Showing papers by "Benedetto Saraceno published in 2005"

Los trastornos mentales en América Latina y el Caribe: asunto prioritario para la salud pública

Abstract: OBJETIVO: La creciente carga de trastornos mentales que afecta a las poblaciones de America Latina y el Caribe es demasiado grande para hacer caso omiso de ella. Por lo tanto, es una necesidad impostergable conocer la prevalencia de los trastornos mentales y la brecha de tratamiento, que esta dada por la diferencia entre las tasas de prevalencia verdadera y las de las personas que han sido tratadas, que en algunos casos es grande pese a la existencia de tratamientos eficaces. Si se dispone de mayor informacion, se hace mas factible 1) abogar mejor por los intereses de las personas que necesitan atencion, 2) adoptar politicas mas eficaces, 3) formular programas de intervencion innovadores y 4) adjudicar recursos en conformidad con las necesidades observadas. METODOS: Los datos se obtuvieron de estudios comunitarios publicados en America Latina y el Caribe entre 1980 y 2004. En esas investigaciones epidemiologicas se usaron instrumentos diagnosticos estructurados y se estimaron tasas de prevalencia. Las tasas brutas de diversos trastornos psiquiatricos en America Latina y el Caribe se estimaron a partir de las tasas media y mediana extraidas de los estudios, desglosadas por sexo. Tambien se extrajeron los datos correspondientes al uso de servicios de salud mental para poder calcular la brecha en el tratamiento segun trastornos especificos. RESULTADOS: Las psicosis no afectivas (entre ellas la esquizofrenia) tuvieron una prevalencia media estimada durante el ano precedente de 1,0%; la depresion mayor, de 4,9%; y el abuso o la dependencia del alcohol, de 5,7%. Mas de la tercera parte de las personas afectadas por psicosis no afectivas, mas de la mitad de las afectadas por trastornos de ansiedad, y cerca de tres cuartas partes de las que abusaban o dependian del alcohol no habian recibido tratamiento psiquiatrico alguno, sea en un servicio especializado o en uno de tipo general. CONCLUSIONES: La actual brecha en el tratamiento de los trastornos mentales en America Latina y el Caribe sigue siendo abrumadora. Ademas, las tasas actuales probablemente subestiman el numero de personas sin atencion. La transicion epidemiologica y los cambios en la composicion poblacional acentuaran aun mas la brecha en la atencion en America Latina y el Caribe, a no ser que se formulen nuevas politicas de salud mental o que se actualicen las existentes, procurando incluir en ellas la extension de los programas y servicios.

Mental and social health during and after acute emergencies: emerging consensus?

Abstract: Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial. There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services. A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion. Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health. In terms of early interventions, this agreement is exemplified by the recent inclusion of a "mental and social aspects of health" standard in the Sphere handbook's revision on minimal standards in disaster response. This affirmation of emerging agreement is important and should give clear messages to health planners.

Aid after disasters.

Abstract: Needs a long term public mental health perspective The crisis caused by the earthquake and tsunami in South East Asia six months ago elicited an unprecedented aid response by humanitarian agencies financed by numerous governments and private citizens. With communicable disease more or less under control, aid agencies now focus increasingly on the mental suffering of surviving populations. We estimate here the likely mental health and psychosocial support needs of those affected and provide a public health framework for long term assistance. Although no reliable data exist on numbers of people with problems related to mental health in countries affected by the tsunami, the estimated rates described in the table give a rough picture at the population level of what may be expected. Observed prevalence rates will vary with case definition, method of assessment, time since the disaster, and community. Across and within countries, communities differ in current and previous disaster exposure and in sociocultural factors that may influence social support, coping, and …

A Framework for Mental Health Policy, Legislation and Service Development: Addressing Needs and Improving Services

Abstract: The global burden of mental disorders is enormous. Approximately 450 million people suffer from some kind of mental or neurological disorder at any given moment. These conditions included unipolar depressive disorders, bipolar affective disorder, schizophrenia, epilepsy, alcohol and selected drug use disorders, Alzheimer’s and other dementias, post traumatic stress disorder, obsessive and compulsive disorder, panic disorder, and primary insomnia. Together, it is estimated that these disorders account for 13% of the disability-adjusted life years (DALYs) worldwide. Even in Africa, the WHO region for which mental disorders constitute the smallest percentage of the burden of disease, it is estimated that about 5% of all DALYs are due to mental disorders. Among the 15-44 age group, the most productive segment of the population, mental disorders account for 6 of the 20 leading causes of disability worldwide.1 In addition, there is very high comorbidity between mental and physical disorders, including both infectious and

Breaking the vicious circle of determinants and consequences of harmful alcohol use.

Abstract: Heavy drinking has been known for centuries to be a health hazard and cause of death. Efforts to quantify the disease burden associated with different risk fac-tors clearly demonstrate that hazardous and harmful alcohol drinking is one of the leading risk factors and is respon-sible for 4% of the global disease burden (1). This enormous health burden, with its numerous social problems associated with disorders attributable to alcohol use, is distributed unevenly: poor and underprivileged groups are often at higher risk and are deprived of health and social interventions that can help to alleviate individual and family distress. According to the results of the Com-parative Risk Assessment (CRA) within the Global Burden of Disease (GBD) study, alcohol is the main risk factor for ill-health in low mortality developing countries, where alcohol consumption is on the rise (2, 3).In countries with high levels of alcohol consumption and hazardous patterns of drinking, the impact of alcohol use on overall mortality and morbidity can be substantial. The article by Nicholson et al. in this issue (pp. 812–819) demonstrates a linear relationship between frequency of drink-ing and binge drinking and long-term all-cause mortality trends in men in the Russian Federation. Whereas cultural norms related to alcohol consumption and overall drinking patterns have probably not changed significantly in the recent past, mortality fluctuations in the Russian Federation — which are partly attributed to alcohol consump-tion — are dramatic. As discussed by Nicholson et al., other factors could be involved in these relationships, and a broad understanding of hazardous drinking patterns includes aspects other than just binge drinking. Social and economic factors are powerful determi-nants of alcohol and drug use (4, 5), and enormous social changes experienced by the Russian population (6) have affected the broad context of drinking and risks

Mental health services in Central and Eastern Europe: current state and continuing concerns.

Abstract: Aims – This paper attempts to examine the current state of mental health services in Central and Eastern Europe. Methods – Selected review of available literature has been done with emphasis on information complied by World Health Organization (WHO). Results – The magnitude and burden of mental disorders is high in Europe, the mental health services are inadequate in most Central and Eastern European countries and human rights situation is unsatisfactory. However, there are some positive recent developments worth noting. These include increased attention to human rights, cooperation and collaboration at subregional level and emergence of family and consumer associations. Conclusions – A concerted and systematic attempt needs to be made to respond to the challenge of providing adequate and human rights-based mental health services in Central and Eastern European countries. The framework developed by WHO can assist the countries in their initiatives aimed at improving mental health systems.Declaration of Interest: none