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Introduction Mental pain is a transdiagnostic symptom, predictive of suicide and reported as a critical outcome by patients. A previous systematic review of epidemiological and clinical research has shown a lack of consensual definition of mental pain in clinical research and high heterogeneity across the different measurement instruments of mental pain. Up today there is no systematic review synthetizing all published biological investigations on mental pain. Objectives This study aims to map the field of biological investigations of mental pain in human to identify what and how biomarkers are investigated with a meta-research approach, by providing a critical appraisal of the terms and definitions of mental pain, the studies’ hypotheses, the experimental paradigms used to induce or mimic mental pain and the measurement instruments used to measure mental pain. Methods We conducted a systematic review (compliant with PRISMA guidelines) of all primary research reporting to investigate candidate biomarkers of mental pain in human subjects as stated by the authors. We searched from inception to June 23rd, 2022, the 3 databases MEDLINE, Web of Science and EMBASE. We extracted the study characteristics (e.g., year of publication, population, etc.), the terms used for meaning mental pain, the definition of mental pain, the method to induce mental pain and its rational, the hypotheses and aims, the measurement instruments of mental pain, the candidate biomarkers, and their method of investigation. We performed descriptive statistics of the sample’s characteristics and the extracted data, a qualitative analysis of the definitions, hypothesis, aims and experimental paradigms, and a data visualization linking candidate biomarkers, experimental paradigms, and their investigation methods. Results The search retrieved 5685 papers of which we included 72 primary research publications constituting 78 distinct research studies. Only 37.5% of studies reported a definition of mental pain. 11.5% of studies did not show a measurement instrument of mental pain. The Cyberball (a social exclusion paradigm) was the most frequently used paradigm in experimental studies (62.7%). The cingulate cortex was the most frequently investigated biomarker category (15.3% of all candidate biomarkers), with fMRI as the most frequent investigation method (53.7% of all investigation methods). Conclusions The field of biological investigations on mental pain shows a marked heterogeneity of definitions, terms, hypotheses, experimental paradigms, and measurement instruments, with an over-representation of the construct of social pain and the Cyberball. These could compromise the comparison and combination of studies results in evidence synthesis and their translation into clinical practice. Disclosure of Interest None Declared

Introduction To reduce Coronavirus Disease 2019 (COVID-19)-related mortality and morbidity, widely available oral COVID-19 treatments are urgently needed. Certain antidepressants, such as fluvoxamine or fluoxetine, may be beneficial against COVID-19. Objectives The main objective was two-fold: (i) to test the hypothesis that the prevalence of antidepressant use in patients hospitalized with COVID-19 would be lower than in patients with similar characteristics hospitalized without COVID-19, and (ii) to examine, among patients hospitalized with COVID-19, whether antidepressant use is associated with reduced 28-day mortality. Our secondary aim was to examine whether this potential association could only concern specific antidepressant classes or molecules, is dose-dependent, and/or only observed beyond a certain dose threshold. Methods We included 388,945 adult inpatients who tested positive for SARS-CoV-2 at 36 AP–HP (Assistance Publique–Hôpitaux de Paris) hospitals from 2 May 2020 to 2 November 2021. We compared the prevalence of antidepressant use at admission in a 1:1 ratio matched analytic sample with and without COVID-19 (N = 82,586), and assessed its association with 28-day all-cause mortality in a 1:1 ratio matched analytic sample of COVID-19 inpatients with and without antidepressant use at admission (N = 1482) (Figure 1). Results Antidepressant use was significantly less prevalent in inpatients with COVID-19 than in a matched control group of inpatients without COVID-19 (1.9% versus 4.8%; Odds Ratio (OR) = 0.38; 95%CI = 0.35–0.41, p < 0.001) (Figure 2). Antidepressant use was significantly associated with reduced 28-day mortality among COVID-19 inpatients (12.8% versus 21.2%; OR = 0.55; 95%CI = 0.41–0.72, p < 0.001), particularly at daily doses of at least 40 mg fluoxetine equivalents (Figure 3). Antidepressants with high FIASMA (Functional Inhibitors of Acid Sphingomyelinase) activity seem to drive both associations. Image: Image 2: Image 3: Conclusions Antidepressant use is associated with a reduced likelihood of hospitalization in patients infected with SARS-CoV-2 and with a reduced risk of death in patients hospitalized with COVID-19. These associations were stronger for molecules with high FIASMA activity. These findings posit that prospective interventional studies of antidepressants with the highest FIASMA activity may be appropriate to help identify variant-agnostic, affordable, and scalable interventions for outpatient and inpatient therapy of COVID-19. Disclosure of InterestNone Declared

