Hospitalized cocaine detoxification patients in Paris, France: Increased patient levels and changing population characteristics since 2011.

AIM OF THE STUDY: The past twenty years have seen a rise in cocaine-related statistics in France, including cocaine use in the general population, emergency ward presentations of acute cocaine intoxication, cocaine use disorders related outpatient appointments and cocaine-related deaths. This study's objectives were to describe trends in patients' admission for specific cocaine detoxification as well as changes in patients' characteristics in the Assistance publique-Hôpitaux de Paris (AP-HP) hospitals group located in Paris region, France. METHODS: We reviewed the international classification of diseases 10th edition (ICD-10) discharge codes of the AP-HP hospitals group between 2011 and 2021. In addition, medical reports of the largest addiction medicine ward were also analysed for changes across the years 2009, 2014, 2019 and 2022. RESULTS: The regional database showed an almost 3-fold increase in cocaine-related disorders discharge codes between 2011 and 2019. This occurred due to a rise in hospital stays for cocaine dependence or cocaine acute intoxication prior to the fall in levels of inpatient stays associated with the coronavirus disease 2019 (COVID-19) pandemic. The in-depth analysis of inpatients' stays in the specialized addiction medicine ward also showed an increase in admissions for cocaine detoxification programs, with a prevalence of 1.19% in 2009 to 15.73% in 2022 (P=1.44×10-20). Inpatient characteristics showed significant changes, especially in 2022, namely: more daily users, less intravenous administration and less comorbid illicit substances use disorders, with heightened levels of cured hepatitis C patients (P<0.05). Inpatient prescriptions were primarily dopaminergic antagonists with sedatives properties (cyamemazine, loxapine and chlorpromazine), dopamine-receptors partial agonist (aripiprazole) and serotonin reuptake inhibitors. CONCLUSION: The referral to hospital care for cocaine detoxification has increased in Paris region since 2011, coupled with changes in inpatients' characteristics. This trend has significant implications for the management of inpatient hospital services.

Assessing the performance of indicators during their life cycle: the mixed QUID method.

BACKGROUND: Quality indicators (QI) are mandatory in French hospitals. After a decade of use, the Ministry of Health set up an expert workgroup to enhance informed decision-making regarding currently used national QI, i.e. to propose a decision of withdrawing, revising or continuing their use. We report the development of an integrated method for a comprehensive appraisal of quality/safety indicators (QI) during their life cycle, for three purposes, quality improvement, public disclosure and regulation purposes. The method was tested on 10 national QI on use for up to 10 years to identify operational issues. METHODS: A modified Delphi technique to select relevant criteria and a development of a mixed evaluation method by the workgroup. A 'real-life' test on 10 national QI. RESULTS: Twelve criteria were selected for the appraisal of QI used for regulation goals, 11 were selected for hospital improvement and seven for public disclosure. The perceived feasibility and relevance were studied including hospital workers, patients and health authorities professionals; the scientific soundness of the indicator development phase was reviewed by analyzing reference documents; the metrological performance (limited to the discriminatory power and dynamics of change during the life cycle dimensions) was analyzed on the national datasets.Applied to the 10 QI, the workgroup proposed to withdraw four of them and to modify or suspend the six others. CONCLUSIONS: The value of the method was supported by the clear-cut conclusions and endorsement of the proposed decisions by the health authorities.

Exposure to Traumatic Events and Posttraumatic Stress Disorder in France: Results From the WMH Survey.

This study examined the prevalence of traumatic events and the conditional probability of posttraumatic stress disorder (PTSD) associated with both specific and broad classes of events in a nationally representative sample from France. The sample (N = 1,436) was a part of the European Study of the Epidemiology of Mental Disorders Survey (ESEMeD), under the WHO World Mental Health Surveys-2000 initiative. Overall, exposure to any traumatic event was 72.7%, which appeared to be lower than what has been reported in Sweden (80.8%), similar to data from the Netherlands (71.1%), and higher than what has been reported in Spain (54.0%), Italy (56.1%), Northern Ireland (60.6%) or the U.S (55.9%). Lifetime prevalence of PTSD was 3.9%, lower than in the United States (7.8%), Sweden (5.6%), or Northern Ireland (8.8%), but higher than in Spain (2.2%) or Italy (2.4%). Being beaten up by a romantic partner (25.0%), having a child with serious illness (23.5%), and rape (21.5%) were associated with the highest risk of PTSD. The average duration of PTSD was 5.3 years (0.2-28.1). The burden of PTSD in France appeared to come from the consequences of violence and social network events suggesting that prevention efforts might focus on limiting the occurrence of exposure to avoidable events such as violence as well as provide support for persons exposed to social network events.

