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H Chabrol

Publications and source records attributed to H Chabrol.

At least 55 records · Page 3Linked to original sources
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[Relations between anxious, depressive and borderline symptomatology and frequency of cannabis use and dependence].

The aims of this paper is to study the relations between anxious, depressive and borderline symptomatology and cannabis use and dependence in adolescents and young adults. A convenient sample of 212 subjects composed of high-school and college students from Toulouse, France (85 boys, 127 girls; mean age=18.3 1.8 Years) completed questionnaires assessing the patterns of cannabis use, age of first use, the symptoms of dependence using a questionnaire derived from the Mini International Neuropsychiatric Interview, and the anxious, depressive and borderline symptomatology using the STAI-YA (State-Trait Anxiety Inventory; Spielberger et al., 1970), the CES-D (Center for Epidemiological Studies-Depression scale; Radloff, 1977) and the BPI (Borderline Personality Inventory; Leichsenring, 1999), respectively; 54% of subjects reported having used cannabis once during the last 6 Months (45.3% of girls and 66.6% of boys, p=0.002). Frequency of use was higher in boys: eg, 61% of boys used cannabis at least almost daily versus 31% of girls (p<0.00001). Age of first use was lower in boys than in girls (14.6 2.6 versus 15.7 2.3, t=- 2.46, p=0.02). Length of use was higher in boys than in girls (3.9 2.2 versus 3 1.6, t=2.2, p=0.03). Among users, near of 64% of boys and 36% of girls met the criteria for cannabis dependence (p=0.003). BPI, CES-D and STAI-YA scores were compared between non-users and users and between non-dependent and dependent users: the only significant differences were that BPI scores were higher in users versus non-users and in dependent users versus non-dependent users; CES-D and STAI-YA scores did not distinguished users from non-users and dependent users from non-dependent users. BPI and CES-D scores were correlated with the length of cannabis use (Pearson r=0.19 and r=0.19, respectively, p<0.05). In a multiple regression analysis predicting the frequency of cannabis use, we entered age, sex, CES-D, STAI-YA and BPI scores. This model accounted for 23% of the variance of the frequency of use (F5,206=14.4, p<0.0001). Sex, age, and BPI scores were significant predictors (b=- 0.31, t=- 5.03, p<0.0001; b=0.29, t=4.87, p<0.0001, b=0.27, t=3.80, p<0.0001, respectively). CES-D scores were a nearly significant predictor (b=- 0.17, t=- 1.96, p=0.051). STAI-YA scores were not a significant predictor (b=0.11, t=1.29, p=0.20). In a multiple regression analysis predicting the dependence scores, we entered age, sex, frequency of use, CES-D, STAI-YA and BPI scores. This model accounted for 41% of the variance of the dependence score (F6,107=12.6, p=0.005). Frequency of use and BPI scores were significant predictors (b=0.51, t=6.12, p<0.0001; b=0.26, t=2.86, p=0.005, respectively). Age, sex, CES-D and STAI-YA scores were not significant predictors (b=- 1.04, t=- 1.32, p=0.19; b=0.008, t=0.09, p=0.92; b=0.16, t=1.53, p=0.12; b=- 0.14, t=- 1.46, p=0.15, respectively). The frequency of use and dependence observed in this study confirm the results obtained in epidemiological studies of use and dependence in France. The high frequency of daily or almost daily users suggests that a high proportion of subjects were "high" while completing the questionnaires. This is a confounding variable now inevitable in epidemiological studies of cannabis use given the high proportion of daily users. The consequence may be that responses to mood questionnaire express both the acute effect of cannabis consumption and the chronic effect that might be different: the acute euphoriant effect of cannabis may mask a chronic depressive symptomatology induced by chronic cannabis consumption. The antidepressant and anti-anxiety acute effect of cannabis may explain that CES-D and STAI-YA scores did not distinguished users from non-users and dependent users from non-dependent users. The correlation between length of use and CES-D scores may reveal the depressant chronic effect of long-term use. The correlation between length of use and BPI scores suggest that long-term cannabis use induces an increase in borderline symptomatology. Results of the regression analyses suggest that the borderline symptomatology is highly linked to frequency of use and cannabis dependence. This may be due to the increase in borderline symptomatology induced by both acute and chronic effects of cannabis. The relation between cannabis use and dependence on one hand and anxious and depressive symptomatology on the other hand may have been obscured by the acute mood effect of cannabis consumption. Borderline symptomatology appeared to be highly linked to cannabis use and dependence in adolescents and young adults. Borderline personality disorder in adolescents is not the only risk factor for cannabis use and dependence in adolescents: borderline symptomatology even at a subclinical level seems to be a higher risk factor than anxious or depressive symptomatology. The frequency of daily or almost daily users may be a confounding variable for the study of relations between anxiety and depressive disorders in adolescents and young adults.

Adolescent↗
PubMedDate not supplied

[Perceptions of cannabis effects a qualitative study among adolescents].

