[Psychiatry in the 21st century].
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Biomedical subjects
Publications and source records attributed to N Sartorius.
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In 1975 the World Health Organization began a multinational collaborative study of the feasibility and effectiveness of offering community-based mental health care in developing countries. Services were to be offered by primary health care workers in pilot study areas in seven countries. The authors discuss the philosophic and epidemiologic underpinnings of the study, the factors that helped the collaborative effort develop, and some of the issues that emerged. Areas for future study are outlined.
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The field of mental health, at the present time, has an important potential for rapid development. The reasons for this include important new knowledge that has become available, increased awareness of governments about the size of mental health problems and about the importance of psychosocial factors, and the development of an appropriate technology and a new doctrine of mental health care which allow useful interventions to be made, even when financial resources are extremely scarce.
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The paper is a report on results obtained in the course of a multi-centre international study on depressive disorders in four countries, which was sponsored and co-ordinated by the World Health Organization. A screen form was developed and tested in order to select depressive patients among psychiatric in-patient and out-patient populations. The patients selected in this way were assessed clinically by experienced investigators using the WHO schedule for Standardized Assessment of Depressive Disorders (SADD). A total of 53 patients were evaluated in the five research centres, and the data were utilized in uni- and multivariate statistical analyses aiming to establish whether similar cases of depression could be found in different cultures, to describe their characteristics and to ascertain the extent to which diagnostic concepts and classification categories could be applied in different settings. The results point to a considerable degree of similarity in depressive symptomatology across the cultures if particular selection criteria are applied, and suggest that broad diagnostic groupings such as 'endogenous' and 'psychogenic' depressions could be used consistently by clinicians working in different cultures.
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There are at least 100 million people in the world who suffer from depressive disorders and who could benefit from qualified help. There is also every likelihood that this number will increase because of the higher life expectancy, the increase of depression associated with chronic diseases and