogés, 9,6 % (IC 95 % : 8,6–10,6) ont déclaré des symptômes compatibles avec au moins un épisode dépressif caractérisé au cours des 12 derniers mois. Trois facteurs étaient indépendamment associés à une probabilité plus importante de survenue d’un épisode dépressif majeur dans les 12 derniers mois : être de sexe féminin (odds ratio ajusté = 3,0 ; IC 95 % : 2,4–3,8), avoir un âge supérieur ou égal à 16 ans (ORa = 2,2 ; IC 95 % : 1,0–5,0) et vivre avec sa mère seule (ORa = 1,7 ; IC 95 % : 1,3–2,4) ou avec sa mère et le conjoint de cette dernière (ORa = 1,4 ; IC 95 % : 1,0–2,1).

Après discussion de ces résultats obtenus à partir d’un échantillon national représentatif montrant l’ampleur des troubles dépressifs dans la population adolescente, la nécessité de mettre en place une surveillance de la santé mentale dans cette population, ainsi qu’une prévention et une prise en charge adaptés, s’avère réelle.

Considérant l'accès à l'enseignement supérieur comme une situation potentiellement stressante, nous avons étudié, à la lumière du modèle transactionnel du stress de Lazarus et Folkman, le rôle de quelques variables cognitives (stress perçu, contrôle perçu, enjeux) dans l'adoption de stratégies d'ajustement fonctionnelles (recherche d'informations, recherche de soutien social) ou de stratégies de coping dysfonctionnelles (consommation d'alcool, de médicaments ou d'autres toxiques, refuge dans le sommeil, etc.) durant les deux premiers mois d'adaptation à l'Université. Un quart des étudiants ont un degré de stress très élevé ou élevé et le degré global de stress augmente pour 22,5 % des étudiants, diminue pour 22,5 % des étudiants et ne change pas pour 55 % des étudiants. Les évaluations positives de défi et de bénéfice sont plus élevées que les évaluations négatives de menace et de perte pendant ces deux premiers mois d'adaptation à l'Université. Celles-ci sont liées aux enjeux que constitue la réussite universitaire tandis que celles-là sont liées au contrôle perçu de la situation. Les stratégies dysfonctionnelles sont choisies par un nombre significatif d'étudiants (35 et 45 % pour la fuite dans le sommeil ; 16 à 17 % d'étudiants pour la consommation d'alcool, de médicaments ou autres toxiques, et 13 % pour les conduites autoagressives ou hétéroagressives). Les évaluations positives de défi et de bénéfice suscitent plutôt des stratégies de coping fonctionnelles (planification, recherche d'informations) tandis que les évaluations négatives de menace et de perte tendent à mobiliser des stratégies dysfonctionnelles de fuite–évitement (sommeil, alcool) ou de confrontation hétéroagressive.

The anxiodepressive symptomatology concerns a quarter of the studying population of sample and the factors cited are stress, solitude, relational problems, and addictions. Depressive students are likely to be more female and students in literary studies than scientific. Anxiolytics are the psychotrops most used by students (31% of students consume during courses, 23% occasionally and 8% regularly). The use of these medicines is significantly more frequent in the case of female students (40 vs 14%). Desbrosse-Baloche (2000) and the utilization of hypnotic, anxiolytic or antedepressor is higher in students of the Humanities and Letters. This disquieting situation has incited us to study some dysfunctional comportments in the light of transactional model of stress and coping. According to this transactional model, Lazarus et Folkman (1984) differentiate between two forms of evaluation that converge to describe the potential stressfull situation and the available resources for coping: a) the primary evaluation or perceived stress designates the manner that the subject identifies the situation and estimates his different characteristics; b) the secondary evaluation designates the stage where the subject estimates his personal and social resources or perceived control; c) the coping strategies.

Objective. – Keeping in mind that gaining access to university is a potential stressful situation, we have studied, in light of transactional model of stress of Lazarus and Folkman the rule of cognitive variables (stress perceived, control perceived and stakes) and the adoption of functional coping strategies (problem solving, social support) or dysfunctional coping strategies (consumption of alcohol, medicine or other toxic substances, excessive sleeping, etc.) during the first two months of adaptation to university life.

Population. – The subjects were students in the first year of psychology, that have twice completed five questionnaires in October (T1, N =110), then, in December (T2, N =119).

Results. – A high or very high degree of stress was experienced by a quarter of the students and the global level of stress increased for 22,5% of students, decreases for 22,5% of them and does not change for 55% of students. The University seems stressful for a large number of students. The positive evaluations of challenge and benefit were significantly higher than the negative evaluations of threat and loss. The former are related to the stakes, which make up university success, whereas the later are linked to a perceived control. The positive evaluations decreased significantly whereas the negative evaluations increased during the two months of adaptation.

Coping strategies. – The dysfunctional coping strategies were chosen by a significant number of students (35 to 45% over sleep as a mean of refuge, a quarter of students accept their situation passively, 16 to 17% of students consume alcohol, medicine or other toxic substances, and 13% behave auto or heteroaggressively). The positive evaluations of challenge and benefit seems to instigate functional coping strategies (planning, information's research, self control strategies) whereas the negative evaluations of threat and loss lead to mobilization dysfunctional coping strategies like avoidance or escape (sleep, alcohol) and hetero aggressive confrontation.

A wide literature has demonstrated how attachment style can impact symptomatology, for instance anxious, depressive, and post-traumatic symptoms. Life as a student, as a transition period between adolescence and adulthood, constituting a at-risk population in terms of health measures, may be particularly interesting to study regarding attachment to a partner and anxiety, depression, and trauma. The aims of this study were to evaluate in a French University student population: (1) the presence of anxious, depressive, and post-traumatic symptoms; and (2) the relationship between those symptoms and the attachment style with the partner.

Based on volunteer French students, we conducted an internet-based data collection procedure with online questionnaires (PCLS, HADS, ECR).

Both attachment dimensions (i.e., abandonment anxiety and intimacy avoidance) impacted post-traumatic symptoms (PCLS score). The higher the attachment anxiety score, the higher the HAD scores of anxiety and depression. In contrast, a decrease in the attachment avoidance score was associated with an increase in the anxiety and depression HAD score.

From a psychotherapeutic perspective, consideration might be given to attachment style as a risk factor, maybe even a psychopathological vulnerability. From a clinical point of view, we must take that parameter into account to explain the clinical situation of patients.