Mental health workgroup Update 16th Washington Group meeting 7 – 9 December 2016

Session structure Overview of purpose and strategies to meet the purpose Update on scoping review of functional limitations associated with common and severe mental disorders Review of analyses comparing WG ES Affect data to that for other MH scales Discussion on work so far and suggestions for way forward

Purpose Ensure adequate coverage of common and severe mental disorders in the WG disability measures Symptoms are covered by Affect questions on anxiety and depression Functional consequences of these symptoms – activity limitations, participation restrictions and effect of environmental factors; e.g. difficulty with social interactions, negative impact of stigma, etc. Add further measures to the WG Extended set if coverage is not adequate for functional consequences Review the performance of the WG Affect (anxiety and depression) measures in the Extended Set relative to common scales used in surveys

Strategy for ensuring adequate coverage Scoping review of activity limitations, participation restrictions and environmental barriers commonly associated with common and severe mental disorders If coverage is not adequate, develop a strategy to add 1 – 3 measures to the Extended Set and to environmental factors module (being developed) Review existing survey measures and scales Select and test additional measures for the WG Extended Set OR Develop new measures

Scoping review: functioning and mental disorders Do the search and collect all the articles identified Review the collected articles for: Type and severity of mental disorder Nature of activity limitation, participation restriction and environmental barriers Analyze the data to extract: Typical profiles of functioning for different types and severity of mental disorders Differences by region, income status of countries, age, urban/rural Compare the common functional difficulties to the WG Short and Extended sets

Search strategy Search for articles: Reviewing the documents Electronic databases Manual searches Reviewing the documents Review titles and exclude non-relevant articles Review abstracts of remaining articles and exclude non- relevant ones Review full text of articles and exclude non-relevant ones Extract information from all relevant articles Excel spreadsheet Review trends in data

Summary of articles found and analysed Collected and reviewed 83 full text articles 60 were excluded as not relevant (reporting on MH scale validation, about policy, not reporting clear functional limitation examples, etc.) All English papers (for now) 23 were reviewed as relevant: Focused on common or severe mental illness Described functional status directly related to the mental illness Identified clear domains that are difficult for people with mental illness Excluded: Intellectual impairments Alcohol and drug abuse dementia

Primary types of mental disorder/ illness addressed (i. e Primary types of mental disorder/ illness addressed (i.e. the diagnosis) Anxiety Severe anxiety Depression (mild to moderate) Major depression Post Traumatic Syndrome Disorder (PTSD) Psychosis (e.g. schizophrenia) Bipolar mood disorder Obsessive Compulsive Disorder (OCD) Other (e.g. personality disorder, somatoform disorders, phobia, panic disorder)

Description of studies reviewed WB Country classification Urban vs rural

Anxiety Severe anxiety Activity Limitations/Participation Restrictions (AL/PR) Social relationships Social Role functioning Work Environmental factors (EFs) Low social support AL/PR Emotional state Memory and thinking Social relationships Work Self care Communication EFs ??

Mild/Moderate depression major depression AL/PR Mobility: move from place to place (e.g. to market) Work Social relationships Community life Memory and thinking Executive function Attention difficulties Verbal and visual memory Language functions EFs ?? AL/PR Social relationships Leisure Social Role functioning Work and Household activities Mobility Self care EFs ??

Psychosis AL/PR: Efs: Self care Communication Attitudes: Public image of MI (e.g. being violent) Hostile social climate No differentiation between MI and intellectual impairment Services: Poor quality of mental health services Inadequate help in crisis situations Inequitable distribution of resources in health care system Four dimensions of stigma: Interpersonal interaction, The public image of mental illness, Structural discrimination, and Access to social services Self care Communication Social relationships (including intimate partners) Work Social role functioning Physical functioning Memory and thinking Executive function Attention difficulties Verbal and visual memory

Bipolar mood disorder AL/PR: Efs: Self-care (less affected) Social relationships Communication/language functions Work Leisure Household/domestic tasks Memory and thinking Executive function Attention difficulties Verbal and visual memory ?? Likely to be similar to Psychosis

Obsessive Compulsive Disorder (OCD) AL/PR: Efs: Sleep disturbance (insomnia), Work/Occupational Educational functioning Social Relationships (family and friends) Social Role functioning Leisure Household/domestic activities Formal and information discrimination

Severe mental disorders in general AL/PRs Domestic/household activities: washing clothes, preparing food, daily routine Self-care: washing self, carrying out daily routine Social functioning and relationships/Communication: family, friends, community Communication: Verbal fluency Memory and thinking (Executive function, Attention difficulties, Verbal and visual memory) Controlling behaviour: getting upset, conflict with others, misinterpretations, violent Mobility Formal work Informal work (farming) and domestic activities Community Activities

Severe mental disorders in general EFs Attitudes: community beliefs and attitudes stigma family/caregivers attitudes lowered expectations of the person with SMD exaggerated fear (unnecessary restraint) Support: Lack of support (no autonomy or freedom) Professionals Family 3. Poverty 4. Medication Personal factors: Underestimating self Impact of medication side effects

Some recommendations Additional domains for WG Extended set Social functioning and relationships (family, friends and community) More detailed domains Communication: Verbal fluency Memory and attention Environmental factors Attitudes/Stigma Services Support (including medication)

What next?

Workplan for 2017 Further review of journal articles – non-English Further analyses of data sets More detailed trends with covariates (physical co-morbidities, smoking, etc.) Comparison with other MH measurement scales Review of existing measures to cover additional and more detailed domains Analysis of typical profiles for people with SMDs Functional profile predicting a diagnosis Description of typical profiles Determine extent to which WG SS and WG ES currently identify people with SMDs