Nincs diacm

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Depression and self-destructive behaviour in a
changing society Maria S Kopp Semmelweis
University, Budapest Institute of Behavioural
Sciences www.behsci.sote.hu WHO Regions for
Health, Nyíregyháza, 7-9 March, 2002
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Mental health monitoring

• Mental and physical health, predisposing and
  confounding factors
• National Research and Development Programme,
  2001-2003

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National representative surveys in the Hungarian
population

• The samples represent the Hungarian population
  above age 16 according to gender, age and county
• Hungarostudy 1983 more than 6000 persons
• Hungarostudy 1988 20.902 persons
• Hungarostudy 1995 12.463 persons
• Hungarostudy 2002 about 14.000 persons

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Hungarostudy indicators, mental health

• Shortened Beck Depression Score
• Self-efficacy score
• Hostility score
• Social capital measures
• Suicidal behaviour

• 2002
• Hospital Anxiety Score
• WHO Wellbeing Quest
• Hopelessness Score
• Type D Questionnaire (Dennolet, J)

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Further mental health indicators

• Ways of coping questionnaire (Folkman, Lazarus)
• Social support questionnaire (Caldwell)
• Dysfunctional attitude score
• Purposes in Life score(Crombough, Macholick)

• 2002
• Anomie score (Andorka)
• TCI shortened cooperativeness and sensation
  seeking score
• Life events (Rahe,2000)
• Stress and coping (Rahe)

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Health behaviour, lifestyle and other confounding
factors

• Smoking
• Alcohol consumption(CAGE)
• Drug consumption
• Physical activity
• Sleep complaints
• Vital exhaustion score
• religion
• work related values

• 2002
• Womens health- factors related to pregnancy and
  birth
• marital stress
• ethnical factors
• work conditions

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Predisposing factors

• Education,income
• housing environment
• acces to car
• Marital status
• Housing environment
• Family environment
• Employment
• Self-rated socioeconomic status

• 2002
• Childhood experiences
• Self-rated socioeconomic changes
• Chicago social capital questionnaire

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Self-assesed health, health and health care
related factors

• Self-rated health
• Body weight and height- BMI
• Self-rated pain complaints
• Disability questionnaire
• Illness history
• Allergy complaints
• Health care related needs

• Illness intrusiveness score
• Use of services

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Increase in alcohol related mortality

• Psychosocial determinants of self-destructive
  behaviour?

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Spirit consumption and smoking

• Average values in the Hungarian population

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Prevalence of depressive symptoms in the
Hungarian population in 1988 and 1995
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Independent predictors of severity of depression
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Depression and self-destructive behaviour

• In the last decades there was a significant
  increase in alcohol consumption in the Hungarian
  population
• Depression is closely correlated with alcohol
  abuse and with smoking
• Depression explains a considerable part of spirit
  consumption and smoking on self-reported
  morbidity, both among men and women

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Relative material deprivation and depression

• In a traditional society as in Central-Eastern-Eur
  opean countries until the late eighties
• the income and education related relative
  deprivation seems to be more closely connected
  with health deterioration among men than among
  women,
• Among the psychosocial risk factors depression
  explained a considerable part of effect of
  relative material deprivation among men in 1988,
• Smoking and spirit consumption show a marked
  social gradient,more among men than among women

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Increasing importance of depression

• relative GDP and depression differences explained
  the 78,6 of male mortality differences between
  the 20 Hungarian counties, while these factors
  could not explain the female mortality
  differences
• there is a need for differentiate between male
  and female depression and its physical
  consequences
• In 1995 depression became a more important risk
  factor that it was earlier, it explained a
  considerable part of the effect of material
  deprivation on self-reported morbidity, both
  among men and women

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Mental health promotion

• The role of schools, workplace and community

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Community based health promotion and prevention
programs using evidence-based methods

• National Research and Development Programme,
  2001- 2003
• The principal mechanism of action of all
  prevention programs is the modification of risk
  behaviours such as smoking, alcohol abuse, stress
  related eating habits and of pathologic forms of
  psychological regulation such as
• disfunctional attitudes
• non-adaptive coping strategies
• hopelessness
• hostility

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The evaluation of the programs is based on
measurable changes of the following dimensions

• a) quality of life,
• b) psychological indices (anxiety, depression,
  sleep problems etc.),
• c) capacity for work and creativity,
• d) health behaviour,
• e) other (eg. somatic) indicators of health
  status

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Methods

• Cognitive behavioural methods of early treatment
  of depressive symptoms in high risk groups are in
  the focus of our preventive programmes (i.e.
  Cuijpers P, 1998, A psycho-educational approach
  to the treatment of depression a metaanalysis of
  Lewinsohns Coping with depression Course, Beh.
  Ther. 29,521-533)

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Preventive programmes

• School based programmes for strengthening mental
  and physical health- train the trainers
• Health evaluation survey and general health
  promotion program among the members of the
  Dimension health funds- workplace.
• Further development of the interactive
  counselling service on the Internet
  www.behsci.sote.hu

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Community based health promotion and prevention
programs for high risk groups

• Depression screening in schools and selected
  workplaces among highly disadvantaged young
  people, preventive group-intervention for the
  at-risk persons.
• Screening of post-partum depression among young
  mothers with the participation of the district
  nurses.
• Screening and prevention of depression among
  roma youth.

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Social Communication in connection with the
propagation of evidence-based programs

• Social communication at national level, in the
  frame of communication via
• mass media and information,
• education by means of conferences, workshops and
  courses with involvement of the media, schools
  and churches.
• Organisation of scientific forums to promote the
  diffusion of these programs among professionals.
  Publication of the results on regular and
  continuous basis in international and national
  journals

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Utilization, expected economic results

• 1. Direct effects
• 1.1. Synthesis of the available Hungarian and
  foreign databases, preparation of
  research-database
• 1.2. Preparation, organizing and analysis of a
  new national representative survey (Hungarostudy
  2002)
• This project will provide new data about the
  health status and needs of the Hungarian
  population.
• 1.3. Community-based health maintaining and
  prevention programs with evidence-based methods.

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Indirect effects

• 2.1. New results about the East European health
  paradox, and dramatic decrease of the quality of
  life.
• 2.2. Increasing need for professional knowledge
  in the field of health maintainance and
  prevention.
• 2.3. As a result of the research and the
  developmental work we expect the amelioration of
  the health-care system and Mutual Health Fund
  services. Recruitment of enterprises to organize
  health funds and investment of material resources
  is expected.

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References

• Kopp MS (interview) (2000) Stress The invisible
  Hand in Eastern Europe s Death Rates, Science,
  288, 9.June 2000, 1732-1733.
• Kopp, M.S., Skrabski, Á., Szedmák, S. (1995)
  Socioeconomic factors, severity of depressive
  symptomatoliogy and sickness absence rate in the
  Hungarian population, J. Psychosom. Res. 39,
  8,1019-1029.
• Kopp, M., Falger, P, Appels, A. ,Szedmák, S.
  (1998) Depression and Vital Exhaustion are
  differentially related to behavioural risk
  factors for coronary heart disease, Psychosom.
  Med.60, 752-758.
• Kopp MS, Skrabski Á, Szedmák S (2000)
  Psychosocial risk factors, inequality and
  self-rated morbidity in a changing society,
  Social Sciences and Medicine 51, 1350-1361.