Skip to main content Accessibility help
×
×
Home

Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study

  • F. J. Charlson (a1) (a2) (a3), Y. Y. Lee (a1) (a2), S. Diminic (a1) (a2) and H. Whiteford (a1) (a2) (a3)

Abstract

Background

Epidemiological models are frequently utilised to ascertain disease prevalence in a population; however, these estimates can have wider practical applications for informing targeted scale-up and optimisation of mental health services. We explore potential applications for a conflict-affected population, Syria.

Methods

We use prevalence estimates of major depression and post-traumatic stress disorder (PTSD) in conflict-affected populations as inputs for subsequent estimations. We use Global Burden of Disease (GBD) methodology to estimate years lived with a disability (YLDs) for depression and PTSD in Syrian populations. Human resource (HR) requirements to scale-up recommended packages of care for PTSD and depression in Syria over a 15-year period were modelled using the World Health Organisation mhGAP costing tool. Associated avertable burden was estimated using health benefit analyses.

Results

The total number of cases of PTSD in Syria was estimated at approximately 2.2 million, and approximately 1.1 million for depression. An age-standardised major depression rate of 13.4 (95% UI 9.8–17.5) YLDs per 1000 Syrian population is estimated compared with the GBD 2010 global age-standardised YLD rate of 9.2 (95% UI 7.0–11.8). HR requirements to support a linear scale-up of services in Syria using the mhGAP costing tool demonstrates a steady increase from 0.3 FTE in at baseline to 7.6 FTE per 100 000 population after scale-up. Linear scale-up over 15 years could see 7–9% of disease burden being averted.

Conclusion

Epidemiological estimates of mental disorders are key inputs into determining disease burden and guiding optimal mental health service delivery and can be used in target populations such as conflict-affected populations.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: F. J. Charlson, University of Queensland, School of Public Health, Queensland Centre for Mental Health Research, The Park – Centre for Mental Health, Locked Bag 500, ARCHERFIELD QLD 4108, Australia. (Email: fiona_charlson@qcmhr.uq.edu.au)

