MH-O3
Jambo
mh-o3.rtfLesson 3: Epi emiologyof
Readings Predictors for the Daily Value of Bitcoins
Required
enta Health
Frank, R.G., & Glied, S.A. (2009). Better but not Best: Recent trends in the well-being of the mentally ill. Health Affairs, 28(3), 637-648.
Kessler, R.C., McGonagle, K.A .. Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.U., & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives a/General Psychiatry 51,8-19.
National Survey on Drug Use and Health: Mental Health Findings hl:-rJ.
Pages 9-74 (skim).
WHO World Mental Health Survey Consortium (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal a/the American Medical Association, 291(21),
2581-90. -r
1
shapeType75fBehindDocument1pWrapPolygonVertices8;8;(21498,0);(0,0);(0,21496);(11281,21496);(11281,13329);(6219,13329);(6219,10632);(21498,10632)posrelh0posrelv0pib
shapeType75fBehindDocument1pWrapPolygonVertices8;6;(21500,0);(13467,0);(13467,7682);(0,7682);(0,21500);(21500,21500)posrelh0posrelv0pib
Statistics are human faces with the tears wiped off.
What is epidemiology and why is it important?
115.4 percent of American adults have a serious mental illness" (Kessler et ol., 1998)
"Suicide is the 2nd leading cause of death among men 25-34 in the United States" (Centers for Disease Contro!,2014)
"Serious mental illnesses cost society $193.2 billion in lost earnings per year" (Kessler et al., 2008)
"Mental and behavioral disorders, such as depression, anxiety, and drug use, are the primary drivers of disability worldwide and caused over 40 million years of disability in 20- to 29- year-olds" (WHO Organization, 2004)
Broadly speaking, epidemiology is the study of health and illness in human populations (Kleinbaum, Kupper & Morgenstern, 1982). More specifically, epidemiology can fall into two general areas. Descriptive epidemiological studies examine the incidence and prevalence of different health-related outcomes.
• Incidence rate: The rate at which new cases occur in a population during a specific period. For example:
2
o Missouri has the 18'h highest rate of suicide in the nation among youth 10-2-1 year o Ids. In 2013, the rate was 18 higher than the national average (9.6-1 compared to 8.15 per 100,000 nationally). (Centers for Disease Control and Prevention, 2013).
• Prevalence rate: The proportion of a case that exists in a population at a point in time (usually expressed by a percentage). For example:
o "5.4 of all American adults have a serious mental illness" (Kessler et al., 1998)
Descriptive epidemiology also examines the occurrence of a disease or health outcome for different populations, such as age, gender, race, culture, economic status, education, occupation, etc. Descriptive epidemiological questions might include:
1) What mental illnesses (including substance abuse) are most common in the U.S.?
Internationally? Are there differences in the prevalence of these illnesses globally?
2) What mental illnesses are most common among children? Adolescents? The elderly?
3) What is the cost and burden of mental illness to society? Are there differences based upon the type of illness?
4) Do characteristics such as wealth, culture/race, occupation or education affect a person's mental health?
Analytic epidemiological studies explore the relationship between risk factors and antecedent conditions to health outcomes. These studies might examine the effects of parenting, school achievement, alcohol and drug use, exposure to trauma, genetics, religious upbringing or a host of other factors on a mental health outcome. These studies can be used to identify risk factors and assess the relative strength of association of each of these risk factors to the mental health outcome of interest (also called correlational research).
Examples of conclusions that might be reached as a result of an analytic epidemiological study might include:
1) Positive teacher-student relationships are strongly correlated with low substance use among adolescents (Missouri Student Survey. 2014)
2) Prior suicide attempts are among the strongest risk factors for completed suicide" (Moscicki, 1997)
3) Maternal prenatal poverty may be a risk factor for schizophrenia (Cohen, 1993).
Questions to be answered in an analytic epidemiological study might include:
1) Are some mental illnesses inherited? Environmentally related? Induced by stress?
2) What is the impact of war on mental health? What is the impact of natural disasters on mental health?
3) Is mental health stigma more prevalent within certain demographic groups?
