RESUMEN
Context: The shortage of child and adolescent psychiatrists in France affects access to early interventions and mental health services and impacts therapeutic practices and prescribing trends. This study aimed to describe factors associated with choosing child and adolescent psychiatry (CAP) as a career specialty and with assessing the level of attractiveness of this discipline and its predictors. Methods: We generated a self-report questionnaire using a modified two-step Delphi approach. The survey was conducted from January 13 to February 16, 2020, and targeted French child and adolescent psychiatrists or psychiatrists, mainly working with children and/or adolescents. We used a logistic regression model to assess the factors associated with the perception of CAP as attractive. A thematic qualitative analysis of the free comments section of the questionnaire was performed. Results: Of 863 doctors contacted by email, the response rate was 77.4% (668 respondents). Two-thirds of respondents were female and had an official specialization in CAP. One-third were aged between 31 and 40 years. The main reasons for choosing to specialize in CAP were interest in working with children (64.2%), interest in psychotherapy (52.8%), and influence of an internship in CAP during medical studies (46.0%), although only one-third of respondents actually did an internship. Over half of respondents (57.3%) identified personal factors as implicated in their choice of CAP, mainly personal psychotherapy (22.2%) and personal trauma (14.4%). Although only 58.4% of respondents perceived CAP as attractive, 97.8% had no regret about their choice, and 83.5% would make the same career choice today. A positive perception by respondents' surroundings for choosing CAP at the time of the choice was associated with a perception of CAP as currently attractive by respondents (odds ratio: 1.82; 95% confidence interval: 1.27-2.60; p = 0.001). Conclusion: CAP is in crisis and faces many challenges in France, with an urgent need to redress its demographics. Many child and adolescent psychiatrists do not regret their choice and would choose the same specialty today. To increase its attractiveness, better visibility during medical school, enhanced academic recognition, and increased remuneration seem promising.
RESUMEN
Success at school increases self-esteem. Any difficulty will have consequential effects on the psychological health of the subject. The conditions now prevailing in the educational institutions (mass schooling without any individual orientation before the end of college) oblige the teenager to submit to teaching methods and to the school system. School can reveal the subject's personal problems (anxiety, phobia or depression), but may equally create pathology by not recognising the heterogeneity of individual development and differences in cognitive functioning. In adolescence, the ego is particularly vulnerable. Anything that may induce its instability can create behavioural problems (instability, aggressiveness, inhibition) or problems of thought (anxiety links, difficulties in abstraction). In order to cope with such a haemorrhage of the ego, the adolescent may have recourse to certain behaviours (e.g. use of drugs leading to dependence). So it is important the know well the links between school failure and behavioural problems or drug consumption because, in one way or another, by their sanction or by lack of motivation, these situations will lead very quickly to school disengagement, which in turn leads to the breakdown of the ego.