Public health surveillance
Download
1 / 21

Public Health Surveillance - PowerPoint PPT Presentation


  • 361 Views
  • Updated On :

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.”

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Public Health Surveillance' - elina


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Public health surveillance l.jpg
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.”

    • 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.


Features of public mental health surveillance system galea norris l.jpg
Features of Public Mental Health Surveillance System (Galea & Norris)

  • 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


Features of public mental health surveillance system galea norris3 l.jpg
Features of Public Mental Health Surveillance System (Galea & Norris)

  • Surveillance be implemented on a large enough scale to provide data for specific racial, ethnic, and socioeconomic groups.

    • This would increase understanding of the differences in the need for and use of mental health services.

  • Public Mental Health Surveillance must aim to educate major stakeholders, including the general public.


Mental health epidemiologic studies l.jpg
Mental Health Epidemiologic Studies & Norris)

  • First-generation - 16 (Prior to World War II)

    • E. Jarvis: Insanity and Idiocy in MA: Report of the Commission on Lunacy, 1855. Cambridge, MA: HU ‘71

    • Institutional records and key informants

    • Prevalence in specialty mental health settings

  • Second-generation - 60 (1950 – 1980)

    • Stirling County Study (1952)

    • Baltimore Morbidity Survey (1953/54)

    • Midtown Manhattan Study (1954)

    • Mental Health Study in New Haven (1967-75)

      • Predefined “operationalized” criteria

      • Structured interviews by non-clinician interviewers

      • Prevalence in the community


  • Mental health epidemiologic studies5 l.jpg
    Mental Health Epidemiologic Studies & Norris)

    • Third-generation (1980 - present)

      • Epidemiologic Catchment Area (1980-85)

        • In response to President’s Commission on Mental Health (PCMH)

        • Diagnostic Interview Schedule (DIS)

        • Prevalence and incidence of mental disorders

        • Use and need for services

        • Research teams from 5 universities

          • Yale, Johns Hopkins, Washington University, Duke, and UCLA in collaboration with NIMH

        • Community Mental Health Catchment Area sites:

          • New Haven, CT, Baltimore, MD, St Louis, MO, Durham, NC, and Los Angeles, CA


    Mental health epidemiologic studies6 l.jpg
    Mental Health Epidemiologic Studies & Norris)

    • Third-generation (1980 - present)

      • National Comorbidity Survey (NCS)

        • First nationally representative mental health survey in the U.S. to use a fully structured interview (WHO revised CIDI) to assess the prevalence and correlates of DSM-III-R disorders

        • Composite International Diagnostic Instrument (CIDI)

        • Interviews from Fall 1990 to Spring 1992

        • Re-interviewed in 2001 – 2002 (NCS-2)


    Mental health epidemiologic studies7 l.jpg
    Mental Health Epidemiologic Studies & Norris)

    • Third-generation (1980 - present)

      • NCS Replication (NCS-R)

        • Reinterviewed in 2001 – 2002 (NCS-2)

        • Interviewed a new nationally representative sample repeating many of the questions from the original NCS and expanding disease assessment criteria based on DSM-IV

        • Uncover trends in mental health

          • Prevalence

          • Impairment

          • Service use


    Instruments l.jpg
    Instruments & Norris)

    • Diagnostic Interview Schedule (DIS)

      • Used in ECA

    • World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

      • Used in NCS


    Instruments9 l.jpg
    Instruments & Norris)

    • Short Form (SF-36)

      • Mental Component Score (MCS), and Mental Health (MH-5) 1 0f 8 domains

    • General Health Questionnaire (GHQ)

      • GHQ-12

    • Mini-International Neuropsychiatric Interview (MINI), Sheehan et al., (1998)


    Instruments10 l.jpg
    Instruments & Norris)

    • Patient Health Questionnaires (PHQ)

      • Prime-MD, PHQ-9, PHQ-8, and PHQ-2

      • PHQ-8 used in:

        • BRFSS 2006 and 2008

      • PHQ-9 used in:

