Elucidating the Epidemiology of Mental Disorders

Research Paper Title

WHO’s work on the epidemiology of mental disorders.

Background

The WHO programme on epidemiology of mental disorders started in the early 1960’s with a series of reviews of knowledge.

These were followed by activities aiming at four main goals:

  • The standardisation of psychiatric diagnosis, classification and statistics;
  • The development of standardised internationally applicable instruments for the assessment of mental patients and of variables relevant to the assessment of mental illness;
  • The conduct of epidemiological studies of mental disorders; and
  • The training relevant to the above goals.

The paper provides a description of the activities undertaken to achieve these goals and stresses the importance and usefulness of the collaboration of individuals, experts and institutions all over the world in this effort.

Reference

Sartorius, N. (2020) WHO’s work on the epidemiology of mental disorders. Social Psychiatry and Psychiatric Epidemiology. 28(4), pp.147-155. doi: 10.1007/BF00797316.

Book: Decolonising Global Mental Health

Book Title:

Decolonizing Global Mental Health: The Psychiatrisation of the Majority World.

Author(s): China Mills.

Year: 2014.

Edition: First (1st).

Publisher: Routledge.

Type(s): Paperback.

Synopsis:

Decolonising Global Mental Health is a book that maps a strange irony.

The World Health Organisation (WHO) and the Movement for Global Mental Health are calling to ‘scale up’ access to psychological and psychiatric treatments globally, particularly within the global South. Simultaneously, in the global North, psychiatry and its often chemical treatments are coming under increased criticism (from both those who take the medication and those in the position to prescribe it).

The book argues that it is imperative to explore what counts as evidence within Global Mental Health, and seeks to de-familiarise current ‘Western’ conceptions of psychology and psychiatry using postcolonial theory. It leads us to wonder whether we should call for equality in global access to psychiatry, whether everyone should have the right to a psychotropic citizenship and whether mental health can, or should, be global.

As such, it is ideal reading for undergraduate and postgraduate students, as well as researchers in the fields of critical psychology and psychiatry, social and health psychology, cultural studies, public health and social work.

World Suicide Prevention Day

Introduction

World Suicide Prevention Day (WSPD) is an awareness day observed on 10 September every year, in order to provide worldwide commitment and action to prevent suicides, with various activities around the world since 2003.

The International Association for Suicide Prevention (IASP) collaborates with the World Health Organisation (WHO) and the World Federation for Mental Health (WFMH) to host World Suicide Prevention Day.

In 2011 an estimated 40 countries held awareness events to mark the occasion. According to WHO’s Mental health Atlas released in 2014, no low-income country reported having a national suicide prevention strategy, while less than 10% of lower-middle income countries, and almost a third of upper-middle and high-income countries had.

On its first event in 2003, the 1999 WHO’s global suicide prevention initiative is mentioned with regards to the main strategy for its implementation, requiring:

  1. “The organisation of global, regional and national multi-sectoral activities to increase awareness about suicidal behaviours and how to effectively prevent them.”
  2. “The strengthening of countries’s capabilities to develop and evaluate national policies and plans for suicide prevention.”

As of recent WHO releases, challenges represented by social stigma, the taboo to openly discuss suicide, and low availability of data are still to date obstacles leading to poor data quality for both suicide and suicide attempts: “given the sensitivity of suicide – and the illegality of suicidal behaviour in some countries – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.”

Background

An estimated one million people per year die by suicide or about one person in 10,000 (1.4% of all deaths), or “a death every 40 seconds or about 3,000 every day”. As of 2004 the number of people who die by suicide is expected to reach 1.5 million per year by 2020.

On average, three male suicides are reported for every female one, consistently across different age groups and in almost every country in the world. “Conversely, rates of suicide attempts tend to be 2-3 times higher in women than in men, although the gender gap has narrowed in recent years.” More people die from suicide than from murder and war; it is the 13th leading cause of death worldwide. According to the WHO there are twenty people who have a suicide attempt for every one that is fatal, at a rate approximately one every three seconds. Suicide is the “most common cause of death for people aged 15 – 24.”

According to the WHO, suicide accounts for nearly half of all violent deaths in the world. Brian Mishara, IASP president, noted that, “more people kill themselves than die in all wars, terrorist acts and interpersonal violence combined.” As of 2008, the WHO refers the widest number of suicides occur in the age group 15 – 29, while the lowest in the 80+ although representing as well the one with the highest rate (per 100,000) of all age groups, with 27.8 suicides and 60.1 for females and males respectively. In 2015 the reported global age-standardised rate is 10.7 per 100,000.

Social norms play a significant role in the development of suicidal behaviours. Late 19th century’s sociological studies recorded first ever observations on suicide: with statistics of the time at hand, sociologists mentioned the effects of industrialisation as in relations between new urbanised communities and vulnerability to self-destructive behaviour, suggesting social pressures have effects on suicide. Today, differences in suicidal behaviour among different countries can be significant.

