Understanding the burden of mental disorders

Generating Knowledge: Understanding the Burden of Mental Disorders

We conduct large community surveys to estimate the prevalence and social determinants of mental disorders in diverse settings. We interview local stakeholders to understand the experiences and community perceptions of mental health and illness, and use this insight to develop and validate diagnostic methods for different languages and cultural contexts. On this page we provide a sample of the kinds of projects we are working on in this regard.

EUROPE

Understanding the Mental Health Needs of Trafficked People in the UK

PROTECT: Provider Responses, Treatment and Care for Trafficked People

Funded by the Department of Health Policy Research Programme, PROTECT seeks to provide evidence to inform the NHS response to human trafficking. The research includes evidence reviews; surveys with trafficked adults and adolescents about their health needs and use of health services; analyses of mental health needs and care pathways using the Case Register Interactive Search (CRIS) database at South London and Maudsley NHS Foundation Trust;  interviews with NHS and other professionals involved in responding to human trafficking; and surveys with NHS professionals about their knowledge and experiences of identifying, referring, and treating trafficked people.

CGMH Contact: louise.howard@kcl.ac.uk

Understanding Mental Disorders in Georgia

Community-level influences on mental health among conflict-affected persons

Tserovani camp for internally displaced persons in GeorgiaLed by Bayard Roberts (ECOHOST, LSHTM), this project researched patterns of mental disorders and associated community-level factors among people affected by armed conflicts in the Republic of Georgia. A cross-sectional household survey was conducted involving 3,600 respondents, along with structured observations of their communities. Findings have been published on PTSD and common mental disorder comorbidity, harmful alcohol use, tobacco use and nicotine addiction, mental health service utilisation, somatic distress, and coping strategies. The project was funded by the Wellcome Trust and conducted in collaboration with CGMH, Curatio International and Global Initiative on Psychiatry – Tbilisi.

CGMH Contact: bayard.roberts@lshtm.ac.uk

ASIA

Understanding Epilepsy in Bangladesh

KIM: Key Informant Methodology to Identify Children with Epilepsy/Impairments

Mothers and children outside a KIM medical assessment campKey informants were trained to identify children with epilepsy and motor/sensory impairments in three districts of northern Bangladesh. This method was validated with a door-to-door survey in the same area. Almost 4,000 children were identified by the key informants, 95% of whom were examined by a medical team to ascertain the nature of the impairment. The overall prevalence of epilepsy was estimated to be 1.5 per 1,000 children through the key informant method, which showed good agreement with the randomised household sample survey (2.2 per 1,000 children).

CGMH Contact: hannah.kuper@lshtm.ac.uk

Understanding Common Mental Disorders in Sri Lanka

COMRAID: Common Mental Disorders and their association with Resilience Among Internally Displaced people

Data collection for the COMRAID projectLed by Dr. Chesmal Siriwardhana, COMRAID comprised a two-phase cross-sectional survey conducted in northern Sri Lanka between 2010 and 2013. The study investigated forced migration exposure, mental health and resilience in a Muslim minority ethnic group displaced from the province since 1991 and returning since the civil war ended in 2009. Findings have informed an ongoing intervention integrating mhGAP-inspired mental health services into primary care.

CGMH Contact: chesmal.siriwardhana@kcl.ac.uk

Understanding Alcohol Use Disorder in India

SAAHAS: Soryacher Asar Ani Hacher Amcho Shodh

A SAAHAS phlebotomist takes a blood sampleThe SAAHAS team have been conducting a series of epidemiological studies to document the burden, risk factors, course and outcome of alcohol use disorders in men and women in Goa. They have described the prevalence and risk factors of heavy drinking in rural and urban communities, and the relationship between alcohol use and other health and social outcomes, especially sexual risk behaviours. Phase one results showed that 1 in 10 men are hazardous drinkers, consuming sufficient quantities of alcohol to damage their physical, mental and social health. Hazardous drinkers were found to be more likely to physically and sexually abuse their partners and more likely to indulge in risky sexual behaviours like visiting commercial sex workers. The second phase (SAAHAS 2) has been investigating the evolution of drinking patterns and the long term physical, psychological and social outcomes of alcohol use disorder for men in India.

