Transcript Urban Traffic Calming and Health: A Literature Review

Welcome to Fireside Chat #
January 22, 2012 1:00 – 2:30 PM Eastern Time
CRDCN Major depression epidemiology:
implications for health policy
Dr. Scott B. Patten
Department of Community Health Sciences
University of Calgary
www.chnet-works.ca
A project of
Population Health Improvement Research Network
University of Ottawa
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Outline
(1) Definitions
(2) What do we know about the
epidemiology of depression?
–Prevalence
–Incidence
–Duration of episodes
(3) Implications for policy
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Major Depressive Episode
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Depressed mood
Loss of interest
Psychomotor changes
Diminished energy
Sleep disturbance
Appetite changes
Hopelessness, worthlessness
Diminished ability to think or concentrate
Thoughts of death/suicidal ideation
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Major Depressive Episode
(1) Needs to fit with the “general
definition” of a mental
disorder
(2) Duration, distress,
dysfunction, danger
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A Dimensional Characterization?
1st
Episode / Recurrent
“v-codes”
Comp. Bereavement
Adjustment Disorder
MDD
Chronic
Depression
“sub-threshold”
“sub-syndromal”
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Prevalence of Major Depression
• Point Prevalence
• Period Prevalence
• Lifetime Prevalence
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Prevalence of Major Depression
• Point Prevalence (≈ 2%)
• 12-month Period Prevalence (≈ 5%)
• Lifetime Prevalence (≈ 12%)
* Canadian Community Health - Survey, Mental Health and Wellbeing.
Statistics Canada (2002).
See: Patten SB, Wang JL, Williams JV, Currie S, Beck CA, Maxwell CJ et al.:
Descriptive epidemiology of major depression in Canada. Can J
Psychiatry 2006, 51: 84-90.
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Depression: an underestimated
and disabling condition
Respiratory
disease (8%)
Other
non-communicable
diseases (7%)
Sense
organ
impairment
(10%)
Cardiovascular
disease (22%)
Digestive
disorder (6%)
Musculoskeletal
disorders (4%)
Endocrine
(4%)
2%
10%
Neuropsychiatric
disorders (28%)
Schizophrenia
Major depressive
disorder
2%
Bipolar disorder
2%
Dementia
4%
Substance-use and alcohol-use
disorders
3%
Other mental disorders
1%
2%
Epilepsy
3%
Other neurological disorders
Other neuropsychiatric disorders
Cancer (11%)
Contribution (%) by different non-communicable
diseases to disability-adjusted life-years worldwide in 2005
Reproduced with permission. Prince M, et al. Lancet 2007;370:859-877
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Policy Questions
• Does depression remain drastically
undertreated?
• Should be screening in primary care?
• Is depression more like a chronic disease than
an episodic acute disease?
• Are there secular trends/cohort effects?
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The NPHS
– A cohort (panel) study conducted by
Statistics Canada
– In 1994, a representative sample of
n=17,262 respondents were selected
– These have been re-interviewed every 2
years over the telephone
– Response rate to 2006 estimated at 77%
– The 2004 interview included “focus
content” on depression
– Each cycle includes the CIDI-SFMD
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CCHS 1.2
•
•
•
•
National Sampling: Statistics Canada
Cross-sectional Survey, 2002
N=36,000
Canadian Adaptation of the World Mental
Health CIDI
• Note: A 2012 repeat of the national survey is
coming soon!
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Is Drastic Under Treatment?ically
Undertreated?
– NCS-R (Kessler et al. 2003): 21.6% receiving
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adequate treatment .
– Analysis restricted to those with past 12-month
episodes, and required 4 visits lasting at least 30
minutes to health care professionals for
supervision of pharmacotherapy.
1 Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. JAMA 2003;289:3095-105
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Incidence & Lifetime Prevalence
Source: Slomp M, Bland R, Patterson S, Whittaker L:
Three-year physician treated prevalence rate of mental disorders in Alberta.
Can J Psychiatry 2009, 54: 199-203.
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Antidepressant Use
0.12
0.1
0.08
Men
Women
Age Standardized (Men)
Age Standardized (Women)
0.06
0.04
0.02
2008
2006
2004
2002
2000
1998
1996
1994
0
Simpson KR, Meadows GN, Frances AJ, Patten SB:
Is mental health in the Canadian population changing over time?
Can J Psychiatry 2012, 57: 324-331.
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Proportion Reporting Duration < Weeks
Depressive Episode Duration
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0
50
100
150
200
250
300
Reported Weeks Depressed
Survey Data
Weibull Model
Exponential Model
Patten SB: A visual depiction of major depression epidemiology.
BMC Psychiatry 2007, 7: 23.
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Depressive Episode Duration
Vos, T. et al. Arch Gen Psychiatry 2004;61:1097-1103.
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Copyright restrictions may apply.
Incidence & Lifetime Prevalence
Patten SB: Accumulation of major depressive episodes over time
in a prospective study indicates that retrospectively assessed lifetime
prevalence estimates are too low. BMC Psychiatry 2009, 9: 19.
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Episode Characteristics (NPHS)
Patten SB, Williams JV, Lavorato DH, Bulloch AG, Macqueen G:
Depressive episode characteristics and subsequent recurrence risk.
J Affect Disord 2012, 140: 277-284.
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Secular Trends & Cohort Effects
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Cohort Effects (MDE)?
0.1
0.09
0.08
Men
0.07
0.06
Women
0.05
Age Standardized
(Men)
Age Standardized
(Women)
0.04
0.03
0.02
0.01
2008
2006
2004
2002
2000
1998
1996
1994
0
Simpson KR, Meadows GN, Frances AJ, Patten SB:
Is mental health in the Canadian population changing over time?
Can J Psychiatry 2012, 57: 324-331
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What Don’t We Know:
Policy Perspective
depression remain drastically
X• Does
undertreated?
X• Should be screening in primary care?
more like a chronic disease than
X• Isandepression
episodic acute disease?
X• Are there secular trends/cohort effects?
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Flexible Strategies are
Needed
•
•
•
•
•
B.C. Physician Support Program
Alberta: Depression Clinical Pathways
UK: Watchful Waiting (N.I.C.E.)
US: Disease management strategies
Canada: Shared Care Models
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Canadian Research Data
Centre Network
1)
2)
3)
Improve data access by giving
researchers across the country access
to Statistics Canada confidential
microdata and to an increasing range
of administrative data
Expand the pool of skilled
quantitative researchers
Make research count by improving
communication between researchers
and research users
www.rdc-cdr.ca
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End
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