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