3
4) What risk factors are related to suicide? Are there different risk factors for those who attempt suicide compared to those who complete suicide?
5) Are some people more resilient than others in their ability to resist using alcohol or other drugs? What characteristics make them more resilient?
6) Is there a relationship between schizophrenia and violence?
Altogether, information from epidemiological studies can be used to understand the burden of disease and its associated costs, assess the health needs of particular populations, advocate and provide treatment to populations most at risk, develop health- care policies and allocate resources.
Study Quality
Because study and data quality can vary considerably depending on a myriad of factors, there are certain things to watch for when examining epidemiological data. Some questions to be considered in reviewing studies might include:
(1) Who funded the study? Did the funder have a vested interest in the outcomes (e.g., a drug company, an advocacy group, a political party)?
(2) How were data collected? Were there procedures in place to assure that the data were reliably collected? How much documentation is available on the quality of the data collection process?
(3) How and by whom were the data analyzed?
(4) Were the studies peer reviewed? Cited by others?
(5) How long ago was the study conducted? How would time gaps affect the validity of the data?
(6) Was the data being used drawn randomly from a population or is it a convenience sample?
(7) How were data collected? Were there any flaws in the data collection process that would affect the study findings?
(8) Was the sample size large enough to be able to make general statement about a population?
(9) (For randomized or quasi-experimental control designs) Were the individuals in the study selected at random? Do they reflect the population of interest?
Some Interesting Statistics
This week's readings include an extensive array of epidemiological findings from major studies that have been conducted over the past 20 years. There are a few studies that need to be highlighted.
First, the Epidemiologic Catchment Area (EDC) study in the 1980's and the National Comorbidity Study in the early 1990's both surveyed the U.S. adult population to assess the prevalence of mental illness according to DSM-III and DSM-III-R categorizations. When taken together, they estimate that around 20 of the U.S. population is affected by mental illness in a given year, 3 percent have both mental and substance abuse disorders, 6 percent have substance use disorders alone. Anxiety disorders (phobia, generalized
4
anxiety disorder, panic disorder, OCD and PTSD) were most prevalent (16.4) followed by mood disorders (major depressive disorder, dysthymia, and bipolar disorder)(7.1 ), antisocial personality disorder (2.1 ) and schizophrenia (1.3).
From 2001 to 2003, the NCS was administered again, (the National Comorbidity Survey Replication [NCS-R]). Prevalence estimates based on several analyses of these data yielded different estimates. One estimated that 26.2 of adults had a mental illness in a twelve-month period (Kessler et aI., 2005). Another analysis of CS-R data estimated the 12-month prevalence of mental illness to be 32.4 among adults. Differences in estimates may be due to different analytical techniques, with the higher estimate the result of different weighting methods. Both estimates include substance use. More specific data from these studies are in your readings for this week, or in the reference section below.
In 2004, the World Health Organization (WHO) conducted a global survey of mental illness with a sample size of 60,463 (unfortunately, the WHO has not updated these data as of2014). As shown on the table below, in the U.S., anxiety disorders were most prevalent (16.4), followed by mood disorders (9.6), impulse control disorders (6.8), and substance use disorders (3.8). Mental illness was higher in the U.S. than in any other country surveyed.
Table 2. Twelve-Month Prevalence of World Mental Health Composite lnternauonal Oragnosnc Interview/Diagnostic and Steusticst Manual 01 Mentill Disorders. fourth t.dtuon
0/0 (95 Conftd~nce Int~rva~
Country
Anxi~ty
Mood
trnpulse-Controt
Substance
Any
Arne-cas CoIcmba
·C.O·S.c·l· .7)
08113.0·7 T'
2.8 (2.0·3.7)
'7.8116.1·-9.5)
vex co
e.5~.e 1.91: '8.2 '169: '9.5,
48140:'.6 9.618.0 104)
3 !::J9 8\
2.::>1183.3)
'22 (10.0 '3.(0)
Jnited S:81€S
38(5978\
,'38 (3.245)
6.9 '4.59.4\ 62 14.0 7.0§
12 (O.S I.g~+ '2.0 (9.t! K3)
=raoce
. 2.09.8-1 L.2) 85,6.4-' 0 6l§
4 ~7·2..0)
0.7 (0.3-1.2!H - &.4115.3-2- .5)
Ger~.ar·,
62 4.7 7.01 3.612.0-4.3:§
0.3 :Q.' 0.6\
I 10.<: 1.7:rH 9.1 (7.3-108)
:aly_ \,etherlGJlds Soai'1
5.oi45-7:\ 2.8~:':-4.5:§
e.o io 6-1 .. 01 ._6.914.1 -9.7:§_
4.94.0-S.8:§,.
