Moroccan national study on prevalence of mental disorders: a community-based epidemiological study.

OBJECTIVE: The main objective of this study was to assess the prevalence of common mental disorders in the Moroccan general population. METHOD: On a systematic representative randomized sample, the Moroccan Arabic version of the Mini International Neuropsychiatric Interview (MINI) was used to assess the prevalence of mood, anxiety, substance, and alcohol abuse disorders. RESULTS: Among 5498 subjects interviewed, 40.1% had at least one current mental disorder. Current major depressive disorder was the most common (26.5%), and at least one anxiety disorder was found in 37% of the sample. Mental disorders were more frequent among female, urban, divorced, and unemployed subjects. CONCLUSION: Mental disorders are common in the Moroccan general population, particularly mood and anxiety disorders.

[Frequency and risk factors for pathological gambling in a sample of gamblers in Casablanca, Morocco]. / Fréquence et facteurs de risque du jeu pathologique chez une population de joueurs à Casablanca.

INTRODUCTION: Pathological gambling is a major psychiatric disorder and a public health problem that has gained a lot of attention in the last few years. The problems caused by gambling are increasingly serious. The prevalence of pathological or compulsive gambling varies from 0.8 to 2% in Europe, Canada and the USA. AIM OF THE STUDY: A study has been conducted in different gambling spots in Casablanca to measure the frequency of pathological gambling in Morocco and to determine the risk factors and the socio-cultural factors associated with it. DESIGN OF THE STUDY: The collection of data was conducted in the most frequented gambling spots. The first part of the questionnaire permitted the gathering of the sociodemographic characteristics and drug addictions as well as the psychiatric and legal histories. The detection and diagnosis of pathological gambling was conducted using through the South Oaks Gambling Screen (SOCS) questionnaire, which has been translated to Arabic to suit the needs of the study. PARTICIPANTS IN THE STUDY: Two hundred men were retained out of the 243 interviewed, which represent a participation rate of 82%. The frequency of pathological gambling among a population of gamblers is 53%. The mean age of the sample was 42.3 more or less 10.70 years. Thirty-six percent of those interviewed had a monthly income of less than 2000 dirhams (200 euros). Horse and greyhound racing were the most popular forms of gambling among those interviewed, with rates of 91 and 60% respectively. Individuals with an educational level of no more than primary school, a monthly income of less than 5000 dirhams (500 euros), a personal psychiatric history, and a drug addiction, are most risky to be pathological gamblers. CONCLUSION: The topic pathological gambling has been studied very little in Arab and Islamic countries, and it is necessary to conduct larger epidemiological studies on the general population to inquire about its prevalence, risk factors as well as its psychiatric characteristics.

Prevalence of postpartum depression in a Moroccan sample.

The aim of the present study was to determine the prevalence and factors associated with post-partum depression among Moroccan mothers. The authors interviewed 144 mothers at 2 and 6 weeks, and at 6 and 9 months after delivery. They used the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Arabic version of Edinburgh Postnatal Depression Scale (EPDS). Using the M.I.N.I., 18.7% met DSM-IV criteria for depressive disorder in the second week after childbirth. Using a cut-off score of 12, the EPDS indicated a sensitivity and specificity of 92% and 96% respectively. Depressive disorder was significantly associated with pregnancy complications, stressful life events during pregnancy, baby's health problems, and poor marital relationship. The subsequent point prevalences were 6.9%, 11.8% and 5.6% respectively at 6 weeks, 6 and 9 months. Postnatal visits were effective in the identification of Moroccan depressed mothers.

Moroccan colloquial Arabic version of the Mini International Neuropsychiatric Interview (MINI): qualitative and quantitative validation.

The validation of mini international neuropsychiatric interview (MINI) into Moroccan Colloquial Arabic language demonstrated good psychometric properties. The concordance between translated MINI's and expert diagnoses was good with kappa values greater than 0.80. The reliability inter-rater and test-retest were excellent with kappa values above 0.80 and 0.90, respectively.