The aim of the study was to compare perceptions of cannabis use effects and risks of tolerance effect, withdrawal syndrome, dependence and repercussions on school, social, and familial functioning among adolescent cannabis users and non users. Subjects were 210 adolescents (121 boys, 89 girls; mean age=16.3 1.3) from the department of Pyrénées-Orientales, France. Subjects completed a questionnaire assessing the frequency of cannabis use, the method of using cannabis, and including open-ended questions (What are the different methods of cannabis use? What are their pleasant and unpleasant or negative effects? What are their risks? Do you think that cannabis effects decrease in intensity when you are used to it? When someone is used to cannabis and stop using it (or has no more of it), does she experience craving for cannabis and withdrawal symptoms? What do you think of cannabis use?). Among the subjects, 118 (56.2%) were cannabis users and 92 (43.8%) were non-users. Among users, 27% used cannabis once a Month or less than once a Month, 21%, more than once a Month; 24%, more than once a weeks; 6%, every day; 20%, more than once a day. The methods of using cannabis were joints (76%), bong (40%), pipe (23%), and ingestion (18%). Knowledge of methods of using cannabis was higher in users than non-users: joint (87% vs 64%, p<0.0001), bong (69% vs 21%, p<0.0001), pipe (38% vs 7%, p<0.0001), ingestion (41% vs 13%, p<0.0001). Fifty-four per cent of users reported that cannabis use induces pleasant affects versus 30% of non-users (p=0.0006). They were exhilaration (47% vs 9%), relaxation (40% vs 23%), cheerfulness (21% vs 10%). Twenty-seven percent of users reported that cannabis use reduces negative feelings versus 14% of non-users (p=0.02). To be more open to social relationships was mentioned by 13% of users versus 1% of non-users (p=0.0001). The negative effects that were reported were attention and cognitive impairment (13% of users vs 5% of non users, p=0.05), irritability (8% vs 8%), loss of control (8% vs 8%) and feeling faint (13% vs 6%, p=0.09). Users reported than bong has much quicker and stronger effects than joints. The effects of bong class cannabis as a hard drug. Physical negative effects or risk were reported by 35% of users versus 30% of non-users (p=0.44). Bong users described specific physical risks such as respiratory problems and fainting. No subjects reported the risk of road accidents. Most users and non-users considered that cannabis use causes dependence (60% vs 74%, p=0.03), tolerance (68% vs 60%, p=0.23), and withdrawal symptoms (76% vs 52%, p<0.001). A minority of users and non-users reported that cannabis use causes a deterioration in school functioning (42% vs 20%, p=0.69), in social activities (23% vs 14%, p=0.10) and in family relationships (29% vs 20%, p=0.14). Most of users (56%) had a global positive opinion of cannabis use whereas most non-users (66%) had a global negative opinion of cannabis use. The frequency and methods of use reported in this study compare with the results of a recent study carried out in another town of the south of France. These results suggest that a high proportion of French adolescents are using cannabis and that a high proportion of users utilize bongs. Perception of cannabis effects and risks of tolerance effect, withdrawal syndrome, dependence and repercussions on school, social, and familial functioning differed between users and non-users. Users have more positive beliefs and less negative beliefs about cannabis than non-users. Users reported more frequently pleasant effects and less frequently unpleasant or negative effects, physical risks, risks of dependence, deterioration in school, social, and familial functioning than non-users. However, only a minority of non-users reported negative effects or consequences of cannabis use. None subjects reported a risk of road accident. These results suggest that information on negative effects, risks and repercussions of cannabis use may be a target for prevention intervention.

Accidents, Traffic↗
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[A study of the Edinburgh Postnatal Depression Scale (EPDS) on 859 mothers: detection of mothers at risk for postpartum depression].

The postpartum is a high-risk period for the occurrence of anxious and depressive episodes. Indeed, during the first few days after delivery, mothers can present postpartum blues symptomatology: fatigue, anxiety, disordered sleeping and a changing mood. Postpartum depression is characterised by a changing mood, anxiety, irritability, depression, panic and obsessional phenomena. It occurs in approximately 10 to 20% mothers. The exact prevalence depending on the criteria used for detection. The first symptoms usually appear between the fourth and sixth week postpartum. However, postpartum depression can start from the moment of birth, or may result from depression evolving continuously since pregnancy. We can add that the intensity of postpartum blues is a risk factor that can perturb maternal development. So it is important for health professionals to dispose of predictive tools. This study is a validation of the French version of the EPDS. The aims of the study were to evaluate the postpartum depression predictive value at 3 days postpartum and to determine a cut-off score for major depression. Subjects participating in this study were met in 3 obstetrical clinics in, or in the vicinity of, Toulouse. Mothers with psychological problems, under treatment for psychological problems or mothers whose babies present serious health problems were excluded from the study. The EPDS was presented to 859 mothers (mean age=30.3; SD=4.5) met at one of the clinics at 3 days postpartum (period 1). They had an EPDS mean score of 6.4 (SD=4.6); 258 (30%) mothers had an EPDS score 9. 82.6% of these mothers experienced a natural childbirth and 17.3% a caesarean section; 51.5% gave birth to their first child, 36.2% to their second child and 12.3% to their third or more. All subjects were given a second EPDS with written instructions to complete the scale during the period 4 to 6 weeks postpartum and return it for analysis (period 2). Between the 4 to 6 weeks postpartum period, 722 mothers replied again to the EPDS. 131 mothers had an EPDS score 11 (mean age=30.3; SD=4.8). They had an EPDS mean score of 13.6 (SD=3.3). Mothers with probable depression were interviewed and assessed, using the Mini (Mini Neuropsychiatric Interview, Lecrubier et al. 1997), the SIGH-D (Structured Interview Guide for the Hamilton Depression Scale) and the BDI (Beck Depression Inventory) in order to diagnose a major depressive episode. They had a HDRS mean score of 13.7 (SD=5.1) and a BDI mean score of 13.6 (SD=5). At 3 days postpartum, we observed that 258 mothers (30%) had an EPDS scores 9 and 164 mothers (19%) had an EPDS scores 11. Between 4 and 6 weeks postpartum, we observed 18.1% of postpartum depression (EPDS 11) and 16.8% (EPDS 12) of major postpartum depression. The analysis of the sensitivity and the specificity at 3 days postpartum provides a cut-off score of 9 (Sensibility: 0.88) (Specificity: 0.50) as predictive of postpartum depression, for this cut-off score, the type I error is low (5.8%) but the type II error is more higher (18.9%). The analysis of the sensitivity and the specificity between 4 and 6 weeks postpartum provides a cut-off score of 12 (Sensibility: 0.91) (Sensibility: 0.74) for the detection of major postpartum depression. Factor analysis shows at 3 days postpartum that the internal structure of the scale is composed of two subscales. The first factor F1 "anxiety" accounts 28% of the variance and the second factor F2 "depression" accounts 20% of the variance. Between 4 and 6 weeks postpartum, factor analysis suggests an unidimensional model in the evaluation of postpartum depression which is better than a two factor model. This factor accounts 40% of the variance. The scale has a good predictive value, and we can observe a significant correlation with the EPDS periods 1 and 2 (r=0.56; p<0.05). This result shows that the depressive mothers mood intensity predicts a future depressive risk. Furthermore, correlations between EPDS and BDI (r=0.68; p<0.05) and EPDS and HDRS (r=0.67; p<0.05) show a good convergent validity. The reliability study confirms the good internal consistency of the EPDS, at 3 days postpartum and in the postpartum depression -symptomatology evaluation (Cronbach's Alpha>0.80). In conclusion, this scale demonstrates good validity and is fast and easy use in obstetrical services, allowing early detection of women who risk to develop postpartum depression and, in the first week of postpartum, of mothers who suffer from a major postpartum depression. The use of the EPDS for an early screening of the risk of postnatal depression which is essential considering the consequences that postnatal depression can have on the development of the infant, on the quality of the relationship within the couple and on other social relationships. Mothers at risk for postnatal depression should be controlled and surveyed by the health professionals in obstetrical clinics.

