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Epidémiologie des Troubles Anxieux et
Dépressifs
Jean-Pierre Lépine
INSERM U705 - CNRS UMR 7157Université Paris Diderot
Hôpital Lariboisière Fernand WidalAssistance Publique Hôpitaux de Paris
Epidémiologie
Prévalence
Incidence
Facteurs de risque
Prévalence sur la vie du Trouble Anxiété Sociale (DSM-III)
ECAPuerto RicoEdmontonParisZurichMunichFlorenceChristchurchSeoulTaïwan
2.71.61.74.13.82.51.03.50.5
0.4-0.6
Prévalence sur la vie du Trouble Anxiété Sociale DSM-III-R
Bâle 16.0
NCS 13.3
Définition du cas
What is a case ? The problem of definition in psychiatric community surveys
JK Wing, P Bebbington & LN Robins
1981 Grant McIntyre , London
a case for what ?
• maladie - syndrome
• modèle hiérarchique
• critères diagnostiques
• entretiens diagnostiques structurés
Validité du Diagnostic
Establishment of diagnostic validity in psychiatric illness : its application to schizophrenia
Eli Robins, Samuel B Guze
American Journal of Psychiatry, 1970, 126,107-111
Cinq phases
- description clinique
- études de laboratoires
- différenciation des autres troubles
- étude de suivi
- études familiales
Signes
Symptômes
Critères
Syndrome
Critères diagnostiques
• explicites et précis
• possibles interprétations
• "implicites" pour le clinicien
Entretien diagnostique
Classification diagnostique
Jugement clinique
versus
Règles strictes des algorithmes
• Qualité du recueil de données
• Référence aux critères diagnostiques
Instruments Diagnostiques
• Recueil de données
• Critères
• Algorithmes
Intervieweurs
Cliniciens
Non cliniciens
Connaissances requises
Manuel d'utilisation
Formation
libellé des questions
précision des questions
codage des réponses
instructions de saut
algorithmes
SADS
SCID
SCAN - PSE
ADIS
DIGS
MINI
Diagnostic Interview Schedule
Composite International Diagnostic Interview
CIDI 1.0 ... 2.0
CIDI - PPGHC
UM - CIDI
M - CIDI
CIDI - 2000
Comparaison des classifications
Diagnostic grammar and assessment :
Translating criteria into questions
Lee N Robins
The validity of psychiatric diagnosis, LN Robins, JE Barrett (1989)
Traduction des Critères en Questions
Pluriel au moins 2
Souvent, fréquemment au moins 3 fois
• Pouvez-vous vous rappeler quel âge précis vous aviez, quand pour la toute première fois ?
• Environ quel âge aviez-vous ?
• Quel est l'âge dont vous pouvez précisément vous rappeler ?
Seuils de sévérité
évaluation dimensionnelle
handicap
retentissement
Fidélité
inter-cotateurs
test - retest
stabilité temporelle
Validité des Instruments
Comparative
Diagnostic standard
LEAD
Longitudinal observations made by
Expert clinicians utilizing
All Data available
(Spitzer, 1983)
Comparabilité des études
Annual Prevalence of Major Depression, Ages 18 to 64 Years* (Cross National Study)
* Figures standardized to US age and sex distribution** Data not available*** Data from former Federal Republic of Germany (West Germany) based on ages
26 to 64 years
0 2 4 6 8 10
Christchurch, New Christchurch, New ZealandZealand
KoreaKorea
TaiwanTaiwan
Florence, Italy**Florence, Italy**
West GermanyWest Germany******
Paris, FranceParis, France
Puerto RicoPuerto Rico
Edmonton, AlbertaEdmonton, Alberta
United StatesUnited States
Beirut, Lebanon**Beirut, Lebanon**
Rate/100
from Weissman et al, 1996from Weissman et al, 1996
Lifetime Prevalence of Major Depression by Sex, Ages 18 to 64 Years*
* Figures standardized to US age and sex distribution** Data from former Federal Republic of Germany (West Germany) based on
ages 26 to 64 years
0 5 10 15 20 25
MalesFemales
Christchurch, New ZealandChristchurch, New Zealand
KoreKoreaa
TaiwanTaiwan
Beirut, LebanonBeirut, Lebanon
West GermanyWest Germany******
Paris, FranceParis, France
Puerto RicoPuerto Rico
Edmonton, Edmonton, AlbertaAlberta
United StatesUnited States
Florence, ItalyFlorence, Italy
Rate/100
from Weissman et al, 1996from Weissman et al, 1996
Cross National Collaborative Study
Trouble Panique: prévalence annuelle (%)
1.00.9
1.10.9
2.1
1.3
2.1
0.2
1.51.3
0.0
0.5
1.0
1.5
2.0
2.5
USA Edmonton PuertoRico
Paris Munich Florence Beirut Korea NewZealand
Taiwan
Trouble Panique: Prévalence sur la vie en fonction du sexe (%)
USA Edmonton PuertoRico
Paris Munich Florence Beirut Korea NewZealand
Taiwan
Prévalence sur la vie de la dépression majeure en fonction du sexe, sujets de
18 à 64 ans*
* Figures standardisées à la distribution par age et sexe des EU ** Données de l’ancienne Allemagne de l’Ouest (sujets de 26 à 64 ans)
Christchurch, Nlle Christchurch, Nlle ZélandeZélande
CoréCoréee
TaiwaTaiwann
Beyrouth, Beyrouth, LibanLiban
AllemagneAllemagne**
**
Paris, Paris, FranceFrance
Porto Porto RicoRico
Edmonton, Edmonton, AlbertaAlberta
Etats Etats UnisUnis
Florence, Florence, ItalieItalie
Taux/100
d’après Weissman et al, JAMA, 1996d’après Weissman et al, JAMA, 1996
The World Health OrganizationThe World Health Organization
World Mental Health Survey Initiative
Participating Countries Sample Type
National Probability Sample
Regional Probability Sample
Data Collection Status
In progress To be completedCompleted
ESEMeD/MHEDEA 2000Background
• Few comparative studies in Europe
• Different methodology• Lack of comprehensive
information
ESEMeD/MHEDEA 2000 Objectives
• Prevalence of mental disorders
• Associated risk factors
• Health-related quality of life impact
• Services use, including use of psychotropic medication
• Unmet needs for care
• Cross-sectional, home interview
• Non-institutionalised general population(18+ years of age)
• Computer-Assisted Personal Interview (CAPI)
• Composite International Diagnostic Interview (CIDI 2000)
• Standardised severity and QoL scales
ESEMeD/MHEDEA 2000 Methods
ESEMeD/MHEDEA-2000 CIDI-2000
• More disorders assessed
• DSM-IV and ICD-10 criteria
• Clinical severity
• Disability/use of services
• Longer, improved screening section
• Computerised version
Methodology
• Comprehensive, fully structured, diagnostic interview developed by the WHO
• DSM-IV and ICD-10 criteria• Computerised• Broader range of mental disorders assessed
– mood disorders– anxiety disorders– substance use– others (eating disorders, childhood disorders, etc.)