[Depressive disorders among epileptic patients attending a specialised outpatient clinic]. / Troubles dépressifs chez les patients épileptiques suivis au sein d'une unité de consultation spécialisée.

The overall prevalence of psychiatric disorders in epileptic patients is estimated between 19 and 62%. Depressive disorders may be the most common psychiatric disorders and the main reason for psychiatric hospitalisation and taking psychotropic drugs. The underdiagnosis and undertreatment of depressive disorders among epileptic patients represent a problem of considerable magnitude. The aim of the present study was to evaluate the prevalence of depressive disorders among patients with primary epilepsy and to determine the risk factors of the occurrence of the depressive illness. The survey was conducted in a outpatient epilepsy clinic in the Ibn Rochd University Hospital Centre in Casablanca. All patients with idiopathic or cryptogenic epilepsy aged 15 Years and above, were eligible, except for patients with severe physical and mental disabilities. Neurologists diagnosed the epilepsy based on clinical criteria with electroencephalograms data. The depressive disorders met a psychiatrist's evaluation of an ICD-10 criterion. Ninety-two subjects participated in the survey, 57.6% were men and the mean age was 30.3 +/- 10.8 Years. The epilepsy age of onset was 16.3 +/- 11.4 Years with an average duration of 14.1 +/- 9.2 Years. The prevalence of depressive disorders among epileptic patients in our survey was 18.5%. According to sex, the prevalence was 23.1% in women and 15.1% in men. The depressed patients were compared with the remaining patients without depression with regard to seizure variables and sociodemographic characteristics. The epilepsy-depression and epilepsy-control groups did not differ significantly in the duration of epilepsy or in the type of anticonvulsant therapy (mono versus polytherapy). Three variables were significantly different between the two groups. The mean age in the epilepsy-depression group was significantly higher (34.4 +/- 9.6 Years versus 29.4 +/- 10.9, p<0.03), the mean age of epilepsy age of onset was also higher in the epilepsy-depression group than in the epilepsy-control group (21.8 +/- 11.9 Years versus 15.04 +/- 11.0, p<0.03) and the seizure frequency per week was more important among depressed epileptic patients (2.4 + 5.2 seizures versus 0.4 + 1.5, p<0.007). The present survey confirms the findings of previous studies that the prevalence of the comorbidity between epilepsy and depression is common in specialised outpatient units. The detection and the treatment of depressive disorders among the epileptic patients remains a very great challenge in the management of the epileptic illness. It will improve the quality of life of these patients. A closer involvement of psychiatric and psychological treatment in patient management is necessary.

[Prevalence of bulimia among secondary school students in Casablanca]. / Prévalence de la boulimie dans une population de lycéens à Casablanca.