Impact of switching or initiating antipsychotic treatment on body weight during a 6-month follow-up in a cohort of patients with schizophrenia.

OBJECTIVE: Although weight gain is one of the most widely studied adverse effects of second-generation antipsychotics, only relatively few studies have specifically evaluated the long-term effect of switching antipsychotic medication on body weight. We aimed to evaluate the impact of switching antipsychotics on body mass index (BMI) during a 6-month follow-up period in a large cohort of patients with schizophrenia. METHOD: Data came from a 6-month prospective naturalistic survey in 6007 patients with schizophrenia. RESULTS: We prospectively studied the effect on BMI of initiating or switching antipsychotic medication after 6 months of treatment among 3801 patients with schizophrenia in a real-life setting. Patients who were being treated with clozapine or olanzapine at baseline were more likely to experience a decrease in BMI during the follow-up period than the patients who were being treated with a conventional antipsychotic (odds ratio, 2.25 and 1.68, respectively). Patients treated with aripiprazole and, to a lesser extent, those treated with risperidone were more likely to experience a decrease in BMI during follow-up than patients treated with conventional antipsychotics (odds ratio, 2.96 and 2.06, respectively). CONCLUSIONS: Our findings suggest that switching antipsychotics could be an effective strategy for reducing or preventing weight gain.

Determinants of treatment satisfaction of schizophrenia patients: results from the ESPASS study.

BACKGROUND: Knowing the determinants of treatment satisfaction can provide better understanding of patient expectations in schizophrenia. The aim of this study was to determine which treatment-related factors were associated with treatment satisfaction, independently of patient-related or illness-related factors, in schizophrenia patients. METHODS: A cross-sectional study of data collected nationwide in France between 2005 and 2006 was conducted. 5500 adult patients with non-acute schizophrenia and requiring a switch of antipsychotic drug were included by 995 psychiatrists. Treatment satisfaction was assessed using the "PAtient SAtisfaction with Psychotropics" (PASAP) self-report questionnaire. Linear mixed model was used to explore the association between treatment satisfaction and treatment-related factors-including the current antipsychotic drug (none, first or second-generation antipsychotic) and psychosocial therapy-independently of patient-related and illness-related factors. FINDINGS: 3630 (66%) patients filled in the PASAP questionnaire. Main treatment-related determinants of higher levels of satisfaction were: (1) being on second-generation antipsychotics compared to first-generation antipsychotics (olanzapine: ß=1.2; CI95%=[0.5; 2.0], risperidone: ß=0.9; CI95%=[0.1; 1.6], clozapine: ß=2.5; CI95%=[0.6; 4.3] and amisulpride: ß=1.2; CI95%=[0.3; 2.1]) and (2) participating in psychosocial therapy (ß=0.9; CI95%=[0.3; 1.5]). CONCLUSION: Treatment satisfaction in non-acute schizophrenia was related to the more recent antipsychotic agents and psychosocial therapy, which may reflect expectations of more pro-active care.

Association between Body Mass Index and depression: the "fat and jolly" hypothesis for adolescents girls.

BACKGROUND: Results concerning the association between Body Mass Index (BMI) and depression in adolescence are conflicting, some describing a linear association (increase in BMI with level of depression), some a U-shaped association (both underweight and obesity are associated with high levels of depression), and they mostly concern small samples. The purpose of this study was to describe the association between BMI and depression in a large representative sample of French adolescents. METHODS: The association between BMI and depression, measured on the Adolescent Depression Rating Scale (ADRS), was tested in a French national representative sample of 39542 adolescents aged 17. Self-report data is derived from the 2008 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. We used spline function analysis to describe the association between BMI and depression. RESULTS: The association between BMI and depression is significant (p < 0.001) and non-linear for both genders, with no effect of parental working and marital status. For boys, there is U-shaped association. For girls the shape of the association is complex and shows inverted convexity for high levels of BMI. The spline shows higher scores for depression among overweight girls than among obese girls. CONCLUSION: There is evidence for a gender difference in the association between BMI and depression in adolescents, supporting the need to study boys and girls separately. Overweight adolescent girls are more likely to be depressed than obese adolescent girls, giving support for "fat and jolly" hypothesis not only among older women but also among adolescent girls.

