Mortality of people suffering from mental illness: a study of a cohort of patients hospitalised in psychiatry in the north of France

BACKGROUND: The mortality of people suffering from psychiatric illnesses is far higher than that of the general population, all categories of diagnosis combined; mortality statistics can be used as an index of quality of care. The aim of this study was to assess the all-cause mortality in psychiatric patients covering all diagnostic groups. METHODS: The living or deceased status of 4,417 patients of majority age hospitalised in a public mental health establishment between 2004 and 2007 were requested from French National Institute for Statistics and Economic Studies on 1st January 2011. The cause of death of those people who had died was obtained from French National Institute for Health and Medical Research and comparative standardized mortality ratios (SMR) were established from the population in a region of northern France of the same age in 2006. RESULTS: The study population was made up of 54% men and 46% women, median age 41 and 45 years old, respectively. Four hundred and seventy-three people died during the period studied. The SMR were 421 for men (95% CI 378-470) and 330 for women (95% CI 281-388). The highest SMRs were found in patients aged 35-54, with a 20-time higher mortality risk than the general population of the same age. CONCLUSION: Our study confirms the considerably higher mortality in psychiatric patients than in general population, particularly in mean age and mostly due to an unnatural cause

Le recours aux médicaments psychotropes dans le Nord – Pas-de-Calais (France)

Les médicaments psychoactifs présentés au remboursement de l'Assurance maladie constituent une source d'information sur certaines pathologies ou troubles psychiques, dans un contexte de surutilisation de ces molécules en France.
En 2007, 576 493 personnes en bénéficient d'au moins un dans le Nord – Pas-de-Calais, pour un total de 5 070 160 prescriptions.
Durant la période d'étude, 15,6 % de la population régionale couverte recourt à au moins un médicament psychotrope. Ce taux s'établit à 11,7 % pour les benzodiazépines, à 7,6 % pour les antidépresseurs, à 1,8 % pour les antipsychotiques, à 0,5 % pour les traitements de la dépendance alcoolique et à 0,3 % pour les traitements de substitution aux opiacés (TSO). Pour les trois premières classes, le taux augmente assez régulièrement avec l'âge ; il est toujours très supérieur chez les femmes que chez les hommes. Pour les traitements de la dépendance à l'alcool et de l'héroïnomanie, les hommes sont plus nombreux ; le taux de recours augmente dans un premier temps (jusqu'à 40–49 ans pour les premiers, jusqu'à 30–39 ans pour les TSO), pour redescendre ensuite

Les facteurs qui influencent la consommation intensive et régulière de médicaments psychotropes

Cet article propose la construction d'une typologie des recours aux médicaments psychotropes et l'étude des facteurs reliés à leur consommation intense ou régulière. Les résultats s'appuient sur l'exploitation des bases des médicaments présentés au remboursement aux caisses primaires d'assurance-maladie par les assurés au régime général du Nord - Pas-de-Calais. Durant les années 2007 et 2008, 20,7 % de la population protégée (764 650 personnes) bénéficie de remboursements pour ce type de médicaments. Parmi les bénéficiaires, environ trois sur dix (30,5 %) ont un fort recours. L'âge, le bénéfice de la Couverture Maladie Universelle (CMU) et le fait d'être suivi ou non par un psychiatre sont les variables les plus influentes sur l'intensité et la régularité de consommation. La régularité observée du recours aux benzodiazépines est contraire aux recommandations actuelles

La prescription de psychotropes durant la grossesse dans le Nord-Pas-de-Calais

Objectif. La prescription de psychotropes présente des risques durant la grossesse. Il est légitime de mesurer la prescription de ces molécules chez la femme enceinte. Méthode. La prescription des psychotropes aux femmes enceintes a été mesurée à partir de la base de données de la Caisse nationale de l’assurance maladie des travailleurs salariés (Cnamts). Le taux a été comparé aux prescriptions chez les femmes non enceintes de la même tranche d’âge. Résultats. Il y a une baisse de prescription de psychotropes durant la grossesse comparativement à une population non enceinte de même âge. Pour autant une femme sur vingt environ s’est vue prescrire une spécialité présentant un risque néonatal, et quatre sur mille une spécialité à risque malformatif durant le premier trimestre. Conclusion. Si le risque embryo-fœtal de la prescription de psychotropes est en général pris en compte il conviendrait de mieux communiquer sur la tératogénicité de certaines molécules

Which work-related characteristics are most strongly associated with common mental disorders? A cross-sectional study

International audienceObjectives Studies exploring work-related risk factors of common mental disorders (CMDs), such as major depressive disorder (MDD), generalised anxiety disorder (GAD) or alcohol abuse, have generally focused on a limited set of work characteristics. For the first time in a primary care setting, we examine simultaneously multiple work-related risk factors in relation to CMDs.Method We use data from a study of working individuals recruited among 2027 patients of 121 general practitioners (GPs) representative of the Nord-Pas-de-Calais region in the North of France (April–August 2014). CMDs (MDD; GAD; alcohol abuse) were assessed using the Mini-International Neuropsychiatric Interview. Six worked-related factors were examined (work intensity, emotional demands, autonomy, social relations at work, conflict in values and job insecurity). Several covariates were considered (patient, GP and contextual characteristics). To study the association between workplace risk factors and CMDs, we used multilevel Poisson regression models adjusted for covariates.Results Among study participants, 389 (19.1%) met criteria for MDD, 522 (25.8%) for GAD and 196 (9.7%) for alcohol abuse. In multivariable analyses adjusted for covariates, MDD/GAD was significantly associated with work intensity (RR 1.16, 95% CI 1.06 to 1.27) (absolute risk=52.8%), emotional demands (RR 1.24, 95% CI 1.13 to 1.35) (absolute risk=54.9%) and social relations at work (RR 0.78, 95% CI 0.70 to 0.87) (absolute risk=15.0%); alcohol abuse was associated with social relations at work (RR 1.25, 95% CI 1.01 to 1.53) (absolute risk=7.6%) and autonomy (OR 0.82, 95% CI 0.67 to 0.99) (absolute risk=8.9%).Conclusions Several workplace factors are associated with CMDs among working individuals seen by a GP. These findings confirm the role of organisational characteristics of work as a correlate of psychological difficulties above and beyond other sources of risk

Work intensity in men and work-related emotional demands in women are associated with increased suicidality among persons attending primary care

International audienceBackground: A large proportion of persons died by suicide are employed at the time of death and work-related factors partly contribute to suicide risk. Our aim was to examine the association between multiple aspects of work organization and suicidal ideation in a study conducted in primary care.Methods : Data came from a study of 2027 working patients attending a GP representative of patients in the Nord Pas-de-Calais region in France (April-August 2014). Suicidality was assessed using the MINI (Mini International Neuropsychiatric Interview). Six emergent worked-related factors were explored (work intensity, emotional demands, autonomy, social relationships at work, conflict of values, insecurity of work). Several covariates were considered: patient's and GP's characteristics, and area-level data (material and social deprivation, psychiatrist and GPs’ density, suicide attempts and suicide rates).Results : 8.0% of participants reported suicidal ideation in the preceding month (7.5% of men and 8.6% of women, p = .03). In multivariate analyses adjusted for covariates, suicidality was significantly associated with work intensity (OR = 1.65; 95%CI [1.18–2.31]) in men and with work-related emotional demands (OR = 1.35; 95%CI [1.01–1.80]) in women. Area-level data were not associated.Limitations : Our cross-sectional study cannot assess the direction of the relationships under study.Conclusion : Our results emphasise a central role for GPs in suicide prevention among workers and highlight the importance of work-related factors with regard to suicidality in primary care