J 3 (.) 1·05. 3 (.).4·2..2) J 5 (.)2·J8'
0.' (0.0-02,.::)t~+:..- __ 8::.;.::.2 .;.:16;;.;.1_-9::';';..:.1)_
3.,2.(07·5.2)11 '4.9112.2··7 . .§L
0.3 (0 0·0 S)H 9.2 Il.8-106)
6. ~ (4.&-1;, • )H 20.5 111.7 -23.2)
5.9.45 13l
Mldc e East ,,'10 Africa ~eba'lor
9.1113-·09)§
3212.4·':.0\11#"
. 1.2 8.9 :1'::;
6.614.952'
1.31O.0·?£S)
. 0.9 113.6 ·20.2)
0.010.5' .0:
0.810.31.2)
4.7 13.6 5.8)
Asa
"'eop.e's RepubliC of Cr na BeI)fl9
shapeType75fBehindDocument1pWrapPolygonVertices8;14;(6918,0);(4199,0);(4199,5762);(2593,5762);(2593,14666);(0,14666);(0,21494);(21498,21494);(21498,5762);(16925,5762);(16925,0);(13344,0);(13344,5762);(6918,5762)posrelh0posrelv0pib
3.1 12.2-4 •
1 7 (0.3-30)
8.8 (6.4-1' 2)
Japar
S1angha
9,116.0-12.1)
"'J-\tlX:t':::'.,-(~J(Ct1~ fl. tJ~k!d9;r:j:ht.:C ~ J..of:"d1it/1.., .• i. "ii"'t!,j' rnol~~ • r s r : .• .J",,'~ f (JJ"I" !>'Jfl -li .1(1'-1 'I·J"~lIr'!lJl ,Ic 'j",", ;I""I'K'f ~)f1r.ptl~>t)I;lt :i:f"id~"":". pl'Krn. Mal~": {li.'il It:t 1 S j-yIUt:t Li~~.tH .•• ·tl 11 ·.)r'I, f~I·. <:".f'V1 rl ~-:r rl sr .~I If I. t't .....,- ..•. ' ~~.,~ f. ['r(ll.":. '-I 'nr ~ , •••. ' .• , •• 1-. I "If L,t;> tliJrl :,. n~t.:i1 .Ur:nf I· v r-~\J" Qj"JI'"ff6r ~ndrl:~l(,X'l''fln •. -.,\;;J'..flll·r1t1''':)fI;I''-'r .•.• rt .;I'~,rf~'" ;rJ:i flL-J.~!.:lf, •. ''II J"I'I':1"l~JlI'llll "~·l.I"'if.'''',fI_ ,'Ld:j('L~ 1')11 lJ' 1(.- •.. )/'" 4fld'IJUIf,.»IilJlI.:tlfldi-Jr., dstl(J..--r;. ~lr~(j(li t' IS-I" ~ r:; rlt1 •• 11,· '/r .• , •••• 'Jr,JJ -~,J: '" )'p._A"; t·-f'II.:' rt : t ' ,:,., "I .• ,~.t)CJ ,nl J' lt1Jt- .•. -,lth _to I ::rIlllt'". itn' 'Nhlll'ld' lilt (' 'il ti~~! -'.I._ff'~ r:t-f_~ Iff ,,...J, Iti; and .••• tro ceO:1 .e: ";'J.\' 'i··:v.""I('A!:J"'!'"IS ·ire. IlornY1 "--'G IIJ 11'1· • I I Il"I"1 .( f.f"Jlt,n- (,.1111r.'t!,'1 nJT ~'-r: :llJ nlJ~ r·I\"1.~t '~J ('r'~ 1':-4 If A" fl,' (U,*.tt1.!I' , ()((~ l"'!Xrl.~I~ V'1(.1~
fn~ld(·~Jssp.:.~'!~drlt"i·{~:t"~_J"ili.!.J,'· <:i)~J-,",l~J!.sl;,do'·~'-" :.j,.·01~.~'t"70rv·-1-4 t+s rcs« J'JP'; t ::,z!f" n.,cciTJ1lJi'lr r'I,I:JI ·,r ~'/)l;'I"l( .!I 1
f~~w.e COf"r1\,sfli· li';'l' ."1 ·.,.'-r; rkt; ~J.'''' Ss.~,
r~r~_«"fi< ,r-:hut"1d 'A"I 1l1;1,li •• ' .•.• ' •• 11.