Adult↗
PubMedDate not supplied

[Validation of the French version of the Body Shape Questionnaire].

UNLABELLED: In today's societies, pressures from the idea of thinness are omnipresent and lead to a corporal dissatisfaction with an excessive preoccupation of the body's image. It seems important to have, in France, a device that can evaluate the corporal dissatisfaction degree, for the reason that the troubles of the body's image is a common diagnostical category to the anorexia and bulimia (DSM IV, 1994). Cooper et al. (1987) have developed one-dimensional questionnaire of 34 items in order to measure the worries towards the weight and the shape of the body, called the "Body Shape Questionnaire" (BSQ). Its concurrent validity has been shown with the using of the corporal dissatisfaction under-scale of the Eating Disorders Inventory (EDI; Garner et Olmsted, 1984) and the using of the diagnostical questionnaire: Eating Attitude Test (EAT; Garner et Garfinkel, 1979). The BSQ gives us a way to explore the role of extreme worries towards the body's apparence in the development, the keeping and the treatment of eating disorders. From this point the BSQ is a tool widely used on an international level in researches on the eating disorders. It has been validited in Spain and in Germany whereas it has not been yet subject to a validation in France. For this reason, we proposed to use the BSQ on the french population. METHODOLOGY: The sample is made of 242 university girl students. The average age is 20.7 years old with an standard deviation of 2.26. The size and the weight helped us to calculate the Body Mass Index (BMI) which is in fact the weight divided by the size squared. The average BMI is 21.06 kg/m2 +/- 2.87. Regarding the evaluating devices, the BSQ is presented as a scale of 34 items marked by 6 different points: 1 never, 2 barely, 3 sometimes, 4 often, 5 very often, 6 always. After getting the authorization form the authors to respect during these kinds of procedures, we have started validation. The corporal dissatisfaction under-scale of Eating Disorder Inventory (EDI, Garner et al., 1991) is made of 9 items and has a scale of 6 points going from "never" to "always". In order to evaluate the accuracy of the Body Shape Questionnaire (BSQ) in France, we made a test/retest. The concurrent validity of the BSQ has been evaluated by the EDI. The 242 subjects have been asked to fill in both questionnaires during the test and the re-test (4 weeks after the test). We have evaluated the accuracy of the BSQ with the calculation of the constancy test/retest (Pearson's r) and the measure of the internal consistency (Cronbach's alpha). Then, we tested the validity regarding an external criteria. The validation procedure is based here on an examination of the correlations between the tests results (BSQ) and another measure taken as criteria (EDI). The solutions proposed by the factorial exploratory analysis have been tested by confirmatory analysis using the 2 index of adjustment: the GFI ("Goodness of Fit Index") and the CFI (Comparative Index of Bentler) which, greater than 0.85, shows a satisfying adjustment and the RMC (redidue) which has to be less than 0.10 for a satisfying adjustment. Finally, inferential statistical analysis have studied the relations between the weight's category and the total result at the BSQ and the results of the factors sprung from factorial analysis. RESULTS: Correlations between the items of test/re-test BSQ are greater than 0.93. The alpha coefficient is high for the test (0.95) and also for the re-test (0.94). This shows a very good internal consistency between the 34 items of the BSQ. Concerning the EDI, the correlation between the test/re-test are greater than 0.98. The alpha coefficient of Cronbach is high: 0.85 for the test and 0.84 for the re-test. The Pearson's r of the BSQ/EDI test and the BSQ/EDI re-test greater than 0.7 point out the concomitant validity of the BSQ with the EDI. We made a factorial analysis of the BSQ (test) on the 242 subjects. We used the extraction of the main components method with the extraction's rule of the curve for the real values. The transformation method used here is the normalised Varimax. The factorial analysis shows four factors with their own value greater or equal to 1 (15.1; 1.77; 1.48; 1.08). This solution concerning these four factors explains 55.2% of the total variance. The oblical rotations analysis of the four factors seems to point out a high correlation between these latters (from 0.54 to 0.77), this suggests a hierarchical pattern with a single factor which is confirmed with an Cronbach's alpha of 0.95. Then, we chose to gather around each selected factors the items presenting a substantial saturation, greater than or equal to 0.5 and which are saturated by only one factor. The first factor obtained by the factorial analysis of the BSQ has been called "social avoidance and shame of the exposure of the body". The internal coherence of this factor is satisfactory (Cronbach's alpha = 0.87). The second factor obtained has been called "body dissatisfaction compared to the lower parts ot the body (Cronbach's alpha = 0.90). The third factor has been called "using laxatives and vomiting in order to reduce body dissatisfaction" The fourth factor has been called "unsuited cognitions and behaviours in order to control the weight (Cronbach's alpha = 0.76). The solution with 1 and 4 factors has been tested by a confirmatory analysis. The adjustment parameters of the unifactorial pattern were not satisfactory (GFI = 0.76, CFI = 0.83, RMC = 0.5). The 4 factors pattern adjusted better to the data (GFI = 0.86, CFI = 0.90, RMC = 0.5). In order to determinate the differences between the weight/score categories to the BSQ) score in comparison to the 4 factors (coming from the factorial analysis), several Anova have been released as well as post-hoc tests (test of Sheffé). There is a significant effect of the weight category on the corporal dissatisfaction (BSQ result), F (2.230) = 11.34; p < 0.0001. Scheffe's test placed in a prominent position the fact that the subjects having an overweight (99.85 +/- 31.34) have a corporal dissatisfaction significantly greater than the subjects having a normal weight (74.08 +/- 27.94) and presenting a thinness (63.19 +/- 23.61). We pointed out a significant effect of the weight category on factor one "social avoidance and shame of the exposure of the body" [F (2.232) = 20.18; p < 0.001], on factor 2 "body dissatisfaction compared to the lower parts of the body" [F (2.232) = 6.38; p < 0.005] and factor 4 "reduce body dissatisfaction and unsuited cognitions and behaviours in order to control the weight" [F (2.232) = 5.67; p < 0.005]. However, there is no effect in the weight category for factor 3 "using laxatives and cominting in order to reduce the corporal dissatisfaction" [F (2.232) = 5.67; p > 0.05]. Sheffe's test highlighted the fact that the subjects having overweight have a result more important than the ones having a normal weight and presenting a thinness for factor 1.2 and 4. DISCUSSION: The BSQ "French version" seems in fact to present the same metrical qualities than its original Anglo-Saxon and Spanish versions. The concluding results invite us to continue our study of the BSQ including in our patients, the bulimic subjects and the ones who are worried about corporal aspect. Its implications on the clinical field could be really interesting especially on people suffering from the eating disorders. Then, the BSQ could provide us a way to explore the role of an extreme worry of the body's appearance in the development, the maintenance and the treatment of the eating disorders.

