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Aims Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys. Methods The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women. Results Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs. Conclusions Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.

Schizophrenia is a long-term, stigmatized disease which often leads to social impairment, unemployment and isolation, with heavy negative social and psychological consequences both on patients and their families. Close relatives' perceptions of the illness have an impact on their mood, and then on the course of the patient's disease itself. In this context, our objective is to evaluate the perceptions of French close relatives of people with schizophrenia or schizophrenia spectrum disorders, about the disease itself, as well as their experience within the mental healthcare system.Our population is constituted of close relatives of people experiencing schizophrenia or schizophrenia spectrum disorders, recruited through an active patient and families association. We used a French translation of a standardized questionnaire, the Brief Illness Perception Questionnaire, as well as an extensive semi-structured interview assessing the experience of the mental healthcare system (diagnosis divulgation, information about disease and treatment, family psychoeducation, hospitalization experience, and access to health professionals). Some questions in the last were open-ended questions, which allowed us to gather detailed and personal responses, in order to be able to illustrate our quantitative findings with brief clinical cases.Among the 27 close relatives included in our research, results to the standardized questionnaires show threatening perceptions of the disease, in particular regarding the probable duration of the disease and the frequency of symptoms. In our study, a better access to diagnosis is associated with a shorter perceived probable duration of the disease, while an easier communication with healthcare professionals (in particular nurses) is associated with the perception of a better efficiency of the treatment. Family psychoeducation seems to be associated with the perception of less frequent symptoms. When the patient lives independently or is older, close relatives of our sample perceive a higher risk of chronicity of the disease. Our results tend to confirm the available literature on the subject of information towards families in psychiatric services: indeed, studies, especially in the field of nursing research, have shown that families tend to feel excluded from care processes and from useful information exchanges about the patient's illness. Our study also confirms the fact that family psychoeducation seems to reduce the frequency of present symptoms in the patient as perceived by the close relative. This effect could be caused by a better understanding of the real symptoms or by an enhancement of the family mood and functioning. Even if the patient's hospitalization was a difficult or very difficult experience for close relatives, it showed no relationship with their illness negative perceptions. Sociodemographic variables of the patient, such as age or the fact of living in an independent household, were associated in our research with the close relatives' view of a higher potential chronicity of the illness; this could be explained by a different stage of acceptation of the illness when compared to close relatives taking care of a younger or still dependent patient.Our results plead for further research on a larger and less homogeneous sample. Confirming our findings could help build useful recommendations leading to better integrated families who currently seem to feel relatively isolated and exclused in the healthcare process, despite the strategic role they could play and despite the many recommendations of public health policies in that matter. Efforts should continue to be made to reach the goal of a better inclusion of families and close relatives of people experiencing schizophrenia or schizophrenia spectrum disorders, in particular in the field of information and communication with health professionals, both areas which seem to have a potential effect on close relatives' illness negative perceptions. Family psychoeducation deserves more attention and should be more systematically proposed to French families with an easier and free access.

The current study aims to identify the factors associated with the use of psychotherapy among adults with a history of suicide attempt.A large cross-sectional survey (N=22,138) was conducted in four regions of France to characterize mental health care needs in the general population. Data were collected between April and June 2005 by trained interviewers using a computer-assisted telephone interviewing system (CATI). Sociodemographics, past-year mental disorders, lifetime and 12-month history of suicide attempts, and use of psychotherapy were assessed.Overall, 7.1% of adults reported having undergone psychotherapy in the course of their life, and 2.0% in the previous 12 months. While 8.3% of adults with a lifetime suicide attempt (prior to the previous 12 months) underwent a psychotherapy in the previous 12 months, 27.5% of adults with a past-year suicide attempt underwent a psychotherapy in the previous 12 months. Psychotherapy was provided by psychiatrists (49.5%), psychologists (28.2%), and psychoanalysts (10.6%). While the frequency of psychotherapy sessions was greater among those with a prior attempt as compared to those with no prior attempt [ChiOne third of adults with a lifetime suicide attempt and close to half of those with a past-year attempt have received some form of psychotherapy in the course of their life. In line with prior work, higher education and income level predicted past-year use of psychotherapy among adults with a prior suicide attempt. These findings highlight the association between major depressive disorder or anxiety disorders and increased odds of undergoing psychotherapy in the previous 12 months among adults with prior attempt. While pharmacological treatment, inpatient hospitalizations for mental health problems, visits with a general practitioner or specialized physician are free of charge in France, psychotherapy provided by psychologists or psychotherapists is currently not covered by the French Social Security health care system. As the treatment of mental disorders plays an important role in the reduction of suicide risk, supporting evidence-based psychotherapy through its reimbursement appears to be an important public health issue.

Recovery is a process through which people experiencing mental illness learn to live with their disorder and reach social insertion and citizenship. This positive approach focuses on a person's competencies and strengths rather than on the symptoms. Within this philosophy, peer support has been unevenly developing in mental health services worldwide with roots in the South-American social programs for homeless people and in the American recovery circles in the field of addiction. Therapeutic efficiency of peer support has been proven by several studies including a control group, as being at least as good as traditional services and even better in some specific areas such as reduction of need for emergency services and ability to reach "difficult" patients. The integration of former psychiatric services users in mental health services can take several forms, from the participation to scientific research studies to the direct involvement in a professional team at mental health facilities. In this context, our research aims to sum up the situation in France in comparison with other countries.We conducted a worldwide literature review in English and in French on peer support experiences and policies in mental health services, using medical and psychological databases (PsycInfo, PsycArticles, SantéPsy, Cairn, Medline, Wiley Interscience and PubPsych) on a recent period: 2005-2016. In total, 32 relevant scientific papers have been included in our research. In some cases, we have also used official reports, blogs, Internet sites, and mass media articles when they were relevant.Our results show that this movement has been long to develop in France, with controversies having been raised since the beginning on the role that peers should play and confusion with existing social integration programs in the associative sector. Drawing inspiration from the Canadian model, a recent "peer mentor" initiative has been analyzed after 2 years of existence: many benefits for services users such as the optional aspect of this care process, a more authentic therapeutic relationship, a less normative frame, an active partnership, and a more optimistic philosophy aiming to make "small steps" towards improvement have been reported. Health professionals and peer mentors themselves have found benefits during the process. However, several limits such as difficulties to find a place with regards to the psychiatric team and difficulties to take advantage of the peer specificity, resulting in a significant attrition of the number of peer mentors, could be observed. A few other important initiatives focused on social insertion and using the help of professional peer support have been developed in recent years, but they seem to have encountered the same issues about positioning themselves both in terms of day-to-day integration in the professional environment and in the job title given by institutions which rarely corresponds to their experience and specificity. In addition, it remains difficult to obtain reliable information, as only a few papers have been published on this matter. Also, while some evaluation studies are currently being carried out, independent quantitative studies of the few running programs seem to lack in this field.In our presentation, taking into account the difficulties that were raised in French programs and the lessons of practical experiences at work in other countries, we propose recommendations for larger and more effective implementations of peer support programs in France. As this new kind of care is emerging and seems promising in terms of benefits for not only the users but also the peer supporters and the teams of health professionals, we also insist on the need for a systematic scientific and objective evaluation of the programs.

OBJECTIVES: To examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups.METHODS: Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity.RESULTS: 1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort "often" through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors.CONCLUSIONS: Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.

