Prévention de la dépression en milieu professionnel : du dépistage à la psychoéducation - 01/09/16
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The management of psychosocial risks is at the centre of the social debate in France. Having focused on stress, it is now burnout which is most often cited by the media and politicians. A recent report from the French Medical Academy highlights the difficulty in defining professional exhaustion. This concept appears to be more sociological than medical, and even its existence is a subject of debate. There are no scientific diagnostic criteria nor validated evaluation scale (Olié and Légeron, 2016). However, the role of depression as a causal factor in suffering in the workplace is neglected, yet it is a common and serious illness. The frequency of depression, lack of knowledge about its symptomatology and denial of diagnosis mean that many depressed patients work without being treated (Kessler, 2003). Behavioral and cognitive disorders related to this illness can easily induce a sense of overwork, the inability to cope and a feeling of harassment (Raffaitin and Raffaitin-Bodin, 2008). This is not a new problem, and the history of acedia, considered as the work of the devil in the Middle Ages, is a good illustration of the startling psychopathological hypotheses put forward in the case of suffering related to mood disorders. Workplace interventions linking screening and psychoeducation are essential to improve the situation. A diagnosis based on the Centre for Epidemiological Studies-Depression scale (CESD) is recommended. This is a 20-item self-report measure, scored between 0 and 3, widely used in the field of psychiatric epidemiology. Its advantage is that it can be used with the general population contrary to other scales more commonly used in psychiatry. The threshold of positivity is controversial: Rouillon selected 24 for women and 17 for men (Fuhrer and Rouillon, 1989). It should be noted that a free downloadable CESD smartphone application is available at AppStore and GoogleStore (Fuhrer and Rouillon, 1989). The questions are non-intrusive and the acceptability of this test is excellent. This evaluation should be systematic during check-ups with the occupational physician. In the case of a positive result, a clinical examination, ideally including a MADRS, will confirm or refute the diagnosis (Montgomery and Asberg, 1979). Given the lack of knowledge about symptomatology and treatment of mood disorders, it is desirable to train and inform employees. Depressed patients are rarely recognized as being truly ill, treatment is criticized and there are a number of preconceived ideas about the illness. In the business world, there are the additional problems of simulation fantasies and manipulation of patients (Willard, 2013). It may be unrealistic to consider training all employees in a company, however, it is pertinent to offer psychoeducation modules to managers and members of health and safety committees. This information should cover the epidemiology of mood disorders, symptomatology, warning signals and aggravating factors, pharmacological and psychotherapeutic therapies, difficulties in diagnosis, suicide risks and the phenomenon of stigmatization. It is also necessary to define the legal context highlighting the current difficulties in obtaining recognition of depression as a professional illness, but also the economic consequences for the company. Less than 20% of French employees would be willing to inform their employers if they were suffering from depression (European Depression Association, 2012). The benefits of this type of intervention to employees, the company and the health service are obvious. In fact, a European study showed that for each pound invested in the diagnosis and treatment of depression in the workplace, the health service saved five pounds (European Commission 2011). It is also important to differentiate between exclusively medical psychosocial risks (prevention of depression and adjustment disorders), those related to legal matters (problems of violence and harassment) and those related to social dialogue (negotiations about working conditions). It is important to calm the debate. The real problem is not to decide if depression is the cause or consequence of problems in the workplace, but to treat patients effectively.
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Vol 26 - N° 3
P. 139-143 - septembre 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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