Introduction Cancer is the second major cause of death among people with psychotic disorders. With the same incidence, mortality in these patients remains higher than in the general population. As stigma has been identified as a risk factor for excess mortality, we focused on oncologists’ beliefs and attitudes towards people with psychotic disorders. Objectives The aim of this study was to uncover physicians’ representations about the impact of psychosis on oncological care. Methods In this qualitative study, individual semi-structured interviews were conducted with 20 physicians working in oncology in the University Hospital of Brest (France). Transcribed interviews were thematically analyzed. This study meets the COREQ criteria. Results Psychosis is described as a broad-spectrum condition whose severity ranges from the “mild” patient with imperceptible abnormality to the “severe” patient with cognitive and affective deficits. Oncologists identified behavioral and emotional symptoms which may modify the patient-physician relationship with difficulties to interact. Some of them consider that these patients are not interested in their health and will not get involved in oncological care. While the psychotic disorder is not considered as a limiting factor per se, oncologists felt concerned about being stigmatizing. They mentioned different aspects (like anticipation of non-compliance or inability to get help) that lead to changes in conventional treatment regimens and may result in a loss of opportunity. Conclusions Oncologists’ beliefs may lead to stigmatizing attitudes towards people with psychotic disorders who may not be given the best possible chances. Thus, these specific elements should be the basis for collaboration between psychiatrists and oncologists. Disclosure No significant relationships.

Introduction Difficult working conditions could be associated with addictive behaviors. Objectives To examine the prospective associations between atypical working hours and substance use, including sugar and fat consumption. Methods In the CONSTANCES cohort, a total of 47,288 men and 53,324 women currently employed were included from 2012-2017 for tobacco and cannabis outcomes, and 35,647 and 39,767, respectively from 2012-2016 for alcohol and sugar and fat outcomes, and they were then followed up annually. Atypical working hours were self-reported at baseline and considered three different indicators: night shifts, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline atypical working hours while adjusting for sociodemographic factors, baseline depression and baseline level of consumption. Results Night shifts increased significantly the odds of using tobacco in women (Odds ratios, ORs varying from 1.55 to 1.62) and cannabis in men (ORs varying from 1.80 to 1.95). Weekend work increased the odds of using tobacco (ORs varying from 1.51 to 1.67) and alcohol (OR of 1.16) in women. Non-fixed working hours increased the odds of using tobacco and alcohol in men and women (ORs varying from 1.15 to 1.19 and 1.12 to 1.14, respectively). Dose-dependent relationships were found for tobacco use in women (P for trends

Introduction It remains unclear whether substance use in youth could be associated with a lower likelihood of accessing employment. Objectives To examine prospectively associations between substance use and the risk of not getting employed among young people. Methods From the French population-based CONSTANCES cohort, 2,873 students who never worked were included between 2012 and 2018 and followed-up for 2.7 years in average. Generalized estimating equations computed the odds of being unemployed versus employed according to substance use at baseline controlling for sociodemographic factors and depressive state. Tobacco use (smoking status and number of cigarettes), cannabis use frequency, and at-risk alcohol use according to the Alcohol Use Disorder Identification Test (total score >7) were introduced separately in the models. Results Tobacco use wasn’t significantly associated with employment. Cannabis use at least weekly, and at-risk alcohol use, were associated with increased odds of being unemployed (OR=1.85, 95%CI(1.29, 2.64)) and OR=1.34, 95%CI(1.04, 1.71)), respectively. Additional analyses on sub-scores of alcohol use suggested that the association was mainly driven by alcohol dependence rather than frequency of use. Conclusions Public health campaigns must target youth by advising them of the detrimental roles of regular cannabis use and at-risk alcohol use and their lower chances of getting employed. Disclosure No significant relationships.

Background: The role of alcohol, tobacco and cannabis use in social differences in terms of depression is poorly understood. Method: We have applied mediation and moderated-mediation models stratified by gender to a population-based sample (N = 37,192) of French men and women from the Constances cohort with baseline and follow-up measures of depressive states. We have examined whether socioeconomic status (SES, measured by education and income) differences in the prevalence of depressive states may be explained by both differences in prevalence of substance use according to SES (mediating effects) and differential effects of substance use on depressive state according to SES (moderating effects). Results: In the mediation models, substance use only explained 5.3% and 2.4% of the association between low education and depressive state in men and women respectively, and was not a significant mediator for income. Moderated mediation models showed robust moderation effects of education and income in both men and women. The association of tobacco use with depressive symptoms, which was the only substance for which a mediation effect remained and for which the moderation effect of SES was the strongest, was significantly higher in participants with low SES. Limitations: The partially cross-sectional nature of the data restricts the possibility of drawing causality with regards to associations between SES and substance use. Conclusion: Targeting substance use, particularly tobacco, can especially reduce depression risk in individuals of low SES.