Resume Introduction et objectif Les conduites suicidaires sont un reel probleme de sante publique en France. L’objectif de cette etude est d’evaluer la prevalence et les facteurs de risque associes aux comportements suicidaires (projet et tentative) a partir des donnees de l’etude ESEMeD. Methode Cette etude a ete menee en population generale adulte dans le cadre de l’etude ESEMeD qui est une composante de la World Mental Health (WMH) Survey conduite sous l’egide de l’OMS. Un total de 6796 foyers a ete selectionne et contacte. Les sujets etaient evalues a l’aide du Composite International Diagnostic Interview dans la version WMH Survey Initiative de l’OMS (WMH-CIDI) permettant le diagnostic des troubles selon les criteres du DSM IV et du CIM 10. Resultats Dans cette population, la prevalence sur la vie de l’ideation suicidaire, des projets et tentatives de suicide etait elevee, respectivement de 12,4 %, 4,4 % et 3,4 %. Concernant les facteurs de risque, la frequence de l’ideation et des conduites suicidaires en France est associee a l’âge (18–34 ans), au sexe feminin, a la presence d’un trouble psychiatrique et a la comorbidite psychiatrique. L’existence d’un projet suicidaire apparait comme etant un facteur predictif important d’un passage a l’acte suicidaire. Conclusion Les prevalences vie-entiere d’ideation suicidaire, de projets et de tentatives de suicide en population generale en France sont parmi les plus elevees par rapport aux autres pays. Dans un objectif plus large de prevention des comportements suicidaires, ces facteurs de risques doivent etre pris en consideration dans les politiques de sante publique.

Background Panic attacks are heterogeneous with regards to symptom profile. Subtypes of panic attacks have been proposed, of which the most investigated is respiratory panic attacks (RPA). Limited information exists about RPA in the general population. Method The prevalence and correlates of RPA and non-respiratory panic attacks (NRPA) were examined in a subsample ( n = 8.796) of individuals participating in a cross-sectional survey of the adult general population of six European countries. Panic attacks, mental disorders, and chronic physical conditions were assessed with the Composite International Diagnostic Interview (CIDI) 3.0. Data on use of health services and disability were obtained. Results The lifetime prevalence of RPA was 6.77 and the 12-month prevalence was 2.26. No robust associations of RPA with sociodemographic characteristics, mental disorders or physical conditions were found as compared to NRPA. RPA were associated with increased use of health services but similar disability in comparison to NRPA. Limitations Few direct data are available on the validity of the CIDI to assess RPA. Other definitions of RPA exist in the literature. Conclusions Our findings suggest that there are very few differences between RPA and NRPA and do not support the need of subtyping panic attacks in current classification systems.

Objective: Estimate predictive associations of mental disorders with marriage and divorce in a cross-national sample. Method: Population surveys of mental disorders included assessment of age at first marriage in 19 countries (n = 46 128) and age at first divorce in a subset of 12 countries (n = 30 729). Associations between mental disorders and subsequent marriage and divorce were estimated in discrete time survival models. Results: Fourteen of 18 premarital mental disorders are associated with lower likelihood of ever marrying (odds ratios ranging from 0.6 to 0.9), but these associations vary across ages of marriage. Associations between premarital mental disorders and marriage are generally null for early marriage (age 17 or younger), but negative associations come to predominate at later ages. All 18 mental disorders are positively associated with divorce (odds ratios ranging from 1.2 to 1.8). Three disorders, specific phobia, major depression, and alcohol abuse, are associated with the largest population attributable risk proportions for both marriage and divorce. Conclusion: This evidence adds to research demonstrating adverse effects of mental disorders on life course altering events across a diverse range of socioeconomic and cultural settings. These effects should be included in considerations of public health investments in preventing and treating mental disorders.

BackgroundPrior research on whether marriage is equally beneficial to the mental health of men and women is inconsistent due to methodological variation. This study addresses some prior methodological limitations and investigates gender differences in the association of first marriage and being previously married, with subsequent first onset of a range of mental disorders.MethodCross-sectional household surveys in 15 countries from the WHO World Mental Health survey initiative (n=34493), with structured diagnostic assessment of mental disorders using the Composite International Diagnostic Interview 3.0. Discrete-time survival analyses assessed the interaction of gender and marital status in the association with first onset of mood, anxiety and substance use disorders.ResultsMarriage (versus never married) was associated with reduced risk of first onset of most mental disorders in both genders; but for substance use disorders this reduced risk was stronger among women, and for depression and panic disorder it was confined to men. Being previously married (versus stably married) was associated with increased risk of all disorders in both genders; but for substance use disorders, this increased risk was stronger among women and for depression it was stronger among men.ConclusionsMarriage was associated with reduced risk of the first onset of most mental disorders in both men and women but there were gender differences in the associations between marital status and onset of depressive and substance use disorders. These differences may be related to gender differences in the experience of multiple role demands within marriage, especially those concerning parenting.

OBJECTIVE: To investigate the prevailing attitudes towards mental health help-seeking in Europe, their correlates, and whether these attitudes are associated with actual service use for mental health problems. METHOD: Data were derived from the European Study of Epidemiology of Mental Disorders, a survey representative of the adult population of six countries: Belgium, France, Germany, Italy, the Netherlands and Spain (n = 8,796). The World Mental Health Composite International Diagnostic Interview was used to assess attitudes and DSM-IV diagnoses. The attitudes referred to beliefs that the respondents would seek professional help when faced with a serious emotional problem, would feel comfortable talking about personal problems with a professional, would not be embarrassed if friends knew about the professional help, and respondents' perceived effectiveness of mental health care. RESULTS: Almost a third of the respondents held the view that professional care was worse than or equal to no help when faced with serious emotional problems. Female gender, being younger than 65 years of age, high income, living in Spain or Italy, presence of mood disorder and previous service use were associated with at least two of the four assessed attitudes towards mental health help-seeking. All four attitudes were significantly associated with mental health care use, also after adjustment for previous service use. CONCLUSION: The low perceived effectiveness of professional care calls for serious action aiming to improve the visibility and credibility of the mental health care sector. This research was funded by the Netherlands Mental Health Fund (Fonds Psychische Gezondheid). The ESEMeD project was funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028-02), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, and other local agencies and by an unrestricted educational grant from GlaxoSmithKline.

Resume Objectif de l’etude Evaluer les besoins de soins en sante mentale, en pedopsychiatrie ainsi que leurs determinants respectifs chez les enfants des ecoles primaires dans une region de France. Patients et methode L’enquete a ete realisee sur un echantillon randomise de 2341 enfants scolarises dans des ecoles primaires de la region PACA. Les questionnaires utilises pour mesurer la sante mentale des enfants etaient selon l’informant : le Dominique interactif (enfant), le Strengths and difficulties questionnaire (parents) et un questionnaire base sur le DSM-IV (enseignants). Le recours aux soins (12 derniers mois) et les determinants sociaux ont ete recueillis aupres des parents par autoquestionnaire. Resultats Le besoin de soins en pedopsychiatrie (troubles avec retentissement rapportes par deux informants) concerne 7,7 % des enfants, celui en sante mentale 21,9 %. Le recours des enfants de la premiere categorie est de 13,6 % pour la pedopsychiatrie, 38,4 % pour les intervenants specialises en sante mentale. Le besoin de soins en pedopsychiatrie semble etre plus frequent chez les garcons et dans les familles monoparentales. Le besoin de soins en sante mentale serait plus frequent chez les jeunes enfants (six a huit ans) et moins frequent dans les categories socioprofessionnelles elevees. Conclusion Les volumes des besoins sont tres differents. Il semble que moins de la moitie des enfants ayant des besoins en pedopsychiatrie soit en contact avec le systeme specialise, alors que des enfants ayant des besoins moins specialises y sont. Une meilleure definition des besoins, des acteurs et structures permettrait une plus grande equite dans l’utilisation des ressources.

