Burden of Mental disorders

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Burden of Mental disorders

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  (???????????)
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  ????????????????

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DALY (Disability-Adjusted Life Year)
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1 DALY ???????????????????????????????????????
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DALY YLL YLD
YLL N X L N ??????????? L
???????????????????? YLD I X DW X L I
??????????????????????????????????????? DW
disability weights L ???????????????????????
?????????????(??)
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Mental disorders

• Major Depressive disorder
• Bipolar disorder
• Anxiety disorders
• 3.1 Panic disorder
• 3.2 Generalize anxiety disorder
• Schizophrenia
• Alcohol dependence/harmful use
• Drug dependence/harmful use

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Major depressive Disorder And Dysthymic Disorder

• Years of life lost due to disability Data
  sources, methods preliminary results

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Case and sequelae definitions for unipolar
depressive disorders and Dysthymic disorder
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Disability weights and health state descriptions
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DisMod II model inputs
Prevalence
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DisMod II model inputs
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DisMod II model inputsof Dysthymia
Prevalence
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DisMod II model inputsof Dysthymia
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Years of life lost due to disability for major
depression Data sources, methods preliminary
results
SPICE Benjamas Prukkanone, Pudtan Panthunane,
Stephen Lim, Theo Vos
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DisMod II model using the following inputs

• Prevalence
• estimated using Thai Mental Health Survey, 2003
• Should incorporate Mental Health Hospital / DRG
  data?
• Less problematic than schizophrenia due to
  shorter duration
• RR Mortality
• Relative risk of mortality of 1.5
• Remission rate
• Remission rate of 2 based on average duration of
  6 months reported in several longitudinal
  naturalistic studies (Lewinsohn et al. 1997,
  Kendler et al. 1997, Eaton et al. 1997, McLeod et
  al 1992)

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Prevalence of major depression
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DisMod results
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Disability weights

• Dutch disability weight study
• Mild 0.140
• Moderate 0.350
• Severe 0.760
• Severity distribution from Australian BOD
• Male
• 24 Mild, 50 Moderate, 26 Severe
• Female
• 34 Mild, 36 Moderate, 21 Severe

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YLD results
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Bipolar Disorder

• Years of life lost due to disability Data
  sources, methods preliminary results

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DisMod II model inputs
Prevalence
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Prevalence of Bipolar disorder data sources
- summary
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prevalence and incidence studiesOf mood disorders

• Waraich P, Goldner EM,Somers JM, Hsu L.
  prevalence and incidence studies Of mood
  disorders systematic review of literature. Can J
  Psy.2004,Feb49(2)124-138
• Pool rate of 1 year prevalence
• Major depressive disorder 4.1 per100
• Dysthymia 2.0 per100
• Bipolar I disorder 0.72 per100

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DisMod II model inputs
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Disability weights and health state descriptions
in GBD 2000
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Untreated ?????? 5050 or 6040 ?.??????? 4060
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DisMod result Bipolar
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DisMod result Bipolar
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Panic Disorder

• Years of life lost due to disability Data
  sources, methods preliminary results

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DisMod II model inputs
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DisMod II model inputs of Panic disorder
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Disability weights and health state descriptions
(GBD2000)
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DW in Anxiety disorders

• a. Panic disorder
• Mild to moderate panic disorder 0.160 Dutch
  weight
• Severe panic disorder 0.690 Dutch weight
• b. Agoraphobia
• Mild to moderate agoraphobia 0.110 Dutch weight
• Severe agoraphobia 0.550 Dutch weight
• c. Generalized anxiety disorder (GAD)
• Mild to moderate GAD 0.170 Dutch weight
• Severe GAD 0.600 Dutch weight

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Generalize Anxiety Disorder

• Years of life lost due to disability Data
  sources, methods preliminary results

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DisMod II model inputs of GAD
Prevalence
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DisMod II model inputs
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Schizophrenia

• Years of life lost due to disability Data
  sources, methods preliminary results

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Case and sequelae definitions for schizophrenia
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DisMod II model inputs
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DisMod II model inputs
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Disability weights and health state descriptions
(GBD2000)
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Years of life lost due to disability for
schizophrenia Data sources, methods
preliminary results
SPICE Pudtan Panthunane, Benjamas Prukkanone,
Stephen Lim, Theo Vos
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Schizophrenia

• DisMod II model using the following inputs
• Prevalence
• estimated using combination of Thai Mental Health
  Survey, 2003 DRG dataset
• Should incorporate Mental Health Hospital data?
• RR Mortality
• Relative risk of mortality from Australian BOD
• 1.97 males, 1.6 females
• Estimation of RR mortality in Thailand not
  possible with VR data due to poor coding
• May be possible to examine this in the future
  Verbal Autopsy study
• Remission rate
• Assumed to be 1.5
• Based on median annualized remission rate
  reported in several longitudinal natural history
  studies (Harding et al 1987, Ciompi 1980,
  Helgason 1990, Harrison et al 2001, Huber 1980)

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Prevalence of psychosis
Hospital
Combine these two sources to determine national
prevalence
Household
Other

• of schizophrenia amongst all psychosis from Low
  Prevalence Disorders study, Australia 73.15

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Combined prevalence (DRG and MHS)
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DisMod results
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Disability weights

• GBD 2000
• Untreated 0.627
• Treated 0.351
• Assume untreated is 37, treated 63 (WHO 10
  country study 37 worse, 63 better)
• Composite DW 0.453

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Results