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Dimensions de la dépression : modèles statistiques pour l’évaluation des troubles affectifs

Published online by Cambridge University Press:  28 April 2020

P. Bech
P. Bech*
Affiliation:
Frederiksborg General Hospital, 48, Dyrehavevej3400, Hillerod, Danemark
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Résumé

Dans cette étude, les dimensions de la dépression ont été analysées par rapport aux états dépressifs non bipolaires. Les états d’anxiété dans ce domaine ont été considérés comme des formes peu sévères de dépression au niveau phénoménologique. La dimension de l’anhédonie a été considérée comme liée aux troubles schizoaffectifs.

Le concept clinique de la mélancolie a été utilisé pour inclure ces états unipolaires de la dépression. Ce concept comprend et la dimension de sévérité et les types diagnostiques de la dépression. Le principe d’organisation des désordres mentaux utilisé dans le manuel du DSM III implique que la «phénoménologie partagée» précède l’étiologie psychologique dans le cadre des désordres affectifs.

Certains auteurs soutiennent que le moyen le plus efficace de tester la «phénoménologie partagée» est de démontrer l’existence d’une relation additive entre indices et symptômes. Le modèle de Rasch consiste en une théorie générale de la relation statistique entre les dimensions cliniques et les échelles d’évaluation de la dépression.

Moyennant l’usage des analyses de Rasch, on a démontré que notre échelle de la mélancolie mesure une dimension de la sévérité de la dépression. De plus, notre échelle diagnostique de la mélancolie, qui a été élaborée à partir des 2 échelles de Newcastle (pour la dépression endogène versus la dépression réactionnelle (névrotique), mesure ces deux dimensions diagnostiques. Des résultats préliminaires obtenus avec l’échelle de diagnostic de la mélancolie ont démontré que chez des patients classifiés comme ayant une dépression endogène «pure» la courbe d’amélioration dans le temps est plus importante que chez des patients classifiés comme ayant une dépression réactive «pure» ou une association de dépression endogène et de dépression réactionnelle.

Summary

Summary

In this overview the dimensions in depression have been analysed for non-bipolar states of depression. In this area, states of anxiety have been considered as mild forms of depression at the phenomenological level. The dimension of anhedonia has been considered as related to schizo-affective disorders.

The clinical concept of melancholia has been used to cover these unipolar states of depression. This concept includes both the dimension of severity and diagnostic types of depression. The organization principle of mental disorders used in DSM III implies that «shared phenomenology» precedes «psychological aetiology» within affective disorders.

It has been argued that the most adequate tool for testing «shared phenomenology» is to demonstrate an additive relationship between signs and symptoms. This approach refers to phenomenological dimensions. The Rasch model is a general theory of the statistical relationship between clinical dimensions and rating scales. By use of Rasch analyses it has been shown that our Melancholia Scale is measuring a dimension of severity of depression. Furthermore, our Diagnostic Melancholia Scale (which is derived from the two Newcastle Scales) for endogenous versus reactive (neurotic) depression is measuring these two diagnostic dimensions. Preliminary results with the Diagnostic Melancholia Scale have shown that patients classified as «pure» endogenous depression have a more time-dependent improvement curve than patients classified as «pure» reactive depression or as combined endogenous and reactive depression.

Keywords

dépressionmodèles statistiquedepressionstatistical models
Type
Research Article
Information
Psychiatry and Psychobiology , Volume 3 , Issue S1: Les Etats Dépressifs: vers une révision des concepts Paris, 20 Novembre 1987 , 1988 , pp. 37s - 44s
Copyright
Copyright © European Psychiatric Association 1998

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