Prevalence, risk factors, and use of health care in depression: a survey in a large region of France between 1991 and 2005

Objective: To compare the prevalence, risk factors, and use of care for depression between 2 periods, concerning changes in social factors and health care provision. Method: We compared data from 2 surveys carried out in a large urbanized French region (Ile-de-France) 15 years apart (1991, n = 1192; 2005, n = 5308), using comparable methodology and tools. Results: The overall prevalence of depression has slightly increased over this period. In contrast, the tendency of people who claim they feel depressed has dramatically increased. At-risk populations have also changed during this period. The proportion of people consulting a psychiatrist for depression has not changed, while general practitioner (GP) consultations have decreased and psychologist consultations have increased 3-fold. Psychotropic use by people who are depressed has decreased significantly. Conclusion: The trend toward increased depressive symptoms does not correspond to an increase in depressed disorders. In a well-staffed urbanized French region, psychologists are playing a growing role in managing depression at the expense of GPs, when the use of a psychiatrist remains unchanged; decreased use of psychotropic drags may be a consequence. Can J Psychiatry. 2009;54(10):701-709. Clinical Implications * Although people are much more likely to admit depressive symptoms, the prevalence of depressive disorders has not changed. * In an urban region of France with extensive medical resources, psychologists (whose numbers are not state-regulated) are playing a growing role in the management of such disorders. * Psychotropic drug use is decreasing, mainly as a consequence of a decreasing role of the main prescribers, the GPs. Limitations * Although questions and sampling were identical, there are some methodological differences that may hamper comparisons. * Our study was carried out in an urban region well covered in health care resources, which is not representative of the country as a whole. * Use of care was self-reported and therefore unverified. Key Words: depression, surveys, time trends, use of care Abbreviations used in this article CIDI Composite International Diagnostic Interview DSM Diagnostic and Statistical Manual of Mental Disorders INSEE National Institute of Statistics and Economic Studies GP general practitioner MDE major depressive episode Recent studies in the United Kingdom and the United States have indicated that the prevalence of depression has not changed over the past 15 years but that access to care has improved considerably. Two different national studies1,2 that have evaluated the prevalence of mental health problems in representative sample populations using standardized methodologies have reported that this prevalence has not changed over a 10-year period. In particular, the prevalence of depressive disorders3 and suicidal behaviour4 remained stable over time in 2 consecutive surveys from the United States. This stability in mental health was also found over a 40-year period by Murphy et al5 in their Stirling County study. However, these authors noticed a redistribution between social categories of people with a high risk of experiencing mental health problems during the 1990s. The most recent study demonstrated an increase in the relative risk of depression or anxiety among young women, while in previous studies elderly people had the highest risk of depression. Another study ,6^8 based on the Lundby cohort, has studied the evolution of rates and risk factors of depression and neurosis over 50 years (1947 to 1997). Annual standardized incidence rates were found to be lower over the 1972 to 1997 period, compared with 1947 to 1972. However, unlike what was found in the Stirling County study, incidence rates increased in the oldest age groups (age interval of 70 to 99 years). …