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EPIDEMIOLOGical research in mental health.pptx
- 1. EPIDEMIOLOGICAL RESEARCH IN MENTALHEALTH: IMPORTANCE, HYSTORICAL STUDIES, TECHNIQUES AND PROCESS. CHAIRED BY DR DIPANJAN BHATTACHARJEE CO-CHAIRED BY MR KASHTOV PARAJULI PRESENTING BY MS MRINALINI VISHWAKARMA DISCUSSING BY MS FATHIMA HASANATH K P
- 2. Epidemiology is concernedWith Understanding and controlling disease epidemics by investigating empirically the associations between agent โ host โenvironment. Agent Environment Host
- 3. WHY MENTAL HEALTHRESEARCH PROGRAMS ARE NEEDED IN INDIA? ๏ต There is an urgent need to develop specific indicators to monitor the functions, trends and growth of large scale public mental health initiative. ๏ต Mental health research is required to enhance the technical skills of the primary health care providers by giving them inputs about various facets of mental illness. ๏ต There has to a better public-private partnership. ๏ต Research is required to support NGO initiatives. ๏ต Research has phenomenal role in increasing public awareness about the commonness of mental disorders, understandability of mental disorders as illnesses, treat ability, the important of acceptance by the family and the community and rehabilitation. ๏ต Mental disorders and mental health issues are both universal and local. The roles of the social- cultural factors are more with regard to mental health issues than in the physical disorders area. ๏ต There is an urgent need to create structures to support the mental health program.
- 4. Psychiatric Epidemiology Psychiatric epidemiologylags behind than other branches of epidemiology due to โข Difficulties encountered in conceptualizing โข Difficulty in diagnosing โข Difficulty in defining a case โข Difficulty in sampling โข Difficulty in selecting an instrument โข Lack of resources โข Stigma
- 5. MAJOR EPIDEMIOLOGICAL RESEARCH ININDIA Journey started six decades back (1950-60) โข First psychiatric epidemiological study in India: 1961, Agra By Dr. K. C. Dube โข Development of PSE โข Development of Indian Psychiatric Survey Schedule (IPSS)
- 6. ๏ต Initial epidemiologicalstudies in India Prevalence of psychiatric disorders โข 9.5 to 370 per 1000 population Limitation: Wide variation in the prevalence rates ๏ต Landmark International epidemiological studies โข Epidemiological Catchment Area Program โข National comorbidity Survey Limitation: Wide variation in the prevalence rates
- 8. Pitfalls in Indianstudies Indian epidemiological studies were largely inadequate to tap โข Non-psychotic disorders like panic disorder, social phobia, obsessive compulsive disorder, sexual dysfunction, substance use.
- 9. Epidemiological studies insubstance use disorder ๏ต National Household Survey (NHS-Sponsored by the Ministry of Social Justice and Empowerment (Government of India) and the United Nations Office of Drugs and Crime (UNODC)) ๏ต Drug Abuse Monitoring System (DAMS) ๏ต Rapid Assessment Survey (RAS) ๏ต Focussed Thematic Studies (FTS) ๏ต Drug abuse and women in India ๏ต Burden on women through abusing family members ๏ต Drug abuse in rural population ๏ต Drug consumption in border areas ๏ต Drug abuse in prisons
- 11. INDIAN PSYCHIATRIC SURVEY SCHEDULE(IPSS) ๏ต International Pilot Study of Schizophrenia conducted by WHO ๏ต 9 countries (5 developed & 4 developing) ๏ต Indian centre - Agra ๏ต Aim: Feasibility in conducting F/U study ๏ต Assessment: Baseline, 2yr, 5yr ๏ต Drop out at 5yr: 24% ๏ต Conclusion: Outcome of Schizophrenia better in developing countries than developed countries
