Mental Health from a Public Health Perspective

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Mental Health from a Public Health
Perspective Professor Carol S.
Aneshensel Department of Community Health
Sciences
10/12/09
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(No Transcript)
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Mental disorder

• Clinically significant
• behavioral or psychological syndrome or pattern
• that occurs in an individual
• and is associated with
• distress or
• disability or
• a significantly increased risk of suffering
  death, pain, disability, or an important loss
• of freedom.

Source DSMIV
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Mental disorder Is Not

• Distress that is an expectable and culturally
  sanctioned response to a particular event,
• e.g., grief.
• Deviant behavior nor conflicts that are primarily
  between the individual and society.

Source DSMIV
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Syndrome or Pattern
Co-occurrence of multiple symptoms
D
Example Depression
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DEPRESSIVE SYMPTOMS (CES-D 8) Assets and Health
Dynamics Among the Oldest Old StudyU.S. Adults
Aged 70
Source Aneshensel et al. 2004, GSA
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Disorder or Normal?

• Co-occurrence of symptoms
• Severity or intensity of the symptoms
• Duration
• Impairment
• Normal for the person
• Normal for the society

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GENERAL TYPES OF DISORDER

• Affective and anxiety feelings
• Ex Major depression depressed mood or loss of
  interest or pleasure
• Cognitive thinking
• Ex Schizophrenia psychotic symptoms such as
  delusions or hallucinations
• Behavioral action
• Ex. Substance dependence and abuse use in the
  presence of problems

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• At least one of the symptoms is
• 1. Depressed mood most of the day, nearly every
  day
• OR
• 2. Markedly diminished interest or pleasure in
  all, or almost all, activities most of the day,
  nearly every day

Source DSMIV
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MDE continued

• Significant weight loss (not dieting) or gain, or
  loss of
• appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Diminished ability to think or concentrate or
  indecisiveness
• Recurrent thoughts of death suicidal ideas,
  attempt or plan

Source DSMIV
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• The symptoms cause clinically significant
  distress and/or
• Impairment in social, occupational or other
  important areas of functioning
• Exclusions
• Not due to bereavement
• Not due to a general medical condition (e.g.,
  hypothyroidism)
• Not due to substance use
• Presence of manic or mixed episode

Source DSMIV
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Prevalence of Major DepressionU.S. Adults, 18
and Older 2001-2002
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Severity of 12-Month MDDAdults, 2001-2
Percent
Source Kessler et al. 2003
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Lifetime Prevalence of Mood DisordersU.S.
Adults, Ages 18, 2001-2
Percent
Source Kessler and Zhao, 1999
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Lifetime Prevalence of Select DisordersU.S.
Adults, Ages 18, 2001-2
Percent
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Odds Ratio for Lifetime Risk by Gender
U.S. Adults, Ages 18, 2001-2
Percent
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Cultural Considerations

• Culture shapes the expression of some psychiatric
  symptoms.
• Ex. The content of hallucinations
• Some disorders are culture-bound.
• Ex. Bulimia
• Psychiatric disorder exists only in societies
  that medicalize distress.
• Psychiatric disorders can also be viewed as
  expressions of social problems.