Themes

  • 2003 – Suicide Can Be Prevented!.
  • 2004 – Saving Lives, Restoring Hope.
  • 2005 – Prevention of Suicide is Everybody’s Business.
  • 2006 – With Understanding New Hope.
  • 2007 – Suicide prevention across the Life Span.
  • 2008 – Think Globally, Plan Nationally, Act Locally.
  • 2009 – Suicide Prevention in Different Cultures.
  • 2010 – Families, Community Systems and Suicide.
  • 2011 – Preventing Suicide in Multicultural Societies.
  • 2012 – Suicide Prevention across the Globe: Strengthening Protective Factors and Instilling Hope.
  • 2013 – Stigma: A Major Barrier to Suicide Prevention.
  • 2014 – Light a candle near a Window.
  • 2015 – Preventing Suicide: Reaching Out and Saving Lives.
  • 2016 – Connect, Communicate, Care.
  • 2017 – Take a Minute, Change a Life.
  • 2018 – Working Together to Prevent Suicide.
  • 2019 – Working Together to Prevent Suicide.
  • 2020 – Working Together to Prevent Suicide.

Priorities

Suicide prevention’s priorities, as declared on the 2012 World Suicide Prevention Day event, are stated below:

  • We need to continue to research suicide and non-fatal suicidal behaviour, addressing both risk and protective factors.
  • We need to develop and implement awareness campaigns, with the aim of increasing awareness of suicidal behaviours in the community, incorporating evidence on both risk and protective factors.
  • We need to target our efforts not only to reduce risk factors but also to strengthen protective factor, especially in childhood and adolescence.
  • We need to train health care professionals to better understand evidence-based risk and protective factors associated with suicidal behaviour.
  • We need to combine primary, secondary and tertiary prevention.
  • We need to increase use of and adherence to treatments shown to be effective in treating diverse conditions; and to prioritise research into effectiveness of treatments aimed at reducing self-harm and suicide risk.
  • We need to increase the availability of mental health resources and to reduce barriers to accessing care.
  • We need to disseminate research evidence about suicide prevention to policy makers at international, national and local levels.
  • We need to reduce stigma and promote mental health literacy among the general population and health care professionals.
  • We need to reach people who do not seek help, and hence do not receive treatment when they are in need of it.
  • We need to ensure sustained funding for suicide research and prevention.
  • We need to influence governments to develop suicide prevention strategies for all countries and to support the implementation of those strategies that have been demonstrated to save lives.

Factors

Suicide has a number of complex and interrelated and underlying contributing factors … that can contribute to the feelings of pain and hopelessness. Having access to means to kill oneself – most typically firearms, medicines and poisons – is also a risk factor.

The main suicide triggers are:

  • Poverty;
  • Unemployment;
  • The loss of a loved one;
  • Arguments; and
  • Legal or work-related problems.

Suicide results from many complex sociocultural factors and is more likely to occur during periods of socioeconomic, family and individual crisis (e.g. loss of a loved one, unemployment, sexual orientation, difficulties with developing one’s identity, disassociation from one’s community or other social/belief group, and honour).

In richer countries, three times as many men die of suicide than women do, but in low- and middle-income countries the male-to-female ratio is much lower at 1.5 men to each woman.

In the United States, for example, males are four times more likely to die from suicide than are females. However, females are more likely to attempt suicide than are males.

The disparity in suicide rates has been partly explained by the use of more lethal means and the experience of more aggression and higher intent to die in men than women.

Physical and especially mental health disabling issues such as depression, are among the most common of the long list of complex and interrelated factors, ranging from financial problems to the experience of abuse, aggression, exploitation and mistreatment, that can contribute to the feelings of pain and hopelessness underling suicide. Usually substances and alcohol abuse also play a role.

Prevention strategies generally emphasise public awareness towards social stigma and suicidal behaviours.

Cultural and Religious Attitudes

In much of the world, suicide is stigmatised and condemned for religious or cultural reasons.

In some countries, suicidal behaviour is a criminal offence punishable by law. Suicide is therefore often a secretive act surrounded by taboo, and may be unrecognised, misclassified or deliberately hidden in official records of death.

Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need.

The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it.

Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.

Links

Beyond Paranoia & Panic: Mental Health Strategies to Combat the Psychological Impact of COVID-19

Research Paper Title

Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic.

Background

On 30 January 2020, the World Health Organisation (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the number of cases soared across 34 regions in Mainland China and surpassed that of severe acute respiratory syndrome (SARS) in 2003.

The virus was believed to have originated from a wholesale seafood market in the city of Wuhan in the province of Hubei towards the end of December 2019.

Shortly after, the number of cases increased exponentially in Wuhan and nearby cities and provinces before spreading throughout the world.

Located approximately 3,432 km from the epicentre of Wuhan, Singapore is a densely populated city-state of 5.7 million who saw 1,592,612 international visitors in 2019; of these, 380,933 were visitors from Mainland China.

After a tourist from Wuhan was identified as the first case of COVID-19 infection on 23 January 2020 in Singapore, the country responded decisively by initiating a series of public health measures to contain the outbreak that included travel advisories, restriction of entry into the country by individuals who had travelled to Mainland China in the preceding 2 weeks, mandatory quarantine for contact cases and rigorous contact tracing of individuals linked to confirmed COVID-19 cases.

You can access the full article here.

Reference

Ho, C.S., Chee, C.Y. & Ho, R.C. (2020) Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Annals of the Academy of Medicine, Singapore. 49(3), pp.155-160.