Mental Health from a Public Health Perspective Professor Carol S. Aneshensel Department of Community Health Sciences 10/12/09

DSM Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association Defines mental disorders for clinical, research, and educational purposes.

Mental disorder: Clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with distress or disability or a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. [Source: DSMIV]

 Distress that is an expectable and culturally sanctioned response to a particular event, e.g., grief.  Deviant behavior nor conflicts that are primarily between the individual and society. [Source: DSMIV] Mental disorder Is Not

Sad Sleepless Guilt D Co-occurrence of multiple symptoms Syndrome or Pattern Example: Depression

DEPRESSIVE SYMPTOMS (CES-D 8) Assets and Health Dynamics Among the Oldest Old Study U.S. Adults Aged Males Mean = 1.33 Females Mean = 1.79 Percent Number of Symptoms [Source: Aneshensel et al. 2004, GSA]

Disorder or Normal?  Co-occurrence of symptoms  Severity or intensity of the symptoms  Duration  Impairment  Normal for the person  Normal for the society

GENERAL TYPES OF DISORDER  Affective and anxiety: feelings Ex: Major depression – depressed mood or loss of interest or pleasure  Cognitive: thinking Ex: Schizophrenia – psychotic symptoms such as delusions or hallucinations  Behavioral: action Ex. Substance dependence and abuse – use in the presence of problems

CRITERIA FOR MAJOR DEPRESSIVE EPISODE (MDE) Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning. At least one of the symptoms is: 1. Depressed mood most of the day, nearly every day OR 2.Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day [Source: DSMIV]

3.Significant weight loss (not dieting) or gain, or loss of appetite 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Feelings of worthlessness or guilt 8.Diminished ability to think or concentrate or indecisiveness 9.Recurrent thoughts of death; suicidal ideas, attempt or plan MDE continued [Source: DSMIV]

 The symptoms cause clinically significant distress and/or  Impairment in social, occupational or other important areas of functioning Exclusions:  Not due to bereavement  Not due to a general medical condition (e.g., hypothyroidism)  Not due to substance use  Presence of manic or mixed episode MDE continued In addition: [Source: DSMIV]

Prevalence of Major Depression U.S. Adults, 18 and Older [Source: Kessler et al. 2003] Percent

Severity of 12-Month MDD Adults, [Source: Kessler et al. 2003] Percent

Lifetime Prevalence of Mood Disorders U.S. Adults, Ages 18+, Percent [Source: Kessler and Zhao, 1999]

Lifetime Prevalence of Select Disorders U.S. Adults, Ages 18+, Percent

Odds Ratio for Lifetime Risk by Gender U.S. Adults, Ages 18+, Percent

Cultural Considerations  Culture shapes the expression of some psychiatric symptoms. Ex. The content of hallucinations  Some disorders are culture-bound. Ex. Bulimia  Psychiatric disorder exists only in societies that medicalize distress.  Psychiatric disorders can also be viewed as expressions of social problems.