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NHSN 4th Annual National Scientific Conference International Pre-conference Meeting

NHSN 4th Annual National Scientific Conference International Pre-conference Meeting. “Challenges and Opportunities in International Collaborations in Mental Health and Substance Abuse Research: The WMH Initiative in Latin America”

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NHSN 4th Annual National Scientific Conference International Pre-conference Meeting

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  1. NHSN 4th Annual National Scientific ConferenceInternational Pre-conference Meeting “Challenges and Opportunities in International Collaborations in Mental Health and Substance Abuse Research: The WMH Initiative in Latin America” Maria Elena Medina-Mora, Ph.D.National Institute of Psychiatry, México Sergio A. Aguilar-Gaxiola, M.D., Ph.D. California State University, Fresno San Antonio, TX October 11, 2004

  2. Presentation Outline • Why engage in international research collaborations • Examples of two multi-site, cross-cultural, international collaborations • ICPE • Lifetime prevalence of substance use, problems, and dependence • Comorbidity between substance use and mental disorders • WMH • Lifetime comorbidities between mental and substance disorders • Challenges and benefits of international collaborations

  3. Why Engage in International Research Collaborations • We live in a global society: mental and substance abuse disorders have no borders. • The burden of mental and substance disorders in communities has grown and communities need to be supported by strong and effective health services if they are to play an increasing role in improving mental health. • It is important that countries improve their capacity to undertake quantitative and qualitative research and evaluation relevant to service standards and improvement, and to mental health promotion.

  4. Why Engage in International Research Collaborations • Improvements in mental health depend on a culture of research and evaluation. • We need to strive to establish a research capacity in both qualitative and quantitative disciplines in countries. • Priority public health-oriented research such as collection of basic planning information through national mental health surveys is needed. • Assessing the costs of mental disorders and investigating cost-effective approaches to the management of disorders in developing countries is also needed.

  5. Why Engage in International Research Collaborations • Universities, researchers, mental health service providers and communities interested in mental health determinants and outcomes have limited interaction with each other. • Specific efforts need to be made to facilitate interaction among these groups.

  6. Two Examples of International Research Collaborations • The International Consortium in Psychiatric Epidemiology (ICPE) • The WHO’s World Mental Health Survey (WMH) ICPE

  7. ICPE • The International Consortium in Psychiatric Epidemiology (ICPE) is a consortium funded by the US National Institutes of Health • The main goal of the ICPE is to facilitate cross-national comparative epidemiologic studies of psychiatric disorders through application of uniform diagnostic criteria http://www.hcp.med.harvard.edu/icpe

  8. ICPE • Comprised of researchers from around the world who have carried out general population epidemiologic surveys of psychiatric disorders based on the Composite International Diagnostic Interview (CIDI)

  9. ICPE • The Principal Investigator is Ronald Kessler, Ph.D., Harvard Medical School and the CO-PI is Bedirhan Ustun, M.D., the World Health Organization • The administrative home of the ICPE is the Survey Research Center (SRC) in the Institute for Social Research (ISR) at the University of Michigan • The ISR is one of the leading academic survey research training centers in the world

  10. ICPE Lifetime Prevalence of Use, Problems, and Dependence

  11. ICPE DEFINITION OF VARIABLES • Alcohol Use: Lifetime history of alcohol use (ever had at least 12 drinks of alcohol in a single year) • Alcohol Problem: Lifetime occurrence of at least one DSM-III-R Criterion A symptom of alcohol abuse or dependence • Alcohol Dependence: Meets lifetime DSM-III-R dependence criteria

  12. ICPE MAPSS 94.1 94.1 97.1 97.1 95.6 95.6 1.6 52.6 52.6 40.2 40.2 40.7 35.8 40.7 1.1 35.8 44.2 40.0 40.0 44.2 19.8 14.1 16.8 Kessler, Aguilar-Gaxiola, Andrade et al., 2003, Handbook for Drug Abuse Prevention Theory, Science, and Practice.

  13. ICPE MAPSS 90.6 90.6 82.7 82.7 73.6 8.7 73.6 42.7 42.7 22.5 39.0 39.0 22.5 37.7 8.7 3.5 17.2 1.1 4.8 Kessler, Aguilar-Gaxiola, Andrade et al., 2003, Handbook for Drug Abuse Prevention Theory, Science, and Practice.

  14. ICPE Comorbidity of Alcohol, Drug, and Mental Disorders

  15. MAPSS MAPSS 63.6 47.7 34.5 21.3 25.4 18.7 20.5 24.6 12.9

  16. MAPSS MAPSS 71.0 79.4 72.4 56.7 62.4 63.6 63.5 68.6 37.1 45.6 57.4 47.7 34.3 43.5 25.7 44.4 47.4 36.8 10.7 24.2 33.2 21.3 30.0 17.7

  17. ICPE MAPSS 44.9 40.9 30.2 34.5 25.4 18.7 14.7 13.4 8.7

  18. ICPE MAPSS ICPE 71.0 79.4 55.4 56.7 47.6 63.6 63.5 68.6 35.5 37.1 44.4 45.6 57.4 47.7 43.5 25.7 36.8 31.1 47.4 10.7 21.7 24.2 21.3 9.9

