[One year prevalence of mental disorders comorbidity and associated socio-demographic risk factors in the general population of Spain. Results of the ESEMeD-Spain study]. / Prevalencia-año de la comorbilidad de los trastornos mentales y factores de riesgo sociodemográficos asociados en la población general de España. Resultados del estudio ESEMeD-España.

INTRODUCTION: Comorbidity among mental disorders in the general population is common, affecting more than the 50 % of individuals with a lifetime mental disorder. In Spain, there are no data describing it or its associated risk factors. METHOD: The ESEMeD-Spain study is an epidemiological study assessing mental disorders in a sample of 5,473 individuals from the general population of Spain aged 18 years or older. The aims of the present study were to evaluate the frequency of mental disorders comorbidity in Spain (assessed with the Composite International Diagnostic Interview: CIDI 3.0) and associated sociodemographic risk factors. Response rate was 78.6%. RESULTS: Mood disorders showed the highest comorbidity frequency. Analysing specific disorders, generalized anxiety disorder, dysthymic and panic disorders showed the highest comorbidity percentages. Female gender, ages above 24 years old and being previously married were found to be risk factors associated to the presence of comorbid mood and anxiety disorders. CONCLUSIONS: As it has been suggested for other European countries and for the United States, in the general population of Spain mental disorders, specially mood disorders, are frequently comorbid. When treating mental disorders, comorbidity should be taken into account.

[The impact of mood and anxiety disorders, and physical chronic conditions in the quality of life of general population of Spain. Results of the ESEMeD-Spain study]. / Impacto de los trastornos del ánimo, de ansiedad y de las enfermedades físicas crónicas en la calidad de vida de la poblacíon general de España. Resultados del estudio ESEMeD-España.

INTRODUCTION: Mental disorders and chronic physical conditions significantly impair health related quality of life (HRQOL). To date, there are no studies in the general population of Spain about their impact. The aim of the present study is to evaluate the impact of mood and anxiety disorders and chronic physical conditions in HRQOL and functional disability (estimated considering work loss days). METHODS: The ESEMeD-Spain is an epidemiological study carried out in the general population of Spain aged 18 years or older. Mental disorders were assessed with the Composite International Diagnostic Interview (CIDI 3.0); the HRQOL with the SF-12; and functional disability with the WHO Disability Assessment Schedule. Additionally, chronic physical conditions were assessed. RESULTS: A total of 5,473 individuals were assessed. Response rate was 78.6 %. Mental disorders, specially mood disorders, showed the highest impairment in HRQOL and functional disability (more work loss days). This impairment was even higher than the impairment associated to chronic physical conditions. Comorbidity between mood and anxiety disorders was associated to the worst HRQOL. In general, mental HRQOL was more impaired than physical HRQOL. CONCLUSIONS: Mood disorders substantially impair HRQOL and augment functional disability in Spain. Their comorbidity with anxiety disorders in especially impairing.

[Mental health care use in the Spanish general populations. Results of the ESEMeD-Spain study]. / Utilización de los servicios de salud mental en la población general española. Resultados del estudio ESEMeD-España.

INTRODUCTION: Between 17% and 30% of the world population suffers from a mental disorder in a given year and only a small proportion of them established contact with health services. This information is not available concerning the Spanish population. This study aims to describe the health services utilization related with mental disorders in Spain, as well as to identify factors related with such utilization. METHODS: The ESEMeD-Spain is an epidemiological study carried out on a representative sample of the Spanish adult general population, with a sample size of 5,473 individuals. We used the Composite International Diagnostic Interview (version 3.0) to collect information concerning mental disorders symptoms, health services utilization related with mental health, and administered treatments, with a 12 months time frame. RESULTS: 57% of those suffering from a mood disorder, 30.3 % of those suffering from an anxiety disorder and 71.7% of those suffering from both contacted health services in the year they suffered the disorder. Psychiatrists were the most frequently consulted professionals when a 12 month mental disorder was present, with the exception of anxiety disorders or comorbid mood-anxiety disorders. A 30.8% of those with any 12 month mental disorder who did consult were not prescribed with any treatment. Variables significantly related to 12 month health services utilization were age, gender, marital status, and mental disorders. CONCLUSIONS: A large proportion of individuals suffering from mental disorders do not use health services or, if indeed use them, do not receive any type of treatment.

[Psychotropic medications use in Spain. Results of the ESEMeD-Spain study]. / Uso de fármacos psicotrópicos en España. Resultados del estudio ESEMeD-España.

