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Psych TopicsProfessional practice — epidemiology and public mental health

Psych · Professional practice — epidemiology and public mental health

Epidemiology and public mental health

Also known as Psychiatric epidemiology · Public mental health · Global burden of disease mental disorders · DALY mental health · Treatment gap psychiatry · Social determinants mental health · Prevention continuum mental disorders · WMH survey · National Survey of Mental Health and Wellbeing

Exam-exhaustive epidemiology and public mental health for FRANZCP and MRCPsych: measures of occurrence; GBD/YLD/DALY; global and Australian prevalence; age-of-onset and sex patterns; social determinants and ACEs; Rose and Gordon prevention strategies; treatment gap, stepped care and task-sharing; suicide population rates; stigma; STROBE-linked critical appraisal of surveys. FRANZCP-primary, globally tagged.

medium24 referencesUpdated 26 July 202613 min readVerification in progress

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FRANZCPMRCPsychABPNMD-DNBNEET-SS

Red flags

  • Confusing lifetime prevalence with current service need — planning requires 12-month prevalence, severity, and help-seeking
  • Using clinic samples to estimate community incidence — Berkson bias and severity enrichment
  • Quoting relative risks of rare outcomes without absolute rates or population attributable impact
  • Assuming a negative or underpowered survey proves no problem in a population (absence of evidence)
  • Equating diagnosis with violence risk at population level without base rates and absolute risk language
  • Designing only high-risk clinical programmes when most cases arise from the population middle (Rose prevention paradox)
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Your progress

Saved on this device.

Practise this topic10 MCQs with explanations

Target exams

FRANZCPMRCPsychABPNMD-DNBNEET-SS

Red flags

  • Confusing lifetime prevalence with current service need — planning requires 12-month prevalence, severity, and help-seeking
  • Using clinic samples to estimate community incidence — Berkson bias and severity enrichment
  • Quoting relative risks of rare outcomes without absolute rates or population attributable impact
  • Assuming a negative or underpowered survey proves no problem in a population (absence of evidence)
  • Equating diagnosis with violence risk at population level without base rates and absolute risk language
  • Designing only high-risk clinical programmes when most cases arise from the population middle (Rose prevention paradox)
The one-line answer

Public mental health is what you do after the epidemiology: measure need with 12-month prevalence plus severity, not lifetime prevalence and not clinic counts; name the social determinants; mix a population (Rose) strategy with a high-risk one and classify prevention as universal, selective or indicated; then close the treatment gap with stepped care, task-sharing and anti-stigma work. Mental disorders are a disability problem first — high YLD, with mortality travelling mostly by suicide and physical comorbidity.[1][9][13][16]

Meet the business case

You are the psychiatrist on a regional planning committee. The paper in front of you argues for a new service, and its headline is that "almost half the population will experience a mental disorder in their lifetime, so we need capacity for half the region".[4]

The next slide costs beds against that number. Nobody in the room has asked how many people are unwell this year, how severe they are, or how many are already getting care somewhere else.[5][6]

Two exam questions are now live: which number should have been on that slide, and what would actually reduce the burden in this region? Everything below answers those two. The underlying method — stock-and-flow frequency measures, standardisation, RR to PAF arithmetic, the bias taxonomy, Hill, and screening PPV — lives in the foundations topic Epidemiology methods for psychiatry. This page is the population-action layer built on top of it.[4][5][13]

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References24ShowHide
  1. [1]Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 Lancet, 2013.PMID 23993280
  2. [2]GBD 2019 Mental Disorders Collaborators Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 Lancet Psychiatry, 2022.PMID 35026139
  3. [3]Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013 Int J Epidemiol, 2014.PMID 24648481
  4. [4]Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication Arch Gen Psychiatry, 2005.PMID 15939837
  5. [5]Demyttenaere K, Bruffaerts R, Posada-Villa J, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys JAMA, 2004.PMID 15173149
  6. [6]Slade T, Johnston A, Oakley Browne MA, et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings Aust N Z J Psychiatry, 2009.PMID 19530016
  7. [7]Vigo D, Thornicroft G, Atun R Estimating the true global burden of mental illness Lancet Psychiatry, 2016.PMID 26851330
  8. [8]Santomauro DF, Mantilla Herrera AM, Shadid J, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic Lancet, 2021.PMID 34634250
  9. [9]Patel V, Saxena S, Lund C, et al. The Lancet Commission on global mental health and sustainable development Lancet, 2018.PMID 30314863
  10. [10]Lund C, Brooke-Sumner C, Baingana F, et al. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews Lancet Psychiatry, 2018.PMID 29580610
  11. [11]Marmot M Social determinants of health inequalities Lancet, 2005.PMID 15781105
  12. [12]Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study Am J Prev Med, 1998.PMID 9635069
  13. [13]Rose G Sick individuals and sick populations Int J Epidemiol, 2001.PMID 11416056
  14. [14]Gordon RS Jr An operational classification of disease prevention Public Health Rep, 1983.PMID 6856733
  15. [15]Arango C, Díaz-Caneja CM, McGorry PD, et al. Preventive strategies for mental health Lancet Psychiatry, 2018.PMID 29773478
  16. [16]Kohn R, Saxena S, Levav I, Saraceno B The treatment gap in mental health care Bull World Health Organ, 2004.PMID 15640922
  17. [17]Saxena S, Thornicroft G, Knapp M, Whiteford H Resources for mental health: scarcity, inequity, and inefficiency Lancet, 2007.PMID 17804062
  18. [18]Prince M, Patel V, Saxena S, et al. No health without mental health Lancet, 2007.PMID 17804063
  19. [19]Thornicroft G, Mehta N, Clement S, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination Lancet, 2016.PMID 26410341
  20. [20]Nock MK, Borges G, Bromet EJ, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts Br J Psychiatry, 2008.PMID 18245022
  21. [21]McGrath JJ, Saha S, Al-Hamzawi A, et al. Psychotic Experiences in the General Population: A Cross-National Analysis Based on 31,261 Respondents From 18 Countries JAMA Psychiatry, 2015.PMID 26018466
  22. [22]von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies Lancet, 2007.PMID 18064739
  23. [23]Campion J, Javed A, Lund C, et al. Public mental health: required actions to address implementation failure in the context of COVID-19 Lancet Psychiatry, 2022.PMID 35065723
  24. [24]Campion J, Javed A, Sartorius N, Marmot M Addressing the public mental health challenge of COVID-19 Lancet Psychiatry, 2020.PMID 32531299

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