CIDI 2000
Sample characteristicsEurope
Country Sample Size Response Rate (%)
Belgium 2419 50.6
France 2894 45.9
Germany 3555 57.8
Italy 4712 71.3
Netherlands 2372 56.4
Spain 5473 78.6
Ukraine 4725 78.3
ESEMeD/MHEDEA 2000 Sampling frames
Country
Belgium
France
Germany
Italy
The Netherlands
Spain
Sampling frame
National registry
Telephone listing
Community registries
Local electoral census
Local postal registries
Household enumeration
Sample characteristicsAmericas
Country Sample Size Response Rate (%)
Colombia 4544 87.7
Mexico 5782 76.6
United States 9282 70.9
Sample characteristicsMiddle East/Africa
Country Sample Size Response Rate (%)
Lebanon 2856 70.0
Nigeria 4984 79.9
Sample characteristicsAsia
Country Sample Size Response Rate (%)
Japan 1663 56.4
PRC Beijing 2633 74.8
PRC Shanghai 2568 74.6
0% 3% 6% 9% 12% 15% 18% 21% 24% 27% 30%
Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-
IV disordersAny Disorder
United StatesUkraineFrance
ColombiaLebanon
NetherlandsMexico
BelgiumSpain
PRC BeijingGermany
JapanItaly
NigeriaPRC Shanghai
Prevalence
0% 2% 4% 6% 8% 10% 12%
Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-
IV disordersMood Disorders
United StatesUkraineFrance
NetherlandsColombiaLebanonBelgium
SpainMexico
ItalyGermany
JapanPRC Beijing
PRC ShanghaiNigeria
Prevalence
Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-
IV disorders
0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%
Un StatesFrance
LebanonColombia
Netherland
UkraineBelgiumMexico
GermanySpain
ItalyJapan
NigeriaPRC Beijing
PRC
Anxiety Disorders
Prevalence
Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-
IV disorders
0% 1% 2% 3% 4% 5% 6% 7%
Substance Disorders
UkraineUnited States
NetherlandsColombia
PRC BeijingMexicoJapan
LebanonBelgium
GermanyNigeriaFrance
PRC ShanghaiSpain
Italy
Prevalence
Prevalence of anxiety disorders
GAD=Generalised Anxiety Disorder; SAD=Social Phobia/Social Anxiety Disorder; PTSD=Posttraumatic Stress Disorder; PD=Panic Disorder; Ag=Agoraphobia
(%)
1,3 1,63,3
0,9 1 1,3 0,9
3,8 3,8
7,7
2,1 2,63,7
2,8
7,4
16,4
0
5
10
15
2012-monthLifetime
Totalanxiety
disorders
GAD SAD SpecificPhobia
PTSD PD Ag PD + Ag
0,0
0,5
1,0
1,5
2,0
2,5
3,0
Any mooddisorder
Any anxietydisorder
Any substance usedisorder
18-24 years25-34 years35-49 years50-64 years65+ years
Oddsratio
Associated factors: ageUnadjusted odds ratios
Associated factors: marital status
0
1
2
3
4
Any mood disorder Any anxietydisorder
Any substance usedisorder
Single WidowedDivorced
Unadjusted odds ratiosPreliminary results based on the analysis of the first
14,078 interviews completed by 1 April 2002 Fieldwork in Germany started August 2002
Reference group
Oddsratio
Associated factors: employment status
0
1
2
3
4
5
6
7
8
Any mood disorder Any anxietydisorder
Any substance usedisorder
EmployedUnemployedRetiredHomemakerStudent
Oddsratio
Unadjusted odds ratios
Order of Occurrence of Anxiety and Affective
Disorders
Simplephobia
Social phobia
Agoraphobia PD GAD OCD
Standardized mortality ratios by age at first admission in unipolar patients in Sweden
(1973-1995)
Controlled for sex, age at admission, and calendar period (Osby et al,
2001)
Standardized mortality ratios by time at first admission in unipolar
patients in Sweden (1973-1995)
Controlled for sex, age at admission, and calendar period
(Osby et al, 2001)
N° of years of Follow-up
(Lespérance et al, 2002)
Five year risk of cardiac mortality in relation to initial BDI during hospitalization
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