  19. ICPE MAPSS 35.5 29.3 19.9 24.6 17.0 18.2 20.5 9.4 12.9

  20. ICPE MAPSS 71.0 79.4 40.6 56.7 34.9 63.6 34.7 63.5 31.4 68.6 24.1 33.2 37.1 45.6 57.4 47.7 43.5 30.0 25.7 47.4 10.7 14.8 17.7 21.3

  21. ICPE MAPSS 63.6 47.7 37.1 25.7 10.7 21.3

  22. ICPE MAPSS 71.0 79.4 56.7 72.4 63.6 63.5 68.6 62.4 37.1 45.6 57.4 47.7 43.9 43.5 25.7 33.8 47.4 16.1 10.7 34.3 21.3

  23. ICPE MAPSS 79.4 71.0 63.6 56.7 68.6 63.5 37.1 57.4 47.7 43.5 45.6 25.7 47.4 10.7 21.3

  24. ICPE MAPSS 71.0 79.4 100 56.7 83.4 74.4 63.6 63.5 63.4 68.6 37.1 45.6 72.7 57.4 47.7 55.6 43.5 25.7 47.4 60.2 44.3 48.4 10.7 21.3

  25. ICPE MAPSS 52.1 63.6 36.9 37.1 47.7 34.8 25.7 34.3 20.9 32.8 10.7 19.8 21.3 26.1 18.1

  26. ICPE MAPSS 71.0 79.4 55.0 56.7 43.7 63.6 63.5 45.0 68.6 37.1 29.6 45.6 57.4 47.7 43.5 25.7 35.5 47.4 35.1 22.7 10.7 30.4 21.3 18.1

  27. ICPE CONCLUSIONS • Substance abuse and/or dependence were found to co-occur within themselves and with anxiety and depressive disorders (and adult antisocial behaviors) • Substance disorders were found to be most strongly comorbid within themselves, followed by either the depressive or anxiety disorders (depending upon comorbid substance disorder)

  28. ICPE CONCLUSIONS • Strong consistency was found for anxiety disorders temporally preceding the alcohol and drug abuse disorders in both man and women and in U.S. and Mexico-born respondents • Depressive disorders were also consistently found to be temporally secondary to alcohol and drug abuse disorders for both men and women

  29. Temporal Ordering of Substance Disorders with Anxiety and Mood Disorders ANXIETY SUBSTANCE MOOD DISORDERS DISORDERS DISORDERS

  30. ICPE IMPLICATIONS • Early intervention and successful treatment of mental disorders might help prevent the onset of a substantial proportion of substance use disorders • Comparison of age of onset reports for temporally primary mental disorders and subsequent substance use disorders shows a window of opportunity for preventive interventions for most mental disorders

  31. ICPE LIMITATIONS • Results are based on cross-sectional data using retrospective recall of lifetime data (age of onset) to reconstruct temporal priorities between first onsets of substance use disorders and mental disorders • Many people unwilling to admit substance use problems or mental disorders to survey interviewers

  32. The WHO’s World Mental Health Survey: An Overview

  33. T. Bedirhan Üstün, M.D. Assessment Classification Epidemiology Group World Health Organization (WHO) ustunt@who.ch Ronald C. Kessler, Ph.D. Department of Health Care Policy Harvard University Medical School kessler@hcp.med.harvard.edu WMH: PIs http://www.hcp.med.harvard.edu/wmh/index.html

  34. Claudio T. Miranda, M.D. Mental Health Regional Advisor Pan American Health Organization (PAHO) mirandac@paho.gov WMH: PAHO José Miguel Caldas de Almeida, M.D. Coordinator, Mental Health Program Pan American Health Organization (PAHO) caldasaj@paho.gov

  35. WMH: Coordination PAHO Region Sergio A. Aguilar-Gaxiola, M.D., Ph.D. Coordinator for Latin America and the Caribbean of the WMH sergioa@csufresno.edu

  36. The Core Descriptive Goals of WMH To estimate… • Prevalences of mental disorders • Societal burdens of mental disorders • Comparative burdens of physical and mental disorders • Rates of unmet need for treatment • Rates of treatment adequacy

  37. The Core Analytic Goals of WMH To examine… • Modifiable risk factors for onset and course of mental disorders • Barriers to seeking treatment • Predictors of treatment dropout • Predictors of treatment adequacy

  38. Core Nosological Goals To support changes in DSM-V and ICD-11 by… • Searching for evidence of taxonicity • Examining effects of threshold variation on external validators

  39. The Social Policy Messages of WMH • Mental disorders are top illness-related cost drivers of impairment • Safe and effective treatments are available • Substantial barriers exist to treatment that require structural solutions • Enhanced outreach and treatment are investment opportunities

  40. The WMH Study Design • Nationally or regionally representative household surveys • Adults 18 and older • Subsamples of spouses of target respondents • Standardized interviewer training and monitoring • Standardized face-to-face interviews

  41. The WMH Study Design • Sample of at least 5000 interviews per country • Both CAPI and PAPI versions • Shared training, quality control, and data processing protocols

  42. Participating Countries Sample Type National Probability Sample Regional Probability Sample

  43. Data Collection Status Completed In progress To be completed

  44. Unique Aspects of WMH • Large scale, worldwide • Same design, translation methods, training, and quality control protocols • CIDI enhancements • Clinical follow-up

  45. The WMH Instruments • The WHO Composite International Diagnostic Interview (CIDI) • The WHO Disability Assessment Schedule (WHO-DAS) • The Structured Clinical Interview for DSM-IV (SCID-IV) • A wide range of clinical severity measures

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