An International Perspective on Mental Health and Illness Elaine Wethington Department of Human Development Department of Sociology

The World Health Organization Global Burden of Disease Project Estimated the “burden of disease” in the world Defined as lost work productivity Analysis based on archival sources Found that mental and substance use/addiction disorders are among the leading causes of disease burden in the world

The World Mental Health Survey Initiative International survey to establish prevalences, causes, and consequences of mental, substance, and behavioral disorders A series of nationally or regionally representative surveys in 26 countries (so far) Represents all regions of the world Total eventual sample size in excess of 130,000.

Methods of Psychiatric Epidemiology Face-to-face surveys by trained lay interviewers (not psychologists) Use a fully structured diagnostic interview, based on standard international diagnostic criteria, assessing: anxiety disorders posttraumatic stress disorder bipolar disorders and schizophrenia major depressive disorders eating disorders alcohol and drug abuse and dependence

Exposure to violence and mental health Focus of the first South African national study of mental disorders Long-term impact of torture on mental health Rape and sexual abuse  post-traumatic stress disorder Violent crime

War, genocide, and political strife “Parents fear that the atmosphere of despair has destroyed their children’s sense of hope.” (New York Times, March 12, 2007)

A Palestinian guardsman and his son

National Survey in Lebanon, ½ of study participants reported a history of exposure to war-related traumatic events If reported 2 or more war traumas: More likely to report a history of anxiety More likely to report a mood disorder, such as depression Also more likely to report “explosive” episodes (i.e. violent outbursts)

Local action to assess and improve mental health Study of social networks of child- headed households in Namibia 18% of children in Namibia will be orphaned by 2010 Children as young as 9 head households Monica Ruiz-Cesares

How the study was done Enlisted local village heads to locate child- headed households Interviewers were accompanied by aid workers from UNICEF The child-headed households were then offered health, food, and social services

Findings 42% of children heading households reported feeling suicidal in the past year Most of their helpers were other children (not adults) Many reported not only being orphans but having no living adult relatives Others reported having been rejected by adult family members About half were going to school and supporting younger siblings

The Outcome The villages developed sustained connections to the orphaned children Other villages have now adopted the program, with help from UNICEF and local non-governmental organizations