Epidemiological Research
on Mental Disorders at McGill
Reflections on our 50-year life-span trajectory
Can this inform our future ?
Rebecca Fuhrer, Ph.D
Professor and Director, MScPH Program
McGill University
What are Mental and behavioral disorders ?
Psychiatric disorders ?
Neuropsychiatric disorders ?
A mental disorder is conceptualized as a clinically significant behavior
or psychological syndrome or pattern that occurs in an individual
and that is associated with present distress (e.g. Painful symptom)
or disability (e.g. impairment in one or more important areas of functioning)
or with a significantly increased risk of suffering death, pain, disability,
or an important loss of freedom.
How do we define a case ?
Distinctive feature of these disorders is that their diagnosis generally depends
on thoughts, behaviors, feelings, and rarely supported by objective lab results
Why would we want to study the causes ?
Understanding ? Primary prevention?
Early diagnosis and treatment?
Cure or Chronicity?
Burden of disease
Global
• Mental illness accounts for 4 of the 10 leading causes of years lost due to
disability in the world1
• Depression affects approximately 300 million people worldwide2
• Less than 50% of those affected have access to appropriate treatment
and health care2
• Schizophrenia affects approximately 21 million people worldwide5
• Surveys carried out in various countries consistently show incidence
rates per year of schizophrenia in adults within the range of 10 to 40 per
100,0003
1. Langlois, et al 2012
2. Mathers et al 2004
3. Barbato et al 1998
Burden of disease
Mathers, Boerma, & Ma Fat, (2004)
Burden of disease
Neuropsychiatric Conditions
WHO: Investing in Mental Health (2003)
Burden of disease
Canada
• 1 in 5 people will experience a mental illness in their lifetime5
• In 2003, the estimated economic burden of mental illness was $51
billion, (including direct and indirect costs)1
• Mental illness is the second leading cause of hospital admission
among those aged 20-445
• An estimated 4,000 individuals per year end their life through
suicide5
1. Langlois et al (2012)
5. Canadian Mental Health Association (2003)
Etiology
• Up to 70% of mental health problems or illnesses begin in
childhood or adolescence6
• As many as three in four children and youth with mental health problems
and illnesses do not access services and treatments6
• More than 50% of individuals who experience one major
depressive episode suffer from a recurrent episode1
• Genetics
• first degree biological relatives of people with schizophrenia are 10 times
more likely to develop it than the general population1
• first degree biological relatives of those with major depression are 1.5 - 3
times more likely to experience major depression1
1. Langlois, et al, (2012)
6. Bartram, et al. (2012).
Study Design
• Data bases
– Departmental student database (SAO)
– eScholarship database (McGill Library)
• All theses: title and abstract
• Search terms for “mental health”
– Mental health OR mental illness OR psychiatry OR
psychiatric OR drug abuse OR alcohol abuse OR alcoholism
OR addiction OR depression OR anxiety OR psychosis OR
dementia OR Alzheimer’s
Theses completed by years of admission,
by degree (n=670)
100
94
90
85
83
80
70
60
50
43
40
20
10
31
27
30
9
42
37
32
28
22
13
42
38
20
14
7
3
0
MSC-T
MSC-T, Intensive
PhD
Categorization of completed theses n=647/670
120
103
97
100
94
86
80
67
59
60
51
42
40
20
0
17
19
12
Categorization of theses by subject area and
type of research (n=647/670)
120
100
24
25
80
24
17
60
18
5
40
70
54
49
20
5
12
31
Etiology/Treatment/Diagnosis
79
11
72
69
0
Health Services & Measurement
14
37
3
16
1
11
History at McGill
Mental Health-related theses completed in the
Department of EBOH, by year groups (n=647/670)
154
160
140
133
120
100
95
89
80
57
60
49
40
33
16
20
4
0
Total
Mental Disorders
0
0
1
2
3
5
8
8
11
17
4
History of mental disorder research (n=42)
Focus of research
16
14
14
12
14
11
10
8
6
4
3
2
0
Diagnosis/Measurement
Etiology
Health Services
Treatment
History of mental disorder research (n=42)
Types of mental disorders investigated
Risk factor for
other physical
ailments
31%
Severe
19%
Common
50%
History of mental disorder research (n=42)
Age Group Investigated
Children
2%
Adolescents
10%
Older Adults
43%
Adults
45%
Year of Mental Health - 2001
WHO: Investing in Mental Health (2003)
Health Research Funding for
Major Chronic Diseases in Four Countries
ACCESS
(Adolescent/young adult Connections to Community-driven
Early Strengths-based and Stigma-free services)
SPOR
The first network launched under CIHR’s Strategy for Patient-Oriented
Research (SPOR) jointly funded with the Graham Boekh Foundation,
Montreal
Goal
Transform the way youth access and use mental health services in
real world settings and evaluate impact of implementation
Who
Multidisciplinary network of stakeholder groups across six provinces
and one territory in Canada
Objectives
1. Promote early identification
2. Provide timely access to services
3. Match needs with specific interventions
4. Eliminate service transitions at age 18
Acknowledgments
Laura Morrison: MScPH Candidate
Andre Yves Gagnon: Student Affairs Administrator
Genevieve Gore: Liaison Librarian
Sarah Severson: Assistant Librarian
Selected References
1.
Langlois, K. A., Samokhvalov, A. V, Rehm, J., Spence, S. T., & Gorber, S. C. (2012). Health state descriptions for
Canadians : Mental illnesses.
1.
Mathers, C., Boerma, T., & Ma Fat, D. (2004). The Global Burden of Disease 2004 Update. Retrieved April 16,
2015, from http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/
1.
Barbato, A. (1998). Schizophrenia and public health. Retrieved April 26, 2015, from
http://www.who.int/mental_health/media/en/55.pdf?ua=1
1.
Investing in Mental Health. (2003). Retrieved April 22, 2015, from
http://www.who.int/mental_health/media/investing_mnh.pdf
1.
Mental Illness in Canada: Backgrounder - Canadian Mental Health Association. (2003, April 1). Retrieved April
16, 2015, from https://www.cmha.ca/public_policy/mental-illness-backgrounder/
1.
Bartram, M., Chodos, H., Gosling, S., Hardie, S. L., Knoops, F., Lapierre, L., Neuwelt, B. (2012). CHANGING
DIRECTIONS The Mental Health Strategy for Canada.
Thank you
Next Steps ?