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Epidemiology of Mental Disorders

Epidemiology of Mental Disorders. Prof.Dr .Selma KARABEY. M ental H ealth Definition -WHO. It is conceptualized as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully,

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Epidemiology of Mental Disorders

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  1. Epidemiology of MentalDisorders Prof.Dr.Selma KARABEY

  2. MentalHealthDefinition-WHO • It is conceptualized as a state of well-being in which the individual realizeshis or her own abilities, • can cope with the normal stresses of life, • can work productively and fruitfully, • and is able to make acontribution to his or her community. • With respect to children, an emphasis is placed on the developmental aspects, forinstance, having a positive sense of identity, • the ability to manage thoughts, emotions, as well as to build social relationships, • and the aptitude to learn and to acquire an education, ultimately enabling their full active participation in society.

  3. A humanrights perspective is essential! Widespread human rights violations and discrimination • theneedforservices, policies, legislation, plans, strategies and programmes to protect, promote and respect the rights of persons withmental disorders in line with • the International Covenant on Civil and Political Rights, • the International Covenant on Economic,Social and Cultural Rights, • the Convention on the Rights of Persons with Disabilities, • the Convention on the Rights of the Child • and other relevant international and regional human rights instruments.

  4. Mental health and disorders: determinants and consequences • include not only individual attributes such as the ability to manageone's thoughts, emotions, behaviours and interactions with others, • but also social, cultural, economic, political and environmentalfactors such as national policies, social protection, living standards, working conditions, and community social supports. • Exposure to adversity at a young age is an established preventable risk factor for mental disorders.

  5. Vulnerability Certain individuals and groups in society may be placed at a significantly higher risk of experiencingmental health problems: • members of households livingin poverty, • people with chronic health conditions, • infants and children exposed to maltreatment and neglect, • adolescents firstexposed to substance use, • minority groups, • indigenous populations, • older people, • people experiencing discrimination andhuman rights violations, • lesbian, gay, bisexual, and transgender persons, • prisoners, • people exposed to conflict, naturaldisasters or other humanitarian emergencies.

  6. HigherRates of Disability and Mortality • People with mental disorders experience disproportionately higher rates of disability and mortality. • For example, personswith major depression and schizophrenia have a 40% to 60% greater chance of dying prematurely than the general population, • Owing to physical health problems that are often left unattended [such as cancers, cardiovascular diseases, diabetes and HIVinfection) and suicide. • Suicide is the second most common cause of death among young people worldwide.

  7. Burden of MentalDisorders • Mental disorders often affect, and are affected by, other diseases such as cancer, cardiovascular disease and HIVinfection/AIDS, • For example, there is evidence thatdepression predisposes people to myocardial infarction and diabetes, both of which conversely increase the likelihood ofdepression. • Many risk factors such as low socioeconomic status, alcohol use and stress are common to both mental disorders and other noncommunicable diseases. • There is also substantial concurrence of mental disorders and substance use disorders. • Taken together, mental, neurological and substance use disorders exact a high toll, accounting for 13% of the total global burden

  8. Burden of MentalDisorders • In a samplerepresentingthe general population, consisting of 60.559 adultsfrom 14 countries, as six of thelessdevelopedandeightdeveloped, fromdifferentregions of theworldindicatesthatlifetimeprevalance of anypsychiatricdisorder, accordingto DSM-IV criterawasbetween 8.6% (Shanghai) and 47.3% (U.S.). • Lifetimeprevalance of mentaldisorders is about 18% in Turkey • Concordance rate in individualswith a psychiatricdisorder( a secondpsychiatricdisease in thesameperiod) has beenfoundbetween 52% and 75%.

  9. SocialandHumanitarianAspect • Mental disorders frequently lead individuals and families into poverty. • Homelessness and inappropriate incarceration arefar more common for people with mental disorders than for the general population, and exacerbate their marginalization andvulnerability. • Human rightsviolationbecause of stigmatization and discrimination • restrictions on the rights to work and education, • reproductive rights and • the right to the highest attainable standard of health. • unhygienic andinhuman living conditions, • physical and sexual abuse, • neglect, and • harmful and degrading treatment practices in healthfacilities. • They are often denied civil and political rights such as the right to marry and found a family, personal liberty,

  10. TreatmentGap For • non-affective psychotic disorders (mainly schizophrenia) 32.2%, • depression56.3% , • disthymia56.0%, • bipolardisorder 50.2%, • panicdisorder 55.9%, • commonanxietydisorders 57.5%, • obsessive-compulsivedisorder 57.3%, and • alcohol abuse or dependence 78.1%rates were reported.

  11. PsychoticDisordersandLifetimePrevalances • Schizophrenia (1%), • Schizoaffectivedisorder (0.5-0.8%), • Paranoiddisorder (0.05-0.1%), • Briefpsychoticdisorder, sharedpsychoticdisorder, bipolardisorder (1.2%), • Manic episodes and psychotic depression (seen less)

  12. MoodDisorders • Bipolardisordertype-1 andtype-2 • Major depression (lifetime prevalence of 10-25% women, men 5-12%) • Dysthymicdisorder (6%) • Cyclothymicdisorder (0.4-1%) • Otherdepressivedisorders (minordepressivedisorder, recurrentbriefdepressivedisorder 2%, , premenstrualdysphoricdisorder 3-8% in womenaged 14-44)

  13. AnxietyDisorders • Specificphobias 11%, • Panicdisorder 3%, • Socialanxietydisorder 13%, • Obsessive-compulsivedisorder 2%, • Post-traumaticstressdisorder 3%, • Generalizedanxietydisorder 5% , • In total, lifetimeprevalence of all of theanxietydisordersareconsidered as 25%.

