Jesse Kokaua

How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment

BACKGROUND Most information about the lifetime prevalence of mental disorders comes from retrospective surveys, but how much these surveys have undercounted due to recall failure is unknown. We compared results from a prospective study with those from retrospective studies. METHOD The representative 1972-1973 Dunedin New Zealand birth cohort (n=1037) was followed to age 32 years with 96% retention, and compared to the national New Zealand Mental Health Survey (NZMHS) and two US National Comorbidity Surveys (NCS and NCS-R). Measures were research diagnoses of anxiety, depression, alcohol dependence and cannabis dependence from ages 18 to 32 years. RESULTS The prevalence of lifetime disorder to age 32 was approximately doubled in prospective as compared to retrospective data for all four disorder types. Moreover, across disorders, prospective measurement yielded a mean past-year-to-lifetime ratio of 38% whereas retrospective measurement yielded higher mean past-year-to-lifetime ratios of 57% (NZMHS, NCS-R) and 65% (NCS). CONCLUSIONS Prospective longitudinal studies complement retrospective surveys by providing unique information about lifetime prevalence. The experience of at least one episode of DSM-defined disorder during a lifetime may be far more common in the population than previously thought. Research should ask what this means for etiological theory, construct validity of the DSM approach, public perception of stigma, estimates of the burden of disease and public health policy.

Prevalence, interference with life and severity of 12 month DSM-IV disorders in Te Rau Hinengaro: The New Zealand Mental Health Survey

OBJECTIVE To estimate the 12 month prevalence of DSM-IV disorders in New Zealand, and associated interference with life and severity. METHOD A nationally representative face-to-face household survey carried out in 2003-2004. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0) was used. There were 12,992 completed interviews from participants aged 16 years and over. The overall response rate was 73.3%. In this paper the outcomes reported are 12 month prevalence, interference with life and severity for individual disorders. RESULTS The prevalence of any disorder in the past 12 months was 20.7%. The prevalences for disorder groups were: anxiety disorders 14.8%, mood disorders 7.9%, substance use disorders 3.5%, eating disorders 0.5%. The highest prevalences for individual disorders were for specific phobia (7.3%), major depressive disorder (5.7%) and social phobia (5.1%). Interference with life was higher for mood disorders than for anxiety disorders. Drug dependence, bipolar disorder and dysthymia had the highest proportion of severe cases (over 50%), when severity was assessed over the disorder itself and all comorbid disorders. Overall, only 31.7% of cases were classified as mild with 45.6% moderate and 22.7% serious. CONCLUSIONS Compared with other World Mental Health survey sites New Zealand has relatively high prevalences, although almost always a little lower than for the US. For all disorders, except specific phobia, interference with life was reported to be moderate, on average, which has lead to less than a third of cases being classified as mild. Most people who have ever met full DSM-IV criteria, including the impairment criterion, and who experience symptoms or an episode in the past 12 months find that their disorders impact on their lives to a non-trivial extent.

Te Rau Hinengaro: The New Zealand Mental Health Survey: overview of methods and findings

OBJECTIVE To estimate the prevalence and severity of anxiety, mood, substance and eating disorders in New Zealand, and associated disability and treatment. METHOD A nationwide face-to-face household survey of residents aged 16 years and over was undertaken between 2003 and 2004. Lay interviewers administered a computerized fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Oversampling doubled the number of Māori and quadrupled the number of Pacific people. The outcomes reported are demographics, period prevalences, 12 month severity and correlates of disorder, and contact with the health sector, within the past 12 months. RESULTS The response rate was 73.3%. There were 12,992 participants (2,595 Māori and 2,236 Pacific people). Period prevalences were as follows: 39.5% had met criteria for a DSM-IV mental disorder at any time in their life before interview, 20.7% had experienced disorder within the past 12 months and 11.6% within the past month. In the past 12 months, 4.7% of the population experienced serious disorder, 9.4% moderate disorder and 6.6% mild disorder. A visit for mental health problems was made to the health-care sector in the past 12 months by 58.0% of those with serious disorder, 36.5% with moderate disorder, 18.5% with mild disorder and 5.7% of those not diagnosed with a disorder. The prevalence of disorder and of serious disorder was higher for younger people and people with less education or lower household income. In contrast, these correlates had little relationship to treatment contact, after adjustment for severity. Compared with the composite Others group, Māori and Pacific people had higher prevalences of disorder, unadjusted for sociodemographic correlates, and were less likely to make treatment contact, in relation to need. CONCLUSIONS Mental disorder is common in New Zealand. Many people with current disorder are not receiving treatment, even among those with serious disorder.

