Taleb M, Rouillon F, Hegerl U, Hamdani N, Gorwood Ph
Fédération de Psychiatrie, Hôpital René Dubos, 95300 Pontoise.
Encephale. 2006 Jan-Feb;32(1 Pt 1):9-15. doi: 10.1016/s0013-7006(06)76132-2.
Depressive disorders represent a major public health concern, regarding their high frequency and their important cost. Depression impair the quality of life more than any other disease, sometimes leading to suicidal ideas or behavior. Indeed, 50% of patients with severe major depression commit suicide. Numerous studies showed that depressive disorders are frequently not recognised, and regularly untreated. In France, where at least 3 millions of inhabitants are concerned, 38% of depressed patients are not using any health system. When they are asking for care, the majority of depressed patients visit their general practitioner (51%), whereas less than 10% visit a psychiatrist. Even when the diagnostic is correct, the treatment prescribed is not systematically relevant. The treatment is, for example, frequently proposed for a too short period, and sometimes the prescribed product does not have proven antidepressive efficacy. Furthermore, as incorrect informations are frequently given to patients, and as there is a general biased judgement about psychotropic drugs in the general population, the compliance is usually poor for antidepressive treatment. Therefore, only a small minority of depressed patients benefits from an adequate care. Public health information methodological asserts. To improve this situation, delivering simple and clear-cut recommendations cannot be considered as sufficiently effective, and public health interventions are required. Different programs improving the recognition of depressive disorders have already been tested in some countries with encouraging results. These programs are based on information campaigns given to the public, and the training of general practitioners about the management of depressive disorders. The "Defeat Depression" campaign in Great-Britain and the "National Depression Screening Day" in the United-States of America may represent informative examples. Restricting these programs to general practitioners only is frequently criticized, as this may reduce efficacy. A multilevel approach is crucial for the success of action programmes against depression, because synergistic effects can be expected. In Germany, the "Nürnberger Bündnis gegen Depression" project was based on four levels, and effectively reduced the suicide rate. These levels of action included "cooperation with GPs", such as training sessions based on video, and presence of a phone hotline, "public relations activities", "training sessions for multipliers", such as priests, social workers and media, and "special offers for high risk groups and self-help activities". In France, such a program is clearly required.
抑郁症是一个重大的公共卫生问题，因其高发率和高昂的成本。抑郁症对生活质量的损害超过任何其他疾病，有时会导致自杀念头或行为。事实上，50%的重度抑郁症患者会自杀。大量研究表明，抑郁症常常未被识别，且经常得不到治疗。在法国，至少有300万居民受其影响，38%的抑郁症患者未利用任何医疗系统。当他们寻求治疗时，大多数抑郁症患者会去看全科医生（51%），而看精神科医生的不到10%。即使诊断正确，所开的治疗方案也不一定恰当。例如，治疗时间常常过短，而且有时所开药物并无经证实的抗抑郁疗效。此外，由于经常向患者提供错误信息，而且公众对精神药物普遍存在偏见，抗抑郁治疗的依从性通常很差。因此，只有极少数抑郁症患者能得到充分治疗。公共卫生信息方法断言。为改善这种状况，提供简单明了的建议被认为不够有效，需要采取公共卫生干预措施。一些国家已经试验了不同的提高抑郁症识别率的项目，并取得了令人鼓舞的成果。这些项目基于向公众开展的宣传活动以及对全科医生进行抑郁症管理方面的培训。英国的“战胜抑郁症”运动和美国的“全国抑郁症筛查日”可能是有借鉴意义的例子。仅将这些项目局限于全科医生常常受到批评，因为这可能会降低效果。对抑郁症防治行动计划的成功而言，多层次方法至关重要，因为有望产生协同效应。在德国，“纽伦堡抑郁症联盟”项目基于四个层面，有效降低了自杀率。这些行动层面包括“与全科医生合作”，如基于视频的培训课程以及设立电话热线，“公共关系活动”，“对传播者的培训课程”，如牧师、社会工作者和媒体人员，以及“针对高危群体的特别服务和自助活动”。在法国，显然需要这样一个项目。
