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El Puente to the Millenium

El Puente to the Millenium. Comorbidity and Temporal Ordering of Alcohol, Mood, and Anxiety Disorders in a Community Sample of Mexican Americans Sergio A. Aguilar-Gaxiola, M.D., Ph.D. California State University, Fresno Denver, CO October 15, 1999. Workshop Outline.

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El Puente to the Millenium

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  1. El Puente to the Millenium Comorbidity and Temporal Ordering of Alcohol, Mood, and Anxiety Disorders in a Community Sample of Mexican Americans Sergio A. Aguilar-Gaxiola, M.D., Ph.D. California State University, Fresno Denver, CO October 15, 1999

  2. Workshop Outline • Importance of comorbidity • Overview MAPSS Study • Results MAPSS Study • Lifetime prevalence rates of mental disorders • Magnitude and patterns of comorbidity among mental disorders • Patterns of onset for mood and anxiety disorders with respect to alcohol use, problem use, and dependence • Limitations • Conclusions

  3. Comorbidity • is clinically important because people who suffer from two or more mental disorders tend to: • be more disabled (more functionally impaired) • be high users of health services • be more prone to suicide • have higher rates of homelessness • have more legal and medical problems • have more frequent and longer hospitalizations • have more severe illness course (chronic) • have broader societal costs • have social role impairment and work role impairment • have lower treatment compliance • complicate treatment effectiveness more than people with single disorders

  4. Data coming from: Vega, W. A., Kolody, B., Aguilar-Gaxiola, S. A., Alderete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry. 55(9), 771-778. Kessler, R.C., Aguilar-Gaxiola, S.A., Andrade, L., et al. (1999). Cross-national cpmparisons of comorbidities between substance use disorders and mental disorders: Results from the International Consortium in Psychiatric Epidemiology. In W.J. Bukoski & Z. Sloboda (Eds.), Handbook for Drug Abuse Prevention Theory, Science, and Practice. New York, NY: Plenum Publishing Corporation. Merikangas, K.R., Mehta, R.L., Monar, B.E., Walters, E.E., Swendsen, J.D., Aguilar-Gaxiola, S.A., Bijl, R., Borges, G., Caraveo-Anduaga, J.J., DeWit, D.J., Kolody, B., Vega, W.A., Wittchen, H., & Kessler, R.C., (1998). Comorbidity of substance and psychiatric disorders: Results of the International Consortium of Psychiatric Epidemiology. Addictive Behaviors, 23(6), 893-907.

  5. MAPSS Mexican American Prevalence and Services Survey (MAPSS) P.I. William A. Vega, Ph.D. University of Texas, San Antonio On-Site P.I. Sergio A. Aguilar-Gaxiola, M.D., Ph.D California State University, Fresno

  6. MAPSS GOALS • Conduct a comprehensive household survey of mental health services utilization patterns • Determine prevalence rates of 15 DSM-III-R and DSM-IV mental disorders

  7. MAPSS SAMPLE • N = 4,013 completed interviews on rural and urban Mexican American and Mexican origin adults aged 18 to 59 years DATACOLLECTION • From May, 1995 to October, 1996 • Face to face interviews conducted in the respondents’ homes

  8. MAPSS RESEARCH SITE: FRESNO COUNTY • The County’s population is N=764,810 • N=463,600 (60%) are located in the Fresno/Clovis Metropolitan Area • Fresno is the 6th largest city in California • Hispanics constitute 41.4% of the County and 28.9% of the City of Fresno population

  9. Source: New United Way, 1998

  10. MAPSS STUDY DESIGN • Cross-sectional SAMPLING DESIGN • Probabilistic, stratified, multistage cluster sample with complete coverage of the County’s Mexican origin population

  11. MAPSS SAMPLING DESIGN • Sample was stratified on place of residence and sex, from four strata: • Urban males (n=501) and females (n=505) • Town males (n=494) and females (n=512) • Rural males (n=501) and females (n=499) • Seasonally-employed migrant males (n=500) and females (n=501)

  12. MAPSS INSTRUMENT • Fresno-Composite International Diagnostic Interview (Fresno-CIDI), a modified version of the UM-CIDI (used in the NCS) tailored for use in Mexican-origin adults • Fresno-CIDI has been officially recognized by WHO as a modified version of the CIDI

  13. MAPSS Fresno-CIDI • Yields Lifetime, 12-months, Six-months, and One-month DSM-III-R, DSM-IV, and ICD-10 diagnoses of 15 mental disorders: • Mood Disorders (MD, ME, D) • Anxiety Disorders (A, SocP, SimP, PD, GAD) • Substance Use Disorders (AA, AD, DA, DD) • Non-affective Psychosis • Somatization Disorder • Antisocial Personality Disorder

  14. MAPSS Fresno-CIDI Features • Emphasized culturally and linguistically specific questions aimed at the target population • Developed a Computer Assisted Personal Interview (CAPI) version in English and Spanish

