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Prevention of Mental Health Problems > Lecture 1: Introduction > Flashcards

Lecture 1: Introduction Flashcards

1
Q

What is meant by disease burden?

A

The burden of disease is expressed in Disability Adjusted Life Years (DALYs)

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2
Q

Explain in detail what DALYs are

A
  • The amount of ‘health loss’ in a population caused by illness, disability, or early death
  • 1 DALY = 1 year of ‘healthy’ life lost
  • 0 DALY = ‘perfect’ health an no premature death
  • DALY = Years Life Lost (YLL) + Years Lost due to Disability (YLD)
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3
Q

Explain YLD

A
  • Years Lost due to Disability (YLD) = an estimate of reduction in QoL
  • Most important for the burden of mental health disorders
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4
Q
  1. How many people (%) are affected by mental health disorders?
  2. What percentage of the total disease burden (DALYs) ?
  3. How much of all quality of life lost (YLD)?
A
  1. 16%
  2. 7%
  3. 1/5
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5
Q

Name 3 high and 4 low prevalence mental disorders

A
  • High: anxiety, depression, addiction (2/3 of DALYs)
  • Low: bipolar disease, Schitzophrenia, Eating disorders, Autism (1/3 of DALYs)
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6
Q

Why is the burden of mental disorders such as anxiety and depression so high?

Name 4 reasons

A
  • High incidence
  • Recurrence rates are high (high prevalence)
  • Onset is generally at an early age
  • Affect the working population
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7
Q

Give an explanation as to why the prevalence of mental disorders is higher in high income countries (HIC) compared to low and middle income countries (LMIC)

A
  • More empirical evidence in HIC
  • Better treatment in HIC (treatment in LIMC are still lacking, so the impact is more devastating)

(+ in LIMC poverty was related to more mental health burden)

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8
Q

Why is the global burden of mental health disorders underestimated?

A
  • People with personality disorders are not included
  • Indirect contributions of mental health disorders to mortality
  • In some countries: suicide and self-harm are grouped under injuries
  • Overlap with other (neurological) disorders
  • People with chronic pain disorders are not included
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9
Q

Why is prevention important

A

Treatment has a limited effect on YLD:
- E.g., max. estimated reduction in burden with optimal coverage and evidence based treatment is 49% for any anxiety disorder and only 22% for schitzophrenia

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10
Q

Why prevention? (effect + offer)

A
  • 11-17% reduction of disease burden possible with prevention
  • Prevention offers new and cheaper options

“An ounce of prevention is worth a pound of cure”

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11
Q

What is the difference between prevention and promotion?

A

They have different outcomes!

Promotion is focused on increasing well-being, competence, resiliance and creating supportive living conditions and environments

Prevention is focused on reduction of incidence, prevalence, recurrance of disorder (prevent onset)

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12
Q

Mental health condition versus positive mental health?

A

Mental health condition: with/ without diagnosis of a mental health disorder (objective)

Positive mental health: Positive/ poor perceived mental health (subjective)

BUT they are related, poor subjective mental health is a predictor of developing mental health disorder and generally people with a mental health disorder have poor subjective mental health

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13
Q

What does mental health or well-being refer to?

A

Mental health or well-being refers to positive emotional well-being, psychological- and social functioning

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14
Q

Explain primary, secondary and tertiary prevention (traditional medicine)

A

Primary: prevent onset of a disorder
Secondary: early identification and treatment of those diagnosed
Tertiary: prevent recurrence, relapse or worsening (disability)

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15
Q

Explain the different types of primary prevention in mental health

A

Univeral: targeting the population
Selective: target subgroups that are at risk
Indicated: target people in early stages who experience symptoms

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16
Q

What are the 4 different components of the spectrum of prevention according to Mozek & Haggerty (1994)?

A
  1. Promotion
  2. Prevention (universal, selective, indicated)
  3. Treatment (case identification, standard treatment for known disorders)
  4. Maintenance (Compliance with long-term treatment, reduction in relapse and recurrence, aftercare/ rehabilitation)
17
Q

What are challenges in the prevention of mental health problems? (7 items)

A
  1. Costs
  2. Complexity (it is often unknown if the disorder will occur, in who and what kind of disorder)
  3. Low uptake of preventive interventions (less urgency/ no motivation, stigma)
  4. Real prevention interventions need a large sample size (high NNT)
  5. Prevention studies require long follow-ups (long time before a person develops a disorder)
  6. Multiple programs and risk factors are generic (what do you want to prevent?)
  7. Reach (how to reach people who are not integrated into an existing structure, such as a healthcare system)
18
Q

What is the diathesis stress model?