Resume Il n’existe quasiment aucune donnee empirique sur l’usage des psychotherapies en France. Cet article presente une etude concernant les pratiques psychotherapiques a partir de donnees declarees par les patients : frequence des psychotherapies, caracteristiques des personnes qui les suivent, modalites de suivi, association avec differents traitements, lieux de traitement, motifs invoques et pathologies declarees. Les donnees sont issues d’une enquete sante conduite par la fondation MGEN aupres de 6 500 adherents de la mutuelle, comparees aux donnees existantes dans d’autres enquetes. La frequence de recours a la psychotherapie au moins une fois dans la vie est relativement elevee, puisque suivant les etudes de 5 a 11,5 % des repondants y ont eu recours. Les femmes, nees au debut des annees 1960, sont celles qui, au moment de l’enquete, avaient le plus souvent consulte. Pour les hommes, ce sont ceux nes a la fin des annees 1950 qui avaient, au moment de l’enquete, le plus souvent consulte. La tres grande majorite de ces psychotherapies sont faites en individuel, dans des cabinets prives ; elles durent souvent plus d’une annee et ont lieu une fois par semaine ou plus ; 30 % des personnes declarent avoir entrepris plusieurs therapies. Les motifs tels que declares par les patients sont essentiellement les troubles depressifs et anxieux. La satisfaction est importante, puisque plus de 90 % des personnes se declarent satisfaites des resultats, et 60 % estiment qu’elles ont ete ameliorees beaucoup et durablement ; 77,5 % des personnes qui declarent suivre une psychotherapie ont consomme au moins un traitement medicamenteux et 70,8 % un psychotrope. L’ensemble de nos resultats montre l’importance jouee par les pratiques psychotherapiques dans le paysage francais, et la necessite d’etudier ces techniques et de reflechir a la place qui doit leur etre faite dans une politique de sante mentale.

The progressive shifts in the legal and social contexts, along with major changes in information seeking habits with the development of the Internet, have placed patients' information at the core of medical practice. This has to be applied to the psychiatric fields as well, and to questions about how schizophrenic patients are being told their diagnosis nowadays in France.This paper is a national and international literature review about schizophrenia diagnosis disclosure practices, from 1972 to 2014, using French and English languages and various psychology and medical databases. The used key words were "diagnosis", "disclosure", "communication", "breaking bad news", "information", "schizophrenia" and "psychosis".Proportions of diagnosis announcement: our results show that the proportion of psychiatrists delivering schizophrenia diagnosis to their patients varies between countries. Although we must acknowledge that the questionnaires and samples are diverse, we have found that psychiatrists are in general less prone to deliver diagnosis information in France (from 13,5% to 39% given the studies), Germany (28%), Italy (30%), and Japan (30%), than in Anglo-Saxon countries. Thus, 70% of the psychiatrists in North America and 56% in Australia claim that they disclose their diagnosis to schizophrenic patients. In the United-Kingdom, a study targeting psychotic patients themselves has shown that 47% of them had been told their diagnosis by their doctor. Even in the countries where the proportion of diagnosis disclosure is the highest, there remains a substantial difference with other mental illnesses such as affective or anxiety disorders, which are almost always labeled as such in the information communicated to the patient (90% in North America). Diagnostic information about schizophrenia continues therefore to appear problematic for health professionals, which can seem a paradox given the recent social and legal evolutions, the therapeutic progress, the proved benefits of disclosure on compliance and therapeutic alliance, and the fact that numerous studies have shown that a majority of patients already know their diagnosis having discovered it on the Internet or by reading their treatments' notice. Reasons alleged for not disclosing diagnosis: the reasons alleged by psychiatrists for not disclosing diagnosis are various, including fear of aggravating the stigma and the emotional state of the patient, fear of giving a wrong diagnosis, fear of suicidal behavior, risk of misunderstanding, low level of patient's insight, absence of therapeutic advantage, or absence of request from the patient. Evolution of the French position about diagnosis disclosure: The publication of the relatively large study of Baylé et al. in 1999, as well as the patients' rights evolutions, has led to a debate among psychiatrists about the reasons alleged in France for not disclosing diagnosis. Among other explanations, it appeared that the theoretical reference of the psychiatrist plays a role, a psychoanalytic practice leading to increased reluctance in breaking the bad news. Thus, the psychiatrist's view of the disease, in terms of etiology and prognosis, is important as the diagnosis could become accusing if the psychiatrist believes the family environment played a role, or harmful if he has a pessimistic conception of prognosis. The question of stigma: among other reasons alleged by psychiatrists for not announcing the diagnosis, the fear of causing an increased stigma is frequently reported by professionals. In France, stigma about schizophrenia is high, not only among the general population but also among health practitioners. Even if the context has evolved during the past 30 years and the therapeutic efficiency has improved, French representations of schizophrenia remain often tinted with catastrophism and should be modified. Benefits of diagnosis disclosure: however, the benefits of disclosing diagnosis have been constantly proved in France as in other environments. Several studies have shown that patients knowing their diagnosis were likely to develop a better compliance and a stronger therapeutic alliance with their doctor. No aggravation of symptoms, suicidal risk or anxiety has been linked to the diagnosis disclosure. On the contrary, the relief of being able to put some words on symptoms, better recognize them and anticipate them, and be part of a group of patients sharing the same symptomatology has been described by patients. Furthermore, disclosing a schizophrenia diagnosis can be essential to the psychotherapeutic project, in the sense that it places the patient into an active role towards the disease and the care plan. Last but not least, the relatives can benefit from the disclosure as well and build a partnership with health professionals about medical care. Existing recommendations: in the French context, apart from individual recommendations produced by a few authors in the literature, there are no official specific recommendations about how to disclose a difficult diagnosis in the psychiatric field; only recommendations concerning severe chronic somatic disease are available. The complexity of the schizophrenia diagnosis disclosure has led some researchers - especially in North America and Australia - to adapt and use in the context of schizophrenia protocols, recommendations and even communication skills training programs that have been developed in oncology or in the field of severe chronic somatic disease.For the situation to evolve in France, tools able to measure patients' consent - including consent to hear the bad news - ability could be used. The question of how much information and what kind of information the patients really wish should therefore be explored in deep. Also, we have seen that schizophrenia representations should be modified in the general public understanding as well as in the professional environment. Families should be more included in the reflection about diagnosis announcement, as psycho-education programs have shown their efficiency and usefulness for both patients and relatives. Finally, in order to overcome some of the difficulties related to breaking the bad news about a schizophrenia diagnosis, developing the existing Anglo-Saxon models and recommendations in France, where only very few protocols exist, could allow a positive evolution in clinical practice and help to set a therapeutic and partnering approach of diagnosis disclosure. However, in order to better understand the situation in France regarding schizophrenia diagnosis disclosure, the present state of clinical practice still remains to be analyzed precisely, as the last study on a relatively large sample was made only in 1999. Thus, the obvious limits of our study lie in the fact that most available surveys in France are not recent enough to have taken into account legal and social evolutions. Also, the studies that we used for this paper use different methodologies, in the majority focus solely on health professionals, and they are not representative enough in terms of size or sample to inform about the present state of the practice.As a conclusion, having stressed the lack of recent data about schizophrenia diagnosis disclosure in France, we suggest a new study using validated tools on a representative sample and taking into account both perceptions of psychiatrist and patient. As has been the case for other severe pathologies, we also suggest that a consensus conference take place on the subject of schizophrenia diagnostic information in order to elaborate guidelines to support this difficult disclosure.

