Mots à maux… Expression de la souffrance chez les soignants en psychiatrie. Étude comparative en France et dans trois autres pays européens

Abstract

Using the results of the PRESST-NEXT study, concerning 69,902 health care workers (HCWs) in ten European countries and their answers about job satisfaction, the authors present the analysis of data concerning HCWs working in psychiatry in France (in psychiatric hospitals, general hospitals and private clinics) and in three European countries with a sufficient sample size (Germany, Great-Britain and Slovakia). The first part is descriptive and highlights the age of psychiatric HCWs, and, in France, the relative importance of male and qualified HCWs in psychiatry compared to other departments. The way HCWs perceive their working conditions indicates that physical hardship is not infrequent and that violence is a great concern but that this violence is preventable, and that contrarily to accepted ideas, over half of these HCWs mention a lack of psychological support. Half of the psychiatric HCWs are not satisfied with their existing opportunity of giving patients the care they need. Indeed the study shows that their dissatisfaction with the use of their abilities and their intent on leaving nursing are high in each specialty and in each country the highest being in France. A more detailed analysis of work organisation and content shows that interruptions, lack of time to talk to patients and frequent worries about making mistakes are highly important. The context seems strongly influenced by the bad quality of inter-professional relationships except between direct colleagues, and this difficulty is greater with the administration for French HCWs. As far as work autonomy is concerned, if psychiatric HCWs say they are more autonomous than those working in other departments, we have noticed that in France HCWS have the lowest influence in planning rotas. The mental health status of French HCWs is lower than that of their counterparts in other countries and they declare more mental exhaustions and mental disorders via medical diagnoses. After adjustments relative to age, gender and occupational level, the risk of low job satisfaction score is less frequent in psychiatry compared to that in medical and surgical departments (Odds ratio OR = 0.69; 95 % IC 0.58–0.81; P < 0.001). The risk of having a high quantitative demand score (OR = 0.20; 95 % IC 0.16–0.23; P < 0.001) and a high score of uncertainty regarding treatment (OR = 0.49; 95 % IC 0.42–0.56; P < 0.001) is lower in psychiatry compared to that in medical and surgical departments. Psychiatric HCWs declared being subjected to violence from patients or their relatives at least once a month nearly six times more than HCWs working in intensive care units. Psychiatric HCWs in Great-Britain and France are more exposed to risks as compared to HCWs in intensive care units in their country (OR = 9.98; 95 % IC 6.31–15.8; P < 0.001 and OR = 6.17; 95 % IC 4.82–7.89; P < 0.001, respectively). But in these two countries, HCWs working in emergency units are even more at risk. Those working in geriatrics are also a group at risk. HCWs working in psychiatry and in geriatrics in the four countries declared more mental disorders via medical diagnoses than HCWs in intensive care units (Psychiatry OR = 1.72; 95 % IC 1.30–2.28; P < 0.001 and geriatrics OR = 1.51; 95 % IC 1.18–1.94; P < 0.001). In the second part of the study two key questions are analysed in depth using multivariate analysis: these are the factors linked with the intent on leaving nursing and the intent on changing institution. Indeed, factors associated in psychiatry with intent on leaving nursing or on changing institution show the major role of the work environment, the key factors here are harassment by superiors, dissatisfaction with work prospects and the use of HCW abilities. In conclusion, the study draws connexions between factors of dissatisfaction of HCWs, patient conditions in psychiatry and the risk of development of violence.