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El programa APRAND: una intervención para prevenir recaídas de los trastornos de ansiedad y depresivos. Primeros resultados de una intervención médica de promoción de la salud en una población de empleados

Published online by Cambridge University Press:  12 May 2020

C. Godard
Affiliation:
Servicio General de Medicina de Control de EDF GDF, 22-28, rue Joubert, 75009, París, Francia
A. Chevalier
Affiliation:
Servicio General de Medicina de Control de EDF GDF, 22-28, rue Joubert, 75009, París, Francia INVS, Departamento “Salud-trabajo”, 12, rue du Val d'Osne, 94415, St. Maurice, Francia
Y. Lecrubier
Affiliation:
Inserm – Unidad 302, La Salpetrière, Pavillon Clérambault, 47, Boulevard de l'Hôpital, 75651 , París, cedex 13, Francia INVS, Departamento “Salud-trabajo”, 12, rue du Val d'Osne, 94415, St. Maurice, Francia
G. Lahon
Affiliation:
Servicio General de Medicina de Control de EDF GDF, 22-28, rue Joubert, 75009, París, Francia INVS, Departamento “Salud-trabajo”, 12, rue du Val d'Osne, 94415, St. Maurice, Francia
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Resumen

Objetivos

El estudio trataba de determinar si una intervención organizada de promoción de la salud durante las consultas médicas mejora la evolución para los pacientes que cumplen los criterios de la CIE-10 para trastornos de ansiedad o depresivos.

Métodos

En 2001, los médicos utilizaron la MINI para la detección selectiva de 9.743 empleados de baja por enfermedad y médicos especialistas en 21 centros médicos de una gran compañía. Se llevó a efecto una intervención de promoción de salud en ocho centros “activos”. Esta intervención tenía lugar inmediatamente después del diagnóstico y consistía en explicar los trastornos, proporcionar los resultados de la prueba y folletos basados en las recomendaciones de la OMS, y aconsejar a los pacientes que consultaran a su médico personal, psiquiatra o médico laboral, si era necesario. La eficacia de la intervención, evaluada por la gravedad de los síntomas y la evolución al año, se valoró comparando los ocho centros activos con 13 centros de control (sin intervención).

Resultados

Se detectaron trastornos entre 10,6% de los sujetos, 29,4% de los cuales no tenían diagnóstico anterior de trastorno de ansiedad o depresivo. La intervención se asoció con un efecto positivo en las puntuaciones de la HAD a las 6 semanas y a los 6 meses. La ausencia total de trastornos al año se asociaba con la edad, el sexo y la intervención, entre todos los casos identificados (RV = 1,53), entre aquellos con un trastorno de ansiedad al menos (RV = 1,45) y entre aquellos con trastorno depresivo al menos (RV = 1,40).

Conclusión

Combinar la detección con la provisión organizada de información, incluyendo material impreso, mejora la evolución de los pacientes y las capacidades diagnósticas de los médicos.

Type
Artículo original
Copyright
Copyright © European Psychiatric Association 2007

