18. Dépression et lésions médullaires

Capsule pour l’action pour LM (2nd ed., 2013)

Épistage annuel de la dépression au moyen du PHQ-9 ou du PHQ-2. Traitement classique selon les lignes directrices.

Le problème:

On estime que la moitié des personnes ayant une lésion médullaire (LM) présente également un problème important de santé mentale. Le plus fréquent est la dépression, dont la prévalence est de 23-37 % en présence de LM. Les autres problèmes incluent : anxiété, stress cliniquement significatif et syndrome de stress post-traumatique.

Plus d’informations: Patient Health Questionnaire (PHQ-9)

Pratiques d’excellence fondées sur des preuves:

En présence de LM, le risque de problèmes de santé mentale est 2-4 fois plus élevé qu’en l’absence d’incapacité. Le taux de suicide est 3-5 fois plus élevé que dans population générale. Les symptômes de dépression peuvent passer inaperçus ou être mal identifiés parce que certains symptômes, comme la fatigue et les troubles du sommeil, sont souvent attribués à la LM. Les facteurs de risque de dépression identifiés comprennent : jeunesse, LM récente, manque d’activités valorisantes (p. ex. : travail ou études), multiples comorbidités ou complications, problèmes de couple, toxicomanie ou alcoolisme, dépression préexistante ou antécédents familiaux.

Le PHQ-9 s’est avéré un outil de dépistage efficace en présence de LM : sa sensibilité, sa spécificité et sa fiabilité sont excellentes. Le très bref questionnaire PHQ-2 (2 premières questions du PHQ-9) est doté d’une sensibilité de 86 % et d’une spécificité de 78 % en première ligne (valeur seuil = score de 2.

Les études montrent qu’en présence de LM, 29 % seulement des patients déprimés obtiennent un traitement psychologique ou pharmacologique. La posologie et la durée du traitement pharmacologique ne sont conformes aux lignes directrices cliniques que chez 11 % des personnes traitées par médicament (score PHQ9 ≥ 10).

Source clé:

Fann, J.R., Bombardier, C.H., Richards, J.S., Tate, D.G., Wilson, C.S., & Temkin, N. (2011). Depression after spinal cord injury: Comorbidities, mental health service use, and adequacy of treatment. Archives of Physical Medicine & Rehabilitation, 92(3): 352-60.

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