Transcript TYPES OF MENTAL ILLNESS

EPIDEMIOLOGY
• STUDY OF RATES OF DISORDER IN
COMMUNITY POPULATIONS
• FOCUS ON GROUP RATES OF
DISORDER NOT INDIVIDUAL CASES
• FOCUS ON UNTREATED CASES
WHY WANT EPIDEMIOLOGY?
• SMALL PROPORTION OF PEOPLE
WITH M.I. ENTER TREATMENT
• TREATED PEOPLE AREN’T
REPRESENTATIVE
• MUST LOOK AT UNTREATED TO
UNDERSTAND CAUSES, COURSE,
AND TREATMENT
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 AND IMPRACTICAL
• USE STANDARDIZED INSTRUMENTS
• STANDARD QUESTIONS
• STANDARD ANSWERS
TWO TYPES OF MEASURES
• GENERAL MEASURES OF OUTCOME
• DIAGNOSTIC MEASURES OF
OUTCOME
GENERAL MEASURES
• MOST COMMON
• FREQUENTLY OCCURING SYMPTOMS
– NOT COMPARABLE TO DSM
CATEGORY
• E.G. CESD
CES-D - QUESTIONS
DURING THE PAST WEEK
• I FELT SAD
• I DID NOT FEEL LIKE EATING; MY
APPETITE WAS POOR
• MY SLEEP WAS RESTLESS
• I ENJOYED LIFE (REVERSED)
• 20 IN ALL
ANSWER CATEGORIES
• NONE OR RARELY (LESS THAN 1
DAY); SOME (1-2 DAYS); MODERATE
(3-4 DAYS); OFTEN (> 4 DAYS)
• 0, 1, 2, 3 SCORES
SCORES
• ADD RESPONSES
• 16 NORMAL CUTOFF FOR CES-D
ISSUES
• WHAT DOES IT MEASURE –
DISORDER OR DISTRESS?
• HIGH RATES – 20% TO 30% OVER 16
• SENSITIVE TO IMMEDIATE EVENTS
• MUCH CHANGE – ONLY 1/3 OF
PEOPLE STAY IN SAME CATEGORY
OVER SEVERAL MONTHS
• CAN’T SEPARATE DISORDER FROM
DISTRESS
USE FOR RATES
COMPARE GROUPS IN COMMUNITY E.G. GENDER, SOCIAL CLASS,
MARITAL STATUS, ETC.
COMPARABLE TO DSM
• CAN’T TELL WHAT CESD MEASURES
• WANT SPECIFIC MEASURES OF
DIAGNOSTIC CATEGORIES
TWO MAJOR STUDIES
• ECA - EPIDEMIOLOGIC CATCHMENT
AREA) - 1980’S (WAKEFIELD)
• NCS - NATIONAL COMORBIDITY
STUDY - 1990’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.
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)
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SUPPOSED TO BE SAME AS CLINICAL
1. DISCRETION OF INDIVIDUAL
2. DISCRETION OF CLINICIAN
COMMUNITY STUDIES
NO DISCRETION OF EITHER
NO CONTEXT (LIKE CESD)
RESULT IS OVERCOUNTING
DSM SYMPTOMS
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LACK INTEREST IN SEX
ANXIETY ABOUT PERFORMANCE
AROUSAL DIFFICULTIES
UNABLE TO HAVE ORGASM
CLIMAX TOO QUICKLY
FIND SEX PAINFUL
SEX NOT PLEASURABLE
FINDINGS
• 43 % OF WOMEN AND 31% OF MEN
HAVE SEXUAL DYSFUNCTION
• VERY WIDESPREAD PUBLIC HEALTH
PROBLEM
• PEOPLE MUST KNOW THAT
MEDICATIONS ARE AVAILABLE TO
HELP
SEXUAL DYSFUNCTION
• BEST PREDICTOR?
• LOW SATISFACTION WITH PARTNER
• PEOPLE WHO DON’T ENJOY SEX
WITH PARTNERS ARE CALLED
MENTALLY ILL AND SHOULD TAKE
MEDICATION
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