  14. Mental Disorders Connected to a General Medical Condition Delirium • The point prevalence of 10-30% in general hospitals • In general population 0.4%, • InCancerpatients 25-40%, • In post-operativepatients 5-75%, • In ICU patients 12-50%, • Inpeopleremaining in nursinghome 60%↑, • Indementiapatients 22-89%.

  15. Mental Disorders Connected to a General Medical Condition Dementia • Dementia, can occur for many reasons, includingparticularly Alzheimer's type dementia. • The onset of dementia is usually 65 years of age, • Advancing age, having a rising prevalence of dementia; 4% in the population above 65 years of age, while 40% frequency in the population above 85 years of age

  16. Alcohol and Substance Use Disorders • Rapid changes in the social structure, the effects of globalization, population mobility and other changes due to an increase in the use of alcohol and other substances that increase with each passing year, and have been used at younger ages. • Therefore, as the prevention of the spread of alcohol and substance abuse, a sufficient number of treatment and rehabilitation centersaretheneed of community.

  17. Other… • SomatoformDisorders • DissociativeDisorders • SexualDysfunction • PersonalityDisorders

  18. Mental Health Profile of Turkey • A representative sample of the population of Turkey • 3889 households • 7479 adults were interviewed • Interviews were conducted with GPs (Kaynak:Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara: Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  19. Mental Health Profile of Turkey: materials • Composite International Diagnostic Interview (CIDI) • General Health Questionnaire • Brief Disability Questionnaire • Health Services Utilization Survey (Kaynak:Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara:Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  20. Mental Health Profile of Turkey: educationalstatus (Kaynak: Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara: Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  21. Mental Health Profile of Turkey: themeanage (Kaynak:Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara: Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  22. Mental Health Profile of Turkey: prevalanceof ICD-10 groups (Kaynak:Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara: Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  23. Mental Health Profile of Turkey: application-sex relationship for mental problems (Kaynak:Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara: Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  24. Mental Health Profile of Turkey: admission rates due to mental health problems (Kaynak:Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara: Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  25. Mental Health Profile of Turkey: first consultedpersondue to mental health problems (Kaynak:Kılıç C. Türkiye Ruh Sağlığı Profili: Erişkin nüfusla ilgili sonuçlar. Ankara: Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları, 1998)

  26. TÜİK Sağlık Araştırması,2012

  27. TÜİK Sağlık Araştırması,2012

  28. TÜİK Sağlık Araştırması,2012

  29. TÜİK Sağlık Araştırması,2012

  30. Burden of MentalDisorders in Turkey

  31. ProportionalBurden of MentalDisorders in Total.

  32. HumanResources in MentalHealth

  33. Distribution of thePsychiatrists

  34. WHO-EuropeanRegion: Number of thePsychiatrists

  35. Distribution of theChildandAdolescentPsychiatrists

  36. Psychologist InTurkey 1.85 /100.000

  37. SocialWorker • Thereare 613 social workers working actively in the field of health in Turkey (March 2011). • 529 of these individuals in Ministry of Health, while 71 of them working in the universitiesand 13 of in the private sector. • As of the 2010-11 academic year, in 10 universities in our country social services has a quota of 678. • Thenumber of active workingsocial workersin our country is 0,92 per 100 thousand people. • Ministry of Health Medical Social Work Practice Directive was published in February 2011.

  38. Nurse

  39. Institutions in MentalHealth MINISTRY OF HEALTH • MentalHealthDepartment • RegionalPsychiatryHospitalsandPsychiatryClinics • PsychiatryPoliclinics • ProvincialHealthDirectoratesand 112 Emergencyservices • CommunityMentalHealthCenters UNIVERSITIES • Psychiatryclinicsandpoliclinics

  40. MINISTRY OF JUSTICE • Institute of Forensic Medicine • Probation and helpbranch offices • Other topics of concerningthe Ministry of Justice • Prisoners patients • Safeguard Patients • Patients under treatment • Deprivation of liberty in order to protect • Guardianship of children ...

  41. MINISTRY OF FAMILY AND SOCIAL POLICY • MINISTRY OF LABOUR AND SOCIAL SECURITY • MINISTRY OF EDUCATION – General Directorate of Special Education, Guidance and Counseling Services – Department of Counseling and Guidance Services – Department of Special Education • Guidance and Research Centers • Guidance and Counseling Services in Educational Institutions • Guidance and Counseling Services StaffInvolved in Special Education Services Schools and Institutions • Advisory Services

  42. MINISTRY OF INTERNAL AFFAIRS • The Police organization • District Governors • Other topics concerning the Ministry of Internal Affairs – Suicideprevention – Crisisprevention – Theintervention in exciterpatients – Dependencecontrolprograms

  43. MINISTRY OF TRANSPORT • RTUK(RadioandTelevisionSupremeCouncil) • Other • Municipalities • Recruitmentoffice • Gendarme

  44. MentalHealthSystems Therearethreedifferenttypes of mentalhealthsystems in theworld a. Hospitalbased model b. Communitybased model c. Community-Hospitalbalanced model

  45. HospitalBased Model • Theoldestandtraditional model that is usedbetweentheyears of 1800s and1960s. • Manylargepsychiatryhospitalsarefoundedin thisperiod • Thesehospitalsareoutsidethecityandhave on average 2.000 beds (Forinstance in Englandthereare120.000 beds in thisway) • This model is left at 1960 becausehospitalswereverycrowded, hygieneconditionswerebad, violations of patient’srightswereverycommon

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