La santé mentale est marquée par un fort taux de non-recours aux soins spécialisés. L’objectif de notre étude est d’identifier les facteurs associés à un faible recours aux soins spécialisés en psychiatrie chez des agents de la fonction publique en congés pour raison de santé mentale, ayant fait l’objet d’une expertise psychiatrique dans le cadre du Comité médical départemental de la Martinique entre 2000 et 2013.

Étude observationnelle, transversale, portant sur l’analyse des expertises psychiatriques. Nous avons défini un faible recours aux soins spécialisés en psychiatrie comme l’absence de consultation avec un psychiatre dans les douze mois précédant l’expertise médico-administrative par un expert agréé.

Sur 516 dossiers analysés, 293 sujets (57 %) avaient un faible recours aux soins spécialisés en psychiatrie dans le cadre de leur suivi, alors que l’expertise retrouve un diagnostic psychiatrique dans 96 % des cas, et que 81 % ont des antécédents psychiatriques. Un peu moins de la moitié (41 %) est pris en charge uniquement par un généraliste. Le faible recours aux soins spécialisés en psychiatrie est associé de façon significative avec le fait d’être un homme, d’avoir plus de deux enfants, d’avoir des événements de vie personnelle (notamment de souffrir de pathologie somatique), et l’absence d’antécédents psychiatriques et d’hospitalisation en psychiatrie.

Alors qu’ils sont en congés pour raison de santé mentale, de nombreux agents de la Fonction Publique n’ont pas une prise en charge spécialisée en psychiatrie satisfaisante. Nos résultats renforcent la nécessité de développer des partenariats afin d’améliorer la collaboration entre secteurs de psychiatrie et acteurs de soins primaires.

Mental illness is noted for being in one of the first places in global burden of disease in terms of years lived with disability (YLDs). Notably, absences due to mental health problems greatly affect the world of work, and mental illness is one of the most economically important diseases. However, there is a high rate of those not seeking care in mental health, both in the general population but also in workers in private and public sectors with significant economic impacts. The aim of our study was to identify factors associated with low access to specialized psychiatric care among French Public Sector employees referred to a psychiatric expertise upon request from the Departmental Medical Board of Martinique (Comité médical départemental [CMD] de Martinique), between 2000 and 2013.

We carried out an observational and transversal study, analyzing sociodemographic and clinical data from psychiatric assessments done to help the CMD give notification on the medico-administrative situation of Public Sector employees, a large majority of whom had been on sick leave due to mental health for at least 6 months. The variable of interest – low access to psychiatric care – was defined as the absence of consultation at the time of the assessment provided by a psychiatrist since at least 12 months. Descriptive analyses were performed first, then univariate analysis using a non-adjusted binary logistic regression model, to identify factors associated with low access to psychiatric care. Finally, multivariate analyses using a binary logistic regression model were performed after excluding non-relevant factors (with significance level above 5%) during the univariate analysis. A significance threshold of 0.05 was adopted for all of the statistical analyses.

We retrospectively analysed the records of 516 Public Sector employees. Two hundred and ninety-three subjects (57% of the population) had a low access to psychiatric care as part of their regular clinical follow-up, even the 81% who were identified has having had psychiatric antecedents (55% with ‘mood disorders’, and 17% with ‘neurotic, stress-related and somatoform disorders’). Moreover, psychiatric expertise found a psychiatric diagnostic in 96 % of cases, mostly ‘mood disorders’, ‘neurotic, stress-related and somatoform disorders’ and ‘personality disorders’. For mood disorders, clinical characteristics of episodes were defined as ‘severe’ or ‘with psychotic symptoms’ in many cases. Suicidal thoughts were found in 96 subjects (18%) during the expertise. Fewer than half of the subjects (43%) had a specialized psychiatric care (mostly subjects with ‘mood disorders’ and ‘psychotic disorders’) and 41% only had care by a general practitioner (mostly subjects with ‘neurotic, stress-related and somatoform disorders’). In most of the cases, psychotropic drugs were insufficiently and inadequately prescribed. Using multivariate analysis, we found a significant association between low access to psychiatric care and: being masculine, having had more than two children, having had personal life events (in particular chronic somatic diseases), and having had no history of mental illness or of psychiatric hospitalization. It appears that chronic somatic diseases are frequently associated with psychiatric diseases, and the association worsens the prognosis of the two disorders. However, even if employees with mental disorders associated with chronic somatic diseases are unfit for work, many of them do not have access to mental health care and only have care by a general practitioner.

More than half of French Public Sector employees referred to the Departmental Medical Board of Martinique for a medico-administrative decision relevant to sick leave due to mental diseases, had low access to specialized psychiatric care. By identifying barriers to care and reasons for not seeking specialized mental health care, we would be able to prevent disability claims and days off work (predicting malaise in the workplace and health-related limitations). Our results demonstrate the need to strengthen existing partnerships, and thus enhancing cooperation between public psychiatric sectors and primary healthcare players, facilitating access to mental healthcare and decreasing the stigma about mental disorders.