- 12. DITERMINANTS OF OUTCOMEOF SEVERE MENTAL DISORDERS (DOSMeD) ๏ต Conducted by WHO ๏ต โข 12 centres in 10 countries ๏ต โข Indian centres โ Agra & Chandigarh (rural/urban) ๏ต โข Aim: Prevalence of Schiz & outcome ๏ต โข Follow up: 2 years (80%) ๏ต โข Conclusion: Developing countries had better outcome. ๏ต Indian population โ less time spent in psychotic episode & less impairment of social functioning
- 13. INTERNATIONAL STUDY OF SCEZOPHRENIA(ISoS) ๏ต Conducted by WHO ๏ต Follow up of cohorts from DOSMeD and RAPyD (Assessment & Reduction of Psychiatric Disability) ๏ต Cohorts โ Incidence cohorts & Prevalence cohorts ๏ต Incidence cohorts โ 12 from DOSMeD & RAPyD, Hong Kong , Madras ๏ต Prevalence cohorts- 3 from IPSS, Beijing ๏ต ICD-8 , 9 diagnoses were converted to ICD-10
- 14. INTERNATIONAL STUDY OF SCEZOPHRENIA(ISoS) ๏ต 3 groups (Schizophrenia only โ F20; other psychotic disorders- F10.5, F22 to 29, F30 to 34; total psychosis) ๏ต PSE-9, DAS, GAF, SANS, Psychologica Impairement Schedule used ๏ต Conclusion: Outcome of schizophrenia is poorest. No independent role of type of onset. Percentage of time spent in experiencing psychotic symptoms in the first 2 years of onset was the best predictor of outcome.
- 15. ICMR- INDIAN COUNSILOF MEDICAL RESEARCH ๏ต Centres: Vellore, Madras, Lucknow ๏ต Aim: Course & outcome of F20 ๏ต Modified criteria for Schizophrenia used (Modified Feighner et al.)~ duration 3months instead of 6months. ๏ต Follow up period โ 2 years ๏ต Follow up rate- Madras 86%, Lucknow 85%, Vellore 76% ๏ต Conclusion: Best pattern of course in 45%, worst pattern 10%. Confirmed the findings of IPSS, DOSMeD.
- 16. National Mental HealthSurvey โข National Mental Health Survey (NMHS) is the largest nationwide survey on Mental health in India. โข Funded by the Ministry of Health and Family Welfare, Government of India. โข Conducted in 12 states of the country โข National coordinating centre: National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, is the coordinating centre for this survey.
- 17. NATIONAL MENTAL HEALTH SURVEY Objectives: ๏ตโ Estimate the burden of mental health problems ๏ต โ Identify the gap in human resources & services for mental health in the country
- 18.
- 19. CURRENT TRENDS ANDSTATUS OF MHRs. ๏ต Going beyond the medical traditions of individual diagnosis, treatment and cure, public health researchers are now focusing on societal approaches to the promotion of health and the prevention of disease and injury among diverse populations and the communities in which they live.
- 20. Emphasizes issues suchas ๏ถ Improvement and redesign of health services integration and delivery. ๏ถ Prevention programs at schools and worksites. ๏ถ Evaluating and redesigning public and private insurance and funding mechanisms ๏ถ Outreach and intervention in populations at risk, such as the aged and the mentally ill ๏ถ Violence and injury prevention ๏ถ Improving the quality of the environments in which people live and work. ๏ถ changing public policies that impact health and health behavior.
- 21. ๏ต Voluntary andNGOs are taking an active interest in research of various aspects of mental health. ๏ต The growth of a private sector in psychiatric services, especially in the urban areas (increase in the numbers of private nursing homes and hospitals, increase in opportunities for obtaining postgraduate training in psychiatry). ๏ต An increasing number of persons with various minor mental disorders are beginning to seek mental health care services. The special needs of certain categories of the population such as children, the aged, women and the rural underprivileged have been recognized. ๏ต With the current rapid urbanization and economic liberalization in the country and the resultant social change the demand for mental health services is only likely to increase.
