Is it possible to carry out high-quality epidemiological research in psychiatry with limited resources?

National sample survey organization survey report: An estimation of prevalence of mental illness and its association with age in India

BACKGROUND

The Indian population suffers with significant burden of mental illness. The prevalence rate and its association with age and other demographic indicators are needed for planning purpose.

OBJECTIVE

This study attempted to calculate age-wise prevalence of mental illness for rural and urban settings, and its association with age.

MATERIALS AND METHODS

Data published in National Sample Survey Organization (2002) report on disability is used for the analysis. Spearman correlation for strength of association, z-test for difference in prevalence, and regression statistics for predicting the prevalence rate of mental illness are used.

RESULT

Overall population have 14.9/1000 prevalence of mental illness. It is higher in rural setting 17.1/1000 than urban 12.7/1000 (P < 0.001). There is a strong correlation found with age in rural (ϱ = 0.910, P = 0.001) and urban (ϱ = 0.940, P = 0.001).

CONCLUSION

Results of this study confirm other epidemiological research in India. Large-population epidemiological studies are recommended.

Convergent validity of K-SADS-PL by comparison with CBCL in a Portuguese speaking outpatient population

BACKGROUND

Different diagnostic interviews in child and adolescent psychiatry have been developed in English but valid translations of instruments to other languages are still scarce especially in developing countries, limiting the comparison of child mental health data across different cultures. The present study aims to examine the convergent validity of the Brazilian version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) by comparison with the Child Behavior Checklist (CBCL), a parental screening measure for child/adolescent emotional/behavior problems.

METHODS

An experienced child psychiatrist blind to CBCL results applied the K-SADS-PL to a consecutive sample of 78 children (6-14 years) referred to a public child mental health outpatient clinic (response rate = 75%). Three K-SADS-PL parameters were considered regarding current disorders: parent screen interview rates, clinician summary screen interview rates, and final DSM-IV diagnoses. Subjects were classified according to the presence/absence of any affective/anxiety disorder, any disruptive disorder, and any psychiatric disorder based on K-SADS-PL results. All subjects obtained T-scores on CBCL scales (internalizing, externalizing, total problems).

RESULTS

Significant differences in CBCL mean T-scores were observed between disordered and non-disordered children. Compared to children who screened negative, children positive for any affective/anxiety disorder, any disruptive disorder, and any psychiatric disorder had a higher internalizing, externalizing and total problem T-score mean, respectively. Highly significant differences in T-score means were also found when examining final diagnoses, except for any affective/anxiety disorder.

CONCLUSIONS

Evidence of convergent validity was found when comparing K-SADS-PL results with CBCL data.

Social stressors, mental health, and physiological stress in an urban elite of young Afghans in Kabul

Afghanistan provides a unique setting in which to appraise psychosocial stress, given the context of persistent insecurity and widening economic inequality. In Kabul, people experience widespread frustrations, hinging on restricted opportunities for social advancement, education, and employment. We appraised social aspirations, every-day stressors, psychosocial distress, and mental health problems for a random sample of 161 male and female students at Kabul University. The survey featured both existing and newly-developed instruments (Self-Reported Questionnaire SRQ-20; Afghan Symptom Checklist; Afghan Daily Stressor Scale; and Social Aspirations and Frustrations), implementing both internationally-used and culturally-grounded measures of mental health assessment. We also included indicators of physical health (blood pressure, immune responses to Epstein-Barr virus (EBV), C-reactive protein, and body mass index), to map physiological function with reported psychosocial distress. This young, urban elite expressed major feelings of frustrations, related to physical, economic, social, and political stressors of day-to-day life in Kabul. There were striking gender differences for psychosocial and physiological markers of wellbeing; specifically, women showed poorer mental health (SRQ-20, P = 0.01) and elevated EBV antibody titers (P = 0.003). Both diastolic blood pressure (P = 0.018) and EBV (P = 0.038) were associated with a subscale of family stressors among women, but not among men, consistent with women's social vulnerabilities to stressful family dynamics. This is the first study to integrate approaches from anthropology, cross-cultural psychiatry, and human biology to document social stressors, psychosocial distress, and physiological wellbeing in the challenging setting of present-day Afghanistan.

Prevalence, pattern and determinants of mental disorders in rural Bangladesh

OBJECTIVES

Very few studies have examined mental health morbidity in Bangladesh. This community-based study of rural Bangladesh in 2000-2001 estimated the burden of mental morbidity among rural people of working age.

STUDY DESIGN AND METHODS

Community surveys were conducted with one respondent from each household of three selected villages in the service provision area of a non-profit public health organization. General Health Questionnaire 60 (GHQ-60) was used as a screening tool in Stage I, and clinical examination by a Western-trained psychiatrist was undertaken for concurrent validation in Stage II.

RESULTS

The overall prevalence of psychiatric disorders in this rural area was 16.5%. Depressive disorders and anxiety disorders constituted about one-half and one-third of the total cases, respectively. A significantly higher prevalence of mental disorders was found in the economically poor respondents, those over 45 years of age, and women from large families.

CONCLUSION

There is a high prevalence of psychiatric disorders in rural Bangladesh. These findings should aid the planning of locally relevant and appropriate mental healthcare programmes. There is an urgent need for a national mental healthcare policy that strengthens primary mental healthcare services.