Prévalence de la schizophrénie et autres troubles psychotiques en France métropolitaine

Contexte

La littérature internationale indique des prévalences de troubles psychotiques comprises entre 0,5 et 2 % en population générale. En l’absence de données précises en France, deux indicateurs nationaux sont présentés ici : la prévalence annuelle d’habitants pris en charge pour schizophrénie et autres troubles psychotiques par les établissements de santé ayant une activité psychiatrique (EP) et la prévalence de personnes en affection de longue durée (ALD) pour ces mêmes troubles.

Méthodes

Pour le 1er indicateur : l’analyse porte sur les données issues du RIM-P : prises en charge à temps complet ou partiel et activité ambulatoire. Le 2e indicateur réunit les données d’ALD23 des principaux régimes d’assurance maladie (CnamTS, RSI et MSA). Les codes CIM : F20 à F29 de schizophrénie et autres troubles psychotiques ont été sélectionnés pour ces deux indicateurs (diagnostics principaux et associés en EP).

Résultats

En 2012 en France métropolitaine, 235 000 patients, soit 3,7 pour 1000 habitants, ont été pris en charge pour troubles psychotiques en EP, dont 62 % pour schizophrénie et 294 000 personnes (4,6 pour 1000) étaient en ALD pour troubles psychotiques, parmi lesquelles 45 % pour schizophrénie. Les prévalences sont globalement plus élevées chez les hommes que chez les femmes : 1,5 fois pour tous TP et 2 fois plus pour la schizophrénie. Ces prévalences étaient maximales entre 30 et 45 ans chez les hommes (taux de suivi en EP : 8,8 pour 1000 ; ALD : 10 pour 1000), et entre 40 et 60 ans chez les femmes (taux de suivi en EP : 5,1 pour 1000 ; ALD : 6,6 pour 1000). Les taux diminuent ensuite lentement avec l’âge chez les femmes, et de façon plus marquée chez les hommes, après 60 ans, les taux féminins sont supérieurs aux taux masculins.

Conclusion

Ces deux sources de données permettent de préciser la prévalence annuelle en France de personnes suivies pour schizophrénie et autres troubles psychotiques dans le système de soins. Elles ne couvrent néanmoins pas les patients suivis en libéral, qui ne seraient pas déclarés en ALD au titre de leur psychose, ni les malades en rupture totale de soins.

Implementation of a national epidemiological surveillance of prison suicide in France

Context

Worldwide, suicide is a leading cause of death in prison. In France, suicide of prisoners accounts for more than 100 deaths per year representing about half of the total deaths in prison. Moreover, suicide rates in French prisons are seven times higher than in the community and are among the highest in Europe. Reducing prison suicide is a public health priority inscribed in a joint action plan of both the Ministries of health and of justice. In order to prevent this tragic loss of life, prison services and health services must collaborate for the monitoring and understanding of the risk factors involved. The aims of an epidemiologic surveillance of prison suicide are to gather information about the medical factors and factors related to prison environment, analyze them and eventually produce recommendations for prevention.

Methods

After months of consultation between Santé publique France, different administrations and professionals working in prison, a common methodology was set up. As from January 2017, whenever a suicide or suspected death occurs in prison, the Direction of the Prison Administration (DAP) informs Santé publique France, who in turn sends to the medical practitioner in charge of the prison health services a questionnaire including the history before detention: morbidity, addiction, attempted suicide, and during detention: contact with prison health services, diagnosis and final contact prior to death. Each year, the DAP sends to Santé publique France the sociodemographic, administrative, judiciary and prison environmental data of the persons.

Results

In 2017, data were collected for 106 suicides from 71 prisons: 95% males, 49% remand, 44% murder or sexual assault, median incarceration time 96 days. Questionnaires were returned from prison practitioners for 100 cases (94%): regular contact 83%, prior suicide attempt 23%.

Conclusions

Feasibility of a prison suicide surveillance is only possible with the implication of both prison and health services.

Key messages

Reducing death by suicide in prison is a public health priority. Feasibility of a prison suicide surveillance is only possible with the implication of both prison and health services.

Attempted and completed suicide in primary care: not what we expected?

