mh survey result 2011

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National Mental Health Survey 2011

Preliminary Results

LIST OF ABBREVIATIONS


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ABS - Australian Bureau of Statistics

BPD - Brief Psychotic Disorder

CIDI - Composite International Diagnostic Interview

DALY - Disability Adjusted Life Years

DMT- - Dimethyltryptamine

DSM-IV - Diagnostic Statistical Manual of Mental Disorders, Fourth edition

GAD - Generalized Anxiety Disorder

GBD - Global Burden of Disease

ICD 10 - International Statistical Classification of Diseases and RelatedHealth Problems

LSD - Lysergic acid diethylamide

NEC - National Epidemiology Center

NCDPC - National Center for Disease Prevention and Control

NMHP - National Mental Health Program

OCD - Obsessive-Compulsive Disorder

PCP - Phencyclidine [1-(1-phenylcyclohexy-1)piperidine]

PTSD - Post Traumatic Stress Disorder

WHO - World Health Organization

WMH - World Mental Health

WMH-CIDI - World Mental Health version of the Composite International DiagnosticInterview (CIDI version 3.1)


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DEFINITION OF TERMS

DSM-IV Definition of Diagnoses

Alcohol Abuse - a maladaptive pattern of use of alcohol indicated by certain symptoms,continued use despite knowledge of having a persistent or recurrent social, occupational,

psychological or physical problem that is caused or exacerbated by the use (or by) recurrentuse in situations in which it is physical1y hazardous

Alcohol Dependence - a cluster of cognitive, behavioral and physiologic symptoms thatindicate a person has impaired control of psychoactive alcohol use and continues use ofalcohol despite adverse consequences

Nicotine Dependence - a cluster of cognitive, behavioral and physiologic symptoms thatindicate a person has impaired control of psychoactive use of substances containing nicotineand continues use of these despite adverse consequences

Nicotine Withdrawal - a group of symptoms of variable clustering and degree of severity

which occur on cessation or reduction of use of a nicotine containing substances that hastaken repeatedly, usually for a prolonged period and/ or in high doses. Signs ofphysiological disturbance may accompany the syndrome. A withdrawal syndrome is one ofthe indicators of a dependence syndrome. It is also the defining characteristic of thenarrower psycho-pharmacological meaning of dependence.

Substance Abuse a maladaptive pattern of use of substance (other than alcohol ornicotine) indicated by certain symptoms, continued use despite knowledge of having apersistent or recurrent social, occupational, psychological or physical problem that is causedor exacerbated by the use (or by) recurrent use in situations in which it is physical1yhazardous. Substances included in the CIDI diagnoses are: Opioid, Cannabis, Sedative,

Cocaine, Amphetamine, Hallucinogen, Inhalant, PCP, and other substances.

Opioid- refers to a group of substances including heroin, codeine, demerol, morphine,percodan, methadone, Darvon, opium, and Dilaudid.

Cannabis the worlds most common illicit substance. Refers to a group of substancesincluding Marijuana, Hashish, Bhang and Ganja.

Sedative refers to a group of substances including tranquilizers, sleepingpills, barbiturates, Seconal, Valium, Librium, Xanax and Quaaludes. These are drugs thatreduce subjective tension and induce mental calmness.

Cocaine one of the most addictive of the commonly abused substances and one of themost dangerous. Commonly referred to as snow, coke, girl and lady, it is a white powder thatcan be inhaled, smoked and injected. Refers to a group of substances including Cocaine,Crack, coca leaves.

Crack a freebase form of cocaine, which is extremely potent. Highly addictiveassociated with extremes of behavior and violence.

Amphetamine were first synthesized for therapeutic use for narcolepsy, attention-deficitdisorders and depression. Refers to a group of substances including Amphetamines, Khat,Betel Nut and Shabu.


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Khat fresh leaves of the East African bush Catha edulis. Active ingredient isCathinon which has the same CNS and peripheral actions of amphetamine.

