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HAL CCSD Résumé : International audience
Despite the recent interest in psychiatric illness in prison, the psychopathology of the Remire-Montjoly prison population remains largely unknown. Subject to significant population movements, French Guiana and its prison houses a very mixed population in which recent history has left a strong mark (earthquake in Haïti, civil war in Suriname, violence related to gold mining population and drug trafficking). These negative life events appear as potential vectors of psychological trauma. Additionally, strong links have been established in the literature between post-traumatic stress disorder (PTSD) and many other psychiatric disorders, including suicidal behavior and addictions. Under these conditions, we felt it essential to focus on the identification of PTSD in this sensitive population.Through adapted reception interviews, we tried to identify the PTSD, to describe by means of socio-demographic factors the studied population and to detect psychiatric comorbidities. The screening tool was the M.I.N.I. 5.0, which identifies 17 psychiatric disorders including the PTSD, based on the DSM IV definition. The target population was the prison incomers, agreeing to participate in the study, aged more than 18 years old and imprisoned between 18 January 2013 and 31 December 2013. To this date, 549 inmates were included in the study.The main result of this study was a prevalence of PTSD of 17% for incomers in detention. We found that the PTSD+ population is more likely to be female (15% against 7% p = 0.0246), which is consistent with the literature data. The M.I.N.I. 5.0 showed a higher prevalence of psychiatric disorders in the PTSD+ group. This association was confirmed in several types of pathology like mood disorders including: major depressive episode and manic or hypomanic episode, suicidal risk, some anxiety disorders including: panic disorder, obsessive-compulsive disorder and generalized anxiety disorder. Strong association was found for current major depressive episode, current manic or hypomanic episode and suicidal risk (p < 0.005).The prevalence of PTSD is very high in this study, about 24 times higher than in a general population survey using the same screening tool.A large number of comorbidities have been identified, which corresponds to those described in the literature. The specific issues of psychiatry in prison lead us to examine more specifically the significance of the results about suicide risk. A comprehensive suicide risk (sum of medium and high risk screened by the M.I.N.I.) was found in significantly more PTSD+ inmates (17% versus 7%, p = 0.005). This study supports the need for routine screening of PTSD among incomers in detention. This disease is both worrying and common in this population but the real issues are the comorbidities. Suicidal potential is among the most important issues in detention. Its evaluation should be completed by an early recognition of a PTSD.
Soumis à des mouvements de population importants, la Guyane Française et son centre pénitentiaire abritentune population métissée chez qui l’histoire récente a laissé une empreinte forte (tremblement de terre en Haïti,guerre civile au Suriname, violence liée à l’orpaillage et au trafic de stupéfiants). Ces événements de vienégatifs apparaissent comme autant de vecteurs potentiels de psychotraumatismes. Dans ces conditions, il nous a paru essentiel de mettre l’accent sur le repérage du TSPT (Trouble de Stress Post-traumatique) dans cette population sensible. A l'aide d’entretiens d’accueil dédiés nous nous sommes proposé de repérer les TSPT, de décrire sur un plan sociodémographique la population étudiée et de rechercher les comorbidités psychiatriques. Le résultat principal de cette étude était une prévalence du TSPT de 17% chez les arrivants en détention. Le MINI 5.0 a montré une prévalence plus élevée des pathologies psychiatriques dans le groupe présentant un TSPT avec un lien très fort (p<0.005) pour l’épisode dépressif majeur actuel, l’épisode (hypo)maniaque actuel et le risque suicidaire. Cette étude appuie la nécessité d’avoir un dépistage systématique du TSPT chez les arrivants en détention. Cette pathologie est à la fois fréquente dans cette population et invalidante mais ce sont ses comorbidités, dont le potentiel suicidaire, qui font tout l’enjeu d’un repérage précoce.
ISSN: 0383-6320
inserm-01421075
http://www.hal.inserm.fr/inserm-01421075 http://www.hal.inserm.fr/inserm-01421075/document http://www.hal.inserm.fr/inserm-01421075/file/2016%2C%20Arnal%20-%20Post-Traumatic%20Stress%20Disorder%20among%20Incomers%20in%20Remire-Montjoly%20Prison%2C%20French%20Guiana.pdf PUBMED : 27570960
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