PurposeThe COVID-19 pandemic has put hospital workers around the world in an unprecedented and difficult situation, possibly leading to emotional difficulties and mental health problems. We aimed to analyze psychological symptoms of the hospital employees of the Paris Saint-Joseph Hospital Group a few months after the 1st wave of the pandemic.Participants and methodsFrom July 15 to October 1, 2020, a cross-sectional survey was conducted among hospital workers in the two locations of our hospital group using the Hospital Anxiety and Depression Scale (HADS) and Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) to measure anxiety, depression, and PTSD symptoms. Factors independently associated with these symptoms were identified.ResultsIn total, 780 participants (47% caregivers, 18% health administrative workers, 16% physicians, and 19% other professionals) completed the survey. Significant symptoms of anxiety, depression, and PTSD were reported by 41%, 21%, and 14% of the participants, respectively. Hierarchical regression analysis showed a higher risk of having psychological symptoms among those (1) who were infected by SARS-CoV-2 or had colleagues or relatives infected by the virus, (2) who retrospectively reported to have had an anxious experience during the first wave, and (3) with a previous history of burnout or depression. In contrast, job satisfaction appeared to be a protective factor. Overall, hospital workers showed the statistically same levels of anxiety, depression, and PTSD symptoms, regardless of their profession and whether they had worked in units with COVID-19 patients or not.ConclusionsOur cross-sectional survey of 780 hospital workers shows that after the first wave, hospital employees had a significant burden of mental health symptoms. Specific preventive measures to promote mental well-being among hospital workers exposed to COVID-19 need to be implemented, first among particularly vulnerable staff, and then, for all hospital staff for whom anxiety is detected early, and not only those who were directly exposed to infected patients.