International audience; Introduction: When evaluating gender differences in mental disorders and suicidality, specifically between European countries, studies are sparse and frequently hindered by methodological issues, such as the limited items evaluated and inconsistent sampling designs.Methods: In ten European countries participating in the World Mental Health Survey Initiative, lifetime internalizing and externalizing disorders and suicidality were assessed among 37,289 respondents. Disorders were classified using DMS-IV criteria. Odds ratios (OR) for gender differences were calculated using logistic regression, while trends across age-groups were tested via gender × age interaction.Results: Within countries, prevalence of any lifetime internalizing disorder ranged from 10.8% to 44.5% among women and 5.9% to 26.5% among men, with women having consistently higher odds than men (OR range: 1.52-2.73). Prevalence of any lifetime externalizing disorders ranged from 0.2% to 6.6% among women and 2.2% to 22.4% among men, with women having consistently lower odds than men (OR range: 0.05-0.35). Any lifetime suicide attempt was found in 0.8-5.4% of women and 0.3-2.4% of men, showing inconsistent relative gender-differences across countries (OR range: 0.77-4.72). Significant effects in gender OR across age-groups were not observed for any internalizing disorder or suicide attempt, yet were present for any externalizing disorder in France (p = 0.01), the Netherlands (p = 0.05), and Spain (p = 0.02).Limitations: Mental disorders were assessed with the CIDI 3.0 and not psychiatric evaluations. Suicidality does not fully represent more important clinical events, such as suicide mortality.Conclusions: Consistent across European countries, internalizing disorders are more common among women and externalizing disorders among men, whereas gender differences in suicidality varied.

Resume Les Hopitaux de Jour et Centres d'Accueil Therapeutiques a Temps Partiel (CATTP) sont des structures alternatives a l'hospitalisation qui visent a favoriser l'insertion ou le maintien du patient dans son environnement familial, social, educatif ou professionnel. Si leur interet est bien reconnu, il n'en reste pas moins que ces structures sont encore peu etudiees dans leur specificite, au plan de leur fonctionnement global en termes d'organisation, de moyen, d'activite. L'Agence Regionale de l'Hospitalisation a lance une etude exhaustive en deux temps (1998 puis 2000) en Ile-de-France visant a mieux connaitre ces etablissements. Au total 207 structures adultes (10 663 patients adultes) et 150 structures infanto-juveniles (4 199 enfants/adolescents) ont ete enquetees. L'etude montre en quoi, malgre leurs files actives sensiblement equivalentes, les CATTP et les Hopitaux de Jour different dans leur fonctionnement. En ce qui concerne les patients, les facteurs determinants de differenciation des structures sont relatifs a l'âge et a la pathologie. Enfin, pour un groupe de patients ayant le meme type de pathologie et des caracteristiques communes, la prise en charge est plus intensive en hopital de jour qu'en CATTP, particulierement en hopital de jour non sectorise.

Resume Ce document decrit un large eventail de projets conduits aupres d'enfants entre zero et six ans dans les 15 pays de la Communaute Europeenne et la Norvege. La plupart d'entre eux ont ete mis au point et experimentes dans des milieux defavorises et de cultures diverses. Les interventions aupres des enfants et des parents, le choix des tranches d'âge concernees, les moyens de realisation varient selon la politique de sante, le systeme scolaire et le systeme de soins de chaque pays. Certains projets concernent les jeunes enfants, voire les futurs parents, d'autres s'interessent aux enfants scolarises, aux enseignants et aux parents. Ces programmes ne pretendent pas traiter les enfants qui presentent des troubles cliniques mais apporter des elements permettant de soutenir les parents en general, notamment ceux qui sont confrontes a des difficultes liees a leur situation sociale.

Position du probleme L’objectif de cette etude etait de mettre en evidence les facteurs associes au depistage des cancers du col uterin dans une population ou la prise en charge des examens est assuree par la Mutuelle Generale de l’Education Nationale. Methodes Un auto-questionnaire anonyme a ete adresse par voie postale a un echantillon de 10 000 sujets de 20 a 60 ans tires au sort a partir du fichier national des mutualistes metropolitains. Le taux de reponse a ete de 66,5 % (N = 6 518). Resultats Parmi les femmes mutualistes de 20 a 60 ans (n = 3 741), 88,5 % ont pratique un frottis du col uterin au moins une fois dans la vie. L’âge moyen etait de 29,3 ans (IC a 95 % : 29,0-29,6) au premier frottis. Les pratiques preventives (mammographie, frottis et recherche de sang dans les selles) etaient fortement liees entre elles. Les facteurs associes a une pratique de frottis dans les 3 dernieres annees etaient l’âge entre 30 et 49 ans, le statut marital (mariees, separees ou divorcees), le statut socioprofessionnel (les ouvrieres pratiquaient significativement moins souvent un frottis que les autres categories socioprofessionnelles). Les femmes qui ont declare avoir consulte un gynecologue dans les 12 derniers mois avaient 9 fois plus de chances d’avoir pratique un frottis et celles qui ont consulte un medecin generaliste en avaient 2 fois plus par rapport a celles qui n’avaient consulte ni l’un ni l’autre. Conclusions Dans une population ou la prise en charge des examens est assuree par la mutuelle, le niveau socioprofessionnel etait un des determinants de la pratique du frottis.

Resume Lorsque au cours de l’annee 2000 les procedures d’accreditation ont commence a voir le jour, on a pu craindre que les etablissements psychiatriques ne soient penalises par certaines de leurs specificites. Cet article presente une analyse des 120 premieres procedures d’accreditation conduites par l’ANAES comparant les resultats des etablissements psychiatriques et non psychiatriques. A l’examen de ces comptes rendus, il apparait que les evaluations menees dans le cadre des procedures d’accreditation sont plutot favorables aux etablissements psychiatriques. Il existe neanmoins au moins deux « zones de conflit » entre les modes specifiques de fonctionnement des etablissements psychiatriques et la demarche d’accreditation : certains aspects de la gestion des risques, ainsi que de l’intimite, de la dignite et de la liberte du patient.

The European Study of the Epidemiology of Mental Disorders (ESEMeD/MHEDEA 2000) is a new cross‐sectional study investigating the prevalence and the associated factors of mental disorders, as well as their effect on health‐related quality of life and the use of services in six European countries. This paper describes the rationale, methods and the plan for the analysis of the project. A total of 22,000 individuals representative of the non‐institutionalized population aged 18 and over from Belgium, France, Germany, Italy, the Netherlands and Spain are being interviewed in their homes. Trained interviewers use a computer‐assisted personal interview (CAPI) including the most recent version of the Composite International Diagnostic Interview (CIDI, 2000), a well‐established epidemiological survey for assessing mental disorders. This is the first international study using the standardized up‐to‐date methodology for epidemiological assessment. Sizeable differences in prevalence, impact and level of need that is met by the health services are expected. The analysis of these differences should facilitate the monitoring of ongoing mental health reform initiatives in Europe and provide new research hypotheses. Copyright © 2002 Whurr Publishers Ltd.