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References

Bibliografía

[1]Andews, GSanderson, KSlade, TIssakidis, CWhy does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment. Bull World Health Organisation 2000;78(4):446–53.Google Scholar
[2]Anguis, MRoelandt, JLCaria, ALa perception des problemas de santé mentale: les résultats d’une enquête sur neuf sitas, Drees, Etudes et Résultats, n° 347, octobre 2004.Google Scholar
[3]Barkow, KHeun, RWittchen, HUBedirhan Ustun, TGansicke, MMaier, WMixed anxiety-depression in a 1 year follow-up study: shift to other diagnoses or remission? J Affect Disord 2004;79(1-3):235–9.CrossRefGoogle ScholarPubMed
[4]Barkow, KHeun, RUstun, TBBerger, MBermejo, IGaebel, W et al. Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care. Eur Psychiatry 2004;19(5):250–7.CrossRefGoogle ScholarPubMed
[5]Barkow, KMaïer, WUstun, TBGansicke, MWittchen, HUHeun, RRisk factors for depression at 12-month follow-up in adult primary health care patients with major depression: an international prospective study. J Affect Disord 2003;76(l-3):157–69.CrossRefGoogle ScholarPubMed
[6]Berkels, HHenderson, JHenke, NKuhn, KLavikamen, JLehtinen, V et al. Mental health promotion and prevention strategies for coping with anxiety, depression and stress related disorders in Europe. Federal Institute for Occupational Safety and Health. Final report 2004, 125p.Google Scholar
[7]Brunello, NDen Boer, JAJudd, LLKasper, S et al. Social phobia: diagnosis and epidemiology, neurobiology and pharmacology, comorbidity and treatment. J Affect Disord 2000;60(1):6174.CrossRefGoogle ScholarPubMed
[8]Chevalier, ABonenfant, SPicot, MCChastang, JFLuce, DOccupational factors of anxiety and depressive disorders in the french national electricity and Gaz company. JOEM 1996;38 (N° 11, nov).Google ScholarPubMed
[9]Donoghue, JMTylee, AThe treatment of depression: prescribing patterns of antidepressants in primary care in the UK. Br J Psychiatry 1996; 168(2): 164–8.CrossRefGoogle ScholarPubMed
[10]Dowrick, CDunn, GAyuso-Mateos, JL et al. Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. BMJ 2000;312.Google Scholar
[11]Geddes, JCarney, SDavies, C et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet 2003;361.CrossRefGoogle ScholarPubMed
[12]Goldberg, MLeclerc, ACohorte GAZEL 20000 volontaires d’EDFGDF pour la recherche médicale. Bilan 1989-1993. Paris: les éditions de l’INSERM; 1994 (220p).Google Scholar
[13]Kessler, RCBerglund, PADewit, DJUstun, TBWang, PSWittchen, HUDistinguishing generalized anxiety disorder from major depression: prevalence and impairment from current pure and comorbid disorders in the US and Ontario. Int J Methods Psychiatr Rs 2002;11(3):99111.CrossRefGoogle ScholarPubMed
[14]Lecrubier, YUstun, TBPanic and depression, a worldwide primary care perspective. Int Clin Psychopharmacol 1998;13(Suppl 4):S7S11.Google ScholarPubMed
[15]Lecrubier, YBoyer, PLépine, JPWeiller, EResults from the Paris centre. In: Ustün, TBSartorius, N editors. Mental illness in general health care. New York: Wiley and Sons; 1995. p. 211–25.Google Scholar
[16]Lecrubier, YSheehan, DVWeiller, E et al., The Mini International Neuropsychiatric Interview (MINI). A short structured interview: reliability and validity according to the CIDI. Eur Psychiatry 1997;12:224–31.Google Scholar
[17]Le Pape, ALecomte, TPrévalence et prise en charge médicale de la dépression en 1996-1997. Irdes, Biblio n° 1277, Septembre 1999.Google Scholar
[18]Lépine, JPGastpar, MMendelowicz, JTylee, ADepression in the Community: the First Pan-European Study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol 1997;12:1920.CrossRefGoogle Scholar
[19]Maier, WGansicke, MFreyberger, HJLinz, MHeun, RLecrubier, YGeneralized anxiety disorder (ICD10) in primary care from a cross-cultural perspective: a valid diagnostic entity? Acta Psychiatr Scand 2000;101(1):2936.CrossRefGoogle Scholar
[20]McAlpine, DWilson, AScreening for depression in primary care: what do we still need to know? Depress Anxiety 2004;19:137–45.Google ScholarPubMed
