RESUMEN
BACKGROUND AND AIMS: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. DESIGN: Cross-sectional household surveys. SETTING: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. PARTICIPANTS: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. MEASUREMENTS: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). FINDINGS: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. CONCLUSIONS: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.
Asunto(s)
Alcoholismo/diagnóstico , Abuso de Marihuana/diagnóstico , Alcoholismo/clasificación , Alcoholismo/epidemiología , Argentina/epidemiología , Australia/epidemiología , Brasil/epidemiología , Colombia/epidemiología , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Clasificación Internacional de Enfermedades , Irak/epidemiología , Abuso de Marihuana/clasificación , Abuso de Marihuana/epidemiología , Irlanda del Norte/epidemiología , Polonia/epidemiología , Portugal/epidemiología , Rumanía/epidemiología , España/epidemiología , Trastornos Relacionados con Sustancias/clasificación , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Organización Mundial de la SaludRESUMEN
CONTEXT: The scarcity of cross-national reports and the changes in Diagnostic and Statistical Manual version 5 (DSM-5) regarding panic disorder (PD) and panic attacks (PAs) call for new epidemiological data on PD and PAs and its subtypes in the general population. OBJECTIVE: To present representative data about the cross-national epidemiology of PD and PAs in accordance with DSM-5 definitions. DESIGN AND SETTING: Nationally representative cross-sectional surveys using the World Health Organization Composite International Diagnostic Interview version 3.0. PARTICIPANTS: Respondents (n = 142,949) from 25 high, middle, and lower-middle income countries across the world aged 18 years or older. MAIN OUTCOME MEASURES: PD and presence of single and recurrent PAs. RESULTS: Lifetime prevalence of PAs was 13.2% (SE 0.1%). Among persons that ever had a PA, the majority had recurrent PAs (66.5%; SE 0.5%), while only 12.8% fulfilled DSM-5 criteria for PD. Recurrent PAs were associated with a subsequent onset of a variety of mental disorders (OR 2.0; 95% CI 1.8-2.2) and their course (OR 1.3; 95% CI 1.2-2.4) whereas single PAs were not (OR 1.1; 95% CI 0.9-1.3 and OR 0.7; 95% CI 0.6-0.8). Cross-national lifetime prevalence estimates were 1.7% (SE 0.0%) for PD with a median age of onset of 32 (IQR 20-47). Some 80.4% of persons with lifetime PD had a lifetime comorbid mental disorder. CONCLUSIONS: We extended previous epidemiological data to a cross-national context. The presence of recurrent PAs in particular is associated with subsequent onset and course of mental disorders beyond agoraphobia and PD, and might serve as a generic risk marker for psychopathology.
Asunto(s)
Encuestas Epidemiológicas/estadística & datos numéricos , Internacionalidad , Trastorno de Pánico/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asia/epidemiología , Australia/epidemiología , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Nigeria/epidemiología , Trastorno de Pánico/psicología , Prevalencia , América del Sur/epidemiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. METHODS: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. RESULTS: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. CONCLUSIONS: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers.
Asunto(s)
Cuidadores/psicología , Costo de Enfermedad , Personas con Discapacidad/estadística & datos numéricos , Familia/psicología , Trastornos Mentales/enfermería , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Medición de Riesgo , Factores de Tiempo , Organización Mundial de la Salud , Adulto JovenRESUMEN
Objective: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. Methods: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. Results: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. Conclusions: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers. .
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Cuidadores/psicología , Costo de Enfermedad , Personas con Discapacidad/estadística & datos numéricos , Familia/psicología , Trastornos Mentales/enfermería , Estudios Transversales , Trastornos Mentales/epidemiología , Salud Mental/estadística & datos numéricos , Medición de Riesgo , Factores de Tiempo , Organización Mundial de la SaludRESUMEN
[Introduction]. n the last quarter century, several projects emerged to reform mental health services in Latin American and Caribbean countries. Some did not survive the difficulties that inevitably arise in processes of change, and ended up disappearing before the intended changes could be introduced. Others, however, as shown in this publication, were able to overcome difficulties and meet intended objectives, effectively transforming the structure and quality of services. All these projects, including the many that did not survive, were part of one of the richest experiences in the transformation of mental health care worldwide - the experience of mental health reform in Latin America and the Caribbean...As proved by the experiences included in this book, a great deal can be learned from mental health reforms in Latin America and the Caribbean., On the one hand, each initiative developed truly original and innovative solutions for some of the problems usually encountered in the reform processes. Obviously, many of the innovative solutions can be applied in those countries that are at a similar stage of development as the Latin American and Caribbean countries where the reported experiences took place. However, many of these innovations also can be useful to any country interested in reforming its mental health services, regardless of the country’s degree of development. I also believe that the reform of mental health services in Latin America and the Caribbean―given specific aspects such as the dynamic following the Caracas Declaration and the impact of international cooperation―help us to better understand the real importance of some factors, such as social and political aspects and international cooperation, in implementing mental health service reforms.
Asunto(s)
Salud Mental , Reforma de la Atención de Salud , América Latina , Región del CaribeRESUMEN
OBJECTIVE: The growing burden of mental disorders in Latin America and the Caribbean has become too large to ignore. There is a need to know more about the prevelance of mental disorders and the gap between the number of individuals with psychiatric disorders and the number of those persons who remain untreated even though effective treatments exist. Having that knowledge would make it possible to improve advocacy, adopt better policies, formulate innovative intervention programs, and apportion resources commensurate with needs. METHODS: Data were extracted from the community-based psychiatric epidemiological studies published in Latin America and the Caribbean from 1980 through 2004 that used structured diagnostic instruments and provided prevalance rates. Estimates of the crude rates in Latin America and the Caribbean for the various disorders were determined by calculating the mean and median rates across the studies, by gender. In addition, data on service utilization were reviewed in order to calculate the treatment gap for specific disorders. RESULTS: Non affective psychosis (including schizophrenia) and an estimated mean one-year prevalence rate of 1.0 percent; major depression, 4.9 percent; and alcohol use abuse or dependence, 5.7 percent. Over one-third of individuals with nonaffective psychosis, over half of those with an anxiety disorder, and some three-fourths of those with alcohol use abuse or dependence did not receive mental health care from either specialized or general health services. CONCLUSIONS: The current treatment gap in mental health care in Latin America and the Caribbean remains wide. Further, current data likely greatly underestimate the number of untreated individuals. The epidemiological transition and changes in the population structure will further widen the treatment gap in Latin America and the Caribbean unless mental health policies are formulted or updated and programs and services are expanded (AU)