Acceptability of DBS for psychiatric disorders by French psychiatrists: a network clustering analysis based on a mixed method study.

BACKGROUND

Deep brain stimulation (DBS) is an emerging intervention for treatment-resistant psychiatric disorders, particularly obsessive-compulsive disorder (OCD). Despite strong evidence of efficacy, its acceptability remains limited among psychiatrists, especially in France. Understanding professional attitudes is essential for its clinical integration.

METHODS

We conducted a mixed-method study using the script method, combining qualitative item development with quantitative analysis through a self-administered online questionnaire. The survey, based on a multidimensional model of acceptability, assessed French psychiatrists' perceptions of DBS across dimensions such as utility, usability, reliability, risk, and professional culture. Data were analyzed using network clustering analysis, centrality metrics, and community detection, allowing exploration of structural relationships among acceptability factors. Subgroup analyses were conducted by gender, professional seniority, practice type, and theoretical orientation.

RESULTS

Among 418 respondents, the most central determinant of DBS acceptability was adherence to professional guidelines. Other influential factors included perceived utility, self-acceptability, and the classification of DBS as part of psychiatry's therapeutic arsenal. Peripheral concerns, such as cost or multidisciplinary logistics, were weakly connected to the core network. Gender and seniority influenced network structure: male psychiatrists showed stronger associations between adherence to professional guidelines and viewing DBS as a legitimate psychiatric treatment, while senior psychiatrists exhibited denser patterns of associations between acceptability-related factors. No significant differences were found by practice type or theoretical orientation.

CONCLUSIONS

DBS acceptability among French psychiatrists hinges on institutional validation and perceived alignment with psychiatric norms. These findings highlight the need for guideline-based dissemination strategies and tailored communication to support the ethical and effective adoption of DBS in psychiatric care.