~J~fx>ta' ctiS<)I'Ut.'r"; Wt'h "xJ( f:ts..·~'· ....• s",'l
1n;.;:.>rr-lIth.:nt i::"r:fll~!o..!' :13~)('~' r V"'J~ /lill ;.s,,_'). ':-"'~~" l1B~irr~ ..,'rdS 11;,): &..$i,".>,.<.:,-/I
N,'\Ut'fr.llfi <.Jt"-nl tl','l,'r;.tcl :y .;'.-f k·, \.'.:11":' -j' "i'O~l)(J51ljfY'':'j SCli-JHI dSnHl!.. ••. , •• ~;.j~ Ilu! '-j.S·~ ·;~dl. t 'COrllil('! (Ii:;:..-fli'f ·II~I' ''10 ,I j .;.,:""" r l
t :Onh al~'nhll ;j~'IIJ-';'" ,:r1:1 ,1'-1"11"1 I,flt " 'N .. I! ~~";,'''~-I; N.:) iI~k •• -.,,,1"I"'1 '_\"I~~r';H':' 1/ .·~h·1 Ii •• J 'I:~I"" :)1' ~111"'I'-11(.j
5
Years Lost to Disability (YLD). YLD is the equivalent years of healthy life lost through time spent in a state of less than full health. When all the years of life with reduced capability for all the sufferers of each condition are added up and weighted by the disability weight, a total of YLD for each condition is obtained.
Globally, unipolar depression accounts for the highest number of years lost to disability for both males and females. It is estimated that 41.0 million years are lost to disability among women worldwide and 24.3 million years among men. Alcohol use is the 2nd leading YLD among males. Schizophrenia is 5th and 6th among men and women respectively.
Leading global causes of YLD by sex, 2004 (Global Burden of Disease Report, 2004)
Males
Females
Unipolar depression
24.3
Unipolar depression
41.0
Alcohol use
19.9
Refractive errors
14.0
Hearing loss
14.1
Hearing loss, adult onset
13.3
Refractive errors
13.8
Cataracts
9.9
Schizophrenia
8.3
Osteoarthritis
9.5
Cataracts
7.9
Schizophrenia
8.0
Bipolar disorder
7.3
Anaemia
7.4
COPO
6.9
Bipolar disorder
7.1
Asthma
6.6
Birth asphyxia and birth trauma
6.9
Falls
6.9
Alzheimer and other dementias
5.8
Taken together, these data sources stress the importance of treating mental health issues to improving quality of life worldwide.
Data Sources for Epidemiological Research
Data for epidemiological studies come from a variety of sources, including population surveys and censuses, randomized control trials, cost studies, existing records (e.g., crime statistics, mortality data, child abuse and neglect data, etc.).
In addition to published articles and reports, there are data sets that you can access on- line if you want to do your own research with existing data. Here is a website that has a large list of national. state and local public health data sets and we strongly encourage you to explore them and see the extent to which they include mental health related data.