Impact of an educational program on the management of bipolar disorder in primary care.

OBJECTIVE: Government agencies and industry have recently undertaken educational programs for the management of bipolar disorder in primary care, but their medical impact is not well known. Therefore, we conducted a survey among general practitioners to evaluate the impact of the Bipolact Educational Program on the diagnosis and treatment of bipolar disorder. METHODS: A total of 45 general practitioners attending the Bipolact Educational Program (trained group) were compared with a control group of 50 untrained general practitioners on their ability to: (i) diagnose bipolar I and II disorders and (ii) treat bipolar disorder patients appropriately. RESULTS: Trained physicians, but not untrained physicians, showed a significant improvement (p < 0.0001, chi-square test) in the ability to identify patients as having bipolar I (from 10.4% to 28.8%) and bipolar II disorder (from 20.1% to 45.8%). This trend resulted in a strong decrease in nonidentified bipolar disorder patients (from 64.6% to 19.5%). Trained physicians, but not the untrained group, greatly increased the number of prescriptions for mood stabilizers for bipolar disorder patients, from 25.6% to 43.2% (p = 0.0013, chi-square test). Finally, trained physicians reduced the number of antidepressant prescriptions for bipolar disorder patients (the control group also reduced the number of antidepressant prescriptions, suggesting some bias in the survey). CONCLUSION: A well-designed education package on diagnosis and management of bipolar disorder greatly increased the likelihood of physicians correctly assigning a subtype, namely bipolar I or bipolar II disorder, to patients already perceived as having some form of bipolar illness, and to prescribing mood stabilizers instead of antidepressants to these patients.

Screening for bipolar disorder in patients consulting general practitioners in France.

BACKGROUND: Recently, an unexpected 3-fold higher screen positive rate for bipolar disorder was found among low-income American patients who were seeking primary care at an urban general medicine clinic as compared with the general population of the United States. The social health system in France is characterized by its open access, where most bipolar patients ask for care and where the major problem is diagnosis by the general practitioner (GP). Therefore, we investigated the prevalence of bipolar disorder among patients attending GP offices in France. METHODS: This observational, single visit survey was performed among 10,265 patients (47.2±18.0 years old, 40% males) attending primary care in 95 GP offices in France. The participating GP made available an MDQ-French version questionnaire to all patients aged 15 years and over, going to his office during a full week, independently of the reason for medical consulting. In addition to the MDQ-French version questionnaire, patients answered items concerning sex, age, professional situation and marital state. RESULTS: One thousand twenty-five (1025) patients did not complete the questionnaire and were excluded from the analysis. Of the 9240 analyzed questionnaires, 8.3% were classified as MDQ positives (MDQ+). MDQ+ patients were significantly younger (41.6 years versus 46.6 years for MDQ- patients, p<0.0001), more frequently divorced or separated (19.2% versus 8.6%, p<0.0001) and more frequently unemployed (15.2% versus 6.4%, p<0.0001). The gender distribution was not significantly different between the two groups. CONCLUSIONS: The prevalence of receiving positive screening results for bipolar disease in 9240 patients consulting 95 randomly selected french general practitioners was 8.3%, as assessed by the MDQ questionnaire. This is a similar and unexpected high value as that reported for low-income american patients (9.8%). Besides low socioeconomic status, other factors should explain the high screen positive rate for bipolar disorder in patients attending primary care.

Comparing mental health of francophone populations in Canada, france, and belgium: 12-month prevalence rates of common mental disorders (part 1).

OBJECTIVE: To compare the 12-month prevalence of common mental disorders among francophones in Canada, France, and Belgium. This is the first article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations. METHODS: This is a secondary analysis of data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) in 2002 and the European Study of Epidemiology of Mental Disorders-Mental Health Disability (ESEMeD) from 2001 to 2003, where comparable questionnaires were administered to representative samples of adults in Canada, France, and Belgium. In Canada, francophone respondents living in Quebec (n = 7571) and outside Quebec (n = 500) completed the French version of the CCHS 1.2 questionnaire. Francophone respondents in Belgium (n = 389) and in France (n = 1436) completed the French version of the ESEMeD population survey questionnaire. Major depressive episodes (MDEs), specific anxiety disorders (ADs), and alcohol abuse and (or) dependence disorders' rates were assessed. RESULTS: The overall prevalence rate for the presence of any MDE, AD, or alcohol abuse and (or) dependence was similar in all francophone populations studied in Canada and Europe and averaged 8.5%. CONCLUSIONS: Mental disorders were equally distributed in all francophone populations studied. Cross-national comparisons continue to be instrumental in providing information useful for the creation of appropriate policies and programs for specific subsets of populations.

