State of Mental Health in Ukraine: 2002

Evelyn J. Bromet

September, 2007

Global Burden of Disease

Late 1990s, WHO published a list of top 10 causes of disease burden in the world

Depression and alcohol use are in top 10 Decision was made to organize prevalence

studies around the world to determine the rates and need for treatment.

Assessment schedule

• Composite International Diagnostic Interview (CIDI)

• Covers major psychiatric disorders, alcoholism, disability, and use of medical and psychiatric services

• Also medical problems, childhood disorders, marital conflict, demographic

Strength

• Strength: all countries used virtually the same interview, sampling strategy, centralized quality control

• Ukraine: first former Soviet country to participate and the only one with published data (Bulgaria has data; Romania is collecting data)

Countries in World Mental Health

Europe+ South America Asia

Belgium Brazil (one city) India

France Costa Rica (planned) China (2 cities)

Germany Colombia China (nat’l planned)

Italy Mexico Australia (planned)

Spain Peru (not done) New Zealand

Netherlands Middle East Japan

Portugal (planned) Israel Africa

N. Ireland Lebanon South Africa

Turkey Palestine (in field) Nigeria

Ukraine Iraq (in field)

Bulgaria

Romania (in field)

Ukraine WMH

Funded by US National Institutes of Health

Collaboration of Kiev International Institute of Sociology, Ukrainian Psychiatric Association, and Stony Brook

Focus Group Work

Examine the face validity of the items in key sections of the interview (depression, PTSD, alcoholism employment, services)

Big discussion on consent form

Two Studies

Population Survey

Clinical Reappraisal Study

Population survey

National probability sample adults 18+ N=4725 Response rate = 78.3%

Number of respondents in each oblast

Characteristics of 4,725 respondents

• 1/3 rural, 1/3 mid-size urban, 1/3 large urban areas

• 47% interviewed in Ukrainian

• 44% currently employed; 38% retired

• 16% adequate financial status, 51% inadequate, 33% very inadequate

Characteristics of 4,725 respondents

• Sex: 38% male• Age: median=49• 44% education beyond high school• 60% currently married

• Therefore data were weighted to census for all analyses

Prevalence

• Overall, 32% of population had 1+ disorder in their lifetime; 18% in year before interview.

• Consistent with WHO report, depression and alcoholism were the two most common disorders.

Alcohol Abuse and Dependence

Abuse: Persistent use for 12 months or more in spite of:

1. Physical hazards

2. Being arrested for drunken behavior

3. Getting into major fights while drunk

Dependence: Period of 12 months or more with:

1. Tolerance (needing more for an effect)

2. Withdrawal (needing alcohol in morning)

3. Persistent desire for alcohol

4. Can’t cut down

5. Give up normal activities in order to drink

Prevalence of Any Alcohol Disorder

0

5

10

15

20

25

30

Lifetime 12-month Past month

%

Men

Women

Lifetime prevalence compared with Europe

0

5

10

15

20

25

30

Total Males Females

Ukraine

Europe

How to tell if your cat is a male............

Generational differences in alcoholism

0

5

10

15

20

25

30

35

Men Women

%

<25

25-34

35-49

50+

Median age of onset = 25

Risk factors for alcoholism

• Male

• Russian-speaking

• Low education

• Separated and divorced

• Adequate finances

Hospitalization

• 7.7% of men and 14.9% of women were hospitalized overnight for alcoholism

DSM-IV major depression

Period of 2 weeks or more with 5 of 9 persistent symptoms1. Depressed mood most of day2. Loss of interest 3. Weight loss or gain4. Sleep problems5. Agitated or slowed down6. Fatigue, loss of energy7. Worthlessness or guilt8. Concentrate problems9. Suicidal thoughts

Prevalence of Depression in Ukraine

0

5

10

15

20

25

Lifetime 12-month

Men

Women

%

Lifetime prevalence compared with Europe

0

5

10

15

20

25

Total Males Females

Ukraine

Europe

Generational differences in depression

0

5

10

15

20

25

30

Males Females

<2525-3435-4950+

%

Median age of onset 28

Risk factors for depression

• Female

• Older

• Widowed, separated or divorced

• Retired

• Western region

• Low education

• Poverty

Talked to a professional…

• 17% talked to a professional (usually general doctor)

• 25% with suicidal thoughts spoke to their doctor

• Thus most did not seek help.

Chornobyl story

• AFTER assessing disorders, asked if ever lived in area contaminated by Chornobyl.

• 388/4725 exposed to Chornobyl, 8%

• Slightly more exposed (p<0.05)

--rated health poor (25% vs 21%)

--depression (18% vs 14%)

--alcoholism (19% vs 11%)

Chornobyl story: liquidators

• After completed the study, RCRM did the interview with 295 liquidators from 5 regions

• Compared them with 397 men from same regions who were in World Mental Health

• Liquidators >depression, anxiety, suicide ideation and severe headaches, and missed more days from work.

Validity study

• Diagnostic Reinterview Study SCID

• Dr. Gutkovich, Kostyuchenko & Havenaar

• Trained 15 psychiatrists from 3 cities: Lviv,

Kyiv, Donetsk

Method

176 respondents were assessed by psychiatrist

Interviews were tape recorded

Tapes reviewed in Kyiv and at Stony Brook

Comparisons between CIDI and SCID

Results

• CIDI –SCID agreement: 98% alcoholism

78% depression

• Areas of disagreement:

SCID alcoholism > CIDI

SCID depression < CIDI

Conclusion

• Ukraine among countries with highest rates of disorder, especially alcoholism

Lifetime Rates Any Disorder: Top 5 Countries

0

10

20

30

40

50

USA NewZealand

Colombia France Ukraine

%

Conclusion

• Ukraine among countries with lowest rates of mental health treatment

Mental health specialty care past 12 months: Lowest 5 Countries

0

0.5

1

1.5

2

2.5

3

S. Africa Ukraine Lebanon China Nigeria

%

Ukraine: 1.2% of population, 4% of those with a 12-month disorder; 0.6% without

Conclusion

• In most countries, treatment, if sought, is from general practitioners

• In all countries, especially Ukraine, poorly trained to treat mental health and alcohol problems.

• Challenge for Ukraine, given the small number of mental health professionals, is to train general practitioners to recognize and adequately treat mental health and alcohol problems.