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Aurelie Tinland,1,2 Laurent Boyer,1,3 Sandrine Loubière,1,3 Tim Greacen,4 Vincent Girard,1,2 Mohamed Boucekine,1,3 Guillaume Fond,1,5 Pascal Auquier1,3 1EA 3279: CEReSS – Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France; 2Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France; 3Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France; 4Research Unit, Public Health Institution Maison Blanche, Paris, France; 5Jeanne d’Arc – private Hospital, Paris-East University, FondaMental Fundation, Paris, France Objective: This study aimed to determine the following: 1) the proportion of women in the homeless population with schizophrenia (SZ) or bipolar disorder (BD), in addition to the trajectory of their homelessness (ie, homelessness history, number of nights spent without home during the 180 past nights) and the characteristics of their illnesses compared to men (ie, illness severity, suicide risk, physical health status, and quality of life [QoL]); 2) whether these women were victimized more frequently than similarly situated men; 3) the impact of victimization on these women in terms of illness severity, suicide risk, physical health status, and QoL; and lastly 4) the differences and overlap of homeless women with SZ and BD. Methods: This study employed data at baseline from a multicenter randomized controlled trial conducted in the following four large French cities: Lille, Marseille, Paris, and Toulouse. Mobile mental health outreach teams recruited SZ/BD homeless patients in the street, emergency shelters, hospitals, and jails from August 2011 to April 2014. Evaluations were performed during face-to-face interviews by psychiatrists and research assistants in the offices of mobile mental health outreach teams that were located in the downtown area of each city. The quantitative data were analyzed using descriptive analyses, chi-square and Student’s t-tests, generalized estimating equation regression models, and path analysis. Results: A total of 703 patients were included in this study. The proportion of women in the SZ/BD homeless population was 123/703 (17.5%). In this population, women were more likely than men to declare that they were subjected to physical or sexual assault during the past 6 months, that they had been diagnosed with posttraumatic stress disorder (PTSD), and that they had experienced more severe depressive symptoms. Moreover, these women presented a higher suicide risk, worse physical health status, and lower QoL than similarly situated men. Homeless women with BD were more vulnerable than women with SZ. A path analysis revealed that PTSD and violent victimization might explain the higher levels of depression and suicide risk and the lower levels of physical health status and QoL in homeless women. Conclusion: SZ/BD homeless women experience more PTSD and victimization than men, which are both associated with poor clinical outcomes. These results confirm the vulnerability of homeless women in this high need population and should be considered by public health policy. Keywords: homelessness, victimization, quality of life, schizophrenia, bipolar disorder, women

Abstract Recovery Colleges (RCs) are learning-based mental health recovery communities, located globally. However, evidence on RC effectiveness outside Western, educated, industrialised, rich, and democratic (WEIRD) countries is limited. This study aimed to evaluate associations between cultural characteristics and RC fidelity, to understand how culture impacts RC operation. Service managers from 169 RCs spanning 28 WEIRD and non-WEIRD countries assessed the fidelity using the RECOLLECT Fidelity Measure, developed based upon key RC operation components. Hofstede’s cultural dimension scores were entered as predictors in linear mixed-effects regression models, controlling for GDP spent on healthcare and Gini coefficient. Higher Individualism and Indulgence, and lower Uncertainty Avoidance were associated with higher fidelity, while Long-Term Orientation was a borderline negative predictor. RC operations were predominantly aligned with WEIRD cultures, highlighting the need to incorporate non-WEIRD cultural perspectives to enhance RCs’ global impact. Findings can inform the refinement and evaluation of mental health recovery interventions worldwide.

IntroductionCertain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless.MethodsThe study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted.ResultsA total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases.ConclusionThe study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed.

Abstract Background The World Health Organization (WHO) considers that the heterogeneity of concepts and definitions of migrants is an obstacle to obtaining evidence to inform public health policies. There is no recent data on the health status of only asylum seekers who have recently arrived in their Western host country. The purpose of this study was to determine the health status of asylum seekers and search for explanatory factors for this health status. Methods This cross-sectional observational study screened the mental and somatic health of adult asylum seekers who had arrived in France within the past 21 days and went to the Marseille single center between March 1 and August 31, 2021. In order to study the explanatory factors of the asylum seekers' health status, a multivariate analysis was performed using a logistic regression model to predict the health status. Factors taken into account were those significantly associated with outcome (level