- 22. EPIDEMIOLOGY OF MENTALHELATH PROBLEMS IN COVID 19 ๏ต Studies have shown that the general population who had been experiencing different levels of psychosocial stressors amid the COVID-19 pandemic had developed mental health problems. ๏ต A fear of ongoing outbreak, susceptibility to infection, exposure, or close contact with someone with COVID-19 affected mental health and wellbeing among the general population. ๏ต Individuals with COVID-19 diagnosis had profound psychological distress, anxiety, depression, and other mental health problems compared to those who were not infected. ๏ต This illustrates the fear of adverse health outcomes due to COVID-19 may have affected mental health, which also highlights the mental health aspect of a physical health problem among those individuals.
- 23. FUTURE OF EPIDEMIOLOGICAL STUDIES ๏ตMajor advances in descriptive psychiatric epidemiology in recent years include the development of reliable and valid fully structured diagnostic interviews, the implementation of parallel cross-national surveys of the prevalence and correlates of mental disorders, and the initiation of research in clinical epidemiology. Remaining challenges include the refinement of diagnostic categories and criteria, recognition and evaluation of systematic underreporting bias in surveys of mental disorders, creation and use of accurate assessment tools for studying disorders of children, adolescents, the elderly, and people in less developed countries, and setting up systems to carry out small area estimations for needs assessment and program planning.
- 24. ๏ต A majorchallenge for psychiatric epidemiologists is to increase the relevance of their analytical research to their colleagues in preventative psychiatry as well as to social policy analysts. ๏ต Another challenge is to develop interventions aimed at increasing the proportion of people with mental disorders who receive treatment. ๏ต Despite encouraging advances, much work still needs to be conducted before psychiatric epidemiology can realize its potential to improve the mental health of populations.
- 25. CONCLUSION Mental health problemsconstitute a wide spectrum ranging from sub-clinical states to very severe forms of disorders. Majority of the epidemiological studies focused on visible mental health problems. Invisible mental health problems continue to remain unexplored and unaddressed. Mental healthcare priorities need to be shifted from psychotic disorders to common mental disorders and from mental hospitals to primary health centres. Increase in invisible mental health problems such as suicidal attempts, aggression and violence, widespread use of tobacco, alcohol and other drugs, increasing marital discord and divorce rates emphasize the need to prioritize and make a paradigm shift in the strategies to promote and provide appropriate mental health services.
- 26. REFERENCES ๏ต Baumeister, H.,& Hรคrter, M. (2007). Prevalence of mental disorders based on general population surveys. Social psychiatry and psychiatric epidemiology, 42(7), 537-546. ๏ต Borges, G., Medina-Mora, M. E., & Lรณpez-Moreno, S. (2004). The role of epidemiology in mental disorder research. Salud Pรบblica de Mรฉxico, 46(5), 451-463. ๏ต Dohrenwend, B. P. (1998). A psychosocial perspective on the past and future of psychiatric epidemiology. American journal of epidemiology, 147(3), 222-231. ๏ต Hossain, M. M., Tasnim, S., Sultana, A., Faizah, F., Mazumder, H., Zou, L., ... & Ma, P. (2020). Epidemiology of mental health problems in COVID-19: a review. F1000Research, 9. ๏ต Lee, Y. M., & Lee, E. S. (2005). International Trends of Psychiatric Epidemiology. Psychiatry Investigation, 2(1), 14-21.
- 27. REFERENCES ๏ต Leff, J.,Sartorius, N., Jablensky, A., Korten, A., & Ernberg, G. (1992). The International Pilot Study of Schizophrenia: five-year follow-up findings. Psychological medicine, 22(1), 131-145. ๏ต Math, S. B., & Srinivasaraju, R. (2010). Indian Psychiatric epidemiological studies: Learning from the past. Indian journal of psychiatry, 52(Suppl1), S95. ๏ต Reddy, V. M., & Chandrashekar, C. R. (1998). Prevalence of mental and behavioural disorders in India: A meta-analysis. Indian journal of psychiatry, 40(2), 149. ๏ต Sartorius, N., Shapiro, R., & Jablensky, A. (1974). The international pilot study of schizophrenia. Schizophrenia Bulletin, 1(11), 21. ๏ต Shepherd, M., & Cooper, B. (1964). Epidemiology and mental disorder: a review. Journal of neurology, neurosurgery, and psychiatry, 27(4), 277.