outline how measure m.i. in community populations? major instruments and findings problems with...
Post on 21-Dec-2015
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OUTLINE
• HOW MEASURE M.I. IN COMMUNITY POPULATIONS?
• MAJOR INSTRUMENTS AND FINDINGS
• PROBLEMS WITH INSTRUMENTS
• POLICY IMPLICATIONS
REASONS FOR ENTERING TREATMENT
• MENTAL ILLNESS
• CHANGING CULTURE SO MORE RECOGNITION
• EDUCATIONAL CAMPAIGNS
• PHARMACEUTICAL ADS
• CHANGE IN FINANCING
PROBLEMS WITH TREATED SAMPLES
• CAN REFLECT UNDERTREATMENT
• OR OVERTREATMENT
• SO NOT ACCURATE REFLECTION OF AMOUNT
• NOT REPRESENTATIVE OF TYPES OF PEOPLE
• “CLINICIAN’S ILLUSION”
EPIDEMIOLOGY
• FOCUS ON UNTREATED CASES
• STUDY OF RATES OF DISORDER IN COMMUNITY POPULATIONS
• FOCUS ON GROUP DIFFERENCES IN DISORDER NOT INDIVIDUAL CASES
GOALS
• 1. SEE HOW WIDESPREAD M.I. IS
• 2. LOOK AT UNMET NEED FOR SERVICES
• 3. EXAMINE GROUP DIFFERENCES IN RATES
• 4. BETTER WAY TO DISCOVER CAUSES AND COURSE OF M.I.
HOW MEASURE M.I.?
• PSYCHIATRIC INTERVIEWS VERY EXPENSIVE, IMPRACTICAL, UNRELIABLE
• USE STANDARDIZED INSTRUMENTS
• STANDARD QUESTIONS
• STANDARD ANSWERS
TWO MAJOR STUDIES
• ECA - EPIDEMIOLOGIC CATCHMENT AREA) - 1980’S (WAKEFIELD)
• NCS - NATIONAL COMORBIDITY STUDY - 1990’S and EARLY 2000’S (KESSLER)
• BOTH USE FORMAL DIAGNOSES
FINDINGS
• MENTAL ILLNESS WIDESPREAD
• DEPRESSION - 10% IN PAST YEAR; 25% OVER LIFETIME
• ANXIETY - 20% IN PAST YEAR; 30% OVER LIFETIME
• SUBSTANCE ABUSE - 15% PAST YEAR; 25% OVER LIFETIME
FINDINGS
• ALL DISORDERS - 1/3 OF POPULATION HAS DISORDER IN PAST YEAR; 1/2 OVER LIFETIME
• MANY PEOPLE “COMORBID” - MORE THAN ONE DISORDER
• MANY GROUP DIFFERENCES - CLASS, ETHNIC, GENDER, AGE, ETC.
ISSUES WITH BOTH TYPES
• HIGH RATES – 20% TO 30% • FEW FALSE NEGATIVES• MANY FALSE POSITIVES• IGNORES CONTEXT OF SYMPTOMS• PHYSICAL ILLNESS?• INSTABILITY – ONLY 1/3 IN SAME
CATEGORY OVER SEVERAL MONTHS• EXPLOITATION BY DRUG CO?
USUAL CONCLUSIONS (KESSLER)
• MENTAL DISORDER WIDESPREAD
• TREMENDOUS “UNMET NEED” FOR TREATMENT
• UNMET NEED GREATEST AMONG POOR, MINORITIES, MEN, OLDER
• MUST EXPAND MENTAL HEALTH SERVICES
OVERESTIMATES (WAKEFIELD)
• SUPPOSED TO BE SAME AS CLINICAL
• 1. DISCRETION OF INDIVIDUAL
• 2. DISCRETION OF CLINICIAN
• COMMUNITY STUDIES LACK DISCRETION OF EITHER
• RESULT IS OVERCOUNTING – FALSE POSITIVES
SCREENING
• FIND UNTREATED INDIVIDUALS
• SETTINGS THAT HAVE HIGH % OF M.I.
• PRIMARY MEDICAL CARE
• SCHOOLS
BENEFITS AND COSTS
• GET TREATMENT TO UNTREATED
• PREVENT FROM BECOMING MORE SERIOUS
• SAVE MONEY
• TOO INTRUSIVE?• STIGMA• IS IT EFFECTIVE?• TELL ANYTHING
NEW?• BE CAUTIOUS, NOT
SWEEPING