Adult↗
PubMedDate not supplied

[Epidemiological study of cannabis abuse and dependence in 256 adolescents].

A study of cannabis use in French adolescents was implemented using a questionnaire derived from the French version of the Mini International Psychiatric Interview based on DSM IV criteria for cannabis dependence, among a population of 256 high school students from two high schools with different SES backgrounds. Among the adolescents studied, 41.4% (n = 106) reported using cannabis occasionally or regularly, 51.2% had never used cannabis, and 7.4% had used cannabis and subsequently quit. Incidence of usage appeared to increase as a function of age, 51.4% for those 18 years and over, 44.6% for 17 years-old, and 30.4% for 16 years-old, girls tending to consume less than boys (36.4% to 45.2%). With regards to results of the MINI, of the regular or occasional users (n = 106), 47.2% of the subjects indicated substance dependence while the remaining subjects indicated that they were recreational users only. Among users, data concerning tolerance, withdrawal, and excessive consumption indicated that subjects were significantly affected by their addictive behavior; 33% of users reported having smoked cannabis for one year or less with 10.4% reporting that they have smoked for more than three years. Among those having smoked one year or less, 31.4% reported signs of dependence versus 68.6% who consume on a recreational basis; among those having used cannabis for three years or more, 63.6% reported dependence while 36.4% admitted to recreational usage. This study indicates the seriousness of cannabis usage among high-school students, underlining addictive and dependent behavior and their effects on daily life as well as significant the increase of usage with age and as a function of number of years of smoking.

Adolescent↗
PubMedDate not supplied

[Symptoms of DSM IV borderline personality disorder in a nonclinical population of adolescents: study of a series of 35 patients].