        • NHANES 2005 - 2006


    Instruments11 l.jpg
    Instruments & Norris)

    • Kessler scales

      • K10 has been used in:

        • WHO World Mental Health (WMH) Surveys

          • 250,000 people

          • 30 countries

        • Australian Bureau of Statistics, National Survey of Mental Health and Wellbeing (SMHWB)

      • K6 (past 30 days) used in:

        • BRFSS 2007

        • NHIS (since 1997)

      • K6 (worst 30 days in past year) used in:

        • NSDUH


    Slide12 l.jpg
    SMI & Norris)

    • 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.


    From smi l.jpg
    From SMI… & Norris)

    • NSDUH implemented the modified K6 (worst 30 days in past year) to assess SMI based on a methodological study to evaluate several screening scales for measuring SMI

      • Truncated version of WHO-CIDI

      • K10/K6 scale of non-specific psychological distress

      • WHO-Disability Assessment Schedule

      • Respondents with a total score of 13 or greater were classified as having past year SMI


    To spd l.jpg
    …to SPD & Norris)

    • In 2003 NSDUH contained a broad array of questions about mental health that preceded the K6 items, and the four extra questions in the K10 scale interspersed among the items in the K6 scale.

    • In 2004 NSDUH, the sample of respondents 18 or older was split evenly between the “long form” as used in 2003 NSDUH, and a “short form” consisting of only K6 items.

    • Results showed large differences between the two samples in both the K6 total score and the proportion of respondents with a K6 total score of 13 or greater.

      • K6 scale was found not to be context independent

      • GAF score of less than 60 (moderate) not per definition

        • Changed: GAF score of less than or equal to 50 (serious)


    Clinically significant vs mild disorders l.jpg
    Clinically Significant vs Mild Disorders & Norris)

    • 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


    Clinically significant vs mild disorders16 l.jpg
    Clinically Significant vs Mild Disorders & Norris)

    • 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.


    Managing depression as a chronic disease l.jpg
    Managing depression as a chronic disease & Norris)

    • Evidence from trials of the efficacy of short term treatment

      • Nathan PE, Gorman, J, eds. A guide to treatments that work. Oxford: Oxford University Press, 1998

        • Four types of antidepressant drugs, cognitive behavior and interpersonal therapy, and electroconvulsive therapy produced benefits of 0.5 to 1.0 standard deviation over the response to placebo.

        • Depression is a disorder that remits

        • Depression also recurs


    Dynamic and chronic nature of depression l.jpg
    Dynamic and chronic nature of depression & Norris)

    • 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

      • only 43% had sustained recovery.


    Take away messages l.jpg
    Take-away messages & Norris)

    • Depression, while recognized as a highly recurrent and often a chronic disorder requiring long-term treatment, frequently remains unrecognized and untreated or inadequately treated.

    • Sub-threshold or minor depression is often associated with disability and poor psychosocial functioning, and a potentially more severe course that requires treatment.

    • If left untreated or inadequately treated, depression can be a source of much unnecessary personal distress, prolonged family burden, and significant morbidity and mortality.

    • When left untreated or inadequately treated, including premature termination of treatment, depression more likely persists, reoccurs, and worsens


    Take away messages20 l.jpg
    Take-away messages & Norris)

    • Need ongoing syndromic surveillance focusing on key indicators of current depression because disease-specific surveillance of psychological disorders (diagnoses) would be prohibitively expensive.

    • Occasional disease-specific surveys and more in-depth assessment of risk and protective factors.

    • Periodic combination of the two types of data (indicators and diagnoses) would facilitate interpretation of the indicator data, which would be collected more frequently and regularly.

    • Clinically significant and mild or sub-syndromal disorders need to be monitored


    Public mental health surveillance questions l.jpg

    Public Mental Health Surveillance: Questions & Norris)

    Satvinder “Pearly” Dhingra, MPH

    Behavioral Surveillance Branch

    [email protected]

    770-488-5444


    ad