Strengthening policies through good information

Transcription

1 1 Strengthening policies through good information FPS PUBLIC HEALTH, SAFETY OF THE FOOD CHAIN AND ENVIRONMENT Belgium Pol Gerits, PH. D. Psychosocial Care Service Department Manager With the kind collaboration of Jan Vandevelde and Naomi Langerock

2 2 Health Interview Survey in Belgium Objectives 1. Identification of health problems 2. Description of the health status and health needs of the population 3. Estimation of prevalence and distribution of health indicators 4. Analysis of social (in)equality in health and access to the health services 5. Study of health consumption and its determinants 6. Study of possible trends in the health status of the population

3 3 Health Interview Survey in Belgium Content Five domains: Health status (including mental health) Lifestyle Prevention Consumption of care Health and society

4 4 Health Interview Survey in Belgium Method Interval: basically every 4 years 1 year of preparation, 1 year of fieldwork (1997, 2001, 2004), 1 year of analysis and report writing Sample of all inhabitants of Belgium, stratified per region, and constructed on the basis of the National Register using the household as sample unit Sample of more than respondents (with the possibility of an oversampling of regions and/or specific groups) Instruments : three sorts of questionnaires: Oral questionnaire to be filled out by the household Oral questionnaire to be filled out by each selected person, or by a proxy Written questionnaire to be filled out by each selected person over 15 years (not to be filled out by a proxy)

5 5 Health Interview Survey in Belgium Mental (ill) health indicators (1) Started in 1997 with General Health Questionnaire (GHQ-12): 3 indicators GHQ-12 crude score (0-12): The higher the score, the higher the severity or probability of a disorder GHQ [2+] cut-off score: 0 Psychological well-being; 1 Psychological ill being GHQ [4+] cut-off score: 0 Mental disorder unlikely; 1 Mental disorder probable

6 6 Mental health scales: GHQ-12 - Able to concentrate - Loosing of sleep over worry - Feeling useful - Feeling able to make decisions - Feeling constantly under strain - Feeling unable to overcome difficulties - Able to enjoy daily activities - Able to face up to problems - Feeling unhappy or depressed - Loosing self-confidence - Feeling worthless - Feeling reasonably happy

7 7 Health Interview Survey in Belgium Mental (ill) health indicators (2) In 2001: added 4 subscales of Symptom Check List-90 (SCL-90-R): After extensive debate, 4 scales of the most common mental ill health disorders (Depression, Anxiety disorders, Somatization, Sleeping disorders) on the general population level were retained GHQ-12 alone generates too many false presumptive positives; when combined with SCL-90-R a significant improvement in screening performance results (Schmitz, Kruse & Tress, 2001)

8 8 Mental health scales: SCL-90-R Anxiety - Nervousness or shakiness inside - Trembling - Scared for no reason - Feeling fearful - Heart pounding or racing - Feeling tense or keyed up - Spells of terror or panic - Feeling so restless that can't sit still - Feeling something bad will happen to self - Frightening thoughts and images

9 9 Mental health scales: SCL-90-R Depression - Loss of sexual interest or pleasure - Feeling low in energy or slowed down - Thoughts of ending life - Crying easily - Feeling trapped or caught - Blaming self for things - Feeling lonely - Feeling blue - Worrying too much - Feeling no interest - Feeling hopeless about the future - Feeling everything is an effort - Feelings of worthlessness

10 10 Mental health scales: SCL-90-R Somatisation - Headaches - Faintness or dizziness - Pains in heart or chest - Pains in lower back - Nausea or upset stomach - Soreness of muscles - Trouble getting breath - Hot or cold spells - Numbness or tingling in parts of body - Lump in the throat - Feeling weak in parts of body - Heavy feelings in arms or legs

11 11 Mental health scales: SCL-90-R Sleep - Trouble falling asleep - Awakening in the early morning - Sleep that is restless or disturbed

12 12 Health Interview Survey in Belgium Mental (ill) health indicators (3) In 2004: Added Vitality subscale of SF-36 Added 3 questions about suicide: Have you ever seriously thought of ending your life? (Yes, several times; Yes, once; No, never) Have you ever attempted to commit suicide? (Yes, several times; Yes, once; No, never) Did you make a suicide attempt in the last 12 months? (Yes; No; I don t know)