Comparing mental health of francophones in Canada, france, and belgium: 12-month and lifetime rates of mental health service use (part 2).

OBJECTIVES: To compare 12-month and lifetime service use for common mental disorders in 4 francophone subsamples using data from national mental health surveys in Canada, Quebec, France, and Belgium. This is the second article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations. METHODS: Comparable World Mental Health-Composite International Diagnostic Interviews (WMH-CIDI) were administered to representative samples of adults (aged 18 years and older) in Canada during 2002 and in France and Belgium from 2001 to 2003. Two groups of francophone adults in Canada, in Quebec (n = 7571) and outside Quebec (n = 500), and respondents in Belgium (n = 389) and France (n = 1436) completed the French version of the population survey. Prevalence rates of common mental health service use were examined for major depressive episodes and specific anxiety disorders (that is, agoraphobia, social phobia, and panic disorder). RESULTS: Overall, most francophones with mental disorders do not seek treatment. Canadians consulted more mental health professionals than their European counterparts, with the exception of psychiatrists. CONCLUSIONS: Patterns of service use are similar among francophone populations. Variations that exist may be accounted for by differences in health care resources, health care systems, and health insurance coverage.

Health-related quality of life (HRQL) and continuous antipsychotic treatment: 3-year results from the Schizophrenia Health Outcomes (SOHO) study.

OBJECTIVES: We investigated the association between continuous antipsychotic use and health-related quality of life (HRQL) 3-year change in the European Schizophrenia Outpatients Health Outcomes (EU-SOHO) study. METHODS: EU-SOHO is an observational study of outcomes associated with antipsychotic treatment for schizophrenia in an outpatient setting. HRQL was assessed at study entry and at 6, 12, 18, 24, 30, and 36 months using the EuroQol-5D (EQ-5D). UK population time trade-off (TTO) tariffs were applied to the self-rated EQ-5D health states to calculate HRQL ratings (0 = death, 1 = best). An epoch analysis approach was used as a conceptual framework to analyze the longitudinal data. Follow-up was divided into epochs or periods of continuous treatment. When a patient changed antipsychotic treatment, he or she was considered to have a new observation. Multilevel models were employed to evaluate the association of HRQL with medication and other clinical and sociodemographic variables for each epoch. A total of 9340 patients were analyzed (42.1% women; mean age 40 years). RESULTS: Mean EQ-5D scores increased over time; the largest improvement occurred in the first 6 months (mean increase of 0.19). Longer duration of illness and older age at first treatment were associated with worse baseline EQ-5D scores. Improvements in EQ-5D scores were greater for more socially active patients or those in paid employment. Few significant differences were found between antipsychotic medications. Olanzapine and clozapine were associated with higher HRQL increases. CONCLUSIONS: Continuous antipsychotic treatment is associated with important HRQL benefits at 3 years, most of which occurs during the first 6 months. Although some medications are associated with better HRQL outcomes, differences are small.

Association of headache with childhood adversity and mental disorder: cross-national study.

BACKGROUND: Community studies about the association of headache with both childhood family adversities and depression/anxiety disorders are limited. AIMS: To assess the independent and joint associations of childhood family adversities and early-onset depression and anxiety disorders with risks of adult-onset headache. METHOD: Data were pooled from cross-sectional community surveys conducted in ten Latin and North American, European and Asian countries (n=18 303) by using standardised instruments. Headache and a range of childhood family adversities were assessed by self-report. RESULTS: The number of childhood family adversities was associated with adult-onset headache after adjusting for gender, age, country and early-onset depression/anxiety disorder status (for one adversity, hazard ratio (HR)=1.22-1.6; for two adversities, HR=1.19-1.67; for three or more adversities, HR=1.37-1.95). Early and current onset of depression/anxiety disorders were independently associated (HR=1.42-1.89) with adult-onset headache after controlling for number of childhood family adversities. CONCLUSIONS: The findings call for a broad developmental perspective concerning risk factors for development of headache.

Dual diagnosis: prevalence, risk factors, and relationship with suicide risk in a nationwide sample of French prisoners.