Background: Homelessness is a growing problem in the cities of the western world, and homeless people have a plethora of mental health and social difficulties. These are, nevertheless, difficult to evaluate epidemiologically. Method: In this paper we present a population survey using the Composite International Diagnostic Interview (CIDI) conducted in the city of Paris in winter 1996 on a representative sample of 838 homeless people. Night shelters as well as food kitchens were randomly sampled, and the mean response rate was around 65%. Results: The sample was relatively young and predominantly male (85%). Forty percent were born outside France, 96% had worked at some time, and one-third reported no resources at all. The lifetime prevalence of psychiatric disorders was 57.9%, while the 1-year prevalence was 29.1%. For definite psychotic disorders, prevalence was 16% (lifetime) and 6% (1-year). Generally, this Parisian homeless population had some access to care: in the preceding 6 months 57.7% of them had been medically attended and 14.2% of these had been hospitalised. The survey was cross-sectional, and did not evaluate regular access to care or the quality of care. Conclusions: The implications for health and social systems are discussed in the light of comparisons with European and North American data.

Background: This paper presents and epidemiological survey of 300 adults randomly sampled among the Parisian population and 207 randomly sampled recipients of a social benefit. The RMI (Revenu Minimal d'Insertion) provides a regular minimal income to any person with resources below a certain level. It is not targeted at people with mental health problems. Methods: The subjects were evaluated by trained interviewers using collateral information provided by an informant, together with CIDIS, a simplified version of the CIDI, covering: somatisation, panic attack, phobias, generalised anxiety, major depression and alcohol and illegal drug abuse (DSM-III-R and ICD-10 classifications). Results: The response rate was 79% for the Parisian sample and 75% for the RMI recipients. As expected, the sociodemographic composition of the two groups adjusted for age differed considerably: RMI recipients were likely to be unemployed and single or divorced. The collateral information showed that psychoses of all types were more frequent among RMI recipients (4.2% vs 1.2%, P < 0.02). There were large differences in rates for substance abuse and dependence, antisocial personality and lifetime depressive disorders, but no difference for mental deficiency. This corresponded partly with the direct CIDIS measure: male RMI recipients suffered significantly more from severe depression than male Parisian controls: 16.7% compared to 3.4% (P < 0.01 lifetime) and from drug and alcohol abuse or dependency disorders. Depressed RMI recipients made less use of available medical care for their depression than Parisians controls, mainly because RMI recipients did not consult psychiatrists, whereas controls did (21%, P < 0.0001). On average, the duration of depressive episodes is longer in RMI recipients, especially in women. Conclusion: The high rate of psychiatric disorders and poor access to resources in RMI recipients have implications for the health system. Care would be improved if social workers administering the benefit were better trained to recognise psychiatric problems, and able to link their clients with (particularly) primary care services.

A study of the frequency of life events was conducted in a group of subjects selected from the general population over a period of 9 months. Four assessments were made, using an events questionnaire and the Psychiatric Symptom Index (PSI), at 3-monthly intervals. The results show a significant relationship (maintained over time) between PSI score and the number of upsetting events, but no significant relationship between PSI score and non-upsetting events. These observations are interpreted as follows: the higher frequency of upsetting life events is secondary to the previous psychological pattern of subjects.

International audience; Objective: To investigate patterns of use of general practitioners (GPs) and/or mental health professionals (MHPs) for mental health reasons, across six European countries, and the extent to which these patterns of use are associated with differences in mental health-care delivering systems.Methods: Data are based on the European Study of the Epidemiology of Mental Disorders (ESEMeD): a cross-sectional survey of a representative sample of 8,796 non-institutionalized adults from six European countries, conducted between 2001 and 2003 using computer-assisted interviews with the CIDI-3.0. Countries were classified into: MHP- for countries where access to medical professionals tends to predominate (Belgium, France, Italy), and MHP+ where access to non-medical MHPs predominates (Germany, Spain, The Netherlands).Results: Among respondents consulting GPs and/or MHPs in the past year (n = 1,019), respondents from the MHP- group more often consulted GPs (68 vs. 55 % in MHP+ group), GPs and psychiatrists (23 vs. 14 %). People from the MHP+ group more often used MHPs only (45 vs. 32 %), GPs and non-medical MHPs (16 vs. 8 %). GPs from the MHP+ group were more inclined to refer patients to MHPs. Factors associated with use of GPs versus MHPs were: being over 49 years, not highly educated, lower income and suffering from mood or severe mental disorders.Conclusions: Differences in the use of GPs versus MHPs are markedly linked to individual as well as organizational factors. Interventions are needed, in countries fostering medical access, to reimburse sessions with non-medical MHPs and improve cooperation between professionals to obtain better practice in access to care.

These guidelines have been sent personally to every psychiatrist and to all members of UNAFAM, in all, to more than 20 000 persons; they have been widely covered by medical and non-medical professional journals, as well as by ordinary journals. A book has been published containing the papers produced by experts and their bibliography.

The burden of health problems, including mental disorders, can be assessed in several ways such as through healthcare costs or loss of productivity. Their impact on daily activities as a whole has received much less attention, especially in France. Therefore, we undertook the analysis of the French general population data from the World Mental Health (WMH) surveys promoted by the World Health Organization (WHO) assessing the number of days out of role due to common mental and physical disorders.Face-to-face interviews were carried out with 2894 respondents (45.9% pooled response rate). Presence of ten chronic physical disorders and nine mental disorders was assessed for each respondent along with information about the number of days in the past month each respondent reported being totally unable to work or carry out their other normal daily activities because of problems with either physical or mental health. Multiple regression analysis was used to estimate associations of specific conditions and comorbidities with days out of role, after controlling for basic socio-demographics.One thousand four hundred and thirty-six subjects reporting at least one core-symptom of a mental disorder underwent the whole assessment. The mean annual number of days out of role was high among those with at least one mental disorder (24.2±8.3). The population attributable risk proportion (PARP), i.e. the proportion of days out of role that would have been avoided if the considered disorder had remitted, was also estimated. Mental disorders as a whole accounted for 49.5% of the PARP.French data on days out of role from the WHO WMH surveys showed the high burden of mental illness in the general population. These results may have been underestimated, taking into account that subjects who were hospitalized at the time of recruitment, whose disorders might also account for a high proportion of days out of role, could not be assessed with our design.Common health conditions, especially mental disorders, make up a large proportion of the number of days out of role. Such data should be considered to design more efficient public health strategies.

Estimate predictive associations of mental disorders with marriage and divorce in a cross-national sample.Population surveys of mental disorders included assessment of age at first marriage in 19 countries (n = 46,128) and age at first divorce in a subset of 12 countries (n = 30,729). Associations between mental disorders and subsequent marriage and divorce were estimated in discrete time survival models.Fourteen of 18 premarital mental disorders are associated with lower likelihood of ever marrying (odds ratios ranging from 0.6 to 0.9), but these associations vary across ages of marriage. Associations between premarital mental disorders and marriage are generally null for early marriage (age 17 or younger), but negative associations come to predominate at later ages. All 18 mental disorders are positively associated with divorce (odds ratios ranging from 1.2 to 1.8). Three disorders, specific phobia, major depression, and alcohol abuse, are associated with the largest population attributable risk proportions for both marriage and divorce.This evidence adds to research demonstrating adverse effects of mental disorders on life course altering events across a diverse range of socioeconomic and cultural settings. These effects should be included in considerations of public health investments in preventing and treating mental disorders.

Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55 299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior. These activities were supported by the United States National Institute of Mental Health (R01MH070884, R01MH077883), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP). The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H). The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575). The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the Robert Wood Johnson Foundation (RWJF; Grant 044708).

