Jean-Pierre Lépine

Cross-national epidemiology of DSM-IV major depressive episode.

BackgroundMajor depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative.MethodsMajor depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults.ResultsThe average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed.ConclusionsMDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.

Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys

BACKGROUND Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders. AIMS To examine joint associations of 12 childhood adversities with first onset of 20 DSM-IV disorders in World Mental Health (WMH) Surveys in 21 countries. METHOD Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM-IV disorders with the WHO Composite International Diagnostic Interview (CIDI). RESULTS Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries. CONCLUSIONS Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

Common Chronic Pain Conditions in Developed and Developing Countries: Gender and Age Differences and Comorbidity With Depression-Anxiety Disorders

UNLABELLED Although there is a growing body of research concerning the prevalence and correlates of chronic pain conditions and their association with mental disorders, cross-national research on age and gender differences is limited. The present study reports the prevalence by age and gender of common chronic pain conditions (headache, back or neck pain, arthritis or joint pain, and other chronic pain) in 10 developed and 7 developing countries and their association with the spectrum of both depressive and anxiety disorders. It draws on data from 18 general adult population surveys using a common survey questionnaire (N = 42,249). Results show that age-standardized prevalence of chronic pain conditions in the previous 12 months was 37.3% in developed countries and 41.1% in developing countries, with back pain and headache being somewhat more common in developing than developed countries. After controlling for comorbid chronic physical diseases, several findings were consistent across developing and developed countries. There was a higher prevalence of chronic pain conditions among females and older persons; and chronic pain was similarly associated with depression-anxiety spectrum disorders in developed and developing countries. However, the large majority of persons reporting chronic pain did not meet criteria for depression or anxiety disorder. We conclude that common pain conditions affect a large percentage of persons in both developed and developing countries. PERSPECTIVE Chronic pain conditions are common in both developed and developing countries. Overall, the prevalence of pain is greater among females and among older persons. Although most persons reporting pain do not meet criteria for a depressive or anxiety disorder, depression/anxiety spectrum disorders are associated with pain in both developed and developing countries.

Prevalence of suicide ideation and suicide attempts in nine countries

BACKGROUND There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. METHODS Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. RESULTS The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. CONCLUSIONS While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

Depression in the community: the first pan-European study DEPRES (Depression Research in European Society).

DEPRES (Depression Research in European Society) is the first large pan-European survey of depression in the community. A total of 13359 of the 78463 adults who participated in screening interviews across six countries were identified as suffering from depression, a 6-month prevalence of 17%. Major depression accounted for 6.9% of the cases of depression and minor depression for 1.8%. Depressed subjects in both these categories perceived that their working or social lives were substantially impaired by depressive symptoms. The remaining 8.3% of depressed subjects considered that their functional impairment was not substantial. A significant proportion of sufferers from depression (43%) failed to seek treatment for their depressive symptoms. Of those who did seek help (57%), most consulted a primary care physician, the frequency of consultation increasing with the severity of depression. Sufferers from major depression imposed the greatest demand on healthcare resources, making almost three times as many visits to their GP or family doctor as non-sufferers (4.4 vs 1.5 visits over 6 months). More than two-thirds of depressed subjects (69%) were not prescribed any treatment and when drug therapy was prescribed (31%), only 25% of these subjects were given antidepressant drugs. The number of days of work lost due to illness increased with the severity of depression. Major depression had most impact on productive work, with sufferers losing four times as many working days over 6 months as non-sufferers. The results of the DEPRES survey confirm the high prevalence of depression in the community and the burden imposed on the individual sufferer in terms of impaired quality of life and on society in terms of healthcare utilization and lost productivity.

DEPRES II (Depression Research in European Society II) : A patient survey of the symptoms, disability and current management of depression in the community

The first pan-European survey of depression in the community (DEPRES I) demonstrated that 17% of the general population suffer from depression (major depression, minor depression, or depressive symptoms). This article describes findings from a second phase of DEPRES (DEPRES II), in which detailed interviews based on a semi-structured questionnaire (78 questions) were conducted with 1884 DEPRES I participants who had suffered from depression and who consulted a healthcare professional about their symptoms during the previous 6 months. The mean time from onset of depression was 45 months, and the most commonly experienced symptoms during the latest period were low mood (76%), tiredness (73%) and sleep problems (63%). During the previous 6 months, respondents had been unable to undertake normal activities because of their depression for a mean of 30 days, and a mean of 20 days of work had been lost to depression by those in paid employment. Approximately one-third of respondents (30%) had received an antidepressant during the latest period of depression. Significantly more respondents given a selective serotonin reputake inhibitor found that their treatment made them feel more like their normal self than those given a tricyclic antidepressant, and fewer reported treatment-related concentration lapses, weight problems, and heavy-headedness (all P < 0.05). Approximately two-thirds of respondents (70%) had received no antidepressant therapy during the latest period of depression, and prescription of benzodiazepines alone, which are not effective against depression, was widespread (17%). There is a need for education of healthcare professionals to encourage appropriate treatment of depression.

Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey

A potentially traumatic event (PTE) contributes to trauma through its frequency, conditional probability of posttraumatic stress disorder (PTSD), and experience of other PTEs. A cross-sectional survey was conducted, enrolling 21,425 adults nationally representative of six European countries. Using the WHO-Composite International Diagnostic Interview, 8,797 were interviewed on 28 PTEs and PTSD. Prevalence of 12-month PTSD was 1.1%. When PTSD was present, the mean number of PTEs experienced was 3.2. In a multivariate analysis on PTEs and gender, six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beaten by caregiver.

Prévalence et comorbidité des troubles psychiatriques dans la population générale française : résultats de l’étude épidémiologique ESEMeD/MHEDEA 2000/ (ESEMeD)

Resume Introduction ESEMeD est la premiere etude epidemiologique internationale realisee sur des echantillons aleatoires permettant de mesurer avec precision la prevalence des troubles psychiatriques en France et de comparer directement celle-ci avec celles observees dans d’autres pays europeens. Objectifs 1) Determiner la prevalence des troubles depressifs, anxieux ou lies a l’alcool sur douze mois et au cours de la vie ; 2) estimer leur taux de comorbidite ; 3) evaluer les facteurs demographiques de risque de ces troubles. Methode - Il s’agit d’une enquete transversale realisee en 2001-2003 en population generale chez des sujets âges de plus de 18 ans et non institutionnalises, vivant en Allemagne (n = 3 555), en Belgique (n = 2 419), en Espagne (n = 5 473), en France (n = 2 894), aux Pays-Bas (n = 2 372) et en Italie (n = 4 712). En France, la base de sondage utilisee etait une liste de numeros de telephone generes aleatoirement. Les sujets ont ete interroges a leur domicile par des enqueteurs professionnels. Le questionnaire WMH-CIDI a ete utilise. Resultats Le taux de participation a ete de 46 % pour la France et de 61 % pour l’ensemble des pays. La prevalence au cours des douze derniers mois et au cours de la vie etait respectivement 6,0 % et 21,4 % pour les episodes depressifs majeurs, 1,6 % et 7,9 % pour la dysthymie, 2,1 % et 6,0 % pour l’anxiete generalisee, 1,2 % et 3,0 % pour les troubles panique, 0,6 % et 1,8 % pour l’agoraphobie, 2,2 % et 3,9 % pour l’etat de stress post-traumatique, 1,7 % et 4,7 % pour la phobie sociale, 4,7 % et 11,6 % pour la phobie specifique, 0,5 % et 4,1 % pour l’abus d’alcool, et 0,3 % et 1,6 % pour la dependance a l’alcool.Les troubles depressifs et anxieux etaient significativement plus frequents chez les femmes et les troubles lies a l’alcool plus frequents chez les hommes. La frequence des trois types de troubles est moins importante chez les sujets âges et chez ceux vivant en milieu rural. Les troubles depressifs et lies a l’alcool etaient plus frequents chez les sujets vivant sans conjoint et les troubles depressifs plus prevalents chez ceux sans emploi remunere. 38 % des sujets presentant un trouble depressif avaient egalement un trouble anxieux ou un trouble lie a l’alcool associe. La comorbidite des troubles depressifs et anxieux etait plus frequente chez les femmes, les sujets jeunes et ceux vivant sans conjoint. Le taux de comorbidite chez les sujets presentant des troubles anxieux etait de 26 % sans difference entre les sexes. En ce qui concerne les troubles lies a l’alcool, il existait une forte difference de taux de comorbidite selon le sexe, a savoir 67 % chez la femme et 26 % chez l’homme. Conclusion Cette etude souligne la prevalence elevee des troubles depressifs, anxieux et lies a l’alcool en France, ainsi qu’une importante comorbidite entre eux. En outre, elle souligne la necessite d’evaluer et de prendre en compte la presence eventuelle d’une telle comorbidite dans l’organisation des soins.

Social phobia: diagnosis and epidemiology, neurobiology and pharmacology, comorbidity and treatment.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.

Normative data and factor structure of the Temperament and Character Inventory (TCI) in the French version.

We explored the psychometric features of the French Temperament and Character Inventory (TCI) in a 602-subject community sample (263 men and 339 women), representative of the French population. The factor structures of the temperament and character dimensions, explored separately, were in agreement with the hypothesized constructs, except for the scales Novelty Seeking NS1 (exploratory excitability), Persistence, and Self-Directedness SD4 (self-acceptance). The internal consistency of the main dimensions was good (Cronbach alpha coefficients between 0.68 and 0.82), but weak for Persistence (0.49). The mean scores of the temperament dimensions were notably different from those published in other normative data - especially lower for Novelty Seeking (16.4+/-5.6) and higher for Harm Avoidance (16.1+/-7.2) when compared with US data - suggesting cross-cultural differences in personality assessment, and the necessity to use specific normative values with each translated instrument.