1,363 high school students were solicited to complete a personality disorder questionnaire and were encouraged to continue in the study by signing up for interviews with Master's level psychology students. 107 students (7.8%, 34 males, 73 females, mean age = 16.7 +/- 1.8) manifested themselves for the interview and were assessed by using structured diagnostic interviews for borderline personality disorder and major depressive disorder (DIB-R, Revised Diagnostic Interview for Borderlines; MINI, Mini International Neuropsychiatric Interview). The interviews were audiotaped. Interrater reliability was determined by independent ratings of 12 borderline subjects and 12 non-borderline subjects (kappa: 0.795). The distribution of the 107 subjects based on the number of DSM IV borderline personality disorder criteria indicated a gradual dispersion suggesting a continuum from normality to borderline personality disorder: 8% of the subjects met none of the criteria; 16% met one criterion; 17% met two; 12.5%, three; 13.7%, four; 8.4%, five; 5.6%, six; 9.3%, seven; 4.6%, eight; 4.6%, nine. Thirty-five of these 107 subjects (32.7%, 6 males, 29 females, mean age = 16.7 +/- 1.7) received a diagnosis of borderline personality disorder according to DSM IV criteria. The most frequent symptoms were paranoid ideation or dissociative symptoms (97.1%), affective instability (88.6%), inappropriate, intense anger (85.6%), suicidal gestures or automutilation (82.9%), followed by frantic efforts to avoid abandonment (77%), impulsivity (65.7%), unstable and intense relationships (62.9%), identity disturbance (60%), and emptiness (57.1%). The comparison between borderline and non-borderline subjects showed that all borderline personality disorder criteria discriminated significantly between the two groups. The high incidence of paranoid ideation (97.1%) and dissociative experiences (65.7%) in the borderline group suggests the pertinence of criterion 9 in the diagnosis of borderline personality disorder in adolescents. Two criteria of schizotypal personality disorder were also frequent in this group: 68.6% of the borderline group reported odd beliefs or magical thinking, in particular beliefs in clairvoyance or telepathy and 88.6% reported unusual perceptual experiences, in particular sensing the presence of a force or person and bodily illusions. Moreover, 31.4% of the borderline group reported transient "quasi" psychotic experiences, mainly "quasi" visual hallucinations. Auditory hallucinations or delusional ideas were not observed. This symptomatology suggests a "quasi" psychotic dimension of adolescent borderline personality disorder. Affective instability was the next most frequent symptom which was usually marked by a cyclothymic appearance. Comorbidity with major depressive disorder was high: 85.7% of the borderline subjects had a concurrent diagnosis of major depression versus 45.8% of the non-borderline subjects. Thus, major depression is more frequent than most of the borderline personality disorder criteria, with the exception of the already noted paranoid ideation and affective instability. Hypomanic symptoms were frequent in the borderline group (65.7%) as well as in the non-borderline group (38.8%). This symptomatology suggests that adolescent borderline personality disorder is linked to an attenuated bipolar spectrum characterised by major depressive episodes and soft signs of bipolarity. However, hypomanic symptoms, which were quite frequent in non-borderline subjects, might also be due to a mechanism of defence, i.e. the denial of depression. Comorbidity with anxiety disorders appeared also to be high: anxiety symptoms were found in 91.4% of the borderline subjects who reported symptoms of generalised anxiety disorder, panic disorder, and somatoform disorders. The overall clinical appearance of these borderline adolescents not referred for treatment seemed to be quite similar to that of borderline adolescents in clinical samples. This study shows that adolescent borderline personality disorder in non-clinical population is a serious disorder characterised by the importance of mental suffering and behavioural disturbances the disorganising power of which may fix the developmental process in a pathological pathway. Adolescent borderline personality disorder appears in this study to be strongly associated with major depressive disorder and at-risk behaviours linked to impulsivity, affective instability, and suicidal ideation. However, this study found an absence of precise cut-off between borderline and non-borderline subjects. Two factors might have contributed to the appearance of a continuum. First, some degree of impulsivity and instability in affectivity, self-images and interpersonal relationships is part of normal adolescence. (ABSTRACT TRUNCATED)

Adolescent↗
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[Detection, prevention and treatment of postpartum depression: a controlled study of 859 patients].

This study evaluated the clinical effectiveness of a programme aimed at detecting, preventing and treating postpartum depression. The French version of the EPDS was used to measure the intensity of postpartum blues on a sample of 859 women, during their stay at the obstetrical clinic. Subjects under treatment for psychological problems were excluded from the study. Mothers scoring 9 or above on the EPDS, which is predictive of pospartum depression, were randomly assigned to a prevention and a control group. Written informed consent was obtained from the subjects after the study procedure had been explained. The prevention group received a counselling session integrating supportive, educational and cognitive-behavioral components. Therapists included five female Master's Degree level students in psychology. All therapists participated in didactic and clinical training as wells as weekly supervision from the first author. All subjects were given a second EPDS with written instructions to complete the questionnaire during the period 4 to 6 weeks postpartum and return it for analysis. At four to 6 weeks, women in the prevention group had significant reductions in the frequency of probable depression, as defined by a score of 11 or above on the EPDS (30.2% vs 48.2%, chi 2 = 7.36, dl = 1, p = 0.0067) and in the intensity of depressive symptoms measured by the mean score on the EPDS (8.5, SD = 4 vs 10.3, SD = 4.4, t = 3.06, dl = 209, p = 0.0024). Mothers with a probable depression were interviewed at home and assessed using the MINI (Mini Neuropsychiatric Interview, Lecrubier et al., 1997) to diagnose major depressive episode, the SIGH-D (Structured Interview Guide for the Hamilton Depression Rating Scale, Williams, 1988) and the BDI (Beck Depression Inventory, Beck et al., 1988). The baseline depression rating scores, EPDS (mean = 13.6, SD = 4), BDI (mean = 15.7, SD = 5.9), HDRS (mean = 14.8, SD = 6), were consistent with moderate depression. No significant differences in baseline scores were observed between the two groups on all the rating scales (p < 0.001). Mothers with probable depression in the prevention group were offered a program of 5 to 8 home visits. Most of the mothers in the prevention group (72%) agreed to participate in the program. On the contrary, most of the mothers (83.3%) who scored below 9 on the first EPDS and 11 or above on the second, who so did not received the preventive counselling session, declined to participate. This suggests the importance of the preventive session in establishing therapeutic alliance. The home visits program integrated four components, supportive, educational, cognitive-behavioral and psychodynamic centred on the mother-infant relationship in terms of the mother's personal history. Therapist participated in clinical training and weekly supervision. Fifteen women (71.4%) in the study group demonstrated complete symptom remission, as defined by HDRS score below 7 after the intervention, compared with 4 women (10.5%) in the control group (chi 2 = 23, p < 0.0001). A clearly therapeutic response to treatment was observed in the treated group with a mean reduction in HDRS score of 9.5 (DS = 6.7) from baseline. The improvement in the women in the treated group, as measured by the mean HDRS scores was statistically greater than that in the control group (m = 5.35, SD = 3.5 vs m = 15.8, SD = 4.6, t = 8.24, dl = 52, p < 0.0001). Our results indicate that a program based on an intervention at obstetrical clinics and on home visits is efficacious and well accepted for prevention, detection and treatment of postpartum depression.