Objective: The prevalence of depressive and anxiety disorders is higher in women than in men. In contrast, there is still no clear consensus on the existence of sex-related differences in the effectiveness of antidepressant treatments for these disorders. This real-world study used filled prescription sequences to compare antidepressant medications between women and men at a medication level according to their acceptability (ie, combination of efficacy and tolerability)., Methods: In a nationwide cohort from the French national health data system (Système National des Données de Santé [SNDS]), 1.2 million people were identified as new antidepressant users for any condition in 2011. The outcome was clinical acceptability as measured by the continuation/change ratio over the 6- month period following the introduction of the first-line treatment. Continuation was defined as at least 2 refills of the same treatment. Change was defined as at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood stabilizer. Adjusted odds ratios (aORs) were computed through multivariable binary logistic regressions., Results: Overall, after the first prescription of an antidepressant, the continuation/ change ratio was slightly higher for women than men (aOR [95% CI], 1.06 [1.05-1.08]), with escitalopram ranking first in both. Sex-by-medication interactions were significant for paroxetine (0.91 [0.88-0.95]) and fluoxetine (1.19 [1.12-1.26]) only. Specifically, fluoxetine was significantly more acceptable in female than in male participants (0.73 [0.70-0.75] vs 0.63 [0.60-0.67]), whereas paroxetine was more acceptable in male than in female participants (0.75 [0.72-0.78] vs 0.68 [0.66-0.70])., Conclusion: These real-world data may help practitioners and policymakers prioritize choice of antidepressant medications in women and men., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Objective: Depressive symptoms may overlap with those of long COVID. This cross-sectional study aims to compare the prevalence of depressive symptoms among individuals infected with SARS-CoV-2 with versus without long COVID and to explore specific associations with each of the nine core symptoms of major depression., Methods: Data regarding age, gender, SARS-CoV-2 infections, current symptoms, their date of onset, impact on daily functioning, and consideration of alternative diagnoses were collected through phone interviews between September and December 2022 in a nationally representative sample of adults aged ≥18. Data on chronic health conditions and depressive symptoms (PHQ-9) were collected online in infected participants with or without long COVID, according to the WHO definition of the post-COVID-19 condition., Results: Among 1247 participants (mean age (SD): 48.3 (14.3) years, 53.3 % of women), 12.8 % had long COVID and 87.2 % experienced SARS-CoV-2 infection at least 3 months prior to the survey without long COVID. Participant with long COVID were four-fold more likely to have a PHQ-9 score ≥ 10 than those without (44.0 % versus 11.1 %). Three symptoms out of nine were independently associated with long COVID: little interest or pleasure (aOR [95 % CI]: 2.01 [1.03-3.92]), feeling tired or having little energy (1.92 [1.10-3.33]), and poor attention/concentration (2.02 [1.03-3.96])., Conclusion: Clinicians should screen patients with long COVID for major depression but associations with specific depressive symptoms suggest some clinical overlap. Future studies should consider the course of each depressive symptom separately and focus on those less prone to overlap with symptoms of long COVID., Competing Interests: Declaration of competing interest Dr. Lemogne reports non-financial support from Nordic Pharma France, outside the submitted work. The other authors have no interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Context: Individuals need greater climate change awareness in order to mitigate and adapt to climate changes but this awareness can lead to negative health outcomes including climate change anxiety., Objective: To explore the associations between climate change anxiety, idiopathic environmental intolerances and somatic symptom distress, after accounting for modern health worries, anxiety and depression., Methods: A non-representative sample of healthy volunteers completed a cross-sectional online survey that included the Climate Change Anxiety scale (CCA-13), single questions about idiopathic intolerance to five environmental agents, the Somatic Symptoms scale (SSS-8), the Modern Health Worries scale (MHW-12), and the Patient Health Questionnaire for symptoms of anxiety and depression (PHQ-4). Participants also reported their sex, age and subjective socioeconomic status. Bivariate analyses investigated associations between variables and path analyses explored potential mediating factors., Results: 432 participants completed the questionnaire, 421 of whom were included in analyses (67 % women, mean age: 32.7 standard deviation: 12.4). Climate change anxiety, idiopathic environmental intolerances, somatic symptom distress, modern health worries, and symptoms of anxiety and depression were positively correlated in bivariate analyses (Pearson's ranging from 0.22 to 0.57, all p < 0.001). In path analyses, modern health worries (R 2  = 9.9 %) partially mediated the relation between climate change anxiety (R 2  = 20.3 %) and two correlated outcome variables, idiopathic environmental intolerances (R 2  = 36.8 %) and somatic symptom distress (R 2  = 32.4 %)., Conclusions: Climate change anxiety may negatively affect perceived physical health. Stakeholders should aim at promoting climate change awareness while addressing modern health worries to avoid negative health outcomes., Competing Interests: Declaration of competing interest The authors declare they have no conflicts of interest related to this work to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Limited data are available on long-term respiratory disabilities in patients following acute COVID-19., Patients and Methods: This prospective, monocentric, observational cohort study included patients admitted to our hospital with acute COVID-19 between 12 March and 24 April 2020. Clinical, functional and radiological data were collected up to 28 months after hospital discharge., Results: Among 715 patients hospitalised for COVID-19, 493 (69.0%) were discharged alive. We could access complete medical records for 268 out of 493 patients (54.4%); 138 out of 268 (51.5%) exhibited persistent respiratory symptoms and agreed with the data collection and follow-up. Patients were predominantly male (64.5%), with a mean±sd age of 58.9±15.3 years. At the last follow-up, the leading symptoms were asthenia (31.5%), dyspnoea (29.8%) and neuropsychological symptoms (17.7%). Lung function improved up to the last visit. Mean diffusing capacity of the lung for carbon monoxide ( D LCO ) was 77.8% of predicted value, total lung capacity (TLC) was 83.5% and O 2 desaturation during exercise (O 2 desaturation) was 2.3%. While D LCO improved over the entire period, TLC improved in the early phase and O 2 desaturation in the late phase. Except for those with lung comorbidities, only one patient presented with minor functional and chest radiological alterations at 28 months., Conclusion: Patients with acute COVID-19 discharged alive showed improved clinical symptoms, lung function parameters and radiological signs up to 28 months post-infection. Persistent symptoms consisted mainly of asthenia and dyspnoea, with lung function returning to normal. One patient without prior respiratory issues exhibited moderate pulmonary fibrosis., Competing Interests: Conflict of interest: None declared., (Copyright ©The authors 2024.)