Little is known about attitudes to seeking help from mental health care professionals.To investigate these attitudes and their correlates, and find out whether these attitudes are associated with the use of care services.Data were derived from the European Study of Epidemiology of Mental Disorders, a survey that is representative of the adult population of six countries (n = 8,796).Almost a third of respondents were of the opinion that professional help was worse than or equivalent to no help at all, in relation to serious psychiatric problems. Females, respondents under the age of 65, with a higher income, living in Spain or Italy, with a mood disorder, and those who had previously sought mental health care, more often stated that they would seek professional help if beset by a serious mental health problem. All these groups, except for the younger than 65, also reported more often that they would feel comfortable discussing mental health problems with a professional or that they were receiving this kind of help. All these attitudes were associated with an increased chance that persons would use professional help if beset by mental health problems.Definite steps need to be taken to increase the visibility and credibility of the mental health services.

Suicide is a public health problem worldwide. The objective of this study is to analyse the prevalence and risk factors of suicide related outcomes (ideation, plan and attempt) using data from the ESEMeD-France project.This is a face-to-face household survey carried out in a probability representative sample of the adult general population of France. A total of 6796 subjects were interviewed using the Composite International Diagnostic Interview (CIDI) developed framework of the World Mental Health Survey Initiative. Based on evidence that reports of such potentially embarrassing behaviour are higher in self-administered than interviewer-administered surveys, these questions were printed in a self-administered booklet and referred to by letter.Lifetime prevalence of suicide ideation, plan and attempts were 12.4, 4.4 and 3.4% respectively. Risk of suicide-related outcomes was significantly higher among women and younger cohorts. Having a mental disorder was associated with an increased risk, especially in the case of psychiatric comorbidity. Mental disorders that are associated with an increase in suicidal attempts are anxiety disorders (except social phobia), major depressive episodes, oppositional defiant disorders, and attention deficit hyperactivity disorders. The suicidal risk notably increases in conjunction with multiple mental disorders. In this study, employment and marital status do not appear to be a risk factor for suicidal behaviour.The prevalence of suicide-related outcomes is high when compared with other countries. Results identified groups with higher risk (women, young, subjects with a mental disorder and having a plan) in which suicide prevention could to be targeted. The results of this study suggest that to improve suicide prevention strategies it is necessary to perform an in-depth clinical evaluation of suicidal ideas and projects, and identify precisely psychiatric comorbidity to allow a more efficient treatment.

BACKGROUND: Prior studies in the USA have reported higher rates of mental disorders among persons with arthritis but no cross-national studies have been conducted. In this study the prevalence of specific mental disorders among persons with arthritis was estimated and their association with arthritis across diverse countries assessed. METHOD: The study was a series of cross-sectional population sample surveys. Eighteen population surveys of household-residing adults were carried out in 17 countries in different regions of the world. Most were carried out between 2001 and 2002, but others were completed as late as 2007. Mental disorders were assessed with the World Health Organization (WHO) World Mental Health-Composite International Diagnostic Interview (WMH-CIDI). Arthritis was ascertained by self-report. The association of anxiety disorders, mood disorders and alcohol use disorders with arthritis was assessed, controlling for age and sex. Prevalence rates for specific mental disorders among persons with and without arthritis were calculated and odds ratios (ORs) with 95% confidence intervals were used to estimate the association. RESULTS: After adjusting for age and sex, specific mood and anxiety disorders occurred among persons with arthritis at higher rates than among persons without arthritis. Alcohol abuse/dependence showed a weaker and less consistent association with arthritis. The pooled estimates of the age- and sex-adjusted ORs were about 1.9 for mood disorders and for anxiety disorders and about 1.5 for alcohol abuse/dependence among persons with versus without arthritis. The pattern of association between specific mood and anxiety disorders and arthritis was similar across countries. CONCLUSIONS: Mood and anxiety disorders occur with greater frequency among persons with arthritis than those without arthritis across diverse countries. The strength of association of specific mood and anxiety disorders with arthritis was generally consistent across disorders and across countries. These activities were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R01-TW006481). The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP). The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labor and Welfare. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H). The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575). The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the Robert Wood Johnson Foundation (RWJF; Grant 044708)

The Epidemiological Catchment Area (ECA) program is a major step in psychiatric epidemiology because it uses a structured interview: the Diagnostic Interview Schedule (DIS). This gives psychiatric diagnoses in different diagnostic systems and can be administered by lay interviewers. However many surveys on health-related topics cannot give the time needed to administer the DIS and train the personnel to use such a complex schedule as the DIS. The DISSA is a self-administered abridged form of the DIS and represents an effort to produce a short and simple instrument for three types of diagnoses: major depressive disorder, all anxiety disorders (generalized anxiety, phobias, panic) and alcohol disorders. In this paper we describe the DISSA and give preliminary evidence about its efficiency. This will be done by comparing DISSA results with clinicians judgments, the DIS and a checklist derived from HSC. The DISSA functions in a manner similar to its parent instrument but achieves this in a shorter and less costly mode. Actually the approach by episode used for assessing depression seems to work better than the DIS. Comparisons with the checklist show a clear superiority of the DISSA for depression, alcohol and anxiety disorders but not for generalized anxiety.

This paper reviews the development of psychiatric epidemiology in Quebec from 1960 to the present. The research in this area is divided into three periods: 1960 to 1980, 1980 to 1985, and 1985 onward. Child psychiatric epidemiology is addressed separately. The authors conclude that psychiatric epidemiology has been an active area of research in Quebec and will likely be even more so in the future given the increasing interest in the field.

International audience; INTRODUCTION: Today in France, little empirical data on the use of psychotherapy is available. This paper presents an empirical study of psychotherapeutic practices, from the patient's point of view. We will present results regarding frequency of psychotherapies, patients' characteristics, associations between different kinds of therapy, where they take place, and the reasons given for beginning psychotherapy. METHODOLOGY: Data is based on a general and mental health survey conducted by MGEN(1) foundation among 6,500 persons, as well as on general population data collected by the BVA survey institute. RESULTS: Depending on the population studied, between 5 to 11.5% of people have had psychotherapy sessions at least once in their lifetime. Women born at the beginning of the sixties and men born at the beginning of the fifties are those who consulted the most. The vast majority of these psychotherapies are individual, in private practice. They often last more than one year, with a frequency of once per week or more. Thirty percent declare that they have undergone several psychotherapies. The reasons for consultation reported by users are mainly depression or anxiety. There are significant differences between genders for the reasons for consultation, women being concerned by depression, problems with sleep and food, and men being concerned by obsessive thoughts and addiction (alcohol, tobacco). People undergoing psychotherapy give an average of 2.5 reasons for this psychotherapy, and only 28% gave only one reason. A relationship exists between the number of consecutive treatments and the number of reasons given for undergoing psychotherapy. More than 25% of the psychotherapies last less than 6 months. "Intensive psychotherapy" (at least 6 months and a frequency of 2 to 3 times per month) concern 5.9% of the whole population studied, and represent 51.4% of all psychotherapies. People are quite satisfied by their psychotherapy; 90% are satisfied with the results and 60% believe that their condition has been much improved in a durable manner. 16.6% were unsatisfied with the results. There is (in women only) an association between satisfaction and intensity of treatment; satisfaction is lower in those women undergoing intensive psychotherapy; 77. 7% of users have also used some sort of drugs for the problem (80.6% of women and 69.9% of men) with psychotropic drugs most frequently used: 70.8% of the psychotherapy users had taken such drugs for their problem (women 72.9%, men 65.4%). CONCLUSION: In France, psychotherapies are playing an important role and it is necessary to study these techniques better in order to give them the place they deserve in the French mental health policy.

