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Global Mental Health > The global burden of disease > Flashcards

The global burden of disease Flashcards

1
Q

Where was global health founded?

A

North America

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2
Q

What does global mental health represent?

A

New ways of thinking about and addressing health challenges in all world regions

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3
Q

What is the central aim of global mental health?

A

To improve health while addressing inequities between and within countries

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4
Q

What makes global health truly global?

A

Concerns high, middle and low income countries

  • economic shocks
  • influenza pandemics
  • antibiotic resistance
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5
Q

What is prominent in global mental health compared to global health?

A

Inequities more pronounced in mental health than in any other domain of health

  • treatment gap can be as much as 90% for serious mental illness in LMICs
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6
Q

Why is the mental health treatment gap so significant in low-income countries?

A
  • Most people with mental disorders live in LICs

- Yet, most specialists are in HICs

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7
Q

What was the primary focus for the global mental health movement?

A

To be an effort to reduce the pronounced inequities in access to care

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8
Q

What did the Lancet series (2007) present?

A

> Why there can be no health without mental health

> Scarcity and inefficient use and distribution of mental healthcare resources

> Evidence that treatments could be administered by non-specialists in low-income settings

-> Scale up accessible, affordable, equitable care

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9
Q

What was the development of the global mental health field since the Lancet series (2007)?

A

> PLOS Medicine Series

> WHO Mental Health Gap Action Plan (2008):

  • guidelines for care by non-specialists in LMICs
  • training and guidance on implementation

> Second Lancet series (2011):

  • reviewed progress in scaling up
  • child and adolescent mental health

> Increase in research funding
- particularly action research since 2010

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10
Q

What characterises the action research developing since the new funding in 2010?

A

> Increased awareness within LMIC

> 2013 WHO Mental Health Gap Action Plan

-> Committed governments to action and to invest with key measurable indicators of progress

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11
Q

Are mental health disorders universal or culture-specific?

A

Both

- ethnographic research -> major categories of mental disorders tend to be present, burdensome and impactful

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12
Q

What did the ethnographic research of Wig and colleagues (1980) in Sudan, North India and the Philippines show?

A

> Community informants in each region

  • community and religious leaders
  • traditional healers
  • Primary care workers
  • Local residents

> They recognised vignettes of mental and neurological disorders (epilepsy, mental retardation, psychosis, depression)

  • key features AND carefully culturally adapted
  • distinguished and measured conditions

> All conditions considered serious
- psychosis felt likely to have most adverse impact on social functioning, work and community participation

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13
Q

What is the contrast between LMICs and Western expressions of illness?

A

How health conditions are perceived, understood and expressed is highly culturally-variable

-> same condition BUT very different explanatory models heavily influenced by culture

e. g.:
- West: help-seeking from psychologist or psychiatrist
- Zimbabwe: “I might be possessed by a spirit - I should see a spiritual healer”

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14
Q

What is the importance of culture in the delivery of care?

A

Culture influences almost everything in delivery of care:

  • how people present
  • how they understand and explain their condition
  • words used to describe their distress
  • wether, how, when and from whom, are people likely to seek help
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15
Q

Why do commonalities make cross-cultural studies valid?

A
  • It is possible to study the same thing in broadly the same way, meaningfully across cultures
  • Commonalities are most striking
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16
Q

Why is there no health without mental health?

A

Sheer burden of mental disorder worldwide

- something that contributes to loss of years of healthy active life

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17
Q

How do you calculate the Disability-Adjusted Life Years (DALY) indicator?

A

Years of life lost from premature mortality
+
Years lived with disability

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18
Q

What is the contribution of neuropsychological (mental, neurological and substance use) disorders to the global burden of disease (2015)?

A

Nearly 15% of total global burden of disease accounted for by neuropsychological disorders
(mental, neurological, substance use)

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19
Q

Why is the proportion of neuropsychological disorders in the total burden of disease lower in low income countries (10%) compared to middle income (15%) and high income countries (28%) (Whiteford et al., 2015)?

A

Because the total burden of disease in LICs is much higher compared to MICs and HICs

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20
Q

What is observed in the variation of the burden of mental disorders and the total burden of disease between world regions (by income level)?