BACKGROUND: Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co-occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care. OBJECTIVES: The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison. METHOD: A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger's temperament and character inventory was also used. RESULTS: Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one-third of the prisoners with an axis I PD had co-morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co-morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7-4.6)]. CONCLUSION: DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged.

Mental disorders among persons with diabetes--results from the World Mental Health Surveys.

OBJECTIVE: To estimate 12-month prevalence rate of mood, anxiety, and alcohol-use disorders among community samples of diabetic persons. We assess whether associations of specific mental disorders with diabetes are consistent across diverse countries after controlling for age and gender. RESEARCH DESIGN AND METHODS: Eighteen surveys of household-residing adults were conducted in two phases across 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific (Part 1, N=85,088). Mental disorders, identified by the World Mental Health-Composite International Diagnostic Interview, included anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder, and social phobia), mood disorders (dysthymia and major depressive disorder), and alcohol abuse/dependence. Diabetes was ascertained by self-report (Part 2, N=42,697). Association was assessed by age-gender adjusted odds ratios. RESULTS: Risk of mood and anxiety disorders was slightly higher among persons with diabetes relative to those without: odds ratio of 1.38 for depression (95% CI=1.15-1.66) and 1.20 for anxiety disorders, (95 % CI=1.01-1.42), after adjusting for age and gender. Odds ratio estimates across countries did not differ more than chance expectation. Alcohol-use disorders were uncommon among persons with diabetes in most countries, and not associated with diabetes in pooled survey data. CONCLUSIONS: Population sample surveys revealed mood and anxiety disorders occurred with somewhat greater frequency among persons with diabetes than those without diabetes. Prevalence of major depression among persons with diabetes was lower in the general population than suggested by prior studies of clinical samples. Strength of association did not differ significantly across disorders or countries.

Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey.

A potentially traumatic event (PTE) contributes to trauma through its frequency, conditional probability of posttraumatic stress disorder (PTSD), and experience of other PTEs. A cross-sectional survey was conducted, enrolling 21,425 adults nationally representative of six European countries. Using the WHO-Composite International Diagnostic Interview, 8,797 were interviewed on 28 PTEs and PTSD. Prevalence of 12-month PTSD was 1.1%. When PTSD was present, the mean number of PTEs experienced was 3.2. In a multivariate analysis on PTEs and gender, six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beaten by caregiver.

Long term GP opinions and involvement after a consultation-liaison intervention for mental health problems.

BACKGROUND: Shared Mental Health care between Psychiatry and Primary care has been developed to improve the care of common mental health problems but has not hitherto been adequately evaluated. The present study evaluated a consultation-liaison intervention with two objectives: to explore long-term GP opinions (relating to impact on their management and on patient medical outcome) and to determine the secondary referral rate, after a sufficient time lapse following the intervention to reflect a "real-world" primary care setting. METHODS: All the 139 collaborating GPs (response rate: 84.9%) were invited two years after the intervention to complete a retrospective telephone survey for each patient (181 patients; response rate: 69.6%). RESULTS: 91.2% of GPs evaluated effects as positive for primary care management (mainly as support) and 58.9% noted positive effects for patient medical outcome. Two years post-intervention, management was shared care for 79.7% of patients (the GP as the psychiatric care provider) and care by a psychiatrist for 20.3% patients. Secondary referral occurred finally in 44.2% of cases. CONCLUSION: The intervention supported GP partners in their management of patients with common mental health problems. Further studies are required on the appropriateness of the care provider.

Strategies of treatment with olanzapine in schizophrenic patients during stable phase: results of a pilot study.

OBJECTIVE: There is an ongoing debate regarding doses of antipsychotic in stable schizophrenia patients. This French pilot study was undertaken to estimate two strategies of treatment with olanzapine in stable phase - maintenance of the acute dose or dose reduction. METHOD: 6 months open, randomized trial comparing two strategies of treatment with olanzapine in 97 schizophrenia stabilized outpatients. RESULTS: Mean daily doses at 6 months in the olanzapine full dose (OFD) and reduction dose (ORD) groups were respectively 18.1 mg and 13.3 mg. 4 patients (8%) relapsed in the ORD group versus 3 (6%) in the OFD group. A secondary analysis reflecting more real life setting showed a numerically higher rate of relapse in the dose reduction group (20% versus 10%). CONCLUSION: These results suggest that maintenance treatment with olanzapine, beyond 4 months, with the same dose that was effective acutely could be useful to prevent new psychiatric hospitalization.