Kopfschmerzen gehoren zu den haufigsten Schmerzerkrankungen uberhaupt und haben eine 12-Monats-Pravalenz von > 10 %. Dabei gehen sie haufig mit psychischen Erkrankungen einher – Depressionen sind beispielsweise ein gesicherter Risikofaktor fur die spatere Entwicklung chronischer Kopfschmerzen. Fur andere psychische Storungen sind solche Zusammenhange weniger klar. Eine internationale Gruppe hat das nun systematisch uberpruft.

This paper reports cross-national data concerning back or neck pain comorbidity with mental disorders. We assessed (a) the prevalence of chronic back/neck pain, (b) the prevalence of mental disorders among people with chronic back/neck pain, (c) which mental disorder had strongest associations with chronic back/neck pain, and (d) whether these associations are consistent across countries. Population surveys of community-dwelling adults were carried out in 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific (N=85,088). Mental disorders were assessed with the Composite International Diagnostic Interview, third version (CIDI 3.0): anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder, and social anxiety disorder), mood disorders (major depression and dysthymia), and alcohol abuse or dependence. Back/neck pain was ascertained by self-report. Between 10% and 42% reported chronic back/neck pain in the previous 12 months. After adjusting for age and sex, mental disorders were more common among persons with back/neck pain than among persons without. The pooled odds ratios were 2.3 [95% CI=2.1-2.5] for mood disorders, 2.2 [95% CI=2.1-2.4] for anxiety disorders, and 1.6 [95% CI=1.4-1.9] for alcohol abuse/dependence in people with versus without chronic back/neck pain. Although prevalence rates of back/neck pain were generally lower than in previous reports, mental disorders were associated with chronic back/neck pain. The strength of association was stronger for mood and anxiety disorders than for alcohol abuse/dependence. The association of mental disorders with back/neck pain showed a consistent pattern across both developed and developing countries.

The use of psychotropic drugs is high in France and has increased over the last two decades. To date, no national study evaluating psychotropic drug use in the context of the diagnosis of psychiatric disorders has been performed. Such data has now been generated in the ESEMeD/MHEDEA 2000 study, which has allowed comparison of the situation in France with that in five other European countries (Germany, Belgium, Spain, the Netherlands and Italy).1) To describe the declared use of psychotropic drugs (globally and by therapeutic class) in order to evaluate annual prevalence, treatment duration and demographic factors associated with use. 2) To estimate the proportion of subjects with an anxiety disorder, mood disorder or alcohol-related disorder (abuse or dependence) that have been appropriately treated with an antidepressant or anxiolytic drug. 3) to evaluate the proportion of psychotropic drug users who fulfil diagnostic criteria for these three classes of psychiatric disorder.This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source used was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used.In France, 21% of subjects interviewed (n = 580) had taken at least one psychotropic drug during the year. For 19%, this was an anxiolytic or hypnotic (AX-HY), for 6.0% an antidepressant (AD), for 0.8% an antipsychotic (AP) and for 0.4% a mood regulating drug (TY). The distribution of users of AX-HY according to treatment duration was the following: 44% (1 to 15 days), 13% (16 to 30 days), 14% (1 to 3 months), 6.7% (3 to 6 months) and 23% (6 months). For users of ADs, the distribution was: 21% (1 to 15 days), 7.8% (16 to 30 days), 18% (1 to 3 months), 12% (3 to 6 months) and 42% (6 months). For subjects fulfilling diagnostic criteria for a mood disorder in the previous year or over their lifetime, 43% and 29% respectively had taken an AX-HY in the last twelve months and 29% and 16% an AD. For those who fulfilled diagnostic criteria for an anxiety disorder in the previous year or over their lifetime, the use of an AX-HY, in the last twelve months, concerned 43% and 30% of subjects respectively, whilst that of AD concerned 16% and 14%. For previous year or lifetime alcohol-related disorders, AX-HY use, in the last twelve months, concerned 63% and 22% of subjects respectively and use of ADs 9.3% and 7.2%. Amongst users of AX-HY in the last twelve months, a previous year or lifetime diagnosis of mood disorders was made for 16% and 39% of subjects respectively. Amongst users of ADs, the respective prevalence was 31% and 64%. A twelve-month and lifetime diagnosis of anxiety disorders was identified in 22% and 37% of users of AX-HY and among 27% and 50% of users of AD respectively. A twelve-month and lifetime diagnosis of alcohol-related disorders was found in 2.5% and 6.6% of users of AX-HY and among 1.1% and 7.8% of users of AD respectively. 68% of users of AX-HY had fulfilled none of these diagnostic criteria in the previous 12 months and 46% had never fulfilled them in their lifetime. With respect to AD users, the proportion who did not meet these diagnostic criteria in the previous 12 months was 56%, compared to 20% over their lifetime. Comparison of the French data from the study with those of the entire European sample showed that the annual prevalence of AX-HY and AD use was higher in France with mean treatment durations that were shorter. For antipsychotics and mood regulators, no clear differences were observed between France and the six countries of the study taken together.Over the last two decades, use of AX-HY seems to have decreased in France, even though it remains higher than that observed in the other European countries participating in this study. This high use can be explained in part by the observation that, in around half the cases, it corresponds to occasional use. In contrast, the use of antidepressants has increased. In subjects with recent mood disorders or anxiety disorders, the use of AX-HY remains higher than that of antidepressants. Finally among users of AX-HY, only half of them had presented a mood disorder, anxiety disorder or alcohol use disorder during their lifetime, whereas this proportion rose to 80% for users of antidepressants.

ESEMeD is the first international epidemiological study using a random sampling method that has allowed the prevalence of psychiatric disorders in France to be measured with precision and compared directly with that observed in other European countries.1) To determine the 12 month and lifetime prevalence of mood -disorders, anxiety disorders and alcohol-related disorders. 2) To estimate the comorbidity between these disorders. 3) To evaluate potential demographic risk factors for these disorders.This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used.The participation rate was 46% for France and 61% for all six countries combined. The 12 month and lifetime prevalence rates observed were respectively 6.0% and 21,4% for major depressive episodes, 1.6% and 7.9% for dysthymia, 2.1% and 6.0% for the generalised -anxiety disorders, 1.2% and 3.0% for panic disorders, 0.6% and 1.8% for agoraphobia, 2.2% and 3.9% for post-traumatic stress disorder, 1.7% and 4.7% for social phobia, 4.7% and 11,6% for specific phobia, 0.5% and 4.1% for alcohol abuse and 0.3% and 1.6% for alcohol dependence. Mood disorders and anxiety disorders were significantly more frequent in women, whilst alcohol-related disorders were more frequent in men. The prevalence of all three types of disorder was lower in elderly subjects and in those living in a rural environment. Mood disorders and alcohol-related disorders were more frequent in individuals living alone and mood disorders more frequent in those without paid employment. 38% of subjects with mood disorder also presented an anxiety disorder or an alcohol-related disorder. The comorbidity of mood and anxiety disorders was more frequent in women, younger subjects and those living alone. The comorbidity rate in subjects with anxiety disorders was 26% and did not differ between genders. For alcohol-related disorders, there was a striking difference in comorbidity rate between men and women: 26% in the former and 67% in the latter.This study underlines the high prevalence of mood disorders, anxiety disorders and alcohol-related disorders in France and demonstrates a high degree of comorbidity between them. For this reason, it is important to evaluate and take into account potential comorbidity in the management of individuals with psychiatric disorders.

