L’enquête « Santé mentale en population générale » (SMPG), menée en France métropolitaine entre 1999 et 2003 sur plus de 36 000 personnes, nous fournit une estimation des prévalences des troubles psychotraumatiques en population générale. Des analyses ont été effectuées sur les variables associées aux troubles post-traumatiques (PTSD) et sur les troubles comorbides. La prévalence instantanée (mois écoulé) d’un PTSD complet était de 0,7 % dans l’échantillon global SMPG, avec une quasi-égalité de fréquence entre hommes (45 %) et femmes (55 %). Une très importante comorbidité psychiatrique était retrouvée chez les sujets présentant un PTSD, en particulier avec les troubles de l’humeur, les autres troubles anxieux et les conduites addictives. Le lien avec le risque suicidaire était clairement établi, avec 15 fois plus de tentative de suicide dans le mois écoulé chez les sujets présentant un PTSD. Cette étude a analysé les conséquences d’un traumatisme psychique au-delà de la forme complète de PTSD selon les critères DSM-IV. En prenant ainsi une position clinique, 5,3 % de l’échantillon rapportaient des troubles psychotraumatiques selon la définition suivante : personnes confrontées à un évènement traumatique ; présentant ou ayant présenté des phénomènes de reviviscences de la scène traumatique ; présentant lors de l’interview au moins un élément psychopathologique en rapport avec le trauma (hyperéveil, évitement, troubles du sommeil, etc.), retentissant sur le fonctionnement quotidien de ces personnes.

Trauma-related disorders are disabling affections of which epidemiological data change according to the country, population and measuring instruments.

The prevalence of posttraumatic stress disorder (PTSD) appears to have increased over the past 15 years, but one cannot tell whether it has indeed increased or whether the standardized procedure has improved. Moreover, very few epidemiologic studies among the general population have been conducted in Europe, notably in France.

The “Santé mentale en population générale” (SMPG) survey, that took place in France between 1999 and 2003 among more than 36 000 individuals, gives an estimation of the prevalence of psychotraumatic disorders in the general population. Multi-varied analyses were performed on PTSD-related variables and comorbid disorders. The instantaneous prevalence (past month) of PTSD was of 0.7% among the whole SMPG sample, with almost the same proportion of men (45%) and women (55%). There was a high rate of comorbidity among PTSD individuals, notably with mood disorders, anxiety disorders and addictive behaviour. There was an obvious relationship with suicidal behaviour, with 15-fold more suicide attempts during the past month among the PTSD population.

This survey analysed the consequences of a psychic traumatism over and above complete PTSD according to DSM-IV criteria, observing for instance the consequences for people exposed both to a trauma and suffering from at least one psychopathological symptom since the trauma. Those who suffered from a psychotraumatic syndrome, according to our enlarged definition, represented 5.3% of the population, half suffered from daily discomfort and a third of them used medication.

Then, we compared those psychotraumatic syndromes to complete PTSD from a sociodemographic, functional and type of care point of view. There was little difference in prevalence of PTSD between men and women in the SMPG survey (45% vs 55%), which is clearly distinct from the other epidemiologic surveys named above. Regarding age, as in the ESEMeD survey, anxiety disorders appeared to be more frequent among younger people.

The originality of the SMPG survey is obviously in the fact that it studied the functional impact of the psychic disorder, the type of care and the satisfaction level after care. Only 50% of the PTSD population feels sick which is, however, twice as high as for the psychotraumatized population. This doesn’t fit either with the fact that 100% of the PTSD population say they feel uncomfortable with other people. The type of care is in the same vein: 50% of psychotherapies and 75% of medication, but also 25% of mild medicines and 25% of traditional medicines. Moreover, among the drugs, antidepressants (that are still the first choice treatment in all international recommendations) represent only 30%, whereas anxiolytics, hypnotics and phytotherapy represent the remaining 70%.

Regarding the type of care, the differences between the psychotraumatized population and the PTSD population are obvious. They are obvious in that which concerns the type of care, since the medication is similar. From a very global point of view, patients suffering from a subsyndromal PTSD rarely choose medical care (religion, mild or traditional medicine), while full PTSD patients definitely choose classical medical care (drugs, psychotherapy, and 30% of hospitalization). The prevalence of those who ask for care is very close to that observed in the ESEMeD survey, which was four individuals out of 10 suffering from PTSD.

The SMPG data show that its necessary to maintain the distinction between subsyndromal PTSD and full PTSD since the populations differ, but both need care.