References

Hide All
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). American Psychiatric Association: Washington, DC.
Andrews, G, Sanderson, K, Corry, J, Lapsley, HM (2000). Using epidemiological data to model efficiency in reducing the burden of depression. Journal of Mental Health Policy and Economics 3, 175186.
Barendregt, JJ, Van Oortmarssen, GJ, Vos, T, Murray, CJ (2003). A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Population Health Metrics 1, 4.
Bruckner, TA, Scheffler, RM, Shen, G, Yoon, J, Chisholm, D, Morris, J, Fulton, BD, Dal Poz, MR, Saxena, S (2011). The mental health workforce gap in low-and middle-income countries: a needs-based approach. Bulletin of the World Health Organization 89, 184194.
Buttorff, C, Hock, RS, Weiss, HA, Naik, S, Araya, R, Kirkwood, BR, Chisholm, D, Patel, V (2012). Economic evaluation of a task-shifting intervention for common mental disorders in India. Bulletin of the World Health Organization 90, 813821.
Chapman, C, Mills, K, Slade, T, Mcfarlane, A, Bryant, R, Creamer, M, Silove, D, Teesson, M (2012). Remission from post-traumatic stress disorder in the general population. Psychological Medicine 42, 16951703.
Charlson, FJ, Steel, Z, Degenhardt, L, Chey, T, Silove, D, Marnane, C, Whiteford, HA (2012). Predicting the impact of the 2011 conflict in Libya on population mental health: PTSD and depression prevalence and mental health service requirements. PLoS ONE 7, e40593.
Charlson, FJ, Flaxman, A, Ferrari, AJ, Vos, T, Steel, Z, Whiteford, HA (2015). Post-traumatic stress disorder and major depression in conflict-affected populations: an epidemiological model and predictor analysis. Global Mental Health. doi:10.1017/gmh.2015.26
Chisholm, D, Burman-Roy, S, Fekadu, A, Kathree, T, Kizza, D, Luitel, NP, Petersen, I, Shidhaye, R, De Silva, M, Lund, C (2015). Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: the PRIME study. British Journal of Psychiatry 208, s71s8.
Chisholm, D, Lund, C, Saxena, S (2007). Cost of scaling up mental healthcare in low- and middle-income countries. British Journal of Psychiatry 191, 528535.
Chisholm, D, Sanderson, K, Ayuso-Mateos, JL, Saxena, S (2004). Reducing the global burden of depression Population-level analysis of intervention cost-effectiveness in 14 world regions. British Journal of Psychiatry 184, 393403.
Chisholm, D, Saxena, S (2012). Cost effectiveness of strategies to combat neuropsychiatric conditions in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 344, e609.
Chisholm, D, Sekar, K, Kumar, KK, Saeed, K, James, S, Mubbashar, M, Murthy, RS (2000). Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan. British Journal of Psychiatry 176, 581588.
Coutts, A, Mckee, M, Stuckler, D (2013). The emerging Syrian health crisis. Lancet 381, e6e7.
Edejer, TT-T, Baltussen, R, Adam, T, Hutubessy, R, Acharya, A, Evans, D, Murray, C (2012). WHO Guide to Cost-Effectiveness Analysis.
Epigear International (2012). Ersatz 1.3 [Online]. (http://www.epigear.com/index_files/ersatz.html ). Accessed 6 June 2015.
Ferrari, AJ, Charlson, FJ, Norman, RE, Flaxman, AD, Patten, SB, Vos, T, Whiteford, HA (2013 a). The epidemiological modelling of major depressive disorder: application for the Global Burden of Disease Study 2010. PLoS ONE 8, e69637.
Ferrari, AJ, Charlson, FJ, Norman, RE, Patten, SB, Freedman, G, Murray, CJ, Vos, T, Whiteford, HA (2013 b). Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Medicine 10, e1001547.
Fisher, J, Mello, MCD, Patel, V, Rahman, A, Tran, T, Holton, S, Holmes, W (2012). Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bulletin of the World Health Organization 90, 139149.
Flaxman, AD, Vos, T, Murray, CJL (eds) (2013). An Integrative Metaregression Framework for Descriptive Epidemiology. University of Washington Press: Seattle.
Gureje, O, Chisholm, D, Kola, L, Lasebikan, V, Saxena, S (2007). Cost-effectiveness of an essential mental health intervention package in Nigeria. World Psychiatry 6, 4248.
Habbema, JDF, Boer, R, Barendregt, JJ (2010). Chronic disease modelling. In Epidemiology and Demography in Public Health (ed. Killewo, J, Heggenhougen, HK, Quah, SR). Academic Press: San Diego.
Higashi, H, Barendregt, JJ, Kassebaum, NJ, Weiser, TG, Bickler, SW, Vos, T (2015). Burden of injuries avertable by a basic surgical package in low-and middle-income regions: a systematic analysis from the Global Burden of Disease 2010 Study. World Journal of Surgery 39, 19.
Inter-Agency Standing Committee (IASC) (2007). What should humanitarian health actors know? In IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva: IASC. Available at: http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2007.pdf
Jordans, MJ, Tol, WA, Susanty, D, Ntamatumba, P, Luitel, NP, Komproe, IH, De Jong, JT (2013). Implementation of a mental health care package for children in areas of armed conflict: a case study from Burundi, Indonesia, Nepal, Sri Lanka, and Sudan.
Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gotzsche, PC, Loannidis, JPA, Clarke, M, Devereaux, PJ, Kleijnen, J, Moher, D (2009). The PRISMA Statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLOS Medicine 6, 128.
Makhashvili, N, Van Voren, R (2013). Balancing community and hospital care: a case study of reforming mental health services in Georgia.
Mollica, RF, Mcinnes, K, Sarajlić, N, Lavelle, J, Sarajlić, I, Massagli, MP (1999). Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA: Journal of the American Medical Association 282, 433439.
Morina, N, Wicherts, JM, Lobbrecht, J, Priebe, S (2014). Remission from post-traumatic stress disorder in adults: a systematic review and meta-analysis of long term outcome studies. Clinical Psychology Review 34, 249255.
Murray, CJ, Ezzati, M, Flaxman, AD, Lim, S, Lozano, R, Michaud, C, Naghavi, M, Salomon, JA, Shibuya, K, Vos, T (2012 a). GBD 2010: design, definitions, and metrics. Lancet 380, 20632066.
Murray, CJ, Vos, T, Lozano, R, Naghavi, M, Flaxman, AD, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S (2012 b). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 21972223.
