Adolescents hospitalisés dans les services de psychiatrie adulte : une étude descriptive à la lumière des problématiques relevant de la protection de l'enfance

RésuméObjectif de l'étudeÉtudier la population des adolescents de 14 à 18 ans pris en charge par l'aide sociale à l'enfance (ASE) et hospitalisés dans les services de psychiatrie adulte de secteur.Patients et méthodeNous avons réalisé une étude descriptive, rétrospective, à partir de l'analyse des dossiers des adolescents hospitalisés en psychiatrie adulte entre septembre 2013 et septembre 2014. Des analyses ont ensuite été effectuées par sous-populations en fonction des situations relevant de la protection de l'enfance ou non.RésultatsL'analyse des dossiers des jeunes hospitalisés (n = 60) retrouve que ces adolescents sont exposés à des facteurs importants de survenue de troubles psychiatriques et nombreux sont ceux bénéficiant d'une prise en charge par l'ASE (n = 33). L'analyse en sous-population a permis de rendre compte de la vulnérabilité particulière de ces adolescents. Parmi eux, on retrouve des prévalences significativement augmentées d'antécédents familiaux psychiatriques (76 % contre 34 %, p = 0,001), d'événements traumatiques vécus (89 % contre 37 %, p < 0,0001), de comportements hétéroagressifs (55 % contre 19 %, p = 0,007) et de déscolarisation (45 % contre 19 %, p = 0,032) comparées aux jeunes non pris en charge pas l'ASE. Ils intègrent également plus souvent des filières spécialisées ou adaptées, sont plus souvent réhospitalisés et sont davantage bénéficiaires de dossiers relevant du handicap.ConclusionCette étude met en lumière la vulnérabilité particulière des adolescents relevant d'une mesure de protection de l'enfance et hospitalisés en psychiatrie adulte et souligne leur risque de réhospitalisation. Elle offre des perspectives de réflexion pour repenser leurs modalités de prise en charge.

BackgroundAdolescents hospitalized in adult mental health departments are many, and an important part of them benefit from a child welfare system. Many teenagers hospitalized at the adult psychiatric services have symptoms of auto- or hetero-aggressive behaviours. The aim of our study was to describe the population of adolescents supported by these services by analyzing their demographic and psychiatric characteristics and their links with the areas of child protection and disability.MethodsWe performed a retrospective descriptive study based on the analysis of hospital records of teenagers supported by the adult psychiatric services. Criteria for the analysis include sociodemographic, psychiatric morbidity and schooling data, data on the terrain, and those related to child protection or disability. Then subpopulations were analyzed in order to compare the different criteria whether or not within the child welfare system.ResultsSixty teenagers were included in our study. An analysis of the total population shows that these adolescents wer exposed to risk factors for psychiatric disorders: lower socioeconomic conditions, psychiatric family history and traumatic life events. Many were also school-leavers compared to the general population. Furthermore, a majority of the teenagers benefited from a child protection measure (n = 33) and were institutionalized. The subpopulation analysis helped realize the particular vulnerability of adolescents under the care of child protection. Indeed, we significantly emphasized among them an increased prevalence of parental isolation (P = 0.001), of psychiatric family history (P = 0.001) and of having experienced traumatic events (P < 0.0001). Concerning psychiatric disorders, we also found by the child welfare system that mild to moderate mental retardation was significantly more frequent among teens (P = 0.003). In addition, our results show that these adolescents were significantly more often hospitalized (P = 0.013). Finally, still in comparison with the other adolescents, these teens were significantly more school-leavers (P = 0.032), mostly in specialized or adapted course of study (P < 0.001), and more subject to disability (P < 0.001), implying a double care.ConclusionThis study has allowed us to better know the youth population supported by adult psychiatric services. It has also enlightened the specific vulnerability of the teenagers under the child protection care who need psychiatric treatment. It offers interesting discussion topics to develop new modalities of care for these young people.