Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001—05: an epidemiological survey

The abstract of an article published in the June 13th, 2009, edition of The Lancet:

By Prof. Michael R. Phillips, MD; Prof. Jingxuan Zhang, MMed; Qichang Shi, BMed; Zhiqiang Song, BMed; Zhijie Ding, BMed; Shutao Pang, MMed; Xianyun Li, MMed; Yali Zhang, MD; and Zhiqing Wang, BMed

Background

In China and other middle-income countries, neuropsychiatric conditions are the most important cause of ill health in men and women, but efforts to scale up mental health services have been hampered by the absence of high-quality, country-specific data for the prevalence, treatment, and associated disability of different types of mental disorders. We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China.

Methods

We used multistage stratified random sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China; the sampling frame of 113 million individuals aged 18 years or older included 12% of the adult population in China. 63 004 individuals, identified with simple random selection methods at the sampling sites, were screened with an expanded version of the General Health Questionnaire and 16 577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist.

Findings

The adjusted 1-month prevalence of any mental disorder was 17·5% (95% CI 16·6—18·5). The prevalence of mood disorders was 6·1% (5·7—6·6), anxiety disorders was 5·6% (5·0—6·3), substance abuse disorders was 5·9% (5·3—6·5), and psychotic disorders was 1·0% (0·8—1·1). Mood disorders and anxiety disorders were more prevalent in women than in men, and in individuals 40 years and older than in those younger than 40 years. Alcohol use disorders were 48 times more prevalent in men than in women. Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents. Among individuals with a diagnosable mental illness, 24% were moderately or severely disabled by their illness, 8% had ever sought professional help, and 5% had ever seen a mental health professional.

Interpretation

Substantial differences between our results and prevalence, disability, and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed, country-specific situation analyses before they scale up mental health services.

Funding

China Medical Board of New York, WHO, and Shandong Provincial Bureau of Health.

Bold emphasis in the text of the abstract is mine.

Posting of this abstract on the weblog is for the purposes of research into the prevalence and treatment of mental disorders in China.

Also see:

Mental disorders in China underestimated

National Call to Action: Identifying the Need for Specialized Treatment and Care of Concurrent Mental Health and Substance Use Disorders

An April 9th news release from the Canadian Centre on Substance Abuse:

Ottawa, April 9, 2010 – The Canadian Centre on Substance Abuse (CCSA) — Canada’s non-governmental organization dedicated to reducing the harms associated with alcohol and drugs — today announced the release of Substance Abuse in Canada: Concurrent Disorders, the third in a series of biennial publications that highlight key contemporary substance abuse issues in Canada and identifies areas where action is needed.

Written by members of CCSA’s Scientific Advisory Council — a group of Canada’s leading biomedical, neuroscience and clinical experts — and other leading clinicians and academics in the field, Concurrent Disorders takes an in-depth look at the state of concurrent disorders and provides a call to action to address this significant health issue.

Concurrent disorders — cases in which individuals have both a mental health problem and a substance use problem — are currently poorly understood by the public and inadequately addressed by either Canada’s primary healthcare system or specialized mental health and addiction services.

"Concurrent disorders are generally seen as unlinked and separate as a result of mental health and addiction systems that are compartmentalized and largely independent of each other. The result is that clients are often being treated for one of their disorders but not the other," said Rita Notarandrea, CCSA’s Deputy Chief Executive Officer. "As this report indicates, treating each problem separately leads to poor client outcomes that are characterized by frequent relapses and crises, placing undue strain on the healthcare system and its professionals. Concurrent Disorders is a significant first step towards identifying the actions we must take to effectively address this public health issue."

The publication takes an in-depth look at six areas within the field of concurrent disorders, including the interplay between substance use and anxiety, stress and trauma, impulsivity, mood, and psychosis.

"The rationale for considering concurrent disorders a topic of special significance is in many ways self-evident: the two disorders frequently coexist; they often share common biological, psychological and social roots; and these co-occurring disorders represent a major health challenge," said Dr. Franco Vaccarino, Professor of Psychology and Psychiatry at the University of Toronto and Chair of CCSA’s Scientific Advisory Council. "The limited ability of our parallel substance use and mental health clinical and community programs to approach concurrent disorders in a coordinated, integrated manner represents a significant barrier to effectively treating those affected."

The cost of substance abuse and mental health to Canadians is considerable. In a 2002 study by CCSA, substance abuse disorders were estimated to cost Canada more than $40 billion annually. In addition, a 2001 Public Health Agency of Canada study estimated the price tag of mental health problems in Canada to be $14.4 billion annually. Collectively, substance abuse and mental health issues account for more than $54 billion in costs to Canadian society each year and exact an immeasurable toll on individuals, their family and friends.