In Missouri, there are several places you can go to get state-specific data. Here is a summary of some of the major datasets that might be of interest that related to mental health:
Years Lost to Disability (YLD). YLD is the equivalent years of healthy life lost through time spent in a state of less than full health. When all the years of life with reduced capability for all the sufferers of each condition are added up and weighted by the disability weight, a total of YLD for each condition is obtained.
Globally, unipolar depression accounts for the highest number of years lost to disability for both males and females. It is estimated that 41.0 million years are lost to disability among women worldwide and 24.3 million years among men. Alcohol use is the 2nd leading YLD among males. Schizophrenia is 5th and 6th among men and women respectively.
Leading global causes of YLD by sex, 2004 (Global Burden of Disease Report, 2004)
Males
Females
Unipolar depression
24.3
Unipolar depression
41.0
Alcohol use
19.9
Refractive errors
14.0
Hearing loss
14.1
Hearing loss, adult onset
13.3
Refractive errors
13.8
Cataracts
9.9
Schizophrenia
8.3
Osteoarthritis
9.5
Cataracts
7.9
Schizophrenia
8.0
Bipolar disorder
7.3
Anaemia
7.4
COPO
6.9
Bipolar disorder
7.1
Asthma
6.6
Birth asphyxia and birth trauma
6.9
Falls
6.9
Alzheimer and other dementias
5.8
Taken together, these data sources stress the importance of treating mental health issues to improving quality of life worldwide.
Data Sources for Epidemiological Research
Data for epidemiological studies come from a variety of sources, including population surveys and censuses, randomized control trials, cost studies, existing records (e.g., crime statistics, mortality data, child abuse and neglect data, etc.).
In addition to published articles and reports, there are data sets that you can access on- line if you want to do your own research with existing data. Here is a website that has a large list of national, state and local public health data sets and we strongly encourage you to explore them and see the extent to which they include mental health related data.
http: ph ~
In Missouri, there are several places you can go to get state-specific data. Here is a summary of some of the major datasets that might be of interest that related to mental health:
You can also visit the MICA data set housed in Missouri's Department of Health and Senior Services. They have statistics for births, deaths, disease and illnesses to name a few. nt.
6
Assignment and Group Discussion
The readings for this lesson are essential for anyone interested in understanding the prevalence of mental illness nationally and worldwide. In the first part of this lesson, four questions in the Descriptive Epidemiology section and six questions in the Analytic Epidemiology section were presented. Pick one of these questions, and drawing from at least two of the readings and other articles you may already be familiar with, provide a response. You must incorporate data from at least one dataset of your choice (global, national, state, etc.) into your discussion post. Discuss the degree to which you think the data you are citing are reliable and valid. Remember your response should be posted to Blackboard by Friday evening at 11 :00 p.m. and subsequent discussion posts by Sunday at 11 :00 p.m.
1) Are some mental illnesses inherited? Environmentally related? Induced by stress?
References
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2013). Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Available from URL:
Cohen, C. I. (1993). Poverty and the course of schizophrenia: Implications for research and policy. Hospital and Community Psychiatry, 44, 951-958.
Kessler, R.C., Heeringa, S., Lakoma, M.D., Petukhova, M., Rupp, A.E., Schoenbaum, M., Wang, P.S., Zaslavsky. A.M. (2008). The individual-level and societal-level effects of mental disorders on earnings in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry 165, 703-711.
Kessler, R.C., Chiu, W.T., Denier, O. & Waters, E.E. (2005). Prevalence. Severity, and Comorbidity of Twelve-month DSM-IV Disorders in the National Comorbidity Survey Replication (NCS-R),Archives of General Psychiatry, 62(6), 617-627.
Kleinbaum, D.G., Kupper, L.L., Morgenstern, H. (1982). Epidemiologic research: principles and quantitative methods. Belmont; Lifetime Learning Publications.
Missouri Student Survey (2014). Missouri Institute of Mental Health report to the Missouri Department of Mental Health.
Moscicki, E.K. (1997). Identification of suicide risk factors using epidemiologic studies.
Psychiatric Clinics of North America, 20, 499-517.
7
