En France, il existe peu d’études sur la prise en charge des troubles psychiatriques en médecine générale. Cette étude avait pour objectif d’estimer en médecine générale la fréquence des troubles psychiatriques, de décrire le niveau de détection de ces troubles par les médecins généralistes (MG) et d’étudier la prescription d’anxiolytiques et d’antidépresseurs en fonction du diagnostic.

Mille cent cinquante et un patients (25 patients consécutifs par MG) consultant 46 MG dans la région de Montpellier ont rempli en salle d’attente des auto-questionnaires dont le patient health questionnaire (PHQ) appliquant les critères diagnostiques du DSM-IV. Le MG a évalué pendant la consultation la sévérité des troubles psychiatriques.

D’après leurs réponses au PHQ, 14,9 % des patients remplissaient les critères DSM-IV de trouble dépressif majeur ou de trouble anxieux, dont 66,3 % étaient détectés comme ayant un trouble psychiatrique par le MG. Le taux de détection était de 51 % pour les patients remplissant les critères de trouble dépressif (majeur ou non), anxieux ou somatoforme. Quatre-vingt pour cent des patients recevant la prescription d’un anxiolytique ou d’un antidépresseur avaient un trouble psychiatrique d’après le MG et 48,8 % avaient un diagnostic de trouble dépressif majeur ou de trouble anxieux d’après le PHQ.

Cette étude montre la fréquence élevée des troubles psychiatriques dans une étude régionale française en médecine générale. À l’instar d’autres pays, environ la moitié des cas est détecté par les MG. Près de la moitié des patients traités par anxiolytique/antidépresseur ne remplissaient pas ou plus les critères diagnostiques de dépression majeure ou d’anxiété. Le PHQ pourrait être un outil d’aide au diagnostic utile pour le MG dans sa pratique quotidienne mais reste à valider en France.

Psychiatric disorders, mainly depression and anxiety, are frequently encountered in primary care and are a major cause of distress and disability. Nearly half of cases go unnoticed and among those that are recognised, many do not receive adequate treatment. In France, there is limited research concerning the prevalence, detection and management of these conditions in primary care.

To estimate the prevalence of psychiatric disorders, overall and for the main psychiatric diagnostic categories, encountered in primary care; to describe general practitioners’ (GPs’) case identification rate; to examine psychotropic medication prescription according to diagnosis, in a regionally representative sample of GP attenders.

GP practicing standard general practice in an urban area of the city of Montpellier and a nearby semi-rural region were recruited to participate. The response rate was 32.8% (n=41). Five additional GP almost exclusively offering homeopathy and acupuncture were recruited nonrandomly for convenience purposes. In each GP surgery, consecutive patients entering the waiting room were invited by a research assistant to participate until 25 patients per GP were recruited. Each participant completed self-report questionnaires in the waiting time, including the patient health questionnaire (PHQ), which yields provisional DSM-IV diagnoses. The GP completed a brief questionnaire during the consultation, giving his/her rating of the severity of any psychiatric disorder present and action taken.

The patient response rate was 89.8%. In all, 14.9% of patients reached DSM-IV criteria for major depression or anxiety disorder on the PHQ (9.1% for major depression, 7.5% for panic disorder; 6% for other anxiety disorders). For the subthreshold categories, 7.4% met criteria for other depressive disorders, 11.8% for somatoform disorders and 10.9% for probable alcohol abuse or dependence. 66.3% of patients with DSM-IV diagnoses of major depression or anxiety disorder were identified by the GP as having a psychiatric disorder. The identification rate was 51% for all depressive disorders, anxiety and somatoform disorders. Of patients receiving a prescription for anxiolytic or antidepressant medication on the survey day, 80% were classified as cases of psychiatric disorder by the GP. Only 48.8% met criteria for major depression or anxiety disorder on the PHQ.

This study highlights the frequency of psychiatric disorders in a regional study of French general practice. Overall, prevalence rates were similar to those found elsewhere, except for probable alcohol abuse and dependence, which was considerably higher than in the USA PHQ validation study. As in other countries, GP identified roughly half of psychiatric cases. Furthermore, half of patients treated by anxiolytic or antidepressant medication did not meet the diagnostic criteria on the survey day for which these medications have mainly shown their efficacy. This confirms the French paradox of one of the highest psychotropic medication consumption rates in Europe despite many cases of depression remaining untreated. The PHQ could be a rapid and acceptable diagnostic aid tool for French general practice but first needs to be validated against the diagnosis of mental health professionals in this setting.