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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

10. Description of studies reviewed
WB Country classification
Urban vs rural

12. 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 ??

13. 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 ??

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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)

20. What next?

21. 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