CGMH Contact: abhijit.nadkarni@lshtm.ac.uk

Understanding Autism in India

ARTI: Autism Research and Training Initiative

The primary aim of ARTI was to understand the challenges, coping strategies and unmet needs of families living with a child with Autism in Goa, a state in western India. A case-detection methodology for the identification of Autism Spectrum Disorders (ASD) was developed and evaluated for use with children aged 4 to 7 years. This method was then used to estimate the prevalence, determinants and needs of families affected by ASD. The ARTI project also completed the translation and cultural adaptation of two screening tools and a goal standard diagnostic tool for Autism Spectrum Disorders (the Ten Question Screen, the Social Communication Questionnaire and the Autism Diagnostic Observation Schedule) which are now available for research use in one of the major languages of India (Marathi). 

CGMH Contact: vikram.patel@lshtm.ac.uk

AFRICA

Understanding the Mental Health Needs of Homeless People in Ethiopia

The SEF HOME Project

Monitoring data collection and cleaning in the Sodo districtAlthough a visible problem in urban Ethiopia, there are no services for people with mental illness who are homeless. In the SEF HOME project, CGMH and AAU collaborated (funded by the UK International Health Links Funding Scheme) to carry out a needs assessment of street homeless people with mental illness. Over 90% had experienced some form of mental or substance use disorder, with around 40% assessed to have psychosis. Unmet needs were extensive. Multi-sectoral stakeholders were engaged in developing a feasible plan for implementation.

CGMH Contact: abe.wassie@kcl.ac.uk

Understanding the Impact of Maternal Mental Disorders on Children in Ethiopia

C-MaMiE: Child outcomes in relation to Maternal Mental disorders in Ethiopia

Fieldworkers on their way to collect data on child growth measuresC-MaMiE began in 2004 and is funded by the Wellcome Trrust. A population-based cohort of 1,065 pregnant women was recruited from the predominantly rural demographic surveillance site in Butajira, south central Ethiopia. The women have been followed up ever since to examine the impact of maternal mental health problems on child growth, physical and mental health, development, educational attainment and survival.

CGMH Contact: charlotte.hanlon@kcl.ac.uk

Understanding Depression in Ghana

DON: Depression in the ObaapaVitA and Newhints Population-Based Cohort Study

 role play for field data collectorsThe DON study, led by Dr Benedict Weobong, is perhaps the largest cohort of pregnant and postnatal women ever attempted in sub-Saharan Africa. The locally validated Patient Health Questionnaire (PHQ-9) was used to screen over 20,000 women during pregnancy, almost 14,000 of whom were screened again 4 to 12 weeks after birth. Findings suggest that most risk factors for postnatal depression relate to adverse maternal and/or child birth outcomes, whereas those of antenatal depression are sociodemographic and pregnancy-specific. Both antenatal and postnatal depression were found to have deleterious effects on maternal health, child health and child survival.

CGMH Contact: benedict.weobong@lshtm.ac.uk

MULTI-COUNTRY

Understanding Psychoses in Diverse Settings

INTREPID: India, Nigeria & Trinidad

A primary care worker and patient in Ibadan, NigeriaFunded by the Wellcome Trust, the INTREPID research programme aims to better understand cross-cultural variation in the incidence and outcome of schizophrenia. Phase 1 aims to develop robust, comparable methods for the study of schizophrenia and other psychoses’ epidemiology, phenomenology, aetiology and outcomes in diverse settings. This is being conducted (2011-2014) in defined catchment areas in three countries: Chengalpet Taluk (near Chennai), India; Ibadan South East and Ona Ara, Ibadan, Nigeria; and Tunapuna-Piarco, Trinidad. Phase 2 will implement these methods in a multi-country study of psychoses.

CGMH Contact: craig.morgan@kcl.ac.uk