Download Mental disorder - UCLA Fielding School of Public Health

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]
Mental disorder
Is Not
 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]
Syndrome or Pattern
Co-occurrence
of multiple
symptoms
Sad
Sleepless
D
Guilt
Example: Depression
DEPRESSIVE SYMPTOMS (CES-D 8)
Assets and Health Dynamics Among the Oldest Old Study
U.S. Adults Aged 70+
Percent
50
Males
Mean = 1.33
Females Mean = 1.79
45
40
35
30
25
20
15
10
5
0
0
0
1
2
3
4
5
6
7
8
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]
MDE continued
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
[Source: DSMIV]
MDE continued
In addition:
 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
[Source: DSMIV]
Prevalence of Major Depression
U.S. Adults, 18 and Older
2001-2002
Percent
18
16
14
12
10
8
6
Lifetime
12-Month
4
2
0
Lifetime
12-Month
[Source: Kessler et al. 2003]
Severity of 12-Month MDD
Adults, 2001-2
Percent
40
35
30
25
Mild
Moderate
Severe
Very Severe
20
15
10
5
0
Mild
Severe
[Source: Kessler et al. 2003]
Lifetime Prevalence of Mood Disorders
U.S. Adults, Ages 18+, 2001-2
Percent
25
20
Major
Depression
Dysthymia
15
10
Bipolar
5
Any
0
Major
Depression
Bipolar
[Source: Kessler and Zhao, 1999]
Lifetime Prevalence of Select Disorders
U.S. Adults, Ages 18+, 2001-2
Percent
50
45
40
35
30
25
20
15
10
5
0
Any
Anxiety
Any Anxiety
Any Impulse
Control
Any substance
use
Any Disorder
Any
substance
use
Odds Ratio for Lifetime Risk by Gender
U.S. Adults, Ages 18+, 2001-2
Percent
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Any
Anxiety
Any Anxiety
Any Mood
Any
Substance
Use
Any Impulse
Control
Any Substance
Use
Any Disorder
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.