Transcript Special Challenges in Designing Disaster Studies

State of Mental Health in Ukraine: 2002
Evelyn J. Bromet
September, 2007
Global Burden of Disease
 Late 1990s, WHO published a list of top 10
causes of disease burden in the world
 Depression and alcohol use are in top 10
 Decision was made to organize prevalence
studies around the world to determine the
rates and need for treatment.
Assessment schedule
• Composite International Diagnostic
Interview (CIDI)
• Covers major psychiatric disorders,
alcoholism, disability, and use of medical
and psychiatric services
• Also medical problems, childhood
disorders, marital conflict, demographic
Strength
• Strength: all countries used virtually the
same interview, sampling strategy,
centralized quality control
• Ukraine: first former Soviet country to
participate and the only one with published
data (Bulgaria has data; Romania is
collecting data)
Countries in World Mental Health
Europe+
South America
Belgium
Brazil (one city)
India
France
Costa Rica (planned)
China (2 cities)
Germany
Colombia
China (nat’l planned)
Italy
Mexico
Australia (planned)
Spain
Peru (not done)
New Zealand
Netherlands
Middle East
Asia
Japan
Portugal (planned)
Israel
N. Ireland
Lebanon
South Africa
Turkey
Palestine (in field)
Nigeria
Ukraine
Iraq (in field)
Bulgaria
Romania (in field)
Africa
Ukraine WMH
 Funded by US National Institutes of Health
 Collaboration of Kiev International Institute
of Sociology, Ukrainian Psychiatric
Association, and Stony Brook
Focus Group Work
 Examine the face validity of the items
in key sections of the interview
(depression, PTSD, alcoholism
employment, services)
 Big discussion on consent form
Two Studies
 Population Survey
 Clinical Reappraisal Study
Population survey
 National probability sample adults 18+
 N=4725
 Response rate = 78.3%
Number of respondents in each oblast
Characteristics of 4,725 respondents
• 1/3 rural, 1/3 mid-size urban, 1/3 large
urban areas
• 47% interviewed in Ukrainian
• 44% currently employed; 38% retired
• 16% adequate financial status, 51%
inadequate, 33% very inadequate
Characteristics of 4,725 respondents
•
•
•
•
Sex: 38% male
Age: median=49
44% education beyond high school
60% currently married
• Therefore data were weighted to census for
all analyses
Prevalence
• Overall, 32% of population had 1+ disorder
in their lifetime; 18% in year before
interview.
• Consistent with WHO report, depression
and alcoholism were the two most common
disorders.
Alcohol Abuse and Dependence
Abuse: Persistent use for 12 months or more in spite of:
1. Physical hazards
2. Being arrested for drunken behavior
3. Getting into major fights while drunk
Dependence: Period of 12 months or more with:
1. Tolerance (needing more for an effect)
2. Withdrawal (needing alcohol in morning)
3. Persistent desire for alcohol
4. Can’t cut down
5. Give up normal activities in order to drink
Prevalence of Any Alcohol Disorder
30
Men
25
Women
20
%
15
10
5
0
Lifetim e
12-m onth
Past m onth
Lifetime prevalence compared with Europe
30
25
20
Ukraine
15
Europe
10
5
0
Total
Males
Females
How to tell if your cat is a male............
Generational differences in alcoholism
35
<25
30
25-34
25
%
35-49
20
50+
15
10
5
0
Men
Median age of onset = 25
Women
Risk factors for alcoholism
•
•
•
•
•
Male
Russian-speaking
Low education
Separated and divorced
Adequate finances
Hospitalization
• 7.7% of men and 14.9% of women were
hospitalized overnight for alcoholism
DSM-IV major depression
Period of 2 weeks or more with 5 of 9 persistent symptoms
1. Depressed mood most of day
2. Loss of interest
3. Weight loss or gain
4. Sleep problems
5. Agitated or slowed down
6. Fatigue, loss of energy
7. Worthlessness or guilt
8. Concentrate problems
9. Suicidal thoughts
Prevalence of Depression in Ukraine
25
20
% 15
Men
10
Women
5
0
Lifetime
12-month
Lifetime prevalence compared with Europe
25
20
15
Ukraine
Europe
10
5
0
Total
Males
Females
Generational differences in depression
30
25
%
20
15
<25
25-34
35-49
50+
10
5
0
Males
Median age of onset 28
Females
Risk factors for depression
•
•
•
•
•
•
•
Female
Older
Widowed, separated or divorced
Retired
Western region
Low education
Poverty
Talked to a professional…
• 17% talked to a professional (usually
general doctor)
• 25% with suicidal thoughts spoke to their
doctor
• Thus most did not seek help.
Chornobyl story
• AFTER assessing disorders, asked if ever
lived in area contaminated by Chornobyl.
• 388/4725 exposed to Chornobyl, 8%
• Slightly more exposed (p<0.05)
--rated health poor (25% vs 21%)
--depression (18% vs 14%)
--alcoholism (19% vs 11%)
Chornobyl story: liquidators
• After completed the study, RCRM did the
interview with 295 liquidators from 5
regions
• Compared them with 397 men from same
regions who were in World Mental Health
• Liquidators >depression, anxiety, suicide
ideation and severe headaches, and missed
more days from work.
Validity study
• Diagnostic Reinterview Study SCID
• Dr. Gutkovich, Kostyuchenko & Havenaar
• Trained 15 psychiatrists from 3 cities: Lviv,
Kyiv, Donetsk
Method
176 respondents were assessed by psychiatrist
Interviews were tape recorded
Tapes reviewed in Kyiv and at Stony Brook
Comparisons between CIDI and SCID
Results
• CIDI –SCID agreement: 98% alcoholism
78% depression
• Areas of disagreement:
SCID alcoholism > CIDI
SCID depression < CIDI
Conclusion
• Ukraine among countries with highest rates
of disorder, especially alcoholism
Lifetime Rates Any Disorder: Top 5 Countries
50
40
%
30
20
10
0
USA
New
Zealand
Colombia
France
Ukraine
Conclusion
• Ukraine among countries with lowest rates
of mental health treatment
Mental health specialty care past 12 months:
Lowest 5 Countries
3
2.5
%
2
1.5
1
0.5
0
S. Africa
Ukraine
Lebanon
China
Nigeria
Ukraine: 1.2% of population, 4% of those with a 12-month disorder; 0.6% without
Conclusion
• In most countries, treatment, if sought, is from
general practitioners
• In all countries, especially Ukraine, poorly trained
to treat mental health and alcohol problems.
• Challenge for Ukraine, given the small number of
mental health professionals, is to train general
practitioners to recognize and adequately treat
mental health and alcohol problems.