Adult↗
PubMedDate not supplied

[Factorial analysis and internal consistency of the French version of the Toronto Alexithymia Scale (TAS 20), in obese women].

The term alexithymia is derived from the Greek and means no words for feeling and is used to describe a personality trait characterized by the inability to experience and express emotion. Alexithymia is a relevant feature in subjects with eating disorders. The Toronto Alexithymia Scale (TAS) is the more used scale to assess alexithymia. The TAS 20 represents the latest revised and short version of the TAS, with psychometric properties clearly superior to the other alexithymia scales. The TAS 20 is a 20-items self-administered questionnaire including three subscales: ability to identify feelings, ability to describe feelings and externally oriented thinking. The TAS 20 was sparsely used in obese people and its validity was not studied at the present time in this specific population. The aim of this study was to assess the internal consistency and the factorial structure of the TAS 20 in a group of obese women. Method-The TAS 20 was administered to 192 obese women willing to loose weight, aged from 18 to 60 years. Their body mass index (BMI) was ranged from 27.5 to 55,0 kg/m2. The patients also completed a depression scale (Beck Depression Inventory 13). Cronbach's alpha coefficient was used to investigate the internal consistency of the scale. A confirmatory factorial analysis was performed to examine the validity of the initial three-factor structure in this population. The confirmatory factor analysis was conducted using STATISTICA 5.0((R)). Results-An exploratory factorial analysis using the principal components method was performed to search for a more relevant factorial structure. The global internal consistency value (a) was 0,74 for the full scale. The a coefficients were 0.78 and 0.67 respectively, for the two first subscales, (ability to identify feelings and ability to describe feelings), but was low (a=0.33) for the last subscale (externally oriented thinking). This result questionned the initial three-factor solution and conducted us to perform a exploratory factorial analysis. This analysis yielded a six factors solution, explaining 58.7% of the total variance, with the sole item 3 forming the sixth factor. The factor analysis yielding a five factors solution was retained. This solution explained 53.6% of the total variance. The first factor (22.3% of the variance) was constituted by the majority of the first subscale's items (items 1, 3, 6, 7, 9, 11, 13, 14) and corresponded to the ability to identify feelings. Four items out of five of the second dimension ability to describe feelings (items 2, 4, 12, 17) constituted the fourth factor (7.1% of the variance) of the analysis. The third subscale (externally oriented thinking) was divided in three factors explaining respectively 10.7%, 7.5% and 6.0% of the variance. The first of them included the items 5, 10 and 18, the second one included the items 15, 16 and 20, and the last one included the items 8 and 19. We called these three factors emotional avoidance , lack of interest in psychological comprehension and cognitive avoidance , respectively. The parameter estimates of the confirmatory factorial analysis for this five-factor solution were: c(2) goodness-of-fit=287.50 (df=141; p<0.001), goodness-of-fit-index=0.87, adjusted goodness-of-fit index=0.82, root-mean-square-residual=0.08. The different models were compared by testing the differences in the chi-squares. The five-factor solution was better than the other tested models. Discussion-The results of the present study indicate that the use of the TAS 20 to assess alexithymia in obese subjects willing to loose weight, requires a careful interpretation related to the features of this population. Exploratory factorial analysis suggests a five factors solution statistically and clinically more relevant than the three factors solution. The first dimension (ability to identify feelings) is retained. The second dimension (ability to describe feelings) could rather be linked to the common wishes of obese women to keep their own feelings to themselves than to a dimension of alexithymia. Our data suggest to t to divide the last initial dimension externally oriented thinking in three independant factors which we named: emotional avoidance , cognitive avoidance and lack of interest in psychological comprehension . Emotional and cognitive avoidance could be linked to the fact that our subjects wanted to loose weight and exhibited restrain eating. A positive correlation between restrain eating and alexithymia was previously reported. The last factor lack of interest in psychological comprehension would constitute an actual dimension of alexithymia: former studies found a negative correlation between alexithymia and psychologically oriented thinking.

Adolescent↗
PubMedDate not supplied

[Study of the CES-D on a sample of 1,953 adolescent students].