Background: Should COVID-19 have a direct impact on the risk of depression, it would suggest specific pathways for prevention and treatment. In this retrospective population-based study, we aimed to examine the association of prior SARS-CoV-2 infection with depressive symptoms, distinguishing self-reported v . biologically confirmed COVID-19., Methods: 32 007 participants from the SAPRIS survey nested in the French CONSTANCES cohort were included. COVID-19 was measured as followed: ad hoc serologic testing, self-reported PCR or serology positive test results, and self-reported COVID-19. Depressive symptoms were measured with the Center of Epidemiologic Studies-Depression Scale (CES-D). Outcomes were depressive symptoms (total CES-D score, its four dimensions, and clinically significant depressive symptoms) and exposure was prior COVID-19 (no COVID-19/self-reported unconfirmed COVID-19/biologically confirmed COVID-19)., Results: In comparison to participants without COVID-19, participants with self-reported unconfirmed COVID-19 and biologically confirmed COVID-19 had higher CES-D scores ( β for one interquartile range increase [95% CI]: 0.15 [0.08-0.22] and 0.09 [0.05-0.13], respectively) and somatic complaints dimension scores (0.15 [0.09-0.21] and 0.10 [0.07-0.13]). Only those with self-reported but unconfirmed COVID-19 had higher depressed affect dimension scores (0.08 [0.01-0.14]). Accounting for ad hoc serologic testing only, the CES-D score and the somatic complaints dimension were only associated with the combination of self-reported COVID-19 and negative serology test results., Conclusions: The association between COVID-19 and depressive symptoms was merely driven by somatic symptoms of depression and did not follow a gradient consistent with the hypothesis of a direct impact of SARS-CoV-2 infection on the risk of depression.

Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind-body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor-patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

The relationships between peer bullying victimization in adolescence and substance use have been poorly studied. Thus, we examined the associations between peer bullying victimization and tobacco, alcohol and cannabis use in 496 French high school students. Peer bullying victimization was measured with a 17-item standardized assessment and analyzed as quartiles. Tobacco, alcohol, and cannabis use were assessed with the Hooked on Nicotine Checklist (HONC), the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the Cannabis Abuse Screening Test (CAST), respectively. Total scores at the HONC (0 to 10), AUDIT-C (0 to 12), and CAST (0 to 24) were used as dependent variables in generalized linear models, adjusting for sex, age, prepared graduation, last school marks and friends outside high school. Compared to the first quartile (i.e., the least bullied students), those from the second, third and fourth quartiles had significant increase of the AUDIT-C ( B  = 0.78 [95%CI 0.17-1.40] with p  = 0.013; B  = 0.86 [95%CI 0.26;1.46] with p  = 0.005 and B  = 1.00 [95%CI 0.38;1.62] with p  = 0.002, respectively), with dose-dependent relationships ( B  = 0.33 ([95%CI 0.13; 0.52] with p  = 0.001). Those from the fourth quartile had a significant increase of the CAST ( B  = 2.13[95%CI 1.25;3.01], p  < 0.001). When examining the role of peer bullying victimization on the number of substances used, there were significant increased odds for students from the third and fourth quartiles, with dose-dependent relationships (OR = 1.24 [95% CI 1.07;1.44], p  = 0.005). These findings encourage paying a particular attention to substance use in students who report being bullied. Consequently, information and prevention using standardized screening tools should be proposed. Conversely, substance use could be an indicator of peer bullying victimization and should thus be explored.

Even during the third wave of the COVID-19 pandemic health professionals were facing mental health challenges. The aim of this study was to examine the mental health of doctors, nurses and other professional groups in Europe and to identify differences between the professional groups. We conducted a cross-sectional online survey in 8 European countries. We asked for demographic data, whether the participants were exposed to COVID-19 at work, for main information sources about the pandemic, the Depression Anxiety Stress Scales (DASS-21), and major stressors. A MANCOVA was carried out to find predictors of mental health among health care professionals. The sample (N = 1398) consisted of 237 physicians, 459 nurses, and 351 other healthcare professionals and 351 non-medical professionals with no direct involvement in patient care. The mean mental health of all groups was affected to a mild degree. Major predictors for depression and anxiety were the profession group with higher scores especially in the group of the nurses and working directly with COVID-patients. In the third wave of the COVID-19 pandemic, the psychological burden on health professionals has remained high, with being nurse and working directly with COVID19 patients being particular risk factors for mental distress. We found as a main result that nurses scored significantly higher on depression and anxiety than practitioners., (© 2024. The Author(s).)

