La dépression chez les proches de patients souffrant de schizophrénie : effets longitudinaux sur 8 mois du programme ProFamille
Résumé
Introduction
Mental illness such as schizophrenia is a major public health concern. In France, the economic cost of schizophrenia represents 2% of total medical expenditures. Schizophrenia has an impact on health and quality of life not only for patients but also for relatives. Family psychoeducation is a complementary therapeutic intervention to ordinary clinical care deigned to alleviate the burden of care among relatives of patients with schizophrenia. Literature suggests such programs including the patients’ family members reduce the risk of relapse. Current studies also suggest that negative emotions expressed by family members have negative consequences on patients’ mental health and need to be addressed. However, family psychoeducation is still underdeveloped in France. The objective of this study was to assess the longitudinal outcome on depression level of a psychoeducation program for relatives of schizophrenic patients. The program was held in Paris and Région Île-de-France “Cluster ProFramille Île-de-France” between 2012 and 2014.
Methods
Level of participant's depression was assessed by the Center for Epidemiologic Studies – Depression Scale (CES-D). Measures of depression were made for four time points: 2 months before joining the program (T1), at the beginning of the program (T2), at midpoint of the first program module (3 months, T3) and at the end of the first program module (6 months, T4). Repeated-measures ANOVA were performed to assess longitudinal change in a participant's level of depression. Type of coping strategies, knowledge about the disease, dominant thoughts and emotional progress are assessed by the program. Univariate correlation with CES-D differences between T1 and T4 were assessed. Variables with a significant association were included in a multivariate linear model to explain CES-D difference.
Results
Sixty-five relatives participated to the “Cluster ProFramille Île-de-France” between 2012 and 2014 and terminated with the first module of the program. Repeated-measures ANOVA on CES-D scores between T1 and T4 (8 months) showed a significant decrease in average scores for all participants. The mean of decrease was 7 points, equivalent to a 26.6% pre-post decrease level of depression. Significant univariate correlations with depression decrease over 8 months were with “psychomotor tiredness”, “frequent worries” and “dealing with worries”. Multivariate linear regression only confirmed the significant role of diminishing fatigue in relation to the decrease of depression.
Conclusion
Our study's results showed that the ProFamille program was efficient in reducing the level of depression for its participants over an 8 month period. As the participants progressed on managing their fatigue, their depressed moods improved.
Introduction
La schizophrénie représente un enjeu majeur de santé publique notamment en raison de la charge pesant sur les aidants, les proches et les familles. Les études actuelles montrent que les émotions négatives et notamment le niveau de dépression des membres de la famille auraient un impact négatif sur l’amélioration de l’état de santé psychique de leur proche. Afin de tester l’efficacité du programme psycho-éducatif ProFamille, une évaluation longitudinale a été initiée.
Méthode
Le niveau de dépression a été évalué par le Center for Epidemiologic Studies - Depression Scale (CES-D) à quatre reprises : 2 mois avant le début du programme (T1), au début du programme (T2), 3 mois après le début du programme (T3) et à la fin du 1er module du programme soit 6 mois après le début du programme. L’évolution du niveau de dépression a également été mise en relation avec les effets du programme sur les pensées et émotions dominantes, les connaissances et les stratégies de coping des participants.
Résultats
Les scores à la CES-D ont diminué de 7 points en moyenne, soit une baisse de 26,6 % à la fin du programme. L’évolution positive des variables « fatigue psychomotrice », « fréquence du souci personnel » et « maîtrise du souci personnel » étaient significativement associées à la diminution du score de CES-D. Seule la variable fatigue restait significativement associée à la diminution du niveau de dépression après ajustement sur les autres variables.
Conclusion
Le niveau de dépression des participants a diminué significativement au cours du programme et la diminution du niveau de « fatigue psychomotrice » des participants en est le principal contributeur.