OBJECTIVE: To evaluate the psychometric characteristics of the CES-D (Center for Epidemiological Studies - Depression Scale) in adolescents and to estimate the prevalence of major depression in French high-school students. METHOD: A random sample of 2 583 high-school students from the departments of Haute-Garonne and Pyrénées-Orientales, France, were asked to complete the CES-D. Of these subjects, 1 953 (75.6%) (966 boys and 987 girls, mean age=17 1.4) completed satisfactorily the questionnaire. A sub-sample of 60 adolescents volunteered for an interview and were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview). RESULTS: The internal consistency of the CES-D was satisfactory (Cronbach alpha=0.85). A principal component analysis produced consistent sub-scales. The factor structure was similar to that observed in previous studies in adults. Four factors were extracted which accounted for 49.6% of the variance: a depressive cognition factor (items 1, 9, 10, 15, 19); a positive affect factor (items 4, 8, 12, 16); a factor reflecting slowing of thought and reduction of energy (items 5, 7, 20); and a depressive affect factor (items 2, 3, 6, 11, 14, 17, 18). Among the 1 953 subjects, the mean score for girls was significantly higher than for boys (18,8 10,2 versus 14,4 7,7). Of the 60 subjects who were assessed with the MINI, 28 received the diagnosis of major depressive episode. The mean scores of depressed girls and boys in this sub-sample (respectively 35.5 8.7 and 27.7 9.6) were significantly higher than the mean scores of girls and boys for the total sample. According to the results, the best cut-off score was a score of 24 or higher, providing a sensibility of 0.74 and a specificity of 0.73. According to this cut-off score, 9.9% of boys and 24.2% of girls had a probable major depressive episode. DISCUSSION: This study showed a high level of depressive symptoms and a high frequency of probable depression in French adolescents. Two findings suggest the reliability of these results: first, the male-female ratio, close to 1:2 for probable depression, is in keeping with current epidemiological data; second, the high internal consistency and the factor structure are indicators of the reliability of CES-D in adolescents. Our study found a higher cut-off score than the previous French study of the CES-D in adolescents by Bailly et al. This discrepancy may be due to our small interview sample. However, the cut-off of 24, identified with our study, provided frequency rates more in agreement with epidemiological data than the cut-off of 21 proposed by Bailly et al. Mean CES-D scores of boys and girls in our study were respectively significantly higher than those obtained in boys (n=439, 12.4 7.5) and girls (n=305, 16.6 9.7) by Bailly et al. eleven years before. Given the similarities of mean age and representativeness of samples in both studies, this discrepancy may be due to an increase in depressive symptoms in French adolescents which may be linked to the parallel increase in substance use and particularly in cannabis use. CONCLUSION: The high internal consistency and the factor structure of the CES-D suggest its reliability in adolescents. This study found a high frequency of probable major depression in French high-school students.

Adolescent↗
PubMedDate not supplied

[Personality disorders in a nonclinical sample of adolescents].

OBJECTIVE: To examine the comorbidity of borderline personality disorder and other personality disorders in a nonclinical sample of high-school students. METHOD: 311 high-school students who completed the French version of the CES-D (Center for Epidemiological Studies-Depression Scale), were asked to participate to interviews evaluating personality functioning: 60 subjects (19%) accepted to participate in the study. The mean CES-D score of these 60 subjects (16 boys, 44 girls, mean age=17.7 1.7) was significantly higher than the mean score of the whole sample (23.9 10.4 versus 16.7 9.8). Thus the interviewed sample was not representative of the population of high-school students. Subjects were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview) and the SIDP IV (Structured Interview for DSM IV Personality). Inter-rater reliability was determined by comparing the independent ratings of interviewers and an experienced clinician on a random sample of 20 interviews. For DSM IV borderline personality disorder diagnosis, the Cohen's kappa coefficient was 0.85. For personality disorder criteria, kappa ranged from 0.6 to 1.0 (average kappa=0.79). RESULTS: Sixteen of these subjects (26,7%, 4 males, 12 females) received a diagnosis of borderline personality disorder according to DSM IV criteria. The mean CES-D score of borderline subjects (30.6 10.2) was significantly higher than the mean score of nonborderline subjects (21.6 10.5). Of the 16 borderline subjects, 11 (75%) received a diagnosis of major depressive disorder versus 14 (31%) of the non borderline subjects. None of the other personality disorders approached the frequency of borderline personality disorder. The next most frequent diagnoses were depressive and dependent personality disorders which occurred in respectively in 16.6% and 10% of the 60 subjects. All the personality-disorders occurred at higher rates in the group with borderline personality disorder with the exception of obsessive-compulsive personality disorder which was diagnosed only in nonborderline subjects. Of the 16 borderline subjects, 11 (68.7%) met the criteria for another personality disorder which were depressive personality disorder (N=5), paranoid personality disorder (N=4), dependent personality disorder (N=3), antisocial personality disorder (N=2), histrionic personality disorder (N=2), avoidant personality disorder (N=2), negativistic personality disorder (N=2), schizotypal personality disorder (N=1), narcissistic personality disorder (N=1), self-defeating personality disorder (N=1). The optional diagnoses (self-defeating, depressive and negati-vistic personality disorders) accounted for 8 of 23 (34.7%) cases of personality disorders diagnosed among borderline subjects. Among these 11 adolescents, 5 received 2 diagnoses of personality disorders (borderline and paranoid personality disorders, N=1; borderline and dependent personality disorders, N=1; borderline and depressive personality disorders, N=3), 3 received 3 diagnoses (borderline, antisocial and histrionic personality disorders, N=1; borderline, avoidant and negativistic personality disorders, N=1; borderline, depressive and negativistic personality disorders, N=1), 3 received 5 diagnoses (borderline, paranoid, histrionic, narcissistic and dependent personality disorders, N=1; borderline, paranoid, dependent, avoidant and depressive personality disorders, N=1; borderline, paranoid, schizotypal, antisocial and self-defeating personality disorders, N=1). Among the 44 adolescents (12 boys, 32 girls) without borderline personality disorder, 10 (22.7%) (3 boys, 7 girls) met the criteria for another personality disorder which were depressive personality disorder (N=5) or cluster C disorders -obsessive-compulsive personality disorder (N=4), dependent personality disorder (N=2), avoidant personality disorder (N=1) - with the exception of one diagnosis of histrionic personality disorder. Two subjects received 2 diagnoses (obsessive-compulsive and depressive personality disorder). The internal consistency of personality disorders criteria was assessed with Cronbach's alpha coefficient. Borderline personality disorder criteria had high internal consistency (0.82). The factor structure of borderline personality disorder criteria was studied with an exploratory factorial analysis which extracted three factors. The eigenvalues were 3.70, 1.06, and 1.01. Confirmatory factorial analyses were conducted. The correlated two-factor model and the three-factor model fit the data well but the correlation between factors was, however, judged too high, ranging from 0.70 to 0.78. The one-factor model proved to have a good fit (Goodness of Fit Index=0.89, Comparative Fit Index=0.90, Root Mean Square Residual=0.07). As a previous study showed the frequency of two schizotypal personality disorder criteria (odd beliefs/magical thinking experiences and unusual perceptual experiences), an exploratory factorial analysis was performed on the combined set of criteria of borderline and schizotypal personality disorders. It yielded 2 factors: the first factor consisted of all the borderline personality disorder criteria, odd beliefs/magical thinking, and unusual perceptual experiences and could be called the borderline factor; the second factor consisted of the paranoid and the social avoidance criteria and could be called the interpersonal hypersensitivity factor. A confirmatory factor analysis showed that this two-factor model provided a good fit to the data (GFI=0.82, CFI=0,91, RMSR=0.10). The correlation between factors was weak (0.25). These results suggest that odd beliefs/magical thinking and unusual perceptual experiences are a component of borderline symptomatology in adolescents. DISCUSSION: The high frequency of major depressive disorder and personality disorders in the interviewed sample may be due to the possibility that adolescents with psychological problems have used the interview as a way to obtain attention and support from a psychologist. The interviewed sample, which was characterized by a high intensity of depressive symptomatology and by a high frequency of borderline personality disorder, could thus be seen as intermediate between a clinical and a community sample. Our results may be more generalizable to an outpatients population of adolescents. This study found conflicting results about the construct validity of borderline personality disorder in adolescent. The high internal consistency and the one-factor structure of the borderline personality disorder criteria argue for their validity in adolescents. However, the high rates of comorbidity of borderline personality disorder with depression and other personality disorders, extended to clusters A, B and C and to optional diagnoses, suggest the lack of construct validity of either borderline personality or cluster B disorders in adolescents. CONCLUSION: Borderline symptomatology in adolescents appears more in adequacy with a dimensional model than with a typological classification. More studies are needed to assess and improve the construct validity of borderline personality disorder in adolescents.

