COMPARING MENTAL HEALTH AND RISK FACTORS ACROSS EUROPEAN UNION COUNTRIES

PSYCHOSOCIAL WELL-BEING AND PSYCHIATRIC CARE IN THE EUROPEAN COMMUNITIES : ANALYSIS OF MACRO INDICATORS

M.G. Carta (1), V Kovess (2), M.C. Hardoy (1)
1 Division of Psychiatry, Department of Public Health, University of Cagliari, Italy,
2 MGEN Foundation for Public Health, Paris, France

The study aimed to investigate the well-being in European countries and the availability of psychiatric care by means of available macro indicators. A review of macro indicators capable of providing a synthetic description concerning the mental health status and the availability of psychiatric care and collected routinely from sources such as the World Health Organization, the Organization for Economic Cooperation and Development, the Statistical Office of the European Communities (EUROSTAT) and the Intercontinental Marketing Services (IMS) was carried out. The evaluation of temporal trends in each nation permits the carrying out of a subsequent comparison between countries. In all European countries a decreasing trend of suicides was observed in the period 1980-2000, with the exception of Ireland and partially of Spain. In Ireland the increase was of 130%, with a particularly high risk in young people and adults. Portugal and Greece presented respectively the highest and the lowest rates of undetermined causes of death. A general increase during the mid 1980s in mental disorder mortality was shown. Psychiatrists per 100,000 inhabitants ranged from 3.6 in Spain to 17.5 in Finland, child psychiatrists from 0.9 in Germany to 5.1 in Portugal. Psychiatric beds ranged from 0.4 per 1000 inhabitants in Italy and Spain to 1.3 in Ireland. IMS data indicated a trend towards an increase of consumption for antidepressants and antipsychotics in all European countries. A better coordination in the collection of data concerning mental health status in the European Union and an improvement of the quality of services available is necessary.

Supported by the Project « The status of mental health in Europe ».

RISK FACTOR COMPARISONS ACROSS SOME EU COUNTRIES : ESEMED AND EUROBAROMETER COMPARISONS

V Kovess (1), V Lehtinen (2)
1 MGEN Foundation for Public Health, Paris, France
2 STAKES, Helsinki, Finland

Mental health comparisons between countries are quite hard to conduct. Most European Union (EU) countries have some epidemiological data, but methodologies, specially design and instruments, are too diverse to make comparisons. However, two recent EU surveys have been conducted in diverse countries using Identical instruments (the National Diagnostic Interview and for the first one and the Mental Health 5 Item Scale for the second) and the same design in national representative samples : the European Study of Epidemiology of Mental Disorders (ESEMeD) and the Eurobarometer. These studies collected sociodemographic variables, thus allowing to compare at least the relative risk for the major risk factors,such as gender, age living arrangement, foreigner/native and employment status. The presentation will compare relative risk (odd ratios) for these risk factors across the diverse countries as well as care utilisation. The presentation will for example show that South European women have a higher relative risk than their male counterparts, while in Northern countries there is no higher risk for females. In some of the countries the youngest (those less than 25 years) have more problems than the adults. French young people have a higher risk for mood disorders and German and Spanish young people for anxiety disorders ; taking any disorders French and German young people have a higher risk than their adult counterparts in their own country. In most of the countries, people aged over 65 years have some lower rates than adults, except for Italy where this never happens. Concerning mood disorders, in all countries except Italy and Netherlands those who are unemployed have a higher risk than those who are in paid employment (corrected by sex and age). In most of the countries people who live with a partner have a lower risk for mood disorders than those living in other situations ; however, in France, Germany and Netherlands there is a higher risk. The results will be discussed as well as their implications for fostering prevention policies.

COMPARING THE POSITIVE MENTAL HEALTH IN EUROPE

V Lehtinen (1), B. Sohlman (1), V Kovess (2)
1 STAKES, Helsinki, Finland,
2 MGEN, Paris, France

The Eurobarometer survey 58.2, conducted in Autumn 2002, included items to measure the state of positive and negative mental health as well as social support and help seeking behaviour due to mental illhealth. The main aim of this paper is to compare aspects of positive mental health across the 15 ‘old’ European Union (EU) member States. The dependent variables analysed in this paper are the following : the mean Energy and Vitality Index (EVI) from the Short Form-36 (SF-36) questionnaire and the perceived social support measured by the 3-item Oslo scale. The Eurobarometer survey covers the population of the EU member States aged 15 years and over. The sample sizes are about 1000 per country/region, except Luxembourg (about 600) and Northern Ireland (about 300). The response rates varied from 23% to 84%. Countries where the response rate was lower than 45 % are excluded from the present analyses. The mean EVI for the 11 selected countries together was 62.4, with the score ranging from 58.8 (Italy) to 66.3 (Spain). The mean EVI was generally higher for men (65.3) than for women (60.0). The percentage of people experiencing strong social support varied similarly between countries (froí 9.1% for Italy to 35.1 % for Spain). High EVI score (indicating good mental health) was also associated with younger age, being single or married, and being employed.

