Usage et congruence diagnostique des traitements à visée psychotrope : résultats de l’enquête santé mentale en population générale en France métropolitaine

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Évaluer la prévalence d’usage vie entière de traitements à visée psychotrope dans la population générale française et la congruence entre usage de ces traitements et diagnostic psychiatrique. L’usage vie entière de traitements à visée psychotrope a été documenté chez 36 785 sujets représentatifs de la population générale française inclus dans l’enquête santé mentale en population générale. Les diagnostics psychiatriques ont été posés par le mini international neuropsychiatric interview (MINI). Plus d’un tiers des sujets ont déclaré avoir fait usage de psychotropes au cours de la vie. Près de la moitié des sujets avec un diagnostic MINI ont déclaré n’avoir jamais pris de traitement psychotrope. Moins d’un tiers des sujets présentant un diagnostic de trouble de l’humeur ont fait usage d’antidépresseurs. La proportion de personnes ne présentant aucun trouble selon le MINI et ayant fait au moins une fois usage de psychotropes était d’un quart pour les neuroleptiques, d’un tiers pour les thymorégulateurs et d’un peu moins de la moitié pour les antidépresseurs et anxiolytiques. La fréquence élevée d’usage des psychotropes dans la population française s’associe à une faible congruence entre la présence ou l’absence d’un diagnostic psychiatrique et la présence ou l’absence d’un traitement psychotrope au cours de la vie. The aims of this study were to assess the lifetime prevalence rate of psychotropic drugs use in the French general population and the correspondence between psychotropic drug use and psychiatric diagnoses. Data were derived from the multicentric survey mental health in the general population, carried out in 47 French public sites between 1999 and 2003. A face-to-face questionnaire was used to interview a representative sample of French metropolitan subjects, aged 18 and over, noninstitutionalized or homeless. These subjects were recruited using quota sampling for age, sex, socioprofessional and education levels, according to data from the 1999 national French population census. Lifetime use of psychotropic drugs was explored by an open question. Psychiatric diagnoses were identified using the mini international neuropsychiatric interview (MINI). A national database was then constituted by pooling data from all sites, weighted for age, sex, level of education, socioprofessional level and work status, to be representative of the French general population. Of the 36 785 individuals included in this study, more than one out of three subjects reported having used at least one psychotropic drug during their life. Anxiolytics were the most commonly used drugs, reported by 19.4% of the sample. The other frequently used psychotropic drugs were antidepressants (11.6%) and hypnotics (9.2%). Nearly half of the subjects with a MINI diagnosis reported no lifetime psychotropic drug use. Among the subjects meeting criteria for a diagnosis of mood disorder, 66.3% used pyschotropic drugs. However, less than one out of three subjects with a diagnosis of major depressive disorder used antidepressants while 37.2% reported having used anxiolytics. Less than one out of four subjects with a diagnosis of anxiety disorder used antidepressants while 34.3% used anxiolytics. Among subjects with a diagnosis of anxiety disorder, antidepressants and anxiolytics were the most commonly used drugs for subjects with a diagnosis of panic disorder with agoraphobia (46.4 and 58.1%, respectively). Conversely, these were the treatments used the least by subjects with a diagnosis of generalized anxiety disorder (21.9 and 31.5%, respectively). Only 14.9% of subjects with a psychotic syndrome reported having used neuroleptics. Lastly, the highest proportion of subjects with at least one psychiatric diagnosis was found in mood stabilizer and neuroleptic users. However, one third of mood stabilizer users, a quarter of neuroleptic users and less than half of antidepressant and anxiolytic users presented no psychiatric disorder identified by the MINI. This study highlights the high frequency of exposure to psychotropic drugs in the general French population, and the marked inadequacy between the presence or absence of a psychiatric diagnosis and the lifetime presence or absence of a psychotropic drug treatment.