During the two last decades, several epidemiological studies have been conducted on bulimia nervosa. According to recent studies, prevalence rates were estimated to be 1%. There are a very few studies on eating behaviour conducted in Arab countries. The aims of the current study were to assess prospectively the prevalence of Bulimia Nervosa and its characteristics in a Moroccan context in a randomly selected and representative sample of students attending six secondary schools in Casablanca. A second group composed of the students of the French secondary school of Casablanca was included in the survey in order to verify the influence of socio-cultural factors. Subjects completed a sociodemographic questionnaire and the Bulimic Investigatory Test of Edinburgh (BITE), a 33-item self-report measure of both the symptoms and severity of bulimia nervosa. A score of 25 or higher suggests a bulimic syndrome; 2,044 subjects returned their questionnaires (participation rate = 75.8%). The group of Moroccan school included 1,887 subjects and the French school 157 subjects. Females were preponderant (59%). The mean age was 18.3 +/- 1.2 years (15-22 years). For the first group, at least one substance was taken by 290 (15.3%) students: 12.7% were addicted to tobacco and 5.7% consumed occasionally alcohol. 16.3% reported a familial history of disturbed eating behaviour. According to the BITE, the overall prevalence of bulimia was 0.8% (1.2% in female and 0.1 in male subjects). The mean age of bulimic subjects was 18.6 +/- 1.7 years (16-24 years). The only male case in our sample was aged 24 years, without personal nor familial psychiatric history, consumed regularly tobacco and alcohol. His BITE symptoms score was 20 and severity score was 17, the highest score in our sample. Analyses of correlates of bulimia nervosa in the Moroccan sample showed that the group of bulimic subjects did not differ from the non bulimic with regard to any sociodemographic characteristics except sex: the female sex was predominant (p < 0.005) with 14 cases, the prevalence of bulimic syndrome was 1.2% among girls. This prevalence was 0.1% among boys. The bulimic subjects have regularly used different compensatory behaviours to control their weight: 6 (33.3%) used appetite suppressants, 3 (16.6%) used diuretics and 4 (22.2%) were engaged in self-induced vomiting. In the group of the french school, the prevalence of bulimia was 1.9% in the whole sample (3.4% among girls and no case among boys). These results are comparable to those reported recently in occidental countries and in an Egyptian study. However, the prevalence of bulimic syndrome in our sample was lower to those reported in countries with similar culture. The elevated prevalence of 10% reported in a tunisian study could be explained by the composition of the sample (medical students, aged 22-28 years) and the cut-off point for the BITE was determined to be 20 without taking into account severity criteria. A South African survey, conducted on 1,435 college students representing South Africa's ethnically and culturally diverse population comparable to our sample regarding the age (17-25 years), found a prevalence of 5% with a cut-off of 25 in the BITE. The majority of epidemiological community-based studies estimated the prevalence of bulimia nervosa to be 1 to 3% according to the diagnostic instruments used (self-report questionnaires versus clinical interviews) and the diagnostic criterias operationalized (DSM III, III-R or IV). The rate of occurrence of this disorder in males usually one-tenth of that in females was more decreased among our sample. However, the prevalence among males was comparable to the data of literature. Except the sex, we did not find other risk factors identified in the previous papers. Although in the bulimic group, we noted a higher rate of substance abuse (26.6% versus 15.2%, p > 0.5), familial histories of disturbed eating behaviour (26.6% versus 16.2%, p > 0.3) and less regular practice of sportive activity (72.2% versus 92.3%, p > 0.1), these differences are not statistically significant. The review of the literature identified at least 5 domains associated to bulimic disorder: parental problems (lower parental contact or separation, disruptive events), vulnerability to obesity, parental psychiatric disorder (alcoholism, depression), sexual or physical abuse and a premorbid psychiatric disorder. With the enormous media coverage and the globalisation of the media, cultural differences are disappearing. In order to estimate the prevalence of bulimia nervosa in the Moroccan population and to identify the risk factors, further epidemiological community-based studies using structured psychiatric interviews are required.

[Depression, suicidal ideation and schizophrenia]. / Dépression, suicidalité et schizophrénie.

UNLABELLED: The aim of this study was to find out the prevalence of depressive symptoms in patients with schizophrenia, with a special emphasis on suicidal thoughts and behaviors. 183 schizophrenic patients, according to ICD-10 criteria, were included. The interview was done by a psychiatrist using a questionnaire (socio-demographic data, premorbid functioning, schizophrenic and depressive antecedents and current depressive and suicidal thoughts and behaviors). The mean age was 34.3 +/- 8 years; 90% of the sample were males; 12.6% were married and 17% had children. RESULTS: The mean age at onset of the illness was 24 +/- 5.9 years and its mean duration was 4.8 +/- 1.3 years. The paranoid type was found in 78% of cases, and the schizo-affective one in 7.8%. During the assessment, 44.3% of the patients had depressive symptoms, 2.7% of them had suicidal ideas and 5% had a specific plan to implement them; 40% of the patients with suicidal ideas had a depression or had a painful consciousness of their illness. These results confirm the ones of other studies in the field: depression is frequent among patients with schizophrenia. An emphasis should be put on the necessity of treating both conditions when they co-exist in the same patient.