The societal burden of mental ill-health Flashcards
What are the headlines of the WHO global burden of disease?
> Mental disorders are a leading cause of disability across the world - not usually fatal but cause long-term disability
WHO uses the “Disability Adjusted Life Year” (DALY) as an index of disability
The most disabling mental disorder is depression (common and disabling)
Dementia will become an ever larger source of disability
Schizophrenia and bipolar disorder are important - have a greater impact on health budgets than the GBD reports acknowledge
Burden of diseases varies across countries - particularly in relation to the age structure of the population
What is the prevalence of mental disorders in a year in the EU and Switzerland, in the revisited highly detailed epidemiological study of Wittchen and colleagues (2011)?
What does this study takes into account?
What is the difference between their 2005 study and this revisited one?
1 year period prevalence of 38.2% (= 164.8 million)
- taking into account childhood disorders, personality disorders and dementia
- > estimates went up between 2005 and 2011 because they widened the age range considered and scope of disorders
- European context for the global burden of mental disorder
What are the costs of mental health disorders?
> Treatment and care costs > Social security costs > Costs due to lost of productivity > Costs experienced by carers > "Hidden costs" in terms of pain and suffering - not accounted for in economic analysis
What does Thomas Insel (former director of the NIH) question about the World Economic Forum’s (WEF) estimates on the Global Economic Burden of Non-communicable Diseases (2011)?
WEF: estimates global cost of mental illness at nearly $2.5T (2/3 indirect costs) in 2010, with a projected increase to over $6T by 2030
-> What does $2.5T or $6T mean?
- entire global health spending in 2009 was $5.1T
- annual gross domestic product (GDP) for low-income countries is less than $1T
- entire US overseas development aid over past 20 years < $2T
How do we measure prevalence?
Estimate prevalence with:
> Weight disorders
- by disability and if possible with gradings for severity
> Account for premature mortality
How are the Disability-adjusted life years (DALYs) calculated?
Years Lived with Disability (YLD) (prevalence of disorder x disability weight condition) \+ Years of Lost Life (impact of premature mortality)
What are the first 5 neuropsychiatric disorder DALYs (Whiteford et al., 2015) in global mental health studies?
- Unipolar depressive disorders (65 million DALYs)
- Alcohol use disorders (24m)
- Schizophrenia (17m)
- Bipolar affective disorder (14m)
- Epilepsy (the most significant neurological disorder in DALYs) (8 million)
Regarding the global burden of mental, neurological and substance-use (MNS) disorders, what are the first 6 causes in high-income countries (Whiteford et al., 2015)?
- Unipolar depressive disorders (10m DALYs)
- Alzheimer’s and other dementias (4.4m DALYs)
- Alcohol-use disorders (4.2m DALYs)
- Drug-use disorders (1.9m DALYs)
- Schizophrenia (1.6m DALYs)
- Bipolar affective disorder (1.5m DALYs)
Regarding the global burden of mental, neurological and substance-use (MNS) disorders, what are the first 6 causes in low- and middle-income countries (Whiteford et al., 2015)?
- Unipolar depressive disorders (55.5m DALYs)
- Alcohol-use disorders (19.5m DALYs)
- Schizophrenia (15.2m DALYs)
- Bipolar affective disorder (12.9m DALYs)
- Epilepsy (7.3m DALYs)
- Alzheimer’s and other dementias (6.8m DALYs)
What are the 4 major disorders in Europe 2010, in terms of the global burden of mental disorder, in the revisited epidemiological study of Wittchen and colleagues (2011)?
- Unipolar depression
- Dementias
- Schizophrenia
- Bipolar disorder
Total neuropsychiatric
- males = 23.4%
- females = 30.1%
What are Wittchen and colleagues’ (2011) conclusions on their revisited epidemiological study on the European global burden of disease?
> DALY analyses considerably improved measures
- should be used as “a future standard reference”
> New estimates
- confirm that disorders of the brain are the major contributor to the total EU burden
- show that three are tremendous diagnosis-specific differences
- reveal that depression is already now the most important single contributor to the total disease burden
- confirm existence of substantially different disability differences between males and females
Why is the Global Burden of Disease (GBD) data important?
- Helps policy-makers understand the impact of mental disorder at a population level
- Shows us that mental disorders constitute the most important category of non-communicable disease (NCD) in terms of burden of disease
- Provides an argument for investment in mental health research and mental health services
What are the conclusions of the 2011 World Economic Forum regarding non-communicable diseases (NCDs)?
“it would be illogical and irresponsible to care about economic growth and simultaneously ignore NCDs. Interventions in this area will undeniably be costly.
But inaction is likely to be far more costly.”
- > mental disorders are the most significant NCDs
- > “call to arms” for investment in provision, services and research into intervention
In the face of the combination of individual suffering and societal burden, what agendas need being set?
> Research agenda
Policy agenda
Practice agenda
What is the Grand Challenges in Global Mental Health (2011)?
A consortium of mental health researchers, advocates and clinicians, launched in 2010.
Announced in 2011:
- series of research priorities for improving the lives of people with mental illness around the world
- calls for urgent action and investment to tackle global mental health issues
- series of challenges, detailed research issues and goals