Adolescent↗
PubMedDate not supplied

[Diagnosing eating disorders: presentation of a new diagnostic test and an initial epidemiological study of eating disorders in adolescents].

Precise diagnosis of eating disorders has long been problematic. First off, although the DSM IV provides clear criteria, these are applicable to a very narrow range of disorders. Subclinical disorders, although well defined in the literature, are difficult to diagnose as no tool has been previously available. These subclinical disorders are particularly important if one considers that they are often precursors to more serious and life-threatening eating disorders. In addition, choice of diagnostic tool for eating disorders has also long been the cause of difficulty for both researchers and clinicians. Although interviews are favored for their in-depth approach, they are sometimes difficult to implement and often too long and costly to use on a regular basis. Most available questionnaires are limited by their approach to one or two diagnostic categories, and again, until now, no tool has fully addressed the issue of subclinical disorders. The goal of this work was to translate and use a new questionnaire, The Questionnaire for Eating Disorders (Q-EDD), which was developed in the United States and based on both DSM IV criteria as well as carefully developed subclinical disorder criteria. The Q-EDD can identify the major eating disorder categories while at the same time distinguishing between different qualities in each (for example restricting versus compensatory anorexia). Moreover, the Q-EDD can identify several subclinical disorder categories, providing useful insight into potentially dangerous evolution of these disorders. In collaboration with one of the original authors, the questionnaire was translated into French with careful attention to DSM IV criteria in order to preserve its original validity. The questionnaire was read by several professionals in psychology as well as lay people to assure its face validity and ease of use. Once the questionnaire was adequately translated and corrected, it was used for an epidemiological study with a large sample of adolescents and young adults (n=1 001) from several Junior High and High Schools in the greater metropolitan area of Toulouse, France. The schools were located in a variety of neighborhoods and represented a wide range of population, some of them being more academic oriented, others being more oriented towards practical training. The population was composed of 703 females and 298 males, with an average age of 17.06 years. In addition, the population included several different ethnic categories, all of which are similarly represented in the general French population. The results from the Q-EDD showed levels of various clinical disorders to replicate data from previous epidemiological studies with 1.5% of the population suffering from a serious clinical DSM IV disorder; 7.9% suffering from DSM IV disorders NOS; and 20.9% suffering subclinical disorders. In addition to this finding of 30% of the population with an eating disorder, it was noted that a large number of these young people fell into the severe underweight and low weight categories. Indeed, nearly 10% of this group were within the weight criteria for anorexia, despite the fact that they did not meet the other criteria. This finding seemed to warrant additional investigation, and as a result, a different cut-off for severe underweight was established using literature references; this cut-off was set at the 10(th) percentile for BMI based on age. Yet, even with this new cut-off, 6% of this population still met a severe underweight criteria suggestive of anorexic pathology. These results led to the formulation of 2 hypotheses to explain this finding, the first of which examines morphological differences, the second of which suggests cultural differences in terms of eating habits and diet. The French version of the Q-EDD appears to follow the psychometric properties of the original version, moreover it provides useful and rich data regarding eating disorders in a format that is simple and efficient.

Adolescent↗