Abstract
BackgroundPsychotic disorders are among the most severe psychiatric disorders that have great effects on the individuals and the society. For surveillance of chronic low prevalence conditions such as psychotic disorders, medical administrative databases can be useful due to their large coverage of the population, their continuous availability and low costs with possibility of linkage between different databases. The aims of this study are to identify the population with psychotic disorders by different algorithms based on the French medical administrative data and examine the prevalence and characteristics of this population in 2014.MethodsThe health insurance system covers the entire population living in France and all reimbursements of ambulatory care in private practice are included in a national health insurance claim database, which can be linked with the national hospital discharge databases. Three algorithms were used to select most appropriately persons with psychotic disorders through data from hospital discharge databases, reimbursements for psychotropic medication and full insurance coverage for chronic and costly conditions.ResultsIn France in 2014, estimates of the number of individuals with psychotic disorders were 469,587 (54.6% males) including 237,808 with schizophrenia (63.6% males). Of those, 77.0% with psychotic disorders and 70.8% with schizophrenia received exclusively ambulatory care. Prevalence rates of psychotic disorders were 7.4 per 1000 inhabitants (8.3 in males and 6.4 in females) and 3.8 per 1000 inhabitants (4.9 in males and 2.6 in females) for schizophrenia. Prevalence of psychotic disorders reached a maximum of 14 per 1000 in males between 35 and 49 years old then decreased with age while in females, the highest rate of 10 per 1000 was reached at age 50 without decrease with advancing age. No such plateau was observed in schizophrenia.DiscussionThis study is the first in France using an exhaustive sample of medical administrative data to derive prevalence rates for psychotic disorders. Although only individuals in contact with healthcare services were included, the rates were congruent with reported estimates from systematic reviews. The feasibility of this study will allow the implementation of a national surveillance of psychotic disorders essential for healthcare management and policy planning.
Highlights
Psychotic disorders are among the most severe psychiatric disorders that have great effects on the individuals and the society
The most important contribution came from Chronic severe and costly affections (ALD): 71.9% of the individuals (73.5% in men and 69.9% in women) with psychotic disorders and 64.6% with schizophrenia (66.0% in men and 62.1% in women) benefited from ALD
One person in five with psychotic disorders and one in four with schizophrenia have been hospitalized in psychiatry in 2014 and only 10% or less in general hospitals
Summary
Psychotic disorders are among the most severe psychiatric disorders that have great effects on the individuals and the society. For surveillance of chronic low prevalence conditions such as psychotic disorders, medical administrative databases can be useful due to their large coverage of the population, their continuous availability and low costs with possibility of linkage between different databases. Most people living with psychotic disorders have contact with health services and the use of administrative data may be helpful for developing epidemiological studies on these severe mental disorders [7]. Medical administrative databases are increasingly used for epidemiological projects in developed countries due to their large coverage of the population, their continuous availability and low costs with possibility of linkage between different databases at an individual level over several years. In the only French study, Richieri et al found a Kappa coefficient of 0.8 for schizophrenia while comparing the diagnoses of 112 patients reported in administrative databases and those established by an independent psychiatrist after a thorough interview of the patients [10]
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