We examined the prospective associations between nicotine dependence and the likelihood of psychiatric and substance use disorders in the general adult population. Participants came from a nationally representative sample of US adults aged 18 years or older, who were interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2002; Wave 2, 2004-2005). The primary analyses were limited to 32,671 respondents (13,751 male (47.9% weighted); mean age of 45 years (SD = 0.18)) who were interviewed in both waves. We used multiple regression and propensity score matching (PSM) to estimate the strength of independent associations between nicotine dependence related to the use of tobacco products at Wave 1 and incident psychiatric disorders at Wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV). All analyses adjusted for multiple potential confounders, including childhood (family history of substance use disorders, parental loss, vulnerable family environment), early-adolescence (self-esteem, social deviance, conduct disorder), late-adolescence (education, personality and psychiatric disorders), adulthood (divorce, stressful life events, social deviance, quality of life, history of alcohol or other substance use disorder), and sociodemographic factors. Multiple regression analysis and PSM converged in indicating that nicotine dependence was associated with significantly increased incidence of any psychiatric disorder (OR = 1.39(95%CI:1.20;1.60)), including substance use disorders (OR = 1.91(95%CI:1.47;2.47)), and anxiety disorders (OR = 1.31(95%CI:1.06;1.62)). Population Attributable Risk Proportions were substantial, ranging from 12.5%(95%CI:8.10;17.0) for any psychiatric disorder to 33.3%(95%CI:18.7;48.0) for any other drug use disorder. Supplementary analyses also indicated significant associations between nicotine dependence and persistence of psychiatric and substance use disorders among patients having a disorder at Wave 1. In the general adult population, nicotine dependence is associated with an increased likelihood for several psychiatric and substance use disorders. Given its high prevalence, these findings have important public health implications., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: To assess the Consultation And Relational Empathy (CARE) measure as a tool for examiners to assess medical students' empathy during Objective and Structured Clinical Examinations (OSCEs), as the best tool for assessing empathy during OSCEs remains unknown., Methods: We first assessed the psychometric properties of the CARE measure, completed simultaneously by examiners and standardized patients (SP, either teachers - SP teacher - or civil society members - SP civil society ), for each student, at the end of an OSCE station. We then assessed the qualitative/quantitative agreement between examiners and SP., Results: We included 129 students, distributed in eight groups, four groups for each SP type. The CARE measure showed satisfactory psychometric properties in the context of the study but moderate, and even poor inter-rater reliability for some items. Considering paired observations, examiners scored lower than SPs ( p  < 0.001) regardless of the SP type. However, the difference in score was greater when the SP was a SP teacher rather than a SP civil society ( p  < 0.01)., Conclusion: Despite acceptable psychometric properties, inter-rater reliability of the CARE measure between examiners and SP was unsatisfactory. The choice of examiner as well as the type of SP seems critical to ensure a fair measure of empathy during OSCEs.

Purpose: Among patients with cancer, a comorbid mental disorder is associated with higher mortality. This could be partially attributed to reduced access to oncological care, sometimes due to treatment refusal. Recommendations were issued in 2018 by the French and Francophone Society of Psycho-Oncology concerning the management of oncological treatment refusal. This study aimed to examine oncology residents' view on psychiatric assessment in this context., Methods: In February 2021, we conducted a descriptive, observational, cross-sectional pilot study among French residents involved in oncology regarding their management of cancer treatment refusal and the importance they assign to psychiatric assessment, using an online questionnaire with 12 multiple-choice questions., Results: Among 87 respondents, only 35.6% systematically explore the history of mental disorders when facing cancer treatment refusal. Even in cases with a known history of mental disorders, only 42.5% systematically refer the patient to a psychiatrist. 96.5% of them were unaware of the 2018 recommendations., Conclusion: The importance given to psychiatric assessment in cases of oncological treatment refusal remains insufficient. Qualitative studies are needed to understand the underlying reasons for this refusal. The development of psychiatric consultation-liaison interventions in oncology centers is necessary to improve the management of these cases and provide appropriate training., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Context: Objective Structured Clinical Examinations (OSCEs) are an increasingly popular evaluation modality for medical students. While the face-to-face interaction allows for more in-depth assessment, it may cause standardization problems. Methods to quantify, limit or adjust for examiner effects are needed., Methods: Data originated from 3 OSCEs undergone by 900-student classes of 5 th - and 6 th -year medical students at Université Paris Cité in the 2022-2023 academic year. Sessions had five stations each, and one of the three sessions was scored by consensus by two raters (rather than one). We report OSCEs' longitudinal consistency for one of the classes and staff-related and student variability by session. We also propose a statistical method to adjust for inter-rater variability by deriving a statistical random student effect that accounts for staff-related and station random effects., Results: From the four sessions, a total of 16,910 station scores were collected from 2615 student sessions, with two of the sessions undergone by the same students, and 36, 36, 35 and 20 distinct staff teams in each station for each session. Scores had staff-related heterogeneity (p<10 -15 ), with staff-level standard errors approximately doubled compared to chance. With mixed models, staff-related heterogeneity explained respectively 11.4%, 11.6%, and 4.7% of station score variance (95% confidence intervals, 9.5-13.8, 9.7-14.1, and 3.9-5.8, respectively) with 1, 1 and 2 raters, suggesting a moderating effect of consensus grading. Student random effects explained a small proportion of variance, respectively 8.8%, 11.3%, and 9.6% (8.0-9.7, 10.3-12.4, and 8.7-10.5), and this low amount of signal resulted in student rankings being no more consistent over time with this metric, rather than with average scores (p=0.45)., Conclusion: Staff variability impacts OSCE scores as much as student variability, and the former can be reduced with dual assessment or adjusted for with mixed models. Both are small compared to unmeasured sources of variability, making them difficult to capture consistently., (© 2024. The Author(s).)

