Syndrome dépressif et absentéisme chez le personnel soignant de la région de Sousse (Tunisie).

Résumé Introduction La dépression représente actuellement l’une des plus importantes causes d’absentéisme de longue durée au travail et qui a connu une croissance importante au cours de ces dernières années. L’étude de ce phénomène en milieu hospitalier doit son intérêt à la fois à l’importance numérique du personnel concerné et au polymorphisme des nuisances et des risques encourus. Les objectifs de notre étude étaient d’identifier les caractéristiques socioprofessionnelles du personnel de santé absent pour maladie dépressive et de déterminer les principaux facteurs de risque et les moyens de prévention de ces absences. Patients et méthodes Il s’agit d’une étude descriptive rétrospective, réalisée à la Direction Régionale de la Santé de Sousse (Tunisie) sur une période de cinq ans allant du 1 er janvier 2009 jusqu’au 31 décembre 2013, portant sur tous les dossiers du personnel de la santé du secteur public qui s’est absenté pendant une longue durée pour dépression nerveuse. Résultats Notre étude a porté sur un nombre de 204 personnel de santé répartis en 159 femmes (77,9 %) et 45 hommes (22,1 %). La moyenne d’âge a été de 50,3 ± 7,68 ans. Les services les plus touchés par l’absentéisme pour dépression ont été notamment : les services médicaux (18,6 %), la maternité (14,7 %), l’administration (11,3 %) et les urgences (10,8 %). Au cours des cinq années d’étude, le nombre de congés de longue durée attribués au syndrome dépressif était de 768 congés avec 80 327 jours de travail perdus. Conclusions Les arrêts de travail de longue durée semblent constituer un fléau et ont un impact économique et moral important. Le rôle du médecin du travail reste capital vu sa contribution utile et efficace dans l’amélioration des conditions du travail et la prévention de la maladie dépressive. Depression in the workplace is becoming more common. It is responsible for the upsurge in long-term sick leave. Its prevention requires the improvement of working conditions and the management of burnout. Health workers, faced with suffering, illness, death are subject to significant mental workload. Some authors believe that the mental workload is multiplied by 2–7 among hospital staff. Physical and nervous overload is expressed by psychosomatic and neuropsychiatric manifestations. We conducted a work aimed to study the interactions between depression and professional activity among health care workers in the Governorate of Sousse, Tunisia during five years from 1 January 2009 until 31 December 2013. Data was collected from medical and administrative records accessed at the Regional Commission of long-term sick leave in Sousse. Concerned patients were invited to answer additional questions during consultation. We have attempted to identify the socio-professional characteristics of absentees, and to determine the possible role of working conditions in the decompensation of depression in order to establish preventive measures. Our work is a retrospective descriptive study which surveyed 204 health workers who have obtained a long-term sick leave for depressive syndrome during the study period. The prevalence of absenteeism was estimated to 4.45%. Some employees have submitted more than one sick leave, which raises the number of sick leaves to 768 during the study period. The study population is relatively young, with about 50.9% of absentees aged between 50 and 59 years. A female predominance was noted (77.9% of absentees). Our population was composed mainly of married employees (79.9%) which had, in 88.7% of cases, at least one dependent child. Older paramedics were more affected than any other occupational group. The most affected services were, in descending order, medical, gynecological and obstetric services, administrative services, emergency services, outpatient and finally pediatric services. Most common medical affections were hypertension, diabetes, cancer and rheumatic diseases. Personal history of psychiatric diseases was mentioned by 38% of cases. As pointed by many authors, healthcare workers commonly relate the genesis of their psychiatric disorder to socio-professional conditions. Physical load was declared by 46.1% of cases and metal overload was described by 27.9% of questioned workers. Other common stressing situation was the permanent contact with patients and/or their family. Conflictual relationship with colleagues and/or superiors was declared by 17.6% of cases. It appears from our study that 10.8% of absent for depressive syndrome feel insecure in their work. This feeling seems to be more pronounced in recent years after the revolution in Tunisia (2011). Indeed, the rate of violence against care workers has tripled after the revolution. The most important consequence of this disease is long-term absenteeism which has an expensive cost expressed by economic and social outcomes. In our survey, we found that the absenteeism was 21.57% with 80,327 lost working days which is pretty near to 44 years lost per year of work during the of study period. The analysis of our results showed that the absenteeism indicators are very high and it is urgent to have a real plan of action. This plan primarily affects prevention. The management of depression in the workplace requires a multidisciplinary intervention and better coordination between occupational physician and psychiatrist or psychologist. [ABSTRACT FROM AUTHOR]