Consommation de substances psychoactives chez les internes : une stratégie de régulation du stress professionnel ?

• Published in: Annales médico psychologiques Vol. 176; no. 10; pp. 985 - 990
• Main Authors: Ouagazzal, Ornella, Halim Boudoukha, Abdel, Séjourné, Adrien, Denis, Nathalie
• Format: Journal Article
• Language: French
• Published: Elsevier Masson SAS 01.12.2018; Elsevier Masson
• Subjects: Addiction; Ajustement psychique; Care management; Cognitive science; Emotional regulation; Humanities and Social Sciences; Interne hospitalier; Prise en charge; Psychology; Résident; Sociology; Stress; Temps; Time; Temps; Care management; Emotional regulation; Interne hospitalier; Addiction; Résident; Ajustement psychique; Time; Prise en charge; Stress
• ISSN: 0003-4487; 1769-6631
• DOI: 10.1016/j.amp.2017.10.014

Les phénomènes de souffrance psychique chez les professionnels de santé font l’objet de nombreux travaux. Cependant, peu d’études françaises abordent cette question chez les internes dont le double statut, étudiant et médecin, les confronte à de nombreux facteurs de stress et événements professionnels particulièrement difficiles. Notre recherche porte sur l’étude (1) des situations les plus à risque de souffrance chez les internes et (2) les stratégies mise en œuvre pour y faire face. Pour cela nous avons rencontré 102 internes. Nous les avons interviewés dans le cadre d’un entretien clinique de recherche standardisé. Nous avons numérisé les entretiens et procédé à des analyses statistiques de contenu par le biais d’un logiciel (Iramuteq, méthode ALCESTE). Les résultats montrent, (a) que les situations les plus à risque de souffrance sont les situations rencontrées avec les patients, mais surtout les répercussions sur leur vie professionnelle et personnelle (33,6 % du corpus) et (b) que, parmi les stratégies pour y faire face, l’évocation du recours à une substance psychoactive apparaît clairement et est représentée dans une classe spécifique correspondant à 12,5 % du corpus. Nous discutons les résultats au regard des phénomènes de souffrances psychiques des soignants (burnout) et des implications en termes d’accompagnement des futurs médecins. The stressful situations lived by the healthcare professionals in particular the physician, are described in the literature. Few French studies focus on the professional stress of the residents who have a double status: student and physician. By this status, the residents are often badly identified by the patients and badly recognized by the healthcare professionals. During the Residency, they face many professional and personal stress factors. Many studies have shown that the combination of these factors resulted the psychoactive substance use (alcohol, tobacco and cannabis). Our research deal with (1) the risks situations lived by the residents and (2) the strategies for to cope with it. One hundred and two residents of Faculties of Medicine in Universities of West participated in this study. The resident sample includes 44 men and 58 women aged between 25 and 35 years. Residents are divided from 1st to 10th semester, and they all participated voluntarily and they were not paid in this study. We interviewed them within the framework of a standardized clinical research interview. For the recruitment of resident, we sent an e-mail to the resident through the both syndicates of resident of general medicine and the both offices of the residents further to the agreement of the secretaries of the faculties. We make an individual appointments with the resident for to carry out the interview. We retranscribed the interviews and we produced an analysis of content with the software Iramuteq, who uses the Alceste method. The Alceste method is a technique that consist a modeling of the distribution of words in a speech and language patterns to identify the most words used by the subjects. Results demonstrated, (a) that the situations at risks are the met situations with the patients, and this situations have a repercussions on their professional life and their personal life (33,6 % of the corpus), and (b) that among the strategies for to cope with it, the evocation of the recourse to a psychoactive substance appears clearly in the speech of residents, and is represented in a specific class corresponding to 12,5 % of the corpus. We identified a professional stress factors in three categories: the clinical situations encountered, but the term “patient” doesn’t appear in the speech of residents, the organizational difficulties and the working conditions, and questioning about their professional future. These professional stress factors can have repercussions on the physical and mental health of residents. They could lead a risk of burnout in this population. Substance use take place in a festive context, is one of the ways used by residents to cope with pressure. We described that psychoactive substance use disorder has a hedonic value and auto-therapeutic value to cope with professional stress. Residents mentionned a large number of stressful situations during the period of residency. They are the consequence of a time constraint or a feeling can’t to accomplish patient's care in better conditions. To cope with stress professional, the residents have recourse to psychoactives substances as an outlet. It can have harmful consequences as the health of the residents and the patients. It seems to us therefore pertinent to think about the valuation of devices allowing the residents to verbalize their real-life experience of their professional situations.