Objectives: Long COVID has been recognized since early 2020, but its definition is not unanimous, which complicates epidemiological assessments. This study estimated the prevalence of long COVID based on several definitions and severity thresholds in the adult population of mainland France and examined variations according to sociodemographic and infection characteristics., Methods: A cross-sectional survey using random sampling was conducted in August-November 2022. Participants declaring SARS-CoV-2 infection were assessed for infection dates and context, post-COVID symptoms (from a list of 31, with onset time, daily functioning impact, and alternative diagnosis), and perceived long COVID. Long COVID prevalence was estimated according to the WHO, National Institute for Health and Care Excellence, United States National Centre for Health Statistics, and United Kingdom Office for National Statistics definitions., Results: Of 10 615 participants, 5781 (54.5%) reported SARS-CoV-2 infection, with 123-759 (1.2-13.4%) having long COVID, depending on the definition. The prevalence of WHO post-COVID condition (PCC) was 4.0% (95% CI: 3.6-4.5) in the overall population and 8.0% (95% CI: 7.0-8.9) among infected individuals. Among the latter, the prevalence varied from 5.3% (men) to 14.9% (unemployed) and 18.6% (history of hospitalization for COVID-19). WHO-PCC overlapped poorly with other definitions (kappa ranging from 0.18 to 0.59) and perceived long COVID (reported in only 43% of WHO-PCC)., Discussion: Regardless of its definition, long COVID remains a significant burden in the French adult population that deserves surveillance, notably for forms that strongly impact daily activities. More standardized definitions will improve integrated surveillance of, and better research on, long COVID., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Identifying factors that predict the course of persistent symptoms that occurred during the COVID-19 pandemic is a public health issue. Modifiable factors could be targeted in therapeutic interventions., Objective: This prospective study based on the population-based CONSTANCES cohort examined whether the psychological burden associated with incident persistent symptoms (ie, that first occurred from March 2020) would predict having ≥1 persistent symptom 6-10 months later., Methods: A total of 8424 participants (mean age=54.6 years (SD=12.6), 57.2% women) having ≥1 incident persistent symptom at baseline (ie, between December 2020 and February 2021) were included. The psychological burden associated with these persistent symptoms was assessed with the Somatic Symptom Disorder-B Criteria Scale (SSD-12). The outcome was having ≥1 persistent symptom at follow-up. Adjusted binary logistic regression models examined the association between the SSD-12 score and the outcome., Findings: At follow-up, 1124 participants (13.3%) still had ≥1 persistent symptom. The SSD-12 score at baseline was associated with persistent symptoms at follow-up in both participants with (OR (95% CI) for one IQR increase: 1.42 (1.09 to 1.84)) and without SARS-CoV-2 infection prior to baseline (1.39 (1.25 to 1.55)). Female gender, older age, poorer self-rated health and infection prior to baseline were also associated with persistent symptoms at follow-up., Conclusions: The psychological burden associated with persistent symptoms at baseline predicted the presence of ≥1 persistent symptom at follow-up regardless of infection prior to baseline., Clinical Implications: Intervention studies should test whether reducing the psychological burden associated with persistent symptoms could improve the course of these symptoms., Competing Interests: Competing interests: OR reported personal fees and non-financial support from Gilead, ViiV Healthcare and Merck Sharp & Dohme Corp outside the submitted work. VP reported personal fees from Grunenthal, outside the submitted work. CL reported non-financial support from Nordic Pharma, outside the submitted work. No other disclosures were reported., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Pathology and biology are essential in the patient care. However, they suffer from a lack of attractiveness to medicine students. In order to gain insight and improve the visibility and attractiveness of these specialties, we designed a survey and submitted forms to medical students, laboratory medical staff, and clinical staff from the different hospitals and institutes attached to "Université Paris Cité". The responses (363 students (response rate: 9.1%), 109 medical -laboratory staff (25%), 61 clinical staff (10%)) confirmed the poor visibility of these specialties among students as well as the will of the -medical laboratory staff to be more involved in the student's training. The -development of partnerships between laboratories and clinical -departments, which would allow medical students to spend short periods of time in related laboratories during their clinical internship, is a prospect for improving the teaching of these disciplines. The main expected benefits are to "discover a new specialty" and "to better understand the prescription of laboratory tests", which are crucial aspects for understanding the role of laboratory disciplines and their interaction with clinicians to improve patient care.

