Sunday, March 31, 2013

Canadian "Heat Maps" Looking at the Impact of Major Depression

One of the interactive tools produced by the Global Burden of Disease project is "head map" which produces a colour coded ranking of the impact of various causes of disease burden. If you link to this tool - you can select "high income north america" and then remove the USA in order to obtain a country-specific "heat map" for Canada. Use the drop-down menu where you see "GBD Regions" as a default, then click "add or remove location" to the right of this menu if you want to remove the US column. In order to look at different aspects of disease burden you can select Year of Life Lost (where MDD doesn't count since suicide and risk factor related, e.g. cardiovascular, deaths are accounted for differently) or Years Lived with Disability, where MDD is near the top, or Disability Adjusted Life Years (which combines the two categories of burden). You can look at any age/sex group of interest to you (using the appropriate drop-down boxes) and and also have the option of looking at 1990 or 2010 heat maps (using the drop-down menu on the far right-hand side of the screen). This link will take you to the tool.

Monday, March 25, 2013

Screening - A "Fault-line" in the Mental Health Literature

Screening often seems like an obvious solution to health problems. In mental health there is a strong view that much morbidity is undetected - providing an even more compelling intuitive appeal to screening. However, intuitive appeal is a two edged sword because it allows people to overlook some of the actual challenges and problems that accompany screening. This has resulted in some highly polarized debates with entrenched positions and even a degree of hostility. In keeping with Haedt's concept of a righteous mind one suspects that people tend to adopt one side of this debate instinctively, or according to some unarticulated moral compass. I heard Jonathan Haedt interviewed on CBC on March 22nd, 2013 and I've read his book as well, various of the "morality modules" that he describes seems to factor into this debate. Screening proponents often describe screening opponents as uncaring and disloyal to the cause of mental health whereas screening opponents often accuse screening proponents of having a malfeasant agenda - medicalization specifically. Fortunately, there are a set of scientific rules and principles that help to determine the real impact of screening, and as such the debate can be informed by evidence and methodology, all in the (hopefully) wide open sphere of scientific discourse. James Coyne, a prominent psychologist has engaged fully in this debate in a series of articles and a book - and he now contributes to a blog associated with PLoS Medicine called "Mind the Brain". The blog includes some very detailed critiques of screening studies. This makes for interesting reading for those interested in these issues.

Saturday, March 9, 2013

Is Mental Illness a Bigger Problem than Cancer?

In a previous post, I provided a link to a burden-of-disease study recently conducted in Ontario. These studies try to examine conditions that contribute to premature mortality and also to impaired functioning by looking at parameters designed for this purpose (e.g. the Global Burden of Disease Study, see another recent post, uses Disability Adjusted Life Years (DALYs) to account for years lived with disability and premature mortality due to different diseases. The importance of mental illness is seen clearly in such studies since people often develop such illnesses early in their life and the illnesses often persist for many years and has a sustained impact. The Ontario study found that in terms of disease burden (this study didn't use DALYs, but used a related approach) the effect of common mental illnesses was greater than all cancers! A summary has been presented on the CBC website.

Tuesday, March 5, 2013

Websites and Books in the Treatment of Depression

There has been increasing interest in elements of treatment for depression that don't seem like "heavy duty" interventions. This largely results from the ascendancy of cognitive-behavioral treatments, many of which are highly structured - a person can read about them, learn how to employ them and practice them without a therapist present. A Canadian example is one being developed at the University of Saskatchewan for post-partum depression, see news coverage here. The most famous example is the Australian MoodGym program, which is freely available to anyone that wants to try it. Such strategies are often viewed as a low-intensity treatment for very mild episodes - but recent research suggests that they also help in more severe episodes. The evidence is summarized in a paper in the British Medical Journal, which is summarized here.

Saturday, March 2, 2013

New Opportunity to Explore the Impact of Major Depression in Canada

The burden of depression in a country like Canada varies across different age and gender groups, consistent with the epidemiology of the condition (more common in woman than men, and especially common compared to most medical conditions in the younger age groups). There is a major international initiative called the Global Burden of Disease Study that quantifies the impact of most major medical conditions (including Major Depressive Disorder) based on the amount of disability that they cause and the amount of contribution to premature mortality that they make. The results of this project were recently published in a series of papers in the Lancet. However, if you don't want to read these papers, you can examine the ranking of various conditions in an easy to use interactive visualization, by following this link. At the top, select "North America, High Income" where you see "Global" as a default for estimates that should apply to Canada, then you can select an age and sex group and examine the disease burden (what they call DALYs) rankings. Major Depressive Disorder is always near the top.