13 13 Health Interview Survey Mental health indicators (3 bis) Questions Vitality subscale SF-36: How much during the past 4 weeks did you feel full of life? did you have lots of energy? did you feel worn out? did you feel tired? Answer on 6-point Likert scale: 1: All of the time 2: Most of the time 3: A good bit of the time 4: Some of the time 5: A little of the time 6: None of the time

14 14 Health Interview Survey in Belgium Mental (ill) health indicators (4) Since 1997 also question about self-reported depression: Did you have, during the last 12 months, serious gloom or depression for a period of at least 2 weeks? Since 2004 also question Did you have, during the last 12 months, other serious psychiatric problems (specify)

15 15 HIS Mental (ill) health indicators Results (1) Reports with base statistics of HIS 1997, HIS 2001 and HIS 2004 are available At this moment: data files (needed for additional analyses such as correlational analyses) available for HIS 1997 and HIS 2001, data files for HIS 2004 will soon be released Correlational analyses presented below are based on data of HIS 2001 correlations of risk/protective factors with SF-36 Vitality subscale, suicide items and the question about other serious psychiatric during the last year are not yet available

16 16 HIS Mental (ill) health indicators Results (2) GHQ-12 With a cut-off of 2+, we see a decrease of 7 % of people with psychological ill-being between 1997 and 2004 With a cut-off of 4+, we see a decrease of only 4 % of people with a probable mental health disorder 35,0% 30,0% 25,0% 20,0% 15,0% 10,0% 5,0% 0,0% GHQ GHQ-12 4+

17 17 HIS Mental (ill) health indicators Results (3) SCL-90-R 25,0% On average, 8.3 % of the general population suffers from depression (6.2 % according to the self-report measure) 6.2 % has an anxiety disorder 8 % has a somatisation disorder 20.1 % has sleeping problems 20,0% 15,0% 10,0% 5,0% 0,0% Self-rep depr SCL-Depr SCL-Anx SCL-Som SCL-Sleep

18 HIS Mental (ill) health indicators Results (4) Intercorrelations SCL-subscales ***= p<.0001 SCL-Som SCL-Depr SCL-Anx SCL-Sleep SCL-Som *** 0.44*** 0.30*** SCL-Depr *** 0.34*** SCL-Anx *** SCL-Sleep 1.00

19 19 HIS Mental (ill) health indicators Results (5) Intercorrelations GHQ-indicators with SCL-subscales 2001 ***= p<.0001 SCL-Som SCL-Depr SCL-Anx SCL-Sleep GHQ crude score 0.29*** 0.51*** 0.45*** 0.31*** GHQ 2+ cut-off 0.24*** 0.36*** 0.32*** 0.27*** GHQ 4+ cut-off 0.24*** 0.44*** 0.39*** 0.26***

20 20 HIS Mental (ill) health indicators Results (6) Conclusions about intercorrelations The intercorrelations of the 4 SCL-subscales included in the HIS are all quite high, especially the intercorrelation between the Anxiety- and the Depression subscales The GHQ-indicators also correlate quite high with the SCLsubscales; the highest intercorrelations are found between the GHQ crude score and the GHQ 4+ cut-off score on the one hand, and the Anxiety- and Depression subscales of the SCL on the other hand

21 21 HIS Mental (ill) health indicators Results (7) 14,0% 12,0% 10,0% 8,0% 6,0% 4,0% 2,0% 0,0% ,2 % of the population ever seriously thought of ending his life 3.7 % has ever attempted to commit suicide 0.4 % made a suicide attempt in the last 12 months Suicide-Cognitions Suicide-Attempts ever Suicide-Attempts last year

22 22 Determinants of Mental Health (numbers between brackets give number of indicators in HIS 2001) Risk factors -Access to drugs and alcohol (11) -Isolation and alienation (0) -Lack of education, transport, housing (1) -Poor social circumstances and network (0) -Poor nutrition, poverty (11) -Discrimination (0) -Socially unfair urbanisation policy (0) -Violence, delinquency and war(1) -Work stress (0) -Unemployment (0) Protective factors -Empowerment (0) -Ethnic minorities integration (0) -Positive interpersonal intercations (4) -Social participation (2) -Social responsability and tolerance (0) -Social services (7) -Social support and community networks (0)