A

Both diathesis and stress are necessary for a disorder to develop

Diathesis = predisposition or vulnerability to a disorder
Stress = the occurance of some severe environmental/life event

Aims to explain how a mental disorder develops based on:
- Vulnerability to mental illness
- The the amount of stress

High stress + high vulnerability = onset

19
Q

What are (generic) risk factors for the development of mental disorders?

(5 in total)

A
  1. Stressful environmental or life event
  2. Temperamental and personality traits
  3. Neurobiological factors
  4. Cognitive processes and biases
  5. Genetic make-up

These factors interact (in a complex way) to have direct or indirect effects on the development of psychopathology. Causal pathways are difficult to determine.

20
Q

What are (generic) protective factors for the development of mental health disorders?

(5 in total)

A
  1. Feelings of control
  2. Good interpersonal relationships
  3. Social support
  4. A high self-esteem
  5. Good health

= factors that protect against developing psychopathology. These are also the focus of some preventive interventions

21
Q

What can help understand risk and protective factors in relation to disorder onset?

A

A complex system approach
(e.g. includes different factors on different levels)

22
Q

What is the current state of prevention? (start, professionalization, themes)

A
  • First prevention officials in the 70’s
  • Regionale Instelling voor Ambulante Geestelijke Gezondheidszorg (RIAGGs) were set up
  • Professionalization (complex programs, programmatic approach)
  • 70% in 4 themes:
  1. Depression
  2. Work
  3. Social psychiatry
  4. Children of parents with psychiatric problems (COPP)

Now there is also more attention for:
- Students
- Suicide
- Low SES
- Chronic illness
- Caregivers

23
Q

Programmatic approach (3 levels)

A
  1. Micro-level = individual
  2. Meso-level = community
  3. Macro-level = societal
24
Q

What preventive methods are there? (7)

A
  • Policy
  • Mass media campaings
  • Psycho-education
  • Support- and contact groups
  • Guided self-help
  • Courses or training programs
  • Skills training
  • Etc.
25
Q

Provide an example of a policy method and mass media campaign

A

Policy: smoking ban, strips (pain-killers) to prevent suicide

Mass media campaign: ‘omgaan met depressie’

26
Q

Explain what group prevention is and name one benefit

A
  • Varieties: Psycho-education, support groups, contact groups
  • Contents: Exchanging experiences/ emotions, providing information, teaching coping skills
  • Usually closed groups of 8 to 12, sometimes open
  • Hosted by professionals, lay people or fellow sufferers

Benefit: cheaper

27
Q

Explain what self-help is (varieties/ advantages)

A
  • People work through intervention programs on their own (sometimes with minimal guidance)
  • Guided by phone/ via internet/ therapist or lay trainer
  • Varieties: books, internet/ e-health
  • Advantages: accessible, cheap, 24/7 available, less stigmatizing

E.g.: I Care (website)

28
Q

At what settings can preventive interventions be offered?

A
  1. School settings
  2. Workplace
  3. Hospital
  4. Community
  5. Caring universities
29
Q

What are the main topics of school interventions?

A
  • School drop-out
  • Substance use
  • Risky sexual behavior
  • Delinquency
  • Youth suicide
  • Bullying
30
Q

What are the main topics of workplace interventions?

A
  • Stress
  • Depression
  • Social skills
  • Vitality programs
  • Time-management
31
Q

What are the main topics of hospital interventions?

A

E.g, oncokompas (steun bij leven met kanker)

Screening for problems:
- Practical problems
- Family and social problems
- Emotional problems
- Spiritual problems

Based on screening people can get tailored interventions to adress the problems that they experience

32
Q

What are key aspects of community interventions?

A
  • Usually a combination of interventions
  • In a specific area
  • Involving many layers
  • Positive effects! (but unclear what components are effective)
33
Q

Programs usually involve:

A

Psycho-education and interaction in the form of group meetings and (self-help) courses

Prevention of Mental Health Problems (8 decks)

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