INTRODUCTION: Psychotropic drugs are frequently used in the population and account for a big share of the Spanish health budget. This study aims to describe the patterns of use of psychotropic drugs in the Spanish general population and its relationship with mental health. METHODS: A stratified, multistage, clustered area, probability sample design was used and 5,473 non-institutionalized individuals older than 18 were randomly selected among the Spanish population. They were administered the Spanish version of the World Health Organization- Composite International Diagnostic Interview (CIDI 3.0). Information on previous 12-months psychiatric symptoms and psychotropic drugs use was obtained. The proportion of individuals using psychotropic drugs was estimated and stratified according mental health diagnosis. Multivariate analyses were carried out in order to assess the influence of sociodemographic factors on use. RESULTS: 16% of the sample had used some psychotropic drug. Benzodiacepines (11.4 %) and antidepressants (4.7%) were the most commonly used and the most common combination (1.8%). Women showed the highest use of any drug (odds ratio [OR]: 2.1; 95 confidence interval [CI]: 1.7-2.5), benzodiacepines (OR: 2.3; 95 CI: 1.9-2.8), antidepressants (OR: 2.2; 95 CI: 1.6-3.1) and antipsychotics (OR: 1.9; 95 CI: 1.2-3.0). The odds of use did increase with age, and was related with the presence and number of mental disorders. CONCLUSIONS: Use of psychotropic drugs in the Spanish general population is high, although many individuals with mental disorders remain untreated. Gender and age showed an association with psychotropic drug use independent of mental health.

Cost-utility of selective serotonin reuptake inhibitors for depression in primary care in Catalonia.

OBJECTIVE: To determine the cost-utility of selective serotonin reuptake inhibitors (SSRIs) for treating depressive disorders prescribed in primary care (PC). METHOD: A total of 301 participants beginning antidepressant treatment with an SSRI were enrolled in a prospective 6-month follow-up naturalistic study. Incremental cost-utility ratios (ICUR) were obtained for several comparisons among different SSRIs. To address uncertainty in the ICUR's sampling distribution, non-parametric bootstrapping was carried out. RESULTS: Taking into account adjusted total costs and incremental quality of life gained, fluoxetine dominated paroxetine and citalopram with 63.4% and 79.3% of the bootstrap replications in the dominance quadrant, respectively. Additionally, fluoxetine was cost-effective over sertraline with 83.4% of the bootstrap replications below the threshold of 33,936 US$/quality-adjusted life year (30,000 euro/QALY). CONCLUSION: Fluoxetine seems to be a better cost-utility SSRI option for treating depressive disorders in PC.

Effectiveness and cost-effectiveness of antidepressant treatment in primary health care: a six-month randomised study comparing fluoxetine to imipramine.

BACKGROUND: Over the past decade, studies of the effectiveness of pharmacological treatment for depression have often been based on research designs intended to measure efficacy, and for this reason the results are of limited generalizability. Research is needed comparing the clinical and economic outcomes of antidepressants in day-to-day clinical practice. METHODS: A six-month randomised prospective naturalistic study comparing fluoxetine to imipramine carried out in three primary care health centres. Outcome measures were the Montgomery Asberg Depression Rating Scale (MADRS), direct costs, indirect costs and total costs. Subjects were evaluated at the beginning of treatment and at one, three and six months thereafter. RESULTS: Of the 103 patients, 38.8% (n = 40) were diagnosed with major depressive disorder, 14.6% (n = 15) with dysthymic disorder, and 46.6% (n = 48) with depressive disorder not otherwise specified. Patients with major depressive disorder or dysthymic disorder achieved similar clinical improvement in both treatment groups (mean MADRS ratings decrease in major depressive disorder from baseline to 6 months of 18.3 for imipramine and 18.8 for fluoxetine). For patients with major depressive disorder and dysthymic disorder, the imipramine group had fewer treatment-associated costs (imipramine 469.66 Euro versus fluoxetine 1,585.93 Euro in major depressive disorder, p < 0.05; imipramine 175.39 Euro versus fluoxetine 2,929.36 Euro in dysthymic disorder, p < 0.05). The group with depressive disorder not otherwise specified did not experience statistically significant differences in clinical and costs outcomes between treatment groups. LIMITATIONS: Exclusion criteria, participating physicians may not represent GPs. CONCLUSIONS: In a primary care context, imipramine may represent a more cost-effective treatment option than fluoxetine for treating major depressive disorder or dysthymic disorder. There were no differences in cost-effectiveness in the treatment of depressive disorder not otherwise specified.