SOCIAL INEQUALITIES AND THE COMMON MENTAL DISORDERS

T. Fryers
University of Leicester, UK

This paper discusses the evidence for associations between markers of social position and the prevalence of the ‘common mental disorders’ (mostly non-psychotic depression and anxiety, separately or together). It presents a recent major systematic review of the published evidence for general populations in developed countries, and an extended analysis of the British National Psychiatric Survey of 1993. Additional evidence is drawn from surveys using the General Health Questionnaire, the Composite International Diagnostic Interview or the Short Form-36 from the ‘Survey of Surveys’ undertaken for the European Union (EU) project The Mental Health Status of Europe. Issues of causation are addressed, including evidence from the limited longitudinal studies available. In Western European and similar populations, people of lower social position are generally disadvantaged in health and illness. This includes the common mental disorders, higher frequencies of which are associated with poor education, material disadvantage and unemployment. Their large contribution to morbidity and disability, and their social consequences in working age adults, would justify substantial priority being given to addressing mental health inequalities within social and economic policy in Europe. Disadvantaged people tend to live in communities and cultures that are disadvantaged by noxious environments, poor human services, high levels of smoking, drinking, drug taking, and violence. These are almost certainly causally associated with high levels of psychiatric morbidity found in these populations, probably mediated or enhanced by individual disadvantages. They may affect duration as well as onset and thus increase prevalence. There are well known policy implications relating to social exclusion and deleterious social environments. It does not need population surveys to show that poverty, deprivation, environmental degradation and social stress should be high on the political agenda.

THE STATE OF MENTAL HEALTH IN OLD AGE ACROSS THE « OLD » EUROPEAN UNION

M.C. Angermeyer, S.G. Riedel-Heller
Department of Psychiatry, University of Leipzig, Germany

Aging and the special circumstances of older people are taking an increasingly central place in public health across Europe. The paper provides the first syllabus on the occurrence of mental disorders in old age focusing on surveys conducted in the 15 countries which comprised the « old » European Union. A systematic search of the literature on the prevalence of mental disorders in old age in English and German was conducted, using Medline and Psyndex databases. Mental disorders in old age are common. However, the pattern differs from that in younger cohorts. The most serious threats to mental health in old age are posed by dementia and depression. It is a clear cut finding that dementia exponentially increases with age. The basic issue whether depression increases or decreases with age remains unsolved. Databases on other mental disorders in old age are much smaller. Although among the most prevalent conditions across the life span, decreasing rates of anxiety disorders and alcoholism have been found with increasing age. No firm conclusion can be drawn about the occurrence of drug-related disorders and somatoform disorders with increasing age. Psychotic syndromes in late life appear to increase with age. Unfortunately, variation among studies conducted in different European regions seems to reflect mainly methodological differences rather than real differences. A concerted action in improving the methodology of epidemiological research in old age, producing comparable data across Europe, is needed to meet the challenges of an aging population.

IMMIGRATION AND MENTAL HEALTH IN THE EU

M. Bernal (1), J.M. Haro (1) M.G. Carta (2)
1 Sant Joan de Deu-Serveis de Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
2 Division of Psychiatry, Department of Public Health, University of Cagliari, Italy

Migration during the 1990s in Europe has been high. Besides the migration from developing to developed countries, there has been a rise of new migrations, especially from the Eastern and Central European countries and from the Commonwealth of Independent States. Some countries in Europe, like Spain, Italy or Portugal, that have been traditionally exporters of migrants, have shifted to become importers. Political and socio-economic instability in and around Europe has significantly increased the number of refugees and asylum seekers arriving in European countries. The presence of undocumented immigrants is a well-established fact in most European countries. Among all the changes a human being must face throughout his live, few are so wide and complex as those which take place during migration. Practically everything that surrounds the person who emigrates changes. The singularity of the migratory experience lies in the fact that it is a psycho-social process of loss and change, which is known in the psychiatry of migration as a grief process. In the case of refugees, who have to flee their country for fear of being persecuted, the grief process is even more complex. In Spain, research has been carried out about conditions which points to mental and psychosomatic disorders in the immigrant population. This research came up with the following factors affecting the mental health of immigrants : labour and economic instability, cultural and social marginalisation, family estrangement, pressures to send money to their families, racial discrimination and lack of statutory documentation. The particularly hard conditions of today’s migration seem to be propitiating a worsening in the mental health of the newcomers. Current situations are making of the migratory experience an extremely hard and unbearable process. An example of this is the situation in the South of Europe, particularly Spain and Italy. Psychiatrists from the Psycho-pathological and Psycho-social Assistance Service (SAPPIR) team, located in Barcelona, have described a common syndrome called chronic and multiple stress syndrome in immigrants (or Ulysses syndrome). Despite migrants represent a vulnerable population with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. They are usually only entitled to emergency health services. Some states have done efforts to universalise the right to access national health care services, therefore including undocumented migrants. Nevertheless, the health care gaps that are being left by the authorities are being covered by the informal work of doctors at the health system and by non-governmental organizations. which provide medical and, specially, mental health assistance together with health promotion and prevention programs among other services. Our aim should be to provide specific mental health care services for migrants. It is necessary to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only, as it has been stressed in a recent report of the World Health Organization in collaboration with Red Cross and Red Crescent organizations.