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Epidémiologie des Troubles Anxieux et Dépressifs

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. Epidémiologie. Prévalence Incidence Facteurs de risque.

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Epidémiologie des Troubles Anxieux et Dépressifs

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  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 2.7 1.6 1.7 4.1 3.8 2.5 1.0 3.5 0.5 0.4-0.6

  4. Prévalence sur la vie du Trouble Anxiété Sociale DSM-III-R Bâle 16.0 NCS 13.3

  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, 126,107-111 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 1.0 ... 2.0 CIDI - PPGHC UM - CIDI M - CIDI CIDI - 2000

  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 Pluriel au moins 2 Souvent, fréquemment au 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) United States Edmonton, Alberta * 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 Puerto Rico Paris, France West Germany*** Florence, Italy** Beirut, Lebanon** Taiwan Korea Christchurch, New Zealand Rate/100 from Weissman et al, 1996

  30. Lifetime Prevalence of Major Depression by Sex, Ages 18 to 64 Years* United States Edmonton, Alberta Puerto Rico * Figures standardized to US age and sex distribution ** Data from former Federal Republic of Germany (West Germany) based on ages 26 to 64 years Paris, France West Germany*** Florence, Italy Beirut, Lebanon Taiwan Korea Christchurch, New Zealand Rate/100 from Weissman et al, 1996

  31. Cross National Collaborative Study

  32. Trouble Panique: prévalence annuelle (%) USA Edmonton PuertoRico Paris Munich Florence Beirut Taiwan Korea New Zealand

  33. Trouble Panique: Prévalence sur la vie en fonction du sexe (%) USA Edmonton Paris Munich Florence Beirut Taiwan Korea PuertoRico New Zealand

  34. Prévalence sur la vie de la dépression majeure en fonction du sexe, sujets de 18 à 64 ans* Etats Unis Edmonton, Alberta * 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) Porto Rico Paris, France Allemagne** Florence, Italie Beyrouth, Liban Taiwan Corée Christchurch, Nlle Zélande Taux/100 d’après Weissman et al, JAMA, 1996

  35. The World Health Organization World Mental Health Survey Initiative

  36. Participating Countries Sample Type Regional Probability Sample National Probability Sample

  37. Data Collection Status Completed In progress To be completed

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

  39. 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

  40. ESEMeD/MHEDEA 2000 Methods • 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

  41. 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

  42. Methodology CIDI 2000 • 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.)

  43. Sample characteristicsEurope

  44. Country Belgium France Germany Italy The Netherlands Spain Sampling frame National registry Telephone listing Community registries Local electoral census Local postal registries Household enumeration ESEMeD/MHEDEA 2000 Sampling frames

  45. Sample characteristicsAmericas

  46. Sample characteristicsMiddle East/Africa

  47. Sample characteristicsAsia

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

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

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