Shabu - amphetamine used in the form of a crystalline hydrochloride; used as astimulant to the nervous system and as an appetite suppressant

Hallucinogen refers to a group of substances including LSD, Mescaline, Peyote, Psilocybin,and DMT. It induces hallucinations and a loss of contact with reality and an experience fexpanded and heightened consciousness.

Inhalant refers to a group of substances including glue, toluene, gasoline and rugby

PCP- refers to Phencyclidine [1-(1-phenylcyclohexy-1)piperidine] most commonly abusedarylcyclohexylamine. Commonly referred to as angel dust, crystal, peace, supergrass.

Brief Psychotic Disorder (BPD) - a disorder which lasts less than a month but at least a daywith one or more of the following symptoms: delusions, hallucinations, disorganized

speech, grossly disorganized catatonic behavior. It may have developed in response to asevere psychosocial stressor or group of stressors. Postpartum onset: if within 4 weekspostpartum.

Delusion fixed, false beliefs out of keeping with the patients culturalbackground.

Hallucination false sensory perception not associated with real external stimuli theremay or may not be a delusional interpretation of the hallucinatory experience

Catatonic immobile position that is constantlymaintained

Depressive Disorders - there are 6 diagnoses for depressionMajor Depression Single mild, moderate and severeMajor Depression Recurrent mild, moderate and severe

Major Depressive Disorder - one or more major depressive episodes (lasting two weeks ormore) without a history of manic, mixed or hypomanic episode. Episode is characterizedfeeling sad or empty or losing interest in most activities.

Dysthymic Disorder is a mild form of major depressive disorder characterized by symptomsthat are less severe than major depressive disorder. It is a chronic disorder of having a

depressed (or irritable in children and adolescents) mood that lasts most of the day andoccurs on most days of a two-year period. Dysthymia means ill humored andtypically manifests as : having feelings of inadequacy, guilt, irritability and anger;withdrawal from society; loss of interest and inactivity and lack of productivity.

Panic Disorder characterized as the spontaneous, unexpected occurrence of panic attackswhich can vary from several attacks during 1 day to only a few attacked during a year. May ormay not be accompanied with agoraphobia.

Panic Attack is a discrete period of intense fear or discomfort accompanied by atleast four somatic or cognitive symptoms such as palpitations, trembling, andshortness of breath, sweating and feelings of choking. Can actually mimic a serious

medical condition such as a heart attack.


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Agoraphobia is the fear of being alone in public places, which can be the most debilitatingof all phobias. This phobia impairs a persons ability to function in his daily activitiessuch as work and social situations.

Phobia is an irrational fear that produces a conscious avoidance of the fearedsubject, activity or situation. The presence or just the thought of the phobic object

can elicit severe distress in the affected individual who usually recognizes that thereaction is excessive.

Specific Phobia - is a strong, persisting fear of an object or situation. There are 4 diagnosesfor specific phobias animal, blood, natural & environment and situational phobias.

Social Phobia is a strong, persisting fear of situations in which embarrassment can occur.It also called a social anxiety disorder where there is an excessive fear of humiliation invarious social settings such as speaking in public, or doing things in public.

Post Traumatic Stress Disorder (PTSD) a set of typical symptoms that develop after aperson sees, is involved in, or hears of an extreme traumatic stressor. The

person experiences fear and helplessness, persistently relives the event and tries to avoidbeing reminded of it. These experiences should last for more than a month, affectingimportant areas of a persons life such as work and family.

Conversion Disorder characterized by the presence of one or more neurologicalsymptoms (paralysis, blindness, paresthesias), that cannot be explained by a knownneurological or medical disorder.

Pain Disorder - presence of pain as the predominant focus of clinical attention,which is not fully accounted for by a nonpsychiatric medical or neurological condition. Alsocalled somatoform pain disorder, psychogenic pain disorder, idiopathic pain disorder and

atypical pain disorder.