A

> Little variation of the burden of mental disorders and its subgroups (neurological, substance use) between world regions

> Total burden of disease does vary
- main component is communicable, perinatal and maternal disorders

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21
Q

What does non-communicable disease (NCD) mean?

A

Non transmissible disease

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22
Q

What is observed in mental, neurological and substance use disorders over time (by age)?

A

> Typical onset in adolescence and young adulthood

> Neurological disorders peak in late life (80+)

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23
Q

Why do neurological disorders peak in late life (80+)?

A

Age-dependent onset of dementia among older people

24
Q

What is the consequence of the ageing global population?

A

Middle-age population size is growing, particularly in less-developed countries

-> increases over time the absolute and relative burden of mental disorders

25
Q

What is the state of the mental healthcare funding?

A

Even though mental disorders (chronic NCDs) are the largest portion of the Global Burden of Disease chart
- it is not reflected in relative priorities given to research funding, prevention and care

26
Q

What would be the impact of effective prevention of mental disorders in terms of number of suicides?

A

50 to 80% of all suicides (one million each year) could be prevented

27
Q

What is the part of serious mental disorders in the increased non-suicide mortality?

A

People living with serious mental disorders have approx. 2x risk of dying from other causes not due to lifestyle differences
- depression, schizophrenia, bipolar disorder, dementia

  • inflammatory processes associated with depression may increase risk for heart attacks, stroke
  • many drug treatments for mental disorders have important side effects (e.g. obesity, diabetes)
28
Q

What seems to be most important mechanism in the non-suicide deaths of people living with serious mental disorders?

A
  • Accessing physical healthcare

- Poor quality of care received

29
Q

What is the cause of the reduction of life expectancy associated with mental health disorders?

A

Systematic exclusion from accessible healthcare
(even though it’s a basic human right)

  • Depression: -10-12 years
  • Psychosis: -13-15 years
  • Smoking: -6 years
  • Morbid obesity: -8 years
30
Q

What did the Million Death Study (Patel et al., 2012) reveal?

A

A huge excess of mortality from suicide among adolescents - particularly women under 25 in India vs. HICs

31
Q

What are the links between mental disorders and physical ill-health?

A

These links are protean (frequently changing)

Mental disorder -> reduced help-seeking for physical health condition -> under-detection of physical conditions -> under-treatment and low adherence to treatment recommendations -> worse prognosis and poor outcomes

32
Q

How is depression associated to cardiovascular disease?

A
  • Depression increase risk of taking up smoking, not giving up smoking and developing hypertension and diabetes
  • > depression doubles risk of heart attack
  • Reduced adherence to treatment after heart attack
33
Q

Can more effective detection and treatment of depression improve cardiovascular outcomes?

A

Better management of depression may improve diabetes control

34
Q

What is the importance of HIV care and the high levels of its comorbid depression?

A

Reduced adherence to anti-retroviral treatment

-> viral breakthrough -> increased mortality

35
Q

What are the negative effects of compartmentalising mental and physical health?

A

> Underestimates the true impact of mental disorders (e.g. comorbidities with physical conditions)

> Misses the relevance of mental health to priority topics for global health investments

> Separate mental and physical healthcare systems

> Isolated budgets and healthcare

  • delivered from underfunded asylum hospitals
  • > perpetuates stigma associated to mental disorders
  • > extends to service providers
36
Q

How does the negative effects of isolated mental and physical budgets and healthcare extend to service providers in LMICs?

A

Underfunding -> mental health is not a popular career choice for many LMICs

37
Q

How are health priorities determined in LICs?

A

Health priorities for a minister of Health in LIC still determined largely by the Millenium Development Goal priorities
- improving maternal and child health

  • treatment and control of HIV, tuberculosis, malaria
  • mental health at the bottom of list
38
Q

What is the favorable approach to advocate for better mental health in LMICs?

A

Attending to mental health is important to achieving all the current priority goals

e.g. bi-directional links between perinatal and maternal mental health, pregnancy outcomes and child survival and development

39
Q

What are the 4 social determinants of the onset and maintenance of adult mental disorders?