BACKGROUND

General Practitioners (GPs) play a central role in suicide prevention. This study aims to compare the characteristics of individuals who attempt suicide to those who complete suicide in a same primary care setting.

METHODS

We compared the characteristics and GP's management of all patients with attempted (N=498, SA) or completed suicide (N=141, SC) reported to the GPs'French Sentinelles surveillance system (2009-2013).

RESULTS

Compared to patients who attempted suicide, those who completed suicide were more likely to be male, older and to have used a more lethal method; for men they were less likely to have a history of previous suicide attempt and prior contacts with their GP. In terms of GPs' management, we found no differences between the SA and SC groups in the identification of psychological difficulties and in the care, but GPs were more likely to provide psychological support to the SA group. During the last consultation, the SC group expressed suicidal ideas more frequently than the SA group (26.7% vs. 14.8%, p<0.01), only for women.

LIMITATIONS

The network may have missed cases and selected more serious SA.

CONCLUSIONS

Individuals who commit suicide differ from those who attempt suicide in terms of demographic characteristics and by sex, of history of suicide attempt, previous contact and expressed suicidal ideas. We show that GPs do not act more intensively with patients who will commit suicide, as if they do not foresee them. Current prevention programs particularly in primary care should be tailored.

Medical and social differences between French and migrant patients consulting for the first time for HIV infection

The objectives of the study were to describe the medical and social characteristics of patients consulting for the first time after diagnosis of HIV-infection and to compare the medical and social characteristics between French and migrant patients. From 1 January 2001 to 31 December 2002, all consecutive adults consulting for the first time for HIV infection in two HIV outpatient clinics located in the western suburb of Paris, agreed to an interview based on an administered questionnaire regarding their medical and socioeconomic characteristics. Of the 203 patients (98 women, 105 men), one-third (n=70) was of French nationality. Delay (+/-SD) in access to HIV outpatient clinic after diagnosis was shorter in migrant than in French patients, respectively 7.6+/-29.6 months (median=0.5, range=0 to 196.6) and 23.8+/-51.4 months (median=0.9, range=0 to 199.7); p=0.005. There was no significant difference in the medical characteristics between the two groups of patients on their first consultation. However, most of the migrants were living in very poor socio-economic conditions with minimal resources thus sometimes delaying initiation of HAART. The development of social facilities for HIV-positive migrants should be a public health priority.

Les facteurs associés au dépistage des cancers du col utérin dans une population mutualiste

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSIONS

In a population whose tests were supported by a national health scheme, the socioeconomic status was one of the determinants of Pap smear.

A French study of the Dominic Interactive

INTRODUCTION

The Dominic Interactive was developed in North America to assess a child's perception of her/his own symptoms, which is critical to balance parents' and school professionals' perception. It is a computerized, DSM-IV-based pictorial questionnaire akin to a video game, for children aged 6-11. A strengths and competencies scale displays positive situations. Most children complete the Dominic Interactive 90 situations within 10-15 min.

OBJECTIVE

Because of the cultural differences between North American and French children, a study of the appropriateness of the instrument to assess French children was required.

METHODS

The CD-ROM-based Dominic Interactive was completed by 253 community children, and by 150 children from outpatient clinics in four French cities. The latter also received clinical diagnoses. Prevalence estimates yielded by the Dominic Interactive in the general population and referred children, relationships between prevalence estimates based on the Dominic Interactive and clinical judgments, and differences between Dominic Interactive scores in sub-samples of children with and without a clinical diagnosis were studied.

RESULTS

Significant differences between clinically referred and non-referred children were found for every diagnosis, and between Dominic Interactive scores of referred children with and without a clinical diagnosis with the exception of oppositional disorder. Parental acceptability of the instrument was never a problem, children like it, and clinicians' comments were positive.

DISCUSSION

Reference and clinical judgment both indicate that the Dominic Interactive is appropriate to assess child mental health in France. Clinical judgment discrepancies between sites and small numbers are the limitations of this study.

CONCLUSION

The instrument performed well in the French context. The potential advantages of using the Dominic Interactive (children enjoy the activity, parents approve of it, it is relatively cost-effective, etc.) suggest its applicability in other settings.