Hyphochondriasis a persons preoccupation with the fear of contracting, orbelief of having a serious disease which can result in significant distress and impair hisability to function in his personal, social and occupational role.

Other Definitions

Age group ages of the study participants were divided into four groups: 0-29 age group,30-39 age group, 40-49 age group and the 50 and above agegroup.

Big Family Size having four or more children

Categories of Mental Problems Substance Related, Schizophrenia and Other PsychoticDisorders, Mood Disorders, Anxiety Disorders, Somatoform Disorders and EatingDisorders.

CIDI version 2..1 Composite International Diagnostic Interview is the tool used in thisstudy for gathering prevalence data on mental health problems according to the DSM-IVclassifications

Cohabit term used for a participant who is living with someone, whom may be a spouse

or partner (not necessarily married)


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College Education having at least 14 years of schooling, is also referred to as highereducation

Comorbidity an occurrence of more than one disorder at the same time where there is thepossibility that the occurrence of one problem predisposes the individual to another one

DALY Disability Adjusted Life Years is a measure of disability created by the WHO toestimate the GBD around the world through mortality data of diseases.

DSM IV Classification the fourth edition of the Diagnostic and Statistical Manual of MentalDisorders, published in 1994 by the American Psychiatric Association as the officialpsychiatric nomenclature used for classifying mental health problems.

ICD 10 Classification- International Statistical Classification of Diseases and Related HealthProblems, published by the WHO in 1992 is the most comprehensive classification systemof medical conditions and mental disorders. It is the official medical and psychiatricnomenclature used throughout the world except for Japan and the United States.

Lifetime Prevalence prevalence of having a mental health problem at least once in thepersons whole life.

Marital Status status of each participant were divided into two groups: married andunmarried; and three subgroups for the unmarried: widow, separated/divorced and nevermarried

Mental health problem used interchangeably with diagnosis and disorder to refer to any ofthe diagnoses generated with the CIDI version 2.1.

Participant used interchangeably with respondent referred to the individual who

participated in the study as the interviewee for the CIDI version 2.1

Small Family Size having less than four children


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RESULTS

Demographics of Respondents

A total of 449 respondents were interviewed using the translated CIDI Questionnaire.

Ages ranged from 18 to 89 years (median 39). Most (72.6%) of the respondents were

female. Twenty-eight percent (126) of the respondents were from the 18-29 age group

(Figure 1).

Figure 1. Age and Sex Distribution of Respondents (N=449)

Most (63%) of the respondents are married and 114 (25%) were never married

(Figure 2). Two hundred seven respondents (46%) had children less than 4 and 153 (34%)

had a big family. Only 74 (17%) graduated from college and 105 (23%) finished high school.

100 80 60 40 20 0 20 40 60 80 100

18-29

30-39

40-49

50-59

60-69

70-79

80-89

No. of Cases

Age


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Figure 2. Married and Unmarried Respondents (N=449)

Prevalence of DSM-IV Mental Health Problems

The CIDI can generate 59 DSM-IV diagnoses (Appendix A) in six major problem

categories. These are: 1)Substance Related Disorders, 2)Schizophrenia and other

Psychotic Disorders, 3)Mood Disorders (Depression, Manic and Bipolar Disorders), 4)Anxiety

Disorders, 5)Somatoform Disorders and 6) Eating Disorders.

The results of the study showed that all major categories had at least 1 positive result,

where specifically 52(90%) out of the 59 diagnoses had at least 1 positive result.There were a total of 491 positive diagnoses for all 449 respondents. Majority (51%) of

the diagnoses belonged to the substance related disorders category (52%), followed by

anxiety disorders (38%) and mood disorders (6.9%) (Table 1).

The 3 most prevalent diagnoses among substance related disorders were substance

abuse (14%) and substance dependence (13%) and alcohol abuse (7%) (Table 2).

The 3 most prevalent diagnoses among anxiety disorders were specific phobias (20%),

Agoraphobia (5%) and Agoraphobia without panic (4. 6%) (Table 3).