  15. MAPSS RESPONSE RATES • Urban stratum = 87.8% • Town stratum = 90.6% • Rural stratum = 91.5% • Total Sample = 90.0%

  16. MAPSS

  17. MAPSS

  18. MAPSS

  19. MAPSS

  20. MAPSS KEY EXPLANATORY VARIABLES • Nativity/Acculturation • Gender • Place of Residence

  21. MAPSS MAPSS 29.3 28.2 28.0 24.7 24.1 25.0 48.7 14.3 51.4 48.6 17.1 20.4 18.5 32.3 19.5 9.7 11.8 18.4 10.8 7.6 23.4 8.3 9.0 5.9 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998 MAPSS Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  22. MAPSS MAIN FINDINGS • Mexican immigrants had about one-half the prevalence rates of major psychiatric disorders of either U.S.-born Mexican Americans or other Americans • Mexican Americans born in the U.S. have the same rates (48.7%) of disorders as the U.S. population (48.6%)

  23. MAPSS MAIN FINDINGS • Mexican immigrants have similar levels of psychiatric disorders (24.9%) to residents of Mexico City (23.4%) • When Mexican immigrants with less than 13 years in the U.S. were compared with those with 13 years or more, it was found that risk of having a mental health problem increased dramatically, especially so for alcohol and drug abuse or dependence problems

  24. MAPSS MAIN FINDINGS • 33.8% of Mexican American origin respondents had a lifetime DSM-III-R psychiatric disorder, and 18.9% had a 12-month disorder • These rates are lower than lifetime (48%) and 12-month (29.5%) rates reported by the NCS and similar to the LAECA lifetime rates for any DIS/DSM-III disorder of 30%

  25. MAPSS MAIN FINDINGS • The most prevalent lifetime group of disorders were the substance use disorders followed by the anxiety disorders and the mood disorders

  26. MAPSS MAIN FINDINGS • Women had higher overall lifetime prevalence rates of anxiety and depression than men. In contrast, substance abuse/dependence and antisocial personality disorder were more common among men than among women • The highest lifetime rates for women of any single disorder was major depression (13.4%). The most frequently reported disorder among men was alcohol dependence (18.5%).

  27. MAPSS MAIN FINDINGS • Men were much more likely than women to be at high risk for any substance abuse or dependence regardless of birthplace • Lifetime rates for all substance use disorders were three times as high for U.S. born respondents compared to respondents born in Mexico

  28. MAPSS MAPSS 29.3 28.2 28.0 24.7 24.1 25.0 14.3 17.1 20.4 18.5 19.5 9.7 11.8 10.8 7.6 8.3 9.0 5.9 MAPSS Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  29. MAPSS MAPSS 18.0 15.1 14.2 10.4 8.6 8.2 9.9 5.2 6.6 2.2 3.1 0.5 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  30. MAPSS MAPSS 13.8 7.9 7.0 5.3 3.0 3.4 4.7 3.3 1.8 0.5 0.8 0.3 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  31. MAPSS MAPSS 9.3 6.5 4.6 1.0 3.4 1.0 MAPSS Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  32. MAPSS MAPSS 1.0 1.0 1.0 2.4 1.0 1.6 1.0 1.0 0.2 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  33. MAPSS MAPSS 1.0 1.0 1.0 1.0 1.0 1.0 0.4 0.2 0.2 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  34. MAPSS MAPSS 1.7 1.2 1.0 1.0 1.1 1.0 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  35. MAPSS MAPSS 1.3 1.4 1.0 1.0 1.1 0.7 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  36. MAPSS MAPSS 1.6 1.2 1.0 1.0 0.9 0.7 0.7 0.3 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  37. MAPSS MAPSS 2.3 1.8 1.4 1.6 1.0 1.3 1.0 1.1 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  38. MAPSS MAPSS 2.3 2.2 1.8 1.4 1.6 1.0 1.6 1.3 1.0 1.0 1.1 1.1 1.0 1.1 1.1 0.9 Vega, Kolody, Aguilar-Gaxiola et al., Archives of General Psychiatry, 1998

  39. 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

  40. It is 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) and providing various resources for coordination

  41. The Principal Investigator is Ronald Kessler, Ph.D., from Harvard Medical School and the CO-PI is Bedirhan Ustun, M.D., from 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.

  42. ICPE: CIDI Data Bank • More than 200,000 CIDI records worldwide • Advanced “meta-analysis” at symptom level • Cross-cultural comparisons • Psychometrics for improving CIDI • Collaboration in International Psychiatric Epidemiology • own data jointly • share know-how for surveys and analysis • joint analyses & publications • peer review & support • support for grants

  43. ICPE: CIDI Data Bank (from Spanish-speaking populations) • US (MAPSS; Vega et al) • Puerto Rico (Alegria et al) • México (Caraveo et al; Medina-Mora et al; Salgado et al*) • Chile (Vicente et al) • Colombia* (Torres et al) • Spain* (Vázquez et al) *Not a part of the ICPE data bank

  44. ICPE DEFINITION OF VARIABLES • Alcohol Use: Lifetime history of alcohol use (ever had at least 12 drinks of alcohol in a single year) • Alcohol Problems: 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

  45. MAPSS ICPE 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., Handbook for Drug Abuse Prevention Theory, Science, and Practice, 1999

  46. MAPSS ICPE 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., Handbook for Drug Abuse Prevention Theory, Science, and Practice, 1999

  47. MAPSS ICPE 63.6 47.7 34.5 21.3 25.4 18.7 24.6 20.5 12.9

  48. MAPSS ICPE 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

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

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