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Epidémiologie des Troubles Anxieux et Dépressifs Jean-Pierre Lépine INSERM U705 - CNRS UMR 7157 Université Paris Diderot Hôpital Lariboisière Fernand Widal.

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Présentation au sujet: "Epidémiologie des Troubles Anxieux et Dépressifs Jean-Pierre Lépine INSERM U705 - CNRS UMR 7157 Université Paris Diderot Hôpital Lariboisière Fernand Widal."— Transcription de la présentation:

1 Epidémiologie des Troubles Anxieux et Dépressifs Jean-Pierre Lépine INSERM U705 - CNRS UMR 7157 Université Paris Diderot Hôpital Lariboisière Fernand Widal Assistance Publique Hôpitaux de Paris

2 Epidémiologie Prévalence Incidence Facteurs de risque

3 Prévalence sur la vie du Trouble Anxiété Sociale (DSM-III) ECA Puerto Rico Edmonton Paris Zurich Munich Florence Christchurch Seoul Taïwan

4 Prévalence sur la vie du Trouble Anxiété Sociale DSM-III-R Bâle16.0 NCS13.3

5 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 ?

6 maladie - syndrome modèle hiérarchique critères diagnostiques entretiens diagnostiques structurés

7 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, Cinq phases - description clinique - études de laboratoires - différenciation des autres troubles - étude de suivi - études familiales

8 Signes Symptômes Critères Syndrome

9 Critères diagnostiques explicites et précis possibles interprétations "implicites" pour le clinicien

10 Entretien diagnostique Classification diagnostique

11 Jugement clinique versus Règles strictes des algorithmes

12 Qualité du recueil de données Référence aux critères diagnostiques

13 Instruments Diagnostiques Recueil de données Critères Algorithmes

14 Intervieweurs Cliniciens Non cliniciens

15 Connaissances requises Manuel d'utilisation Formation

16 libellé des questions précision des questions codage des réponses instructions de saut algorithmes

17 SADS SCID SCAN - PSE ADIS DIGS MINI

18 Diagnostic Interview Schedule Composite International Diagnostic Interview

19 CIDI CIDI - PPGHC UM - CIDI M - CIDI CIDI

20 Comparaison des classifications

21 Diagnostic grammar and assessment : Translating criteria into questions Lee N Robins The validity of psychiatric diagnosis, LN Robins, JE Barrett (1989)

22 Traduction des Critères en Questions Plurielau moins 2 Souvent, fréquemmentau moins 3 fois

23 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 ?

24 Seuils de sévérité évaluation dimensionnelle handicap retentissement

25 Fidélité inter-cotateurs test - retest stabilité temporelle

26 Validité des Instruments Comparative Diagnostic standard

27 LEAD Longitudinal observations made by Expert clinicians utilizing All Data available (Spitzer, 1983)

28 Comparabilité des études

29 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 Christchurch, New Zealand Christchurch, New Zealand Korea Taiwan Florence, Italy** West Germany *** Paris, France Puerto Rico Edmonton, Alberta United States Beirut, Lebanon** Rate/100 from Weissman et al, 1996

30 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 Christchurch, New Zealand Christchurch, New Zealand Korea Taiwan Beirut, Lebanon West Germany *** Paris, France Puerto Rico Edmonton, Alberta United States Florence, Italy Rate/100 from Weissman et al, 1996

31 Cross National Collaborative Study

32 Trouble Panique: prévalence annuelle (%) USAEdmontonPuerto Rico ParisMunichFlorenceBeirutKoreaNew Zealand Taiwan

33 Trouble Panique: Prévalence sur la vie en fonction du sexe (%) USAEdmonton Puerto Rico ParisMunichFlorenceBeirutKorea New Zealand Taiwan

34 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 lancienne Allemagne de lOuest (sujets de 26 à 64 ans) Christchurch, Nlle Zélande Christchurch, Nlle Zélande Corée Taiwan Beyrouth, Liban Allemagne ** Paris, France Porto Rico Edmonton, Alberta Etats Unis Florence, Italie Taux/100 daprès Weissman et al, JAMA, 1996

35

36 The World Health Organization World Mental Health Survey Initiative

37 Participating Countries Sample Type National Probability Sample Regional Probability Sample

38 Data Collection Status In progress To be completed Completed

39 ESEMeD/MHEDEA 2000 Background Few comparative studies in Europe Different methodology Lack of comprehensive information

40 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

41 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

42 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

43 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

44 Sample characteristics Europe CountrySample SizeResponse Rate (%) Belgium France Germany Italy Netherlands Spain Ukraine

45 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

46 Sample characteristics Americas CountrySample SizeResponse Rate (%) Colombia Mexico United States

47 Sample characteristics Middle East/Africa CountrySample SizeResponse Rate (%) Lebanon Nigeria

48 Sample characteristics Asia CountrySample SizeResponse Rate (%) Japan PRC Beijing PRC Shanghai

49 Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-IV disorders Any Disorder United States Ukraine France Colombia Lebanon Netherlands Mexico Belgium Spain PRC Beijing Germany Japan Italy Nigeria PRC Shanghai Prevalence

50 Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-IV disorders Mood Disorders United States Ukraine France Netherlands Colombia Lebanon Belgium Spain Mexico Italy Germany Japan PRC Beijing PRC Shanghai Nigeria Prevalence

51 Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-IV disorders Anxiety Disorders Prevalence

52 Twelve-month (12-mo) prevalence of WMH-CIDI/DSM-IV disorders Substance Disorders Ukraine United States Netherlands Colombia PRC Beijing Mexico Japan Lebanon Belgium Germany Nigeria France PRC Shanghai Spain Italy Prevalence

53 Prevalence of anxiety disorders GAD=Generalised Anxiety Disorder; SAD=Social Phobia/Social Anxiety Disorder; PTSD=Posttraumatic Stress Disorder; PD=Panic Disorder; Ag=Agoraphobia (%) Total anxiety disorders GADSADSpecific Phobia PTSDPDAgPD + Ag

54 Odds ratio Associated factors: age Unadjusted odds ratios

55 Associated factors: marital status Unadjusted odds ratios Preliminary results based on the analysis of the first 14,078 interviews completed by 1 April 2002 Fieldwork in Germany started August 2002 Reference group Odds ratio

56 Associated factors: employment status Odds ratio Unadjusted odds ratios

57 Order of Occurrence of Anxiety and Affective Disorders Simple phobia Social phobia AgoraphobiaPDGADOCD

58 Standardized mortality ratios by age at first admission in unipolar patients in Sweden ( ) Controlled for sex, age at admission, and calendar period (Osby et al, 2001)

59 Standardized mortality ratios by time at first admission in unipolar patients in Sweden ( ) Controlled for sex, age at admission, and calendar period (Osby et al, 2001) N° of years of Follow-up

60 (Lespérance et al, 2002) Five year risk of cardiac mortality in relation to initial BDI during hospitalization


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