Saïas T, Greacen T, Brengard D, Lejoyeux M, Bourdais M
Laboratoire de recherche de l'établissement public de santé Maison-Blanche, Paris, France.
Encephale. 2008 Dec;34(6):584-8. doi: 10.1016/j.encep.2008.01.003. Epub 2008 May 19.
The negative effect of social deprivation and poverty on mental health has been the subject of numerous publications since the 1960s, with studies generally showing a higher prevalence of mental health disorders in homeless, unemployed or low income populations. Women in perinatal contexts are also at greater risk for psychopathology: the relative risk for being hospitalised is up to 60% higher in the perinatal period than during the two years preceding pregnancy. Access to social care and informal support is therefore particularly important for pregnant women in vulnerable social conditions. In France, socially excluded mothers access shelter and accommodation in maternal centres. Over the last few years, staff in these centers report what they perceive to be as an increase in the prevalence of mental health problems in the mothers using these services. The current study, CEMAT, set out to examine this question.
Based on a participatory research method, a qualitative and epidemiological study was carried out in order to evaluate the reality and needs in terms of mental health care in this population, as well as to evaluate available care and support networks. The study took place in 2005. All stakeholder groups in six maternal centres agreed to participate in focus groups and, in addition, residents were invited to respond to epidemiological and qualitative questionnaires, including the Mini International Neuropsychiatric Interview (MINI 5.0.0) and its qualitative questions aimed at evaluating use of medical and social network resources. Overall, 95 women took part in this study, representing 61% of all residents. Subjects were young (64% under 26) and 57% had been living in their centre for over 12 months.
A percentage of 68% (N=65) of the participants were identified as having a mental health disorder, according to the MINI. Of these 65 women, 55 (85%) had consulted a physician (mainly general practitioners and gynecologists) during the preceding two months. Ninety seven per cent of women validating one or more MINI diagnoses had specifically looked for help for these disorders, 17% seeking only professional help (GP, psychiatrist, psychologist, social worker, expert in non conventional medicine or traditional care), 23%looking for an informal source of support (partner, family, friends) and 57% using both professional care and informal support. High rates of satisfaction (69% for professional services, 81% for informal support) showed the capacity of this population to request relevant social and medico-social support.
Results tend to confirm the links between psychosocial vulnerability and mental health disorders. On the other hand, the women's ability to ask for and to access specific psychological care, whether it be from professionals or informally from friends and family is to be underlined. The high satisfaction rates tend to prove that, though psychologically vulnerable, this population has coping capacities that should be recognized and valorized. Options open to such structures do not necessarily involve the sole development of internal mental health resources, but need to acknowledge and strengthen existing support networks.
自20世纪60年代以来，社会剥夺和贫困对心理健康的负面影响一直是众多出版物的主题，研究普遍表明，无家可归者、失业者或低收入人群中精神健康障碍的患病率更高。围产期女性患精神病理学的风险也更高：围产期住院的相对风险比怀孕前两年高出60%。因此，获得社会护理和非正式支持对处于弱势社会状况的孕妇尤为重要。在法国，社会排斥的母亲可在母婴中心获得庇护和住宿。在过去几年里，这些中心的工作人员报告说，他们认为使用这些服务的母亲中精神健康问题的患病率有所上升。当前的CEMAT研究旨在探讨这个问题。
基于参与式研究方法，开展了一项定性和流行病学研究，以评估该人群在精神卫生保健方面的实际情况和需求，以及评估现有的护理和支持网络。该研究于2005年进行。六个母婴中心的所有利益相关者群体都同意参加焦点小组，此外，还邀请居民回答流行病学和定性问卷，包括《迷你国际神经精神病学访谈》（MINI 5.0.0）及其旨在评估医疗和社会网络资源使用情况的定性问题。总体而言，95名女性参与了这项研究，占所有居民的61%。受试者很年轻（64%在26岁以下），57%在中心居住超过12个月。
根据MINI，68%（N = 65）的参与者被确定患有精神健康障碍。在这65名女性中，55名（85%）在过去两个月内咨询过医生（主要是全科医生和妇科医生）。97%确诊一项或多项MINI诊断的女性专门针对这些疾病寻求过帮助，17%只寻求专业帮助（全科医生、精神科医生、心理学家、社会工作者、非传统医学专家或传统护理专家），23%寻求非正式支持来源（伴侣、家人、朋友），57%同时使用专业护理和非正式支持。高满意度（专业服务为69%，非正式支持为81%）表明该人群有能力请求相关的社会和医疗社会支持。
结果倾向于证实心理社会脆弱性与精神健康障碍之间的联系。另一方面，应强调女性有能力请求并获得特定的心理护理，无论是来自专业人员还是来自朋友和家人的非正式护理。高满意度倾向于证明，尽管该人群在心理上较为脆弱，但他们具有应得到认可和重视的应对能力。这类机构可选择的方案不一定只涉及内部精神卫生资源的开发，而是需要承认并加强现有的支持网络。
