Public Health Surveillance. “The ongoing, systematic collection, analysis, interpretation, and dissemination of data about a health-related event for use in public health action to reduce morbidity and mortality and to improve health.”
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“The ongoing, systematic collection, analysis, interpretation, and dissemination of data about a health-related event for use in public health action to reduce morbidity and mortality and to improve health.”
Centers for Disease Control and Prevention, (2001). Updated guidelines for evaluating public health surveillance systems: Recommendations from the guidelines working group. Morbidity and Mortality Weekly Report 2001, 50 (No. RR-13), 1 – 35.
A functionally hybrid system to maximize cost-effectiveness because disease-specific surveillance of psychological disorders (diagnoses) would be prohibitively expensive,
they recommend ongoing syndromic surveillance focusing on key indicators of current depression, PTSD, dysfunction, anxiety/fears, and psychosocial resources, punctuated with occasional disease-specific surveys and more in-depth assessment of risk and protective factors
SAMHSA’s official definition of adults with SMI, based on a notice published in the Federal Register (SAMHSA, Center for Mental Health Services, 1993):
Age 18 and over, and
Currently have, or at any time during past year, had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet DSM-IV or ICD-9-CM equivalent, with the exception of substance use disorders, and developmental disorders;
Has resulted in functional impairment which substantially interferes with or limits one or more major life activities.
Using data on clinical significance lowered past-year prevalence rates of “any disorder” among 18 – 54-year-olds by 17% in the ECA and 32% in NCS and discrepancies between these two surveys are largely due to methodologic differences.
Establishing the clinical significance of disorders in the community is crucial for estimating treatment need
Narrow WE, Rae DS, Robins LN, Regier DA. Revised prevalence estimates of mental disorders in the United States. Arch Gen Psychiatry. 2002;59:115-123
Twelve-month NCS/DSM-III-R disorders were disaggregated into:
3.2% severe, 3.2% serious, 8.7% moderate, and 16.0% mild case categories
All 4 case categories were associated with statistically significant (p<.05) elevated risk of NCS-2 outcomes compared with baseline non-cases, with odds ratios of any outcome ranging monotonically from 2.4 to 15.1 for mild to severe cases.
There is a graded relationship between mental illness severity and later clinical outcomes.
Kessler RC, Merikangas KR, Berglund P, Eaton WW, Koretz DS, Walters EE. Mild disorders should not be eliminated from DSM-V. Arch Gen Psychiatry. 2003;60:1117-1122.
Results from the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) indicate six-month recovery and remission rates of 50% and 70% respectively.
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial evaluated depression treatment strategies comparing four sequential steps of different medications, medication combinations, or medication with cognitive behavior therapy.
37% of depressed patients had remission after the first step (citalopram only),
a total of 67% achieved remission after all four steps, and