Psychiatric illness among a nationally representative sample of sole and partnered parents in New Zealand

Objective: To quantify the excess risk of specific, diagnosable mental illnesses experienced by sole parents in New Zealand, and to estimate the contribution of socioeconomic position (SEP), co-residence with other adults (as a proxy for social and practical support) and physical health status to this excess risk. Methods: Data used in the present study were from the New Zealand Mental Health Survey, a nationally representative population-based household survey of 12992 adults (16+years) fielded in 2004. The sample included 1216 sole and 3681 partnered parents living with one or more dependent children, with an overall response rate of 73%. Mental illness (12month prevalence of anxiety, mood, and substance use disorders, and suicidality) was measured with version 3.0 of the Composite International Diagnostic Interview. Illness severity was measured with the Sheehan Disability Scale and the Global Assessment of Functioning Scale. Covariates included household income from all sources, labour market attachment, co-residence with other adults and doctor-diagnosed chronic physical illness. Multiple logistic regression was then carried out on the weighted cross-sectional survey dataset. Results: Adjusting for demographic variables, sole parents had significantly higher 12month prevalences of mental illnesses than their partnered counterparts, with odds ratios (ORs) of 2.6 (95% confidence interval (CI)=2.0–3.3) for any mental illness, 2.9 (95%CI=2.1–4.0) for any serious mental illness, 2.2 (95%CI=1.7–2.8) for anxiety disorder, 2.6 (95%CI=2.0–3.4) for mood disorder, 3.6 (95%CI=2.2–6.0) for substance use disorder and 2.5 (95%CI=1.5–4.0) for suicidal ideation. Chronic physical illness accounted for only a small proportion of these excess risks. SEP and co-residence of another adult each explained approximately one-quarter of the excess risks and jointly explained approximately half (except for substance use disorders). Almost all of the effect of SEP was mediated by income, with employment status making only a very small independent contribution. Conclusions: The present results confirm the higher prevalence of mental illness experienced by sole parents, underlining the importance of improving access to primary mental health care, including alcohol and drug rehabilitation services, for sole parents. But they also caution against a solely clinical response and highlight a need to better understand and respond to the social and economic processes that lie behind the associations between mental health, socioeconomic position and sole parenthood in New Zealand.

Cumulative mental health consequences of acne: 23-year follow-up in a general population birth cohort study.

DEAR EDITOR, Acne is a highly prevalent condition during adolescence and young adulthood worldwide, with rates between 12% and 99%. Rates in adulthood range up to 50%. The effects of acne, regardless of severity, can be debilitating, affecting many life domains. Cross-sectional studies report associations between acne and anxiety, depression symptoms and suicide ideation compared with those having little or no acne. However, no study has examined the relationship of acne with psychiatric disorder (i.e. psychological distress of greatest severity and clinical interest), nor has research ascertained the cumulative life course effects of acne on psychiatric disorder. Here, we report data from a prospective-longitudinal study of a general population sample to determine whether acne preceded poor mental health at the disorder level, from adolescence to adulthood. The specific aim of this study was to examine the association between acne and the development of the most common psychiatric disorders of anxiety, depression, alcohol and cannabis dependence. Data were from the Dunedin Multidisciplinary Health and Development Study, a longitudinal investigation of the health, development and behaviour of a general population birth cohort. Study participants were born between April 1972 and March 1973 in Dunedin, New Zealand. The cohort represents the full range of socioeconomic status in the general population of New Zealand’s South Island and is primarily white. The longitudinal study was established at age three when those who were still resident in the province were followed up, and 91% (n = 1037; 52% male) participated. Subsequent assessments took place at ages 5 (96% of those alive participated), 7 (92%), 9 (92%), 11 (90%), 13 (82%), 15 (95%), 18 (97%), 21 (97%), 26 (97%) and 32 (96%), and most recently at 38 years, when 95% participated. At each age, a range of physical, mental and psychosocial measures were assessed on site by professional staff trained in each of the domains. Ethical approval was obtained for each phase of the study. At all the assessments, professional staff with specific training in the relevant domains received further training standardized to protocol. Health professionals administered the general health interview (which included questions about acne) and the mental health interview. At the age 21 assessment, study participants were asked if, since age 15, they had ‘a bad problem acne’; this was repeated at the next three assessments, i.e. at age 26 for the period from 21 to 26 years, at age 32 (26– 32 years) and at age 38 (32–38 years). Mental health data were collected using the Diagnostic Interview Schedule, allowing disorder status to be made according to standardized Diagnostic and Statistical Manual of Mental Disorders criteria. Each disorder (anxiety, depression, alcohol dependence and cannabis dependence disorders) was diagnosed regardless of the presence of other disorders using the past year as the reporting period. Adjustment was made for potential confounders: sex, socioeconomic status and prior adolescent psychiatric disorder (11–18 years).