The most prevalent mood disorder was Major Depression, while Bipolar Manic Disorders

and Dysthymia were also diagnosed (Table 4).

There were 8 diagnoses found positive in the schizophrenia and delusional disorders

category where 5 (1%) of the respondents have had a brief psychotic disorder at one point in

their lives (Table 5). Less than 1% of the diagnoses generated were somatoform disorders

(Table 6). Only 1 eating disorder diagnosis was identified for anorexia nervosa (Table 7).

Of all 52 positive diagnoses, the most prevalent were specific phobias, comprising 20%

of all the diagnoses (Table 3).

28237

16

114

Married

Widowed

Separated

Never Married


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Table 1.Lifetime Diagnosis Distribution of Mental Health Problems (N=491)*

Disorders No. ofPositive Results

%

Substance Related Disorders 253 52

Anxiety Disorders 187 38Mood Disorders 34 6.9

Schizophrenic Disorders 9 1.6

Somatoform Disorders 7 1.3

Eating Disorders 1 0.20

Total 491 100

*multiple diagnoses per person

Table 2. Lifetime Diagnosis Distribution of Substance Related Disorders (N=491)*

Substance Related Disorders No. ofPositive Results

%

Alcohol Dependence 14 2.8

Alcohol Abuse 32 6.6

Nicotine Dependence 28 6

Nicotine Withdrawal 16 4

(Any) Substance Dependence 64 13

Other Substance Dependence 14 2.8

(Any) Substance Abuse 71 14

Other Substance Abuse 14 2.8

TOTAL 253 52


1 There are 8 substances for Substance Dependence and Abuse (Opioid, Cannabis, Sedative, Cocaine,Amphetamine, Hallucinogen, Inhalant and PCP


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Table 3.Lifetime Diagnosis Distribution of Anxiety Disorders (N=491)*

Anxiety Disorders No. ofPositive Results

%

Obsessive Compulsive Disorder (OCD) 8 1.6

Post Traumatic Stress Disorder (PTSD) 5 1Agoraphobia 25 5

Agoraphobia without panic 23 4.6

Panic Disorder1 7 0.61

Social Phobia 13 2.64

Generalized Anxiety Disorder (GAD) 8 1.6

Specific Phobias2 98 20

Total 187 34

*multiple diagnoses per person1 Panic Disorder includes with and without Agoraphobia2Phobias: Animal, Natural, Situational, Blood

Table 4.Lifetime Diagnosis Distribution of Mood Disorders (N=491)*

Mood Disorders No. ofPositive Results

%

Major Depression1 20 4

Bipolar Disorders2 7 1.5

Dysthymia 7 1.5

Total 34 7

*multiple diagnoses per person1There are 6 diagnoses for Depression (Major Depression Singlemild, moderate, severe; Major DepressionRecurrent mild, moderate, severe2 There are 7 diagnoses for Bipolar Disorders (Single- mild, moderate, severe; Manic mild, moderate, severe,Bipolar II

Table 5.Lifetime Diagnosis Distribution of Schizophrenic Disorders (N=491)*

Schizophrenia and other Psychotic Disorders No. ofPositive Results

%

Schizophrenic Disorders1 3 0.60

Delusional Disorder 1 0.20

Brief Psychotic Disorder 5 1

Total 9 1.8

*multiple diagnoses per person1There are 3 diagnoses for Schizophrenic Disorders (Schizophrenia, Schizophreniform andSchizoaffective)


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Table 6.Lifetime Diagnosis Distribution of Somatoform Disorders (N=491)*

Somatoform Disorders No. ofPositive Results

%

Hypochondriasis 7 1.4

Total 7 1.4


Table 7.Lifetime Diagnosis Distribution of Eating Disorders (N=491)*

Eating Disorders No. ofPositive Results

%

Anorexia Nervosa 1 0.20

Total 1 0.20



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