Remission in the outpatient care of schizophrenia: 3-year results from the Schizophrenia Outpatients Health Outcomes (SOHO) study in France.

OBJECTIVE: To analyse the contribution of socio-demographics, clinical profile and psychotropic treatment on remission in patients with schizophrenia. METHODS: Among 933 French outpatients recruited in the European observational Schizophrenia Outpatient Health Outcomes study (SOHO), 563 were followed-up for 3 years, had at most one missing visit, and were included in the analysis. Symptomatic remission was defined as a score of 3 (mild severity) or less on the Clinical Global Impression-Schizophrenia (CGI) overall, positive, negative and cognitive symptom scales, maintained for at least 6 months and without hospitalization. A logistic regression model was used to analyse the factors associated with time in remission. RESULTS: 60.6% of patients achieved remission during the 3-year follow-up. Patients never treated before inclusion in the study (OR=2.3) and those having paid employment (OR=1.4) were more likely to achieve remission. Higher baseline clinical severity was associated with a significantly lower likelihood of achieving remission: CGI overall (OR=0.67), CGI positive (OR=0.85) and CGI negative (OR=0.74). Compared with olanzapine, other atypicals (OR=0.71) and conventional antipsychotics (OR=0.69) were associated with a lower probability of achieving remission. CONCLUSIONS: Remission can be achieved in a high proportion of patients. Factors such as being previously untreated, having paid employment and taking olanzapine are predictors of remission.

Clinical factors influencing the prescription of antidepressants and benzodiazepines: results from the European study of the epidemiology of mental disorders (ESEMeD).

OBJECTIVE: To examine factors associated with the use of antidepressants (AD) and benzodiazepines (BZD) in 6 European countries. METHODS: A cross-sectional, population-based study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. 21,425 non-institutionalized individuals aged 18 years and over were interviewed using the third version of the Composite International Interview (CIDI-3.0). Respondents were asked about AD and BZD use, and whether they consulted formal health services for emotional problems in the previous year. Sociodemographic variables, presence of mood/anxiety disorders and of painful physical symptoms were collected. RESULTS: 34.38% and 9.17% of the sample reported the use of AD and BZD respectively in the previous 12 months. Only 29.95% of subjects with a 12-month prevalence of major depressive episode (MDE) had been taking antidepressants. After controlling for several clinical and non-clinical factors, help seeking for emotional problems was the most important independent predictor for the use of AD or BZD (OR: 13.58 and 5.17, respectively). Higher age was the second important predictor (OR: 6.52 and 4.86, respectively). A 12-month or lifetime prevalence of MDE or an anxiety disorder were also predictors for AD or BZD use (OR for MDE: 5.00 and 2.82, OR for anxiety disorders: 2.13 and 1.85). Finally, the presence of painful physical symptoms also predicted the use of AD and BZD, while female gender, lower education and higher age predicted only the use of BZD. CONCLUSION: Less than one third of subjects with a 12-month prevalence of MDE had been taking antidepressants. But seeking help for emotional problems was a more important predictor of the use of ADs or BZDs than a formal (DSM-IV) psychiatric diagnosis, suggesting that usage of ADs is not always according to the licensed DSM-IV indication.

Pathways to substance-related disorder: a structural model approach exploring the influence of temperament, character, and childhood adversity in a national cohort of prisoners.

AIMS: Using Cloninger's model of personality, we aimed to specify the relative influence of the more biologically determined variables, temperament and character and more environmentally driven influence, childhood adversity in the development of addiction; and to compare patterns found among alcoholics with those found among drug addicts. METHODS: We studied a group of prisoners, at a high risk of substance abuse and past history of childhood adversity. Using a stratified random strategy we selected (i) 23 prisons among the different types of prison in France, (ii) 998 prisoners. Each prisoner was assessed by two psychiatrists--one junior, using a structured interview (MINI 5 plus), and one senior, completing the procedure with an open clinical interview. At the end of the interview the clinicians met and agreed on a list of diagnoses. Cloninger's Temperament and Character Inventory was used to measure personality. Structural equations models, which have been advocated to disentangle the respective influence of complex risk factors, were used. RESULTS: The "novelty seeking" temperament was a crucial vulnerability factor, for both alcoholics and drug addicts, in the same proportion. Character and childhood adversity played a significant part only in the development of drug abuse. CONCLUSIONS: In a prison population, a common biological loaded factor, novelty seeking is found both at the core of alcohol- and drug-related disorder whereas environmentally loaded factors play a greater role in drug problems.