Lecture 1: Introduction Flashcards
What is meant by disease burden?
The burden of disease is expressed in Disability Adjusted Life Years (DALYs)
Explain in detail what DALYs are
- 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)
Explain YLD
- Years Lost due to Disability (YLD) = an estimate of reduction in QoL
- Most important for the burden of mental health disorders
- How many people (%) are affected by mental health disorders?
- What percentage of the total disease burden (DALYs) ?
- How much of all quality of life lost (YLD)?
- 16%
- 7%
- 1/5
Name 3 high and 4 low prevalence mental disorders
- High: anxiety, depression, addiction (2/3 of DALYs)
- Low: bipolar disease, Schitzophrenia, Eating disorders, Autism (1/3 of DALYs)
Why is the burden of mental disorders such as anxiety and depression so high?
Name 4 reasons
- High incidence
- Recurrence rates are high (high prevalence)
- Onset is generally at an early age
- Affect the working population
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)
- 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)
Why is the global burden of mental health disorders underestimated?
- 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
Why is prevention important
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
Why prevention? (effect + offer)
- 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”
What is the difference between prevention and promotion?
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)
Mental health condition versus positive mental health?
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
What does mental health or well-being refer to?
Mental health or well-being refers to positive emotional well-being, psychological- and social functioning
Explain primary, secondary and tertiary prevention (traditional medicine)
Primary: prevent onset of a disorder
Secondary: early identification and treatment of those diagnosed
Tertiary: prevent recurrence, relapse or worsening (disability)
Explain the different types of primary prevention in mental health
Univeral: targeting the population
Selective: target subgroups that are at risk
Indicated: target people in early stages who experience symptoms
What are the 4 different components of the spectrum of prevention according to Mozek & Haggerty (1994)?
- Promotion
- Prevention (universal, selective, indicated)
- Treatment (case identification, standard treatment for known disorders)
- Maintenance (Compliance with long-term treatment, reduction in relapse and recurrence, aftercare/ rehabilitation)
What are challenges in the prevention of mental health problems? (7 items)
- Costs
- Complexity (it is often unknown if the disorder will occur, in who and what kind of disorder)
- Low uptake of preventive interventions (less urgency/ no motivation, stigma)
- Real prevention interventions need a large sample size (high NNT)
- Prevention studies require long follow-ups (long time before a person develops a disorder)
- Multiple programs and risk factors are generic (what do you want to prevent?)
- Reach (how to reach people who are not integrated into an existing structure, such as a healthcare system)
What is the diathesis stress model?
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
What are (generic) risk factors for the development of mental disorders?
(5 in total)
- Stressful environmental or life event
- Temperamental and personality traits
- Neurobiological factors
- Cognitive processes and biases
- 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.
What are (generic) protective factors for the development of mental health disorders?
(5 in total)
- Feelings of control
- Good interpersonal relationships
- Social support
- A high self-esteem
- Good health
= factors that protect against developing psychopathology. These are also the focus of some preventive interventions
What can help understand risk and protective factors in relation to disorder onset?
A complex system approach
(e.g. includes different factors on different levels)
What is the current state of prevention? (start, professionalization, themes)
- 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:
- Depression
- Work
- Social psychiatry
- Children of parents with psychiatric problems (COPP)
Now there is also more attention for:
- Students
- Suicide
- Low SES
- Chronic illness
- Caregivers
Programmatic approach (3 levels)
- Micro-level = individual
- Meso-level = community
- Macro-level = societal
What preventive methods are there? (7)
- Policy
- Mass media campaings
- Psycho-education
- Support- and contact groups
- Guided self-help
- Courses or training programs
- Skills training
- Etc.
