Transcript TYPES OF MENTAL ILLNESS

OUTLINE
• HOW MEASURE M.I. IN COMMUNITY
POPULATIONS?
• MAJOR INSTRUMENTS AND
FINDINGS
• PROBLEMS WITH INSTRUMENTS
• POLICY IMPLICATIONS
Treatment for Depression
4
3.5
3
2.5
2
% of pop.
1.5
1
0.5
0
1981-82
1991-92
2001-02
REASONS FOR ENTERING
TREATMENT
• MENTAL ILLNESS
• CHANGING CULTURE SO MORE
RECOGNITION
• EDUCATIONAL CAMPAIGNS
• PHARMACEUTICAL ADS
• CHANGE IN FINANCING
PROBLEMS WITH TREATED
SAMPLES
• CAN REFLECT UNDERTREATMENT
• OR OVERTREATMENT
• SO NOT ACCURATE REFLECTION OF
AMOUNT
• NOT REPRESENTATIVE OF TYPES OF
PEOPLE
• “CLINICIAN’S ILLUSION”
EPIDEMIOLOGY
• FOCUS ON UNTREATED CASES
• STUDY OF RATES OF DISORDER IN
COMMUNITY POPULATIONS
• FOCUS ON GROUP DIFFERENCES IN
DISORDER NOT INDIVIDUAL CASES
GOALS
• 1. SEE HOW WIDESPREAD M.I. IS
• 2. LOOK AT UNMET NEED FOR
SERVICES
• 3. EXAMINE GROUP DIFFERENCES IN
RATES
• 4. BETTER WAY TO DISCOVER
CAUSES AND COURSE OF M.I.
HOW MEASURE M.I.?
• PSYCHIATRIC INTERVIEWS VERY
EXPENSIVE, IMPRACTICAL,
UNRELIABLE
• USE STANDARDIZED INSTRUMENTS
• STANDARD QUESTIONS
• STANDARD ANSWERS
DIAGNOSTIC INTERVIEWS
TWO MAJOR STUDIES
• ECA - EPIDEMIOLOGIC CATCHMENT
AREA) - 1980’S (WAKEFIELD)
• NCS - NATIONAL COMORBIDITY
STUDY - 1990’S and EARLY 2000’S
(KESSLER)
• BOTH USE FORMAL DIAGNOSES
FINDINGS
• MENTAL ILLNESS WIDESPREAD
• DEPRESSION - 10% IN PAST YEAR;
25% OVER LIFETIME
• ANXIETY - 20% IN PAST YEAR; 30%
OVER LIFETIME
• SUBSTANCE ABUSE - 15% PAST YEAR;
25% OVER LIFETIME
FINDINGS
• ALL DISORDERS - 1/3 OF
POPULATION HAS DISORDER IN PAST
YEAR; 1/2 OVER LIFETIME
• MANY PEOPLE “COMORBID” - MORE
THAN ONE DISORDER
• MANY GROUP DIFFERENCES - CLASS,
ETHNIC, GENDER, AGE, ETC.
GENERALIZED QUESTIONNAIRES
• MORE PRACTICAL, CHEAPER
ISSUES WITH BOTH TYPES
•
•
•
•
•
•
HIGH RATES – 20% TO 30%
FEW FALSE NEGATIVES
MANY FALSE POSITIVES
IGNORES CONTEXT OF SYMPTOMS
PHYSICAL ILLNESS?
INSTABILITY – ONLY 1/3 IN SAME
CATEGORY OVER SEVERAL MONTHS
• EXPLOITATION BY DRUG CO?
USEFUL FOR RATES
COMPARE GROUPS IN COMMUNITY E.G. GENDER, SOCIAL CLASS,
MARITAL STATUS, ETC.
USUAL CONCLUSIONS
(KESSLER)
• MENTAL DISORDER WIDESPREAD
• TREMENDOUS “UNMET NEED” FOR
TREATMENT
• UNMET NEED GREATEST AMONG
POOR, MINORITIES, MEN, OLDER
• MUST EXPAND MENTAL HEALTH
SERVICES
OVERESTIMATES (WAKEFIELD)
•
•
•
•
SUPPOSED TO BE SAME AS CLINICAL
1. DISCRETION OF INDIVIDUAL
2. DISCRETION OF CLINICIAN
COMMUNITY STUDIES LACK
DISCRETION OF EITHER
• RESULT IS OVERCOUNTING – FALSE
POSITIVES
POLICY STEMMING FROM
COMMUNITY STUDIES
• OVERCOME PROBLEM OF UNMET
NEED
Screening for Depression
SCREENING
•
•
•
•
FIND UNTREATED INDIVIDUALS
SETTINGS THAT HAVE HIGH % OF M.I.
PRIMARY MEDICAL CARE
SCHOOLS
BENEFITS AND COSTS
• GET TREATMENT
TO UNTREATED
• PREVENT FROM
BECOMING MORE
SERIOUS
• SAVE MONEY
•
•
•
•
TOO INTRUSIVE?
STIGMA
IS IT EFFECTIVE?
TELL ANYTHING
NEW?
• BE CAUTIOUS, NOT
SWEEPING
CONCLUSION
• MENTAL ILLNESS IS WIDESPREAD
• BUT CAN’T SEPARATE DISTRESS
FROM DISORDER
• STUDIES OVERESTIMATE AMOUNT
OF MENTAL ILLNESS
• LEAD TO MEDICALIZATION
• NEED TO INCORPORATE CONTEXT
INTO STUDIES