Mesurer la stigmatisation perçue chez les personnes souffrant de troubles psychiques : traduction française, validation et adaptation de la Stigma Scale [French translation, validation and adaptation of the Stigma Scale].

AIM: People suffering from mental illness are exposed to stigma. However, only few tools are available to assess stigmatization as perceived from the patient's perspective. The aim of this study is to adapt and validate a French version of the Stigma Scale (King et al., 2007 [8]). This self-report questionnaire has a three-factor structure: discrimination, disclosure and positive aspects of mental illness. Discrimination subscale refers to perceived negative reactions of others. Disclosure subscale refers mainly to managing disclosure to avoid discrimination and finally positive aspects subscale taps into how patients are becoming more accepting, more understanding toward their illness. METHOD: In the first step, internal consistency, convergent validity and test-retest reliability of the French adaptation of the 28-item scale were assessed in a sample of 183 patients. Results of confirmatory factor analyses (CFA) did not confirm the hypothesized structure. In the light of the failed attempts to validate the original version, an alternative 9-item short-form version of the Stigma Scale, maintaining the integrity of the original model, was developed based on results of exploratory factor analyses in the first sample and cross-validated in a new sample of 234 patients. RESULTS: Results of CFA did not confirm that the data fitted well to the three-factor model of the 28-item Stigma Scale (χ(2)/df=2.02, GFI=0.77, AGFI=0.73, RMSEA=0.07, CFI=0.77 and NNFI=0.75). Cronbach's α was excellent for discrimination (0.84) and disclosure (0.83) subscales but poor for potential positive aspects (0.46). External validity was satisfactory. Overall Stigma Scale total score was negatively correlated with the score on Rosenberg's Self-Esteem Scale (r=-0.49), and each subscale was significantly correlated with a visual analogue scale that referred to the specific aspect of stigma (0.43≤|r|≤0.60). Intraclass correlation coefficients between 0.68 and 0.89 indicated good test-retest reliability. The results of the CFA demonstrated that the items chosen for the short version of the Stigma Scale have the expected fit properties (χ(2)/df=1.02, GFI=0.98, AGFI=0.98, RMSEA=0.01, CFI=1.0 and NNFI=1.0). Considering the small number (three) of items in each subscale of the short version of the Stigma Scale, α coefficients for discrimination (0.57), disclosure (0.80) and potential positive aspects subscales (0.62) are considered as good. CONCLUSION: Our results suggest that the 9-item French short version of the Stigma Scale is a useful, reliable and valid self-report questionnaire to assess perceived stigmatization in people suffering from mental illness. The time of completion is really short and questions are well understood and accepted by the patients.

Du traitement précoce des sujets à risque aux risques du traitement précoce. Le dilemme de la prévention des troubles psychotiques [From early treatment of psychosis risk to the risks of early intervention: the dilemma of psychosis prevention].

While the development of early psychosis intervention programs have improved outcome of such disorders, primary prevention strategies are still out of reach. The elaboration, over the last 15 years, of scales and criteria to identify populations at high risk for psychosis is a real progress, but their low specificity is still a major obstacle to their use outside of research projects. For this reason, even if "ultra high risk", subjects present with real psychiatric disorders and sometimes significant decrease in functioning level, the fact that only a small proportion will eventually develop full blown psychosis will probably lead to the rejection of a "psychosis risk syndrom" from the future DSM-V classification.

Etude des stratégies des travailleurs : un outil pour la prévention des troubles musculosquelettiques

En quoi et comment l'étude des stratégies représente-t-elle un intérêt pour la prévention des troubles musculosquelettiques (TMS) ? Qu'en est-il des retombées d'une telle étude pour l'entreprise et pour les travailleurs ? Cet article se propose d'évaluer les diverses stratégies utilisées par les travailleurs pour gérer leur douleur face aux TMS. Résultats d'une étude qui s'est déroulée au sein de deux usines de transformation du crabe.

L'hôpital psychiatrique: un lieu pour la formation à la psychothérapie des troubles psychotiques

Dans le contexte de prises en charge psychiatriques hospitalières complexes pour des patients souffrant de troubles psychotiques, le risque est grand que le traitement se limite à l'identification de symptômes, à la définition d'un diagnostic et à l'instauration d'un traitement médicamenteux. La prise en compte des aspects psychologiques de la crise qui conduit à l'hospitalisation et son intégration dans le contexte de l'histoire de vie du patient sont pourtant d'une importance fondamentale pour l'évolution et le succès du traitement. Dans cet article, nous rendons compte d'une démarche de réflexion, conduite dans une unité hospitalière universitaire spécialisée dans le traitement des troubles du spectre de la schizophrénie, visant à identifier les moyens qui permettraient de renforcer la place de l'approche psychologique des troubles psychotiques en milieu hospitalier et de rendre cette approche accessible aux médecins psychiatres en formation dans de telles structures.