Training a medical workforce to meet the needs of diverse minority communities

BackgroundThe growing demand for a competent health workforce to meet the needs of increasingly diverse societies has been widely acknowledged. One medical school in New Zealand explored the integration of the commonly used patient-centred model approach, with an intersectional framework in the development of a cultural competency training programme. In the Pacific Immersion Programme, medical students in their fourth year of training are given the opportunity to learn about different factors that influence the health and health care of a minority community through immersion in that community. The programme objectives include enabling students to learn through experience living within the local community context, and supporting them to re-evaluate their own personal beliefs, assumptions and/or prior prejudices. This study evaluates the usefulness of this programme in the training of medical students to work in diverse communities.MethodsTwo analytical approaches were used for evaluation. Deductive and inductive analyses were conducted on 235 reflective essays completed by three cohorts of students from 2011 to 2013 to ascertain the value of the programme for student learning. In addition, one cohort was invited to complete a pre and post-programme questionnaire.ResultsOverall, the students found the programme to be a valued learning environment. They found living within a Pacific family environment to be an eye opening experience. It increased students comfort level in cross cultural engagement and emphasised the importance of patient’s perspectives in health care provision. Students’ self-reported knowledge about Pacific cultural values, protocols, traditional beliefs and the main health challenges increased significantly after the programme. They appreciated learning directly from community members, and through observations about how culture, beliefs and the socio-economic environment influence peoples’ health and wellbeing.ConclusionsMedical schools are required to train a competent health workforce to meet the needs of diverse communities. The Pacific Immersion Programme provides a unique learning environment which can improve the training of doctors to work in diverse communities. The key to its success is enabling students to be engaged learners from “the inside” rather than an “outsider looking in”. The Programme enables experiential learning in a sensitive and meaningful way and can be useful for training in other institutions.

Pacific peoples three months after injury: a comparison of outcomes between Pacific and non-Pacific participants in a NZ cohort study.

Objectives: To: describe pre‐injury characteristics of Pacific (n=239) and non‐Pacific (n=2,611) participants and compare their outcomes three months after injury.

Entry Characteristics and Participation in a Peer Learning Program as Predictors of First-Year Students’ Achievement, Retention, and Degree Completion:

Success in the first year of higher education is important for students’ retention beyond their first year and for completion of their undergraduate degree. Institutions therefore typically front-load resources and interventions in the first year. One such intervention is the Peer Assisted Study Sessions (PASS) program. This program is known in the United States as Supplemental Instruction. It provides first-year students with an opportunity to learn study skills in the context of a particular unit of study (course/module). In this article, we consider the relationship between students’ prior academic achievement and participation in the PASS program, as well as the impact of participation on first-year students’ first-year grade point average, retention, and degree completion. The findings suggest that PASS does not just attract academically high-achieving students and that participation in it contributes to students’ academic achievement in their first year, retention beyond the first year, and completion of an undergraduate degree.

DOES HAVING A CHRONIC PHYSICAL CONDITION AFFECT THE LIKELIHOOD OF TREATMENT SEEKING FOR A MENTAL HEALTH PROBLEM AND DOES THIS VARY BY ETHNICITY

Objective: The comorbidity of mental disorders with chronic physical conditions is known to have important clinical consequences, but it is not known whether mental-physical comorbidity influences mental health treatment seeking. This study investigates whether the presence of a chronic physical condition influences the likelihood of seeking treatment for a mental health problem, and whether that varies among ethnic subgroups in New Zealand. Methods: Analyses were based on a subsample (n = 7,435) of The New Zealand Mental Health Survey, a nationally representative household survey of adults (response rate 73.3%). Ethnic subgroups (Maori and Pacific peoples) were oversampled. DSM-IV mental disorders were measured face-to-face with the Composite International Diagnostic Interview (CIDI 3.0). Ascertainment of chronic physical conditions was via self-report. Results: In the general population, having a chronic medical condition increased the likelihood of seeking mental health treatment from a general practitioner (OR: 1.58), as did having a chronic pain condition (OR: 2.03). Comorbid chronic medical conditions increased the likelihood of seeking mental health treatment most strongly among Pacific peoples (ORs: 2.86–4.23), despite their being less likely (relative to other ethnic groups) to seek mental health treatment in the absence of physical condition comorbidity. Conclusion: In this first investigation of this topic, this study finds that chronic physical condition comorbidity increases the likelihood of seeking treatment for mental health problems. This provides reassurance to clinicians and health service planners that the difficult clinical problem of mental-physical comorbidity is not further compounded by the comorbidity itself constituting a barrier to mental health treatment seeking.

New Zealand District Health Board Mental Health Service Profile

Purpose – This paper seeks to describe the New Zealand Ministry of Health District Health Board (DHB) Mental Health Service Profile, which for the first time compares performance on a number of quality indicators for the populations of 21 DHBs.Design/methodology/approach – The background, theory and development of the Ministry of Health Mental Health Directorate DHB Mental Health Service Profile (Profile) is discussed and example pages from the Profile are includedFindings – The DHB Profile overcomes the problem of setting arbitrary benchmarks by using the range of current practice across the sector. The profile demonstrates that certain levels of performance can be achieved and, given a better understanding of the long‐term client group, is potentially a very powerful tool for encouraging improved service delivery. Improved data quality is also likely to be a spin‐off from the use of the Profile in the sector.Originality/value – Having key DHB mental health quality information in one place and being able...