The aims of our study were to examine the factors associated with cervical screening in women whose tests are supported by a national health insurance scheme, the Mutuelle Générale de l'Education Nationale.A self-administered postal questionnaire was sent to a random sample of 10,000 adults aged 20 to 60 years old living in France and insured with the Mutuelle Générale de l'Education Nationale. Response rate was 66.5% (N=6,518).Of the 3,741 women aged 20 to 60 years old, 88.5% have had at least one cervical smear. Mean age for the first cervical smear was 29.3 years (95% CI: 29.0-29.6). Preventive practices (mammogram, cervical smear and fecal occult-blood testing) were strongly related. The predictive factors for cervical smear during the past three years included: age between 30 and 49 years, marital status (married, separated or divorced), the socioeconomic status (unskilled workers reported cervical smears less often than women from other socioeconomic status). Consulting a gynaecologist in the past twelve months increased 9-fold the probability of having a cervical smear and 2-fold when consulting a general practitioner compared to women who consulted neither a gynecologist nor a general practitioner.In a population whose tests were supported by a national health scheme, the socioeconomic status was one of the determinants of Pap smear.

International audience; Objectif.– Comparer la santé mentale de jeunes adultes français selon leur statut vis-à-vis de l’activité.Méthodes.– Les données proviennent d’une enquête épidémiologique transversale réalisée en 2005 en Haute-Normandie, Île-de-France, Lorraine et Rhône-Alpes, par téléphone chez 20 077 personnes sélectionnées aléatoirement. La présente étude porte sur 2370 individus âgés de 18 à 24 ans et dont le statut vis-à-vis de l’activité (en activité, scolarisé ou demandeur d’emploi) était disponible. Les scolarisé(e)s comprenaient les sujets qui n’étaient ni en activité ni demandeurs d’emploi, c’est-à-dire les étudiants, les lycéens et les apprentis. Les instruments utilisés étaient : le CIDI-SF (troubles de l’anxiété, dépressifs et liés à l’utilisation de substances), l’échelle de Sheehan (évaluation du retentissement fonctionnel des troubles dans la vie quotidienne), le CAGE (troubles de l’usage des substances) et l’échelle de qualité de vie SF-36. Les données ont été pondérées sur sexe/âge/profession du chef de famille/catégorie de commune/département.Résultats.– Les 1130 hommes et 1240 femmes étaient respectivement 41,1 % et 32,7 % en activité, 47,6 % et 55,2 % scolarisés et 11,3 % et 12,1 % demandeurs d’emploi. La majorité des diagnostics psychiatriques étaient plus fréquents chez les demandeurs/demandeuses d’emploi (confirmé après ajustement), significativement chez les hommes pour la dépression (13,6 % versus 5,6 % et 9,8 % chez scolarisés et actifs respectivement, p < 0,009), la phobie spécifique (9,6 % versus 3,1 % et 6,6 %, p < 0,005), la névrose post-traumatique (6,8 % versus 2,4 % et 1,8 %, p < 0,018), la dépendance aux drogues (13,6 % versus 4,9 % et 5,3 %, p < 0,002) et chez les femmes pour la dépendance à l’alcool (4,2 % versus 1,2 % et 1,5 %, p < 0,025). Le retentissement était également plus important chez les demandeurs/demandeuses d’emploi qui étaient respectivement 4,7 % et 7,8 % à avoir au moins un diagnostic avec gêne sévère.Conclusion.– À notre connaissance, il s’agit de la première étude française qui explore ce lien entre santé mentale et statut socioéconomique chez les jeunes adultes.

Two questionnaires measuring satisfaction of the population with regard to health care offer were constructed from measures validated in the USA (the Consumer Satisfaction Survey Questionnaire or CSS, and the Visit-Specific Satisfaction questionnaire, the VSQ). This work was comprised two stages: i) translation and cultural adaptation of the American instrument to the French health care context, implicating 6 translators, users and experts; and ii) a telephone survey in the general population (n = 706) to test the psychometric qualities of the French instrument (content and internal validity). The French version, the CSS-VF comprises 9 scales: access to primary care, access to secondary care, scope for choice, health cover, communication with and competence of GPs, communication with specialists, competence of specialists, human qualities of practitioners and overall satisfaction. The VSQ-VF, which measures satisfaction with the last medical consultation is unidimensional. The results of the psychometric analyses are good overall, and endorse the use of these scales in assessment studies.

Objective:The European Study of Epidemiology of Mental Disorders (ESEMeD) project was designed to evaluate the prevalence, the impact and the treatment patterns in Europe. This paper presents an overview of the methods implemented in the project.Method: ESEMeD is a cross-sectional study in a representative sample of 21 425 adults, 18 or older, from the general population of Belgium, France, Germany, Italy, the Netherlands and Spain. The Composite International Diagnostic Interview (WMH-CIDI) was administered by home interviews from January 21001 to August 2003 using computer Assisted Personal Interview (CAPI) technology. Data quality was controlled to ensure reliability and validity of the information obtained.Results: Response rate varied from 78.6% in Spain to 45.9% in France. Less than 4% of the individuals had errors in the checking procedures performed.Conclusion: The sampling methodologies, comprehensive psychiatric instruments and quality control procedures used have rendered the ESEMeD database a unique and important source of information about the prevalence, the disability burden and unmet medical needs of mental disorders within Europe.

A social and psychological survey was conducted for patients with DMD submitted to home mechanical ventilation for more than one year. Thirty six were tracheostomized and 16 were using non invasive ventilation. Fifty two patients were recruited: 36 were tracheostomized and 16 were using non invasive ventilation. Mean age was 25 +/- 5 years. In the two groups: 1- the main disagreement was air leaking and cutaneous erosions. 2- when present, headache, dyspnea, sleep troubles and general fatigue were improved by mechanical ventilation. 3- ventilation was considered as improving health but with an increasing of dependencies. 4- Majors disappointment are sexual life (70 percent) and physical status (40 percent) but patients spent more than half time with positive feeling (92 percent). There was no difference between satisfaction evaluation and type of ventilation. Home ventilated patients with DMD have positive assessment of satisfaction. Despite technical disagreement as air leaking, patients feel an improvement of their life and advise other DMD to use early home ventilation.

The influence of social factors (demographics, work statute, profession) on patterns of care like psychotropic drugs prescription, psychotherapeutic treatment or hospitalisation was studied on the population receiving care within the MGEN (a semiprivate health insurance system for the teaching related professions, the largest in France). This was possible by the use of a three year data bank (1992, 1993, 1994) where out and inpatients care were systematically recorded along some socio-demographics data in a rather detailed manner if provided within the system. The present study concerns 6,453 patients selected on the most frequent ICD 9 diagnoses as registered by the psychiatrist in charge of the patient: schizophrenia (acute, simple and persistent): 18.5% of the sample, manic-depressive psychosis 7.7%, and neurotic disorders (depressive disorders 38.3%, anxiety disorders 27% and mixed disorders 8.2%). For most of these diagnoses, hospitalization rates vary according the profession of the patient: teachers suffering from schizophrenia (simple) have higher rate of hospitalization than others professions; on the reverse university teachers and managers have the lowest rates of hospitalization for neurotic disorders. Duration of stay is rather identical within profession for psychotic disorders but again there are difference for neurotic disorders: blue collar workers, managers and university teachers have the lowest duration. Number of outpatients acts and provision of psychotherapeutic treatment either individual or group therapy show some variations between professions. Number of psychotropic drugs do not vary according profession but there is difference between men and women suffering from depressive disorders (2.97 for men, 2.72 for women). Neuroleptics are prescribed at the same rate but depot neuroleptics are prescribed mainly to blue collars workers, clerks and whose who are teaching technical matters; this applies only to men. These results are discussed according the context of the MGEN psychiatric health system.