Objective: The 12-item Somatic Symptom Disorder-B Criteria Scale (SSD-12) is a self-reported questionnaire designed to assess the B criteria of the DSM-5 somatic symptom disorder. In this cross-sectional study, we aimed to examine the psychometric properties of the SSD-12 French version and associated health outcomes., Methods: Participants were volunteers from the population-based CONSTANCES cohort who reported at least one new symptom that occurred between March 2020 and January 2021. Depressive symptoms were measured with the Center for Epidemiologic Studies-Depression scale (CES-D)., Results: A total of 18,796 participants completed the SSD-12. The scree plot was consistent with a 1-factor structure, while goodness-of-fit indices of the confirmatory factorial analyses and clinical interpretability were consistent with a 3-factor structure (excluding the item 7): 'Perceived severity', 'Perceived impairment', 'Negative expectations'. The Cronbach's α coefficients of the total and factors scores were 0.90, 0.88, 0.84 and 0.877, respectively. The total score was associated with depressive symptoms (Spearmann's rho: 0.32), self-rated health (-0.46), the number of persistent symptoms (0.32), and seeking medical consultation (odds ratio [95% confidence interval] for one interquartile range increase: 1.51 [1.48-1.54]). Among participants seeking medical consultation, those with higher SSD-12 scores were more likely to have their symptoms attributed to "stress/anxiety/depression" (1.32 [1.22-1.43]) and "psychosomatic origin" (1.25 [1.20-1.29]), and less to "COVID-19" (0.89 [0.85-0.93])., Conclusion: While the SSD-12 French version can be used as a unidimensional tool, it also has a 3-factor structure, somewhat different from the DSM-5 theoretical structure, with high internal consistency and clinically meaningful associations with other health outcomes., Competing Interests: Declaration of Competing Interest Dr. Pitron reported personal fees from Grunenthal, outside the submitted work. Dr. Lemogne reports non-financial support from Nordic Pharma France, outside the submitted work. No other disclosures were reported., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: To assess the associations between anxiety and depressive symptoms and post-COVID-19 condition (PCC) by exploring the direction of these associations and their relevance in the definition of PCC., Methods: Nationwide survey among French adults, recruited between March and April, 2022, using a quota method to capture a representative sample of the general population with regard to sex, age, socioeconomic status, size of the place of residence, and region. We included all participants who met the World Health Organization (WHO) definition of PCC in addition to a random sample of participants infected with SARS-COV-2 for at least 3 months but without PCC. Self-reported anxiety and depressive symptoms, chronic anxiety and depression (for more than 3 years), and anxiety and depression were measured using the GAD-2 and PHQ-2 questionnaires, respectively., Results: In a sample of 1,095 participants with PCC and 1,021 participants infected with SARS-COV-2 without PCC, 21% had self-reported anxiety and 18% self-reported depression, whereas 33% and 20% had current measured symptoms of anxiety and depression, respectively. The high prevalence of these symptoms cannot only be explained by the characterization of PCC, as only 13.4% of anxiety symptoms and 7.6% of depressive symptoms met the WHO criteria for PCC. Only one participant met the WHO criteria based on self-reported anxiety or depressive symptoms alone, as these were always combined with other symptoms in patients with PCC. Chronic symptoms were associated with PCC (aOR 1.27; 95% CI: 1.00-1.61). In addition, measured anxiety was associated with PCC (aOR = 1.29; 95% CI: 1.02-1.62)., Conclusions: Pre-COVID-19 chronic anxiety and depression may play a role in the development of PCC or share vulnerability factors with it. Our results challenge the inclusion of anxiety and depression in the definition of PCC.