23 23 Determinants of Mental Health some remarks In the HIS we have no direct indicators for access to drugs and alcohol, only for use of drugs and alcohol; however, we know that the latter are a risk factor for mental health problems Some indicators can be interpreted both as a risk factor and as a protective factor (e.g. ), but we regard them only as either one or the other Social services include: preventive care for children, school medicine, occupational medicine, center for family planning and marital problems, domestic care service, service providing hot meals at home, and social welfare

24 24 Connection between mental health determinants and mental (ill) health (1) Correlation between each indicator of the risk and protective factors and the following mental health indicators in the HIS: - GHQ-12 crude score (0-12) - GHQ cut-off score (0-1) - GHQ cut-off score (0-1) - SCL-90-R Depression subscale (0-1) - SCL-90-R Anxiety disorders subscale (0-1) - SCL-90-R Somatisation subscale (0-1) - SCL-90-R Sleep disorders subscale (0-1) - Self-reported depression item (0-1)

25 25 Connection between mental health determinants and mental (ill) health (2) Results: risk factors Violence, delinquency and war (1*) Lack of education (1*) Poor nutrition, poverty (11*) Access to drugs and alcohol (11*) % significant 100 % (8**) 63 % (8**) 55 % (88**) 28 % (88**) 100 % 100 % 81 % 60% % in the expected direction ( *) number of indicators in HIS (** ) number of correlations

26 26 Connection between mental health determinants and mental (ill) health (3) Results: protective factors Positive interpersonal interactions (4*) Social participation (2*) (Social) services (7*) % significant 100 %(32**) 100 %(16**) 57 % (56**) 100 % 100 % 13 % % in the expected direction ( *) number of indicators in HIS (** ) number of correlations

27 27 Connection between mental health determinants and mental (ill) health (4) Conclusions (1) - It is important to have reliable data for policy makers - Of the correlations between mental (ill) health indicators and mental health determinants for which we find indicators in the HIS, the majority and the strongest correlations are found with the indicators for social cohesion, social participation and satisfaction of interpersonal interaction policy makers and policies need to support initiatives that strenghten the protective aspects and minimize the risk aspects for those social factors, e.g. by stimulating the social life, the community work and minimizing the chances of isolation and alienation

28 28 Connection between mental health determinants and mental (ill) health (4) Conclusions (2) - Other important factors which can be influenced by policies are: good education, prevention of violence, prevention of poverty, recently a project was set up in Belgium with regard to mental health and poverty another program on violence within the family has already been established for some years - Based on our data, we have the feeling that (the use of) social services is neither a protective nor a risk factor for mental (ill) health, because we see that the people who make use of these services have a poorer mental health in general

29 29 Policy implications (1) Important to integrate information about mental health indicators into a general health information survey on the population level: Costs are less Possibility of investigating the connection between mental health indicators and physical health indicators: examples (HIS 2001) correlation between GHQ cut-off score (psychological well-/ill-being) and: Allergy: 0.05*** Serious heart disease or heart attack: 0.04*** Serious bowel problems: 0.03*** Migraine: 0.10*** Longstanding fatigue: 0.09*** Backache: 0.05*** Gastric/duodenic ulcer: 0.03*** ***= p<.0001

30 30 Policy implications (2) With regard to risk and protective factors: it is important to limit oneself to those indicators on which governments can have an influence, and to investigate the effects of interventions regarding these factors on mental (ill) health indicators, e.g. violence, poverty, education, employment, etc : here governments can have an influence upon Interval between surveys has to be geared to the term within which changes in mental (ill) health indicators are to be expected

31 31 Use of the results of the HIS in Belgian health policies In general: still underused by the different administrations Therefore, an Interdepartmental working group has been created on the level of the FPS Public Health, Safety of the Food Chain and Environment, to enhance the involvement of the different departments in the HIS and to promote the use of its results Example of use: benzodiazepin campaigns since 2001: yearly national campaign for reduction of the use of benzodiazepines (most frequently used category of tranquillizers and sleeping pills) and promotion of alternatives HIS results: the increase of the use of tranquillizers (+3 %) and sleeping pills (+2 %) between 1997 and 2001 has been slowed down to +1 % in the period between 2001 and 2004, most probably as a result of these campaingns efforts must be sustained

32 This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.