The frequency of adults reporting lifetime presence of mental health problems in Europe is estimated to be around:
A. ESEMeD was the first major multicentre European psychiatric epidemiological study; it was not conducted in the UK. It used both Composite International Diagnostic Interview (CIDI) version 3.0 (WHO) and Structured Clinical Interview for DSM Disorders (SCID) based clinical diagnosis (DSM IV criteria). ESEMeD is a part of the World Mental Health Survey Initiative of the WHO. The results showed that 1 in 4 adults in Europe had a lifetime presence of a mental disorder and 1 in 10 had a mental disorder in the last year; 14.7% had a lifetime history of mood disorder (major depression only,13%), while 14% had anxiety (specific phobia only, 8%), and 5.2% had a lifetime alcohol-use disorder. The highest rate of mental disorder was in the age group 18–24.
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Considering pathways of care in mental health, which of the following is not a major filter for help seeking?
D. Also called the filter model, the ‘pathways of care’ model was developed by Goldberg and Huxley to account for how mental illness interacts with the health-care system. Five levels of mental illness occurrence were described: the community, the primary-care attendees, the correctly diagnosed primary-care attendees (in whom the mental illness has been recognized), the level of the psychiatrist, and that at the level of psychiatric in-patient care. Four filters explain the decreasing incidence when going from the general population to in-patient psychiatric care:
Occupational health resources are not major filters in this model.
In epidemiological surveys across life span, the term persistence refers to which of the following?
A. Persistence is defined as the total number of patients with lifetime prevalence of a disorder who also satisfy a defined period prevalence, say 12 months, criteria at the time of survey. It is a measure of illness chronicity, response to treatment, and burden.
Epidemiological catchment area study is one of the major surveys in psychiatric epidemiology.
Which of the following instruments was used for clinical diagnosis in this survey?
B. The Epidemiological Catchment Area study (ECA) was an investigation of the prevalence of psychiatric morbidity which was undertaken during 1976–80 in fi ve sites in the USA. More than 20 000 people were interviewed using the Diagnostic Interview Schedule (DIS). ECA is regarded as a milestone study in psychiatric epidemiology, after which a new generation of epidemiological inquiry concentrating on community samples flourished. However, ECA was criticized for its use of lifetime diagnoses, which may be unreliable due to recollection bias. DIS was the foremost layperson-usable diagnostic instrument designed for psychiatric diagnoses.
Which of the following could explain the differential outcome for schizophrenia between developing and developed nations?
E. The differential outcome of schizophrenia between developed and developing nations was first highlighted through the results of the International Pilot Study on Schizophrenia conducted by the WHO (IPSS). IPSS assessed 1202 persons diagnosed with schizophrenia in nine countries. The results showed that persons with schizophrenia in the ‘developing’ world (e.g. Columbia, India, and Nigeria) had better outcomes than persons in ‘developed’ countries (e.g. Moscow, London, Washington, Prague, and Aarhus in Denmark). In total, 52% of persons in the developing countries were assessed to be in the ‘best’ outcome category (defined as a single episode only, followed by full or partial recovery) compared with 39% in the developed countries. There was a claim that acute onset of psychosis, being more common in the developing nations, confounded the IPSS results, but a subsequent, large-scale, multinational study sponsored by WHO, excluded mode of onset as being a confounding factor for the observed differences in outcome. Differential follow-up rates, differential outcome measures, differential sex and age distribution, and diagnostic ambiguities did not confound the above results, as proved later by Hopper and Wanderling.
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