A
  1. Poverty and its psychosocial stressors
  2. Gender
    - more women than men meet criteria for common mental disorders
  3. Abuse in care facilities and the community
  4. Legislation
    - no adequate protection
    - many countries lack legislation
    - outdated laws
40
Q

What was the Erwadi Asylum fire in Tamil Nadu (India)?

A

> Traditional healing centre for people living with serious mental illness

> Residents were often shackeld and left untended overnight

> 28 died in the fire

41
Q

What were the consequences of the Erwadi Asylum fire in Tamil Nadu (India)?

A

> National enquiry

> 5-year mental healthcare plans
- addressing lack of care in rural and underserved communities

42
Q

What did Thornicroft and colleagues (2009) demonstrate on the discrimination against those with mental disorders?

A

Global pattern of experienced and anticipated discrimination against people with schizophrenia

  • over third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced
43
Q

What is the link between poverty and mental disorders?

A

Mental disorders are both consequence AND cause of living in poverty

Poverty

  • > anxiety and depression
  • > increased severity of mental disorders
  • > longer course of episodes
  • > worse outcome
44
Q

What are the contributing factors in the association of poverty and mental disorders (Lund et al., 2010)?

A

Life-long disadvantage

  • low education
  • poor housing
  • indebtedness
  • inability to make purchases and payments
45
Q

Which is most effective between poverty alleviation and mental health interventions (Lund et al., 2011)?

A
  • Studies show the impact of poverty alleviation on mental health is inconsistent and inconclusive
  • More evidence for the benefits of mental health interventions on poverty

Poverty alleviation interventions
+
interventions to optimise mental health
= increased likelihood of microloans

46
Q

What is a treatment gap?

A

The proportion of people who may benefit from mental health interventions but have not yet accessed a service

47
Q

What is the treatment gap in LMICs (Kessler et al., 2009)?

A

80% of people who may benefit from mental health interventions but have not yet accessed a service

48
Q

What characterises the scarcity of healthcare resources in the world (kakumar et al., 2011)?

A

> Shortages of psychiatrists, psychiatric nurses, psychologists and social workers

> Median figure for psychiatrists in LMICs:

  • 0.05 per 100,000
  • 0.16 per 100,000

> 76% of countries (for 86% of world’s population) have less than 1 psychiatric nurse per 100,000 population

49
Q

What is the solution to the current scarcity of healthcare resources?

A

Task Shifting:

- mental healthcare

50
Q

What is the basis of task shifting?

A
  • Mental healthcare does not require advanced technology or equipment
  • > Use of non-specialised healthcare workers
51
Q

Which arguments make a strong case for narrowing the gap between burden of disorders and budget?

A
  • Effective and affordable interventions are available

- Decision-makers need also to consider the relative cost effectiveness of alternative uses of available resources

52
Q

What did the WHO annual surveys of health ministries reveal about the allocation of mental healthcare resources?

A

Inefficient use of mental healthcare resources:
- 2/3 of all mental health beds are in specialist hospitals (typically urban centres)

  • LMICs typically spend 50% of their mental health budget on mental hospitals
53
Q

What are the four barriers to a more efficient allocation of mental healthcare resources?

A
  1. Funding both hospitals and developing community-based systems
  2. Vested interests
    - hospital institutions provide prestige, power and large budgets
  3. Centralised services are not accessible in LMICs where most people live: rural areas
  4. Cost of access is high and must be combined with high cost of medication and in-patient care
54
Q

What is the consequence of the high costs of treatment in LMICs?

A

Vicious cycle:

High costs of access, medication and in-patient care
-> Discontinuation -> Relapse -> Acute treatment -> Catastrophic costs…

55
Q

What do governments and funders seek to do to “reduce the public health burden and the individual suffering of people with mental health problems worldwide” (Ban Ki-moon - 8th Secretary-General of the UN, 2009)

A
  • Investment
  • Identification of sustainable models

“a pro-poor strategy” that “makes good economic sense”
(Ban Ki-moon, 2009)

Global Mental Health (14 decks)

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