[21]Olie, JPElomari, FSpatone, CLepine JP—Antidepressants consumption in the global population in France. Encephale 2002;28(5 Pt 1):411–7.Google ScholarPubMed
[22]Paykel, ESTylee, AWright, APriest, RGRix, SHart, DThe defeat depression campaign: psychiatry in the public arena. Am J Psychiatry 1997;154(6 suppl):5965.Google ScholarPubMed
[23]Priest, RGVize, CRoberts, ATylee, ALay peoples attiudes to tre6atment of depression: results of opinion poli for Defeat Depression Campagn just before its launch. BMJ 1996;313(7061):858–9.CrossRefGoogle Scholar
[24]Pull, CBCaria, AChaillet, GPull, MCQuemada, NStaner, LCIM-10, Chapître V, Version 24 cartes pour médecins généralistes pour les études sur le terrain. Traduction française 1996.Google Scholar
[25]Rihmer, ZRutz, WPhilgren, HDepression and suicide in Gotland, An intensive Study of all Suicides before and after depression-training programme for General Practitioners. J Affect Disord 1995;354:147–52.CrossRefGoogle Scholar
[26]Rix, SPaykel, ESLelliott, P et al. Impact of a national campaign on GP education: an evaluation of the defeat depression campaign. Br J Gen Pract 1999;49(439):91–2.Google ScholarPubMed
[27]Rutz, WImprovement of care for people suffering from depression: the need for comprehensive education. Int Clin Psychopharmacol 1999;14(Suppl 3):S27–33.CrossRefGoogle ScholarPubMed
[28]Rutz, WPreventing suicide and premature death by education and treatment. J Affect Disord 2001 ;62(1-2): 123–9.CrossRefGoogle ScholarPubMed
[29]Rutz, WCarlson, Pvon Knoring, LWalinder, JCost benefit analysis of an educational program for general practitioners by the Swedish Committee for the Prevention and Treatment of Depression. Acta Psychiatr Scand 1992;85(6):457–64.CrossRefGoogle ScholarPubMed
[30]Sheehan, DVLecrubier, YHarnett-Sheehan, K et al. Reliability and Validity of the MINI International Neuropsychiatric Interview (MINI): According to the SCID-P. Eur Psychiatry 1997;12:232–41.CrossRefGoogle Scholar
[31]Simon, GELong-term prognosis of depression in primary care. Bull World Health Organisation 2000;78(4):439–45.Google ScholarPubMed
[32]Simon, GEGoldberg, DTiemens, BGUstun, TBOutcomes of recognized and unrecognized depression in an international primary care study. Gen Hosp Psychiatry 1999;21(2):97105.CrossRefGoogle Scholar
[33]Singleton, ATylee, AContinuing medical education in mental illness: a paradox for general practitioners. Br J Gen Pract 1996;46(412):690.Google ScholarPubMed
[34]The ESEMed/MHEDEA 2000 investigations. sampling and methods of the European Study of the Epidemiology of Mental Disorders project. Acta Psychiatr Scand 2004;109(Suppl. 420):820.CrossRefGoogle Scholar
[35]Tylee, ADepression in the community: physician and patient perspective. J Clin Psychiatry 1999;60(suppl 7): 12–6 (discussion 17-8).Google ScholarPubMed
[36]Tylee, ADepression in Europe: experience from the DEPRESII survey. Depression research in the European Society. Eur Psychopharmacol 2000;10(Suppl 4):S445–8.Google Scholar
[37]Tylee, AGaspar, MLépine, JPMendlewicz, JDEPRESII (Depression Research in European Society): a patient survey of the symptoms, disability and current management of depression in the community. Int Clin Psychopharmacol 1999;14:139–51.Google Scholar
[38]Tylee, AGaspar, MLépine, JPMendlewicz, JDEPRESII (Depression Research in European Society): identification of depressed patient types in the community and their treatment needs. Int Clin Psychopharmacol 1999;14:153–65.Google Scholar
[39]Ukoumunne, OGulliford, MChinn, SSterne, JBurney, PDonner, AMethods in health Service research: evaluation of health interventions at area and organisation level. BMJ 1999;319:376–9.CrossRefGoogle ScholarPubMed
[40]Ustun, TBThe global burden of mental disorders. Am J Public Health 1999;89(9):58(131).CrossRefGoogle ScholarPubMed
[41]Ustun, TBWho perspectives on international classification. Psychopathology 2002;35(2-3):62–6.Google ScholarPubMed
[42]Zigmond, ASSnait, RPThe hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6):361–70.Google ScholarPubMed