Psychology Chapter on Alcohol and Depression

Disease Burden and DALYs

• Disease burden refers to the impact of a disease on a population, measured in loss of healthy life.
• DALYs (Disability-Adjusted Life Years) is a key metric for disease burden.
• DALYs combine YLLS (Years of Life Lost) from premature death, and YLDs (Years Lived with Disability) from health consequences of a disease or injury.
• One DALY represents the loss of one year of healthy life.
• A higher DALY value indicates a greater burden of disease.
• A DALY value of 0 would represent perfect health for the entire population.

Top 10 Disease Burden in the Netherlands (2021)

• COVID-19 had highest DALYs
• Other causes: Ischaemic heart disease, Trachea, bronchus, lung cancers, Back and neck pain, Stroke, Chronic obstructive pulmonary disease, Diabetes mellitus, Alzheimer's disease and other dementias, Falls, Colon and rectum cancers.

Global Disease Burden of Mental Health Disorders

• The global burden of mental health disorders has increased substantially between 1990 and 2019.
• DALYs attributed to mental health disorders rose from 90 million to 125.3 million.
• The proportion of DALYs due to mental health disorders is significant.
• Mental health disorders are the 7th leading cause of DALYs globally and the second leading cause of YLDs globally in 2019.

Underestimating DALYs for Mental Health Disorders

• The true burden of mental health disorders is likely underestimated due to several factors.
• Exclusion of personality disorders in disease burden estimates.
• Indirect mortality contributions of mental disorders (accidents, substance abuse, chronic diseases).
• Overlap with other disorders (difficulty isolating individual impact).
• Exclusion of chronic pain's impact on mental health.

Global Prevalence of Mental Disorders in 2019

• All mental health disorders affected 970 million people (approximately 1 in 8 people).
• Anxiety disorders: 301 million.
• Depression: 280 million.
• Bipolar disorder: 40 million.

Economic Burden of Mental Health Disorders

• Global economic losses due to mental health disorders were estimated at 1.42 trillion USD and up to 4.74 trillion USD with broader impacts.

Limitations of Treatment Alone

• Treatment can partially reduce the burden of mental health disorders.
• Many mental health disorders have high relapse rates, even after successful treatment (e.g., 26% for bipolar disorder within 5 years).
• Many people who need mental health care do not have access to it.

Prevention Strategies

• Prevention strategies can significantly reduce the burden of mental health disorders (estimates suggest a 11-27% reduction in disease burden).
• Prevention strategies can be cost-effective.
• Prevention can reduce the demand for costly treatment services.
• Prevention focuses on reducing the incidence, prevalence, and recurrence of disorders.

Different Aims and Outcomes

• Each approach to prevention or intervention has distinct goals and expected outcomes.
• Mental health describes positive emotional, psychological, and social well-being - not just the absence of mental illness.

Prevention Strategies and Challenges

• Complex programs often require multiple components and interventions (e.g. micro-level individual interventions, meso-level community interventions, and macro-level societal interventions).

Protective Factors

• Factors that buffer against mental health disorders (e.g. resilience, social support, interpersonal relationships, high self-esteem, and good physical health).

Contextual Factors and Risk Factors

• Stressful life events significantly increase the risk of a first episode of depression & have associated risk factors (cognitive thinking, family history, social support, social health, neuroticism)
• Residual symptoms, prior history, and vulnerability factors increase risk of recurrence.
• Risk factors like younger age of onset, childhood adversity, chronic stress, and family history are associated with chronic depression.

Prevention and Interventions

• Facilitation (providing access to green/blue spaces).
• Behavior Change (encouraging people to use these resources).

Lecture 4 - Prevention in Children and Adolescents

• Prevention interventions for children and adolescents should be tailored and develop competence and reduce ineffective resolution, based on developmental needs/challenges at different ages.
• Considering risk factors and developmental pathways are crucial for effective prevention efforts.

Lecture 7 - Psychosis Prevention

• Psychotic symptoms are experiences that deviate from reality, such as hallucinations and delusions.
• Psychosis is a clinical syndrome that significantly impairs a person's functioning.
• Schizophrenia is a mental disorder that includes psychosis and other symptoms; psychotic symptoms are more common than schizophrenia.

Lecture 3 - Prevention of Addiction

• Drugs alter the normal functioning of the central nervous system.
• Using substances for medicine does not qualify as drug use (in this context).
• Downers (depressants) slow down the nervous system (e.g., alcohol, cannabis, tranquillisers, GHB, opiates, solvents).
• Trippers (hallucinogens) alter perception (e.g., mushrooms, LSD).
• Uppers (stimulants) speed up the nervous system (e.g., tobacco, caffeine, Ecstasy, cocaine, crack, speed).
• Risks of substance use: acute toxicity, chronic toxicity, addiction potential, social damage (individual and population).
• Alcohol risks: lowered inhibitions, hangovers, memory loss, weight gain.
• Risk Factors: Parental alcohol supply, impulsivity, related personality traits, restrictive parental approaches, and education.
• Protective factors: education and parental approaches.

Lecture 9 - Secondary Prevention of PTSD

• Countries with official investigations, ongoing examinations, and closed preliminary examinations related to war crimes are mapped.
• This emphasizes the global scope of war crimes and the need for interventions.
• Trauma events include actual or threatened death, serious injury, and sexual violation.
• PTSD core symptoms as defined by ICD-11: re-experiencing, avoidance, and hyperarousal symptoms.
• Risk factors of PTSD: pre-trauma predictors.