The percentage of costs that can be attributed to those with concurrent disorders is currently unknown. However, findings within Concurrent Disorders suggest that these individuals likely account for a large portion of the total, as they have a limited ability to cope with everyday challenges, experience higher unemployment, and at the extreme, can become homeless, socially marginalized or criminally involved.

A Call to Action

Concurrent Disorders identifies the critical need for Canada to address the issue of concurrent disorders through:

• Policy makers, educators, researchers and health professionals acknowledging that specialized treatment for those with concurrent disorders is a major priority for Canada;

• Increased scientific programs that provide a better understanding of the processes and mechanisms underlying concurrent disorders, and that address current gaps in research and research funding;

• Increased community addiction programs that are better equipped to deal with clients with concurrent disorders;

• Integration of clinical practice guidelines in the substance use disorder and mental health fields that reflects a unified national approach to treatment and care;

• An educational platform that increases the number of trained professionals with a common understanding of concurrent disorders and treatment practices;

• A focus on youth and early detection, as concurrent disorders often have an onset during adolescence and are best treated early; and

• The development of prevention and treatment strategies that focus on life stressors and trauma as significant risk factors in the development and recurrence of concurrent disorders.

To read the full Concurrent Disorders publication or the Highlights report, please click here.

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About CCSA:

With a legislated mandate to reduce alcohol- and other drug-related harms, the Canadian Centre on Substance Abuse (CCSA) provides leadership on national priorities, fosters knowledge translation within the field and creates sustainable partnerships that maximize collective efforts. CCSA receives funding support from Health Canada.


For further information, please contact:

Annie Boucher, Fuse Communications
Tel.: (613) 863-3702
Email: boucher@fusecommunications.ca

Also see:

National approach needed on care for mentally ill who abuse substances: report

Quote for Today

"According to reports published in the Journal of the American Medical Association, roughly 50% of individuals with personality disorders are affected by substance abuse, and 37% of alcohol abusers suffer from some form of mental illness. Individuals with schizophrenia or bipolar disorder are four or five times more likely, respectively, to suffer from substance abuse than the general population."

Source

For help, visit:

Schizophrenia & Substance Use

Addiction Services (Nova Scotia)

Alcoholics Anonymous (Nova Scotia)

Narcotics Anonymous (Nova Scotia)

Schizophrenia and Co-Occurring Substance Use Disorder

The American Journal of Psychiatry's Treatment in Psychiatry section begins with a hypothetical case illustrating a problem in current clinical practice. The authors review current data on prevalence, diagnosis, pathophysiology, and treatment. The article concludes with the authors' treatment recommendations for cases like the one presented.

From the March 2007 issue:

A 29-year-old Caucasian man was brought to the emergency department by the police after he was found wandering barefoot through the snow on Main Street. The police had been called after passers-by reported that the man seemed intoxicated and was acting strangely.

When an officer approached the man, he became belligerent and agitated and angrily exclaimed that they had no reason to question him.

Using some force, the police brought him to the emergency department. The psychiatrist who interviewed him noted a strong smell of alcohol and signs of psychosis; the man demonstrated a clear thought disorder, and he appeared to be responding to internal voices. A physical examination was unremarkable. His urine was positive for cannabis by dipstick test, and an alcohol breath test was positive.

Given the absence of further information about him, the patient was admitted to the crisis service, where he promptly fell asleep. Four hours later, he was less intoxicated. A history was obtained and a mental status examination was performed. As far as could be determined, he had been receiving treatment at a local mental health center, but he had stopped taking his medication (risperidone) 4 weeks earlier and had relapsed to heavy use of alcohol and cannabis. During this period he had been essentially homeless, a situation that presented increasing difficulty for him given the recent cold weather and snow.

The article by Green et al. continues by posing the following questions:

1. How commonly does schizophrenia co-occur with substance use disorder?


2. What are the implications of substance use for the course of the psychosis?


3. What do we understand about the basis of the co-occurrence of substance use disorder and schizophrenia?


4. How best can a psychiatrist work with this type of a patient?


5. What medications are most likely to be helpful?

If you are interested in receiving a copy of this complete article, contact the Schizophrenia Society of Nova Scotia by sending an email to ssns@ns.sympatico.ca.

An excellent audio summary of the schizophrenia-related articles in the March 2007 edition of The American Journal of Psychiatry can be found be clicking here (note, the audio takes a few minutes to download).