Murray, CJL, Vos, T, Lozano, R, Naghavi, M, Flaxman, AD, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basáñez, M-G, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabé, E, Bhalla, K, Bhandari, B, Bikbov, B, Abdulhak, AB, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, S, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, G, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT-A, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, De, VA CCARO, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, Leo, DD, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des, JA RLAIS, DC, Dharmaratne, SD, Dherani, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Ali, SE, Erskine, H, Erwin, PJ, Espindola, P, Ewoigbokhan, SE, Farzadfar, F, Feigin, V, Felson, DT, Ferrari, A, Ferri, CP, Fèvre, EM, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Fo, MH (2012 c). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990?2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 21972223.
National Institute for Health and Care Excellence (2005). Post-traumatic Stress Disorder (PTSD): The Management of PTSD in Adults and Children in Primary and Secondary Care [Online]. (http://www.nice.org.uk/guidance/cg26/chapter/1-recommendations#the-treatment-of-ptsd).
National Institute for HEALTH and Care Excellence (2009). Depression in Adults: The Treatment and Management of Depression in Adults [Online]. (http://www.nice.org.uk/guidance/cg90/chapter/1-recommendations).
O'hara, MW, Swain, AM (1996). Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry 8, 3754.
Patel, V, Belkin, GS, Chockalingam, A, Cooper, J, Saxena, S, Unutzer, J (2013). Grand challenges: integrating mental health services into priority health care platforms. PLoS Medicine 10.
Patel, V, Goel, DS, Desai, R (2009). Scaling up services for mental and neurological disorders in low-resource settings. International Health 1, 3744.
Patel, V, Weiss, HA, Chowdhary, N, Naik, S, Pednekar, S, Chatterjee, S, Bhat, B, Araya, R, King, M, Simon, G, Verdeli, H, Kirkwood, BR (2011). Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. British Journal of Psychiatry 199, 459466.
Political Terror Scale (2011). The Political Terror Scale [Online]. (http://www.politicalterrorscale.org/about.php). Accessed 13/02/2013.
Raja, S, Underhill, C, Shrestha, P, Sunder, U, Mannarath, S, Wood, SK, Patel, V (2012). Integrating mental health and development: a case study of the BasicNeeds model in Nepal. PLoS Medicine 9, e1001261.
Salomon, JA, Tandon, A, Murray, CJ (2004). Comparability of self rated health: cross sectional multi-country survey using anchoring vignettes. BMJ 328, 258.
Saxena, S, Thornicroft, G, Knapp, M, Whiteford, H (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet 370, 878889.
Steel, Z, Chey, T, Silove, D, Marnane, C, Bryant, RA, Van Ommeren, M (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA: Journal of the American Medical Association 302, 537549.
UNDATA (2012). Total Fertility Rate [Online]. (http://data.un.org/Data.aspx?d=PopDiv&f=variableID%3a54). Accessed 3 September 2015.
United Nations, D. O. E. A. S. A., Population Division (2015). World Population Prospects: The 2015 Revision, Custom Data Acquired via Website. [Online]. (http://esa.un.org/unpd/wpp/DataQuery /).
Uppsala Conflict Data Program (2012). UCDP/PRIO Armed Conflict Dataset [Online]. (http://www.prio.no/Data/Armed-Conflict/UCDP-PRIO/). Accessed 13/02/2013.
Ventevogel, P, Van De Put, W, Faiz, H, Van Mierlo, B, Siddiqi, M, Komproe, IH (2012). Improving access to mental health care and psychosocial support within a fragile context: a case study from Afghanistan. PLoS Medicine 9, 535.
Vos, T, Flaxman, AD, Naghavi, M, Lozano, R, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basáñez, M-G, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabé, E, Bhalla, K, Bhandari, B, Bikbov, B, Abdulhak, AB, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, S, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, G, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT-A, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, De, VA CCARO, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des, JA RLAIS, DC, Dharmaratne, SD, Dherani, M, et al. (2012 b). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 21632196.
Vos, T, Flaxman, AD, Naghavi, M, Lozano, R, Michaud, C, Ezzati, M, Shibuya, K, Salomon, J, Aboyans, V, Aggarwal, R, et al. (2012 a). Supplement to: years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 21632196.
Whiteford, HA, Degenhardt, L, Rehm, J, Baxter, AJ, Ferrari, AJ, Erskine, HE, Charlson, FJ, Norman, RE, Flaxman, AD, Johns, N (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382, 15751586.
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
World Health Organization (2006). Disease Control Priorities Related to Mental, Neurological, Developmental and Substance Abuse Disorders. World Health Organization Geneva.
World Health Organization (2008). mhGAP Mental Health Gap Action Programme: Scaling up care for mental, neurological, and substance use disorders. 2011.
World Health Organization (2013). Assessment and Management of Conditions Specifically Related to Stress: mhGAP Intervention Guide Mode. World Health Organization.
World Health Organization (2015). Syrian Arab Republic Builds Capacity for Mental Health care During Conflict [Online]. (http://www.who.int/features/2015/mental-health-syria-conflict/en/) Accessed 31 August 2015.
World Health Organisation. 2nd Quarter (2014 a). Availability of the Health Resources and Services in Public Hospitals [MoH and MoHE] in Syria. HeRAMS: Public Hospitals’ Report.
World Health Organisation. 2nd Quarter (2014 b). HeRAMS: Health Centres Report.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Global Mental Health
  • ISSN: 2054-4251
  • EISSN: 2054-4251
  • URL: /core/journals/global-mental-health
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Charlson supplementary material
Charlson supplementary material

 Word (48 KB)
48 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed