PhD student: Alicia LE BRAS
Title: Innovations in care pathways and costs in psychiatry: what contribution can the SNDS make to their analysis?
Supervisors: Prof. Isabelle DURAND-ZALESKI, Prof. Julien DUBREUCQ
Doctoral school: ED393
Promotion: 2025
Funding: salaried position
Thesis abstract
This thesis investigates the contribution of the French National Health Data System (SNDS) to the evaluation of innovations in psychiatry, drawing on its unique ability to capture complete care pathways and to support the construction of robust comparison groups. Two clinical settings are considered: perinatal depression and bipolar disorder.
The first part examines the impact of maternal perinatal depression on children’s health and healthcare use up to the age of 12. Exposed children are compared with unexposed peers selected through a high-dimensional propensity score. The analysis aims to quantify the associated economic burden, assess potential increased psychiatric risks, and identify the periods of life during which healthcare use is most elevated.
The second part focuses on diagnostic delay in bipolar disorder. Using a cohort of patients identified as having bipolar disorder, it reconstructs care trajectories over the ten years preceding and the two years following diagnosis, and compares them with matched non-bipolar controls. The objective is to estimate the length of diagnostic delay, evaluate its economic implications, and measure the excess costs associated with different delay durations.
Overall, the findings are intended to inform strategies to strengthen prevention, improve early detection, and optimise the organisation of psychiatric care.