Background: As the concept of empowerment is increasingly adopted across various mental health care contexts, there is a growing need for standardized measures to assess the effectiveness of empowerment approaches. The Empowerment Scale is widely utilized and translated within the field of mental health, despite its varied psychometric properties. This study aimed to translate the Empowerment Scale into French and assess its internal consistency, validity, and responsiveness. Methods: This study was part of a larger research project involving 394 participants. The Empowerment Scale was translated into French following cross-cultural adaptation guidelines, with a translation committee consisting of experts and a professional translator. Psychometric properties were assessed using classical test theory. The factor structure was determined through principal component analysis, exploratory factor analysis, and confirmatory factor analysis. Internal consistency was measured using Cronbach's alpha, while validity was evaluated through convergent, discriminant, and concurrent validity analyses. Responsiveness was assessed by comparing empowerment scores to changes in recovery rates. Results: The factor analyses supported a four-factor, 18-item model, showing good fit indices (CFI = 0.97, TLI = 0.97, AGFI = 0.97, SRMR = 0.07, RMSEA = 0.07). Internal consistency was acceptable for the overall scale (alpha = 0.84) and the "self-esteem-self-efficacy" dimension (alpha = 0.88) but lower for the other dimensions. The scale demonstrated moderate correlations with recovery (r = 0.47) and quality of life (r = 0.28). The Empowerment Scale demonstrated low or insignificant responsiveness, except for the "self-esteem-self-efficacy" dimension, which showed moderate responsiveness. Conclusions: The French version of the Empowerment Scale has a good factor structure with 4 factors and 18 items. The "self-esteem" dimension demonstrates good concurrent validity and reliability, and moderate responsiveness, while other dimensions require additional validation. [ABSTRACT FROM AUTHOR]

Abstract Aims We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France. Methods In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results. Results Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, −0.22; 95% confidence interval, [−0.33 to −0.11]; P

Introduction United Nations Convention on the Rights of Persons with Disabilities recognized that people with psychosocial disabilities have the same right to take decisions and make choices as other people. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. However, these principles are far from common practice in many mental health services. Joint-crisis plan (JCP) and Psychiatric advance directives (PAD) are interesting tools to translate the shared-decision making principle into clinical and practical reality. Most existing JCP or PAD involve facilitators, which improves their effectiveness, but facilitators are mostly professionals. Objectives In this context, DAiP study was launched to evaluate the efficacy of PAD facilitated by peer-workers. Methods DAiP was a multicenter randomized controlled trial conducted in 7 French mental health facilities, with a complementary qualitative approach. 394 adults with a DSM-5 diagnosis of schizophrenia (SCZ), bipolar I disorder (BP-I), or schizoaffective disorders (SCZaff ), who were compulsorily hospitalized in the past 12 months were enrolled from January 2019 and followed up for 12 months. Outcomes were compulsory admission rate, therapeutic alliance (4-PAS), quality of life (S-QOL), mental health symptoms (MCSI), empowerment (ES) and recovery (RAS). Results In this communication, we propose to describe the practices of facilitation of peer-workers and analyze outcomes in lights of process measurements (whether or not participants completed PAD document, shared PAD and with whom, met facilitator, used PAD Conclusions Involving peer-workers in the redaction of PADs coherently supports the current shift of mental health care from ‘substitute decision making’ to ‘supported decision making’. Disclosure No significant relationships.

Introduction People with severe psychiatric disorders (SPD) who experience housing vulnerability have to negotiate discontinuous mental health care pathways including poor access to common rights services and an increased risk of incarceration. To reduce morbidity and improve social integration of these people, Médecins du Monde (NGO), in association with the Ministry of Justice and APHM, is piloting the experimentation of an alternative to prison through assertive community treatment (ACT) and independent housing for people with SPS without housing who are referred to the court for immediate appearance. Objectives The main objective is to evaluate the effectiveness of the innovative program (AILSI) compared to usual services by assessing the duration of re-incarceration at 18 months of follow up. Methods The AILSI project has been certified as a Social Impact Bond, in which private investors support the program, with the guarantee that the French government will reimburse the investments if social impact outcomes are met. To measure the effectiveness and efficiency of the program, a randomized controlled study was designed: 100 patients will be included in the AILSI group (intervention) and 120 in the TAU group (usual services). Four social impact outcomes are identified: inclusion rate, signed leases rate, total length of re-incarceration and total resource use. It is a mixed quali-quanti research, which integrates a matching to administrative health and judicial databases. Results Inclusions are ongoing. Conclusions The AILSI program and the research methods used are described herein. In addition, detailed information on the limitations and strengths of the SIB system are also discussed. Disclosure No significant relationships.

Tomado de Prades, Jacques (1992). La tecnociencia. Las fracturas de los discursos. París: L’Harmattan. Capítulo V: La autonomía de la técnica (pp. 121-149). Traducción del francés al español por Luis Alfonso Palau Castaño, Medellín, abril 2017. Nota del editor. El discurso sobre la técnica sigue siendo un discurso estallado en el que se yuxtaponen análisis etnológicos o históricos más o menos segmentados, apreciaciones éticas generalmente inspiradas en reivindicaciones humanistas, consideraciones sobre las interfaces entre técnica y sociedad. La Técnica misma rara vez es pensada a partir de sí misma, a partir de lo que la hace posible, según su modo propio de constitución y de desarrollo. Sin embargo, esto sería necesario para la comprensión de sus efectos de los que se sabe claramente que desbordan con mucho los productos que resultan de la operación de sus medios y procedimientos técnicos, y para la evaluación de la relación de ese desarrollo de nuestra potencia con el dominio que podemos tener sobre lo que condiciona nuestra existencia.