jan 17 lec

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Published on 13 Apr 2011
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Jan 17/2011
Definition and measurement of mental disorders
-reading: even classification , sumtimes go against it. Chapters on the test are as
mcqs. Lecture stuff wud b short essay type
-Formulate
-evaluate theories of the causes of disorders.
-plan efficient distribution of mental health care. More funding than others
-justify funding for services and research cuz a lot of us need gov. money. more u
know more funding
Phyciatric epidemiology.
-in population or in various sects. Specific racial grps or age grps. How distributed.
-sociologists are involed in this area. Try to see the samepatterns etc.
-sampling a huge pop, it can cost a lot of money. we have to min the cost. We reply on
structured interviews. Wat they wana study, come up wid interview schedule, qs abt
backgrnd, mental health etc. then they get interviewers, hire, train and collect data.
This saves money. we rely on lay interviewers .
Not fully trained, not clinicians. As much as it saves us money, lacks corrected
mechanisms that a trained person may have.
-we get false positives or negatives wid lay interviewers. If were relying on them, its
imp that we have valid measures. We reallytrain these people well and get from the
measures wat we really want.
Epi Studies:
- ECA
-NCS- focused on establishing degree to which diff disorders occure in the same
individual.
-whole pop of united states
- NCS-R: see if replicate fidings of ncs.
ECA
-a lot of times gov policy making was relying on clinical data. That doesnt mean
everyone having mental problem seek medical assistance.
-wats really going on in population.
-called DIS administered by trained interviewers.
-ECA used DIS.
- DSM= manual that allows us to diagnose. They use the criteria of DSM to diagnose
illness. At that time DSMIII criteria was used
www.notesolution.com
ECA:how comparable diagnosis is b/w lay and clinician
-sample of both.
-if person suffering not suffering, vs lay interviewers. Not much agreement b/w lay
and clinicians categorization of mentally ill or not.
-criticism: local areas 5 only.
NCS:
-very low agreement b/w dis and clinical diagnosis. New interview schedule. NCS
updated the DIS and came up wid CIDI.
-using CIDI= much better agreement.
(NCS: how many have more than one disorder.
-DSM= if u have a specific disorder, no other diagnosis.)
-NCS-R used CIDI. But exception, by time R was implemented we were now at DSM-
IV criteria
Difficulties:
-first criticism. Too high prevalence rate.
-pple are just not seeking help, butprevelance rates are high
Even though eca and ncs used similar instruments, they got very diff results= second
critism.
-ncs prevalence rates very high.
-not sth distorted, u shud b having similar results (if random 5 samples or whole
population)
-ECA DIS
NCA-CIDI
-diff dsm version.
-more disorders added every year in DMS. Classifications of wats a disorder are
getting changed.
so probably thats y ncs vs dis.
- NCS=subjects for paid(wasnt really intended), ECA =voluntary. Plpe were selected
as for NCS (lower eco status= more likely to participate , more mental health probs
in lower ecs people. Selected for pple wid mental health disorders. Pple wid low
money/socio status=more likely to have mental problems).
-diff methods used by interviewers to help subjects remember. Diff ways to help
subjects remember. Here it was more sensitive.
-if u ask a 50yr old at wat age she had the first kiss, they might have to anchor it ,
was it before or after? Was it grade 11 or 12? CIDI used more sensitive probes.
Therefore NCS pple reported more mental disorders
-screening qs. In DIS at beginning of each section.theyd ask have u in the past 12
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mnths, depressed , suicidal. Yes? And then ask 10 other qs.
hearing things, talking to god etc, interviewee gets tired and say no.
they wanted to get out. Ncs caught on wid that, before interview, ask the screening
qs. Anything possible in the beginning so they cant say no later.
-screening qs: during past 12 mnths, ever sad depressed for 2 weeks ormore?
last 1-2-3-4 days? Ifthey say no, not asked the following string of qs
-not getting high prevelance in ECA wid use of DIS?
Rate of mental disorder:
-nto everyone wid a mental health problem is willing to go to a hospital.
- u get underreporting. Rate of untreated mental disorder not get it.
-true prevelance: not only those who seek help. Whether they seek treatment or not.
Problem wid clinical prevalence to dertemine
-sometimes the typa mental health treatment sites wud not correspond to wat type
of people are in the community.
Hollingshead and redlich vs srole :
-relationship b/w socio eco status and mental health.
-hollingsheadlower sociostatus =higher disorders. In general poor had more
disorders.
-srole: manhattan= higher sociostatus had higher disorders.
-completely opp. Not looking at true prevalence but at clinical prevalence (data from
clinical sites).
-why? Inmanhattan, more private hospitals, means u have the money then u go
tthere.
n new haven: more public hospitals.
This eg. Shows how certain structures can effect studies u do. Typa service
structures, etc. relationship b/w
as SES decrease, MH increase= negative relationship
as SES increase, MH increase= positive relationship
So ,
Conceptual validity:
-successfully distinguish. Using epi survays to have hgher conceptual validity.
- sensitivity.-true cases(wid actual MH problem diagnosed)
-specificity: true non cases they say they have but dont; low rate of false nagatives.
High specificity = instrument donesnt falsely diagnose.
-specificity more imp . cuz we dont want to falsely diagnose someone.
-for clinician sensitivity is more imp.
www.notesolution.com

Document Summary

Reading: even classification , sumtimes go against it. Justify funding for services and research cuz a lot of us need gov. money. more u know more funding: phyciatric epidemiology. Sampling a huge pop, it can cost a lot of money. we have to min the cost. Wat they wana study, come up wid interview schedule, qs abt backgrnd, mental health etc. then they get interviewers, hire, train and collect data. This saves money. we rely on lay interviewers : not fully trained, not clinicians. As much as it saves us money, lacks corrected mechanisms that a trained person may have. We get false positives or negatives wid lay interviewers. If we"re relying on them, its imp that we have valid measures. We reallytrain these people well and get from the measures wat we really want: epi studies: Ncs- focused on establishing degree to which diff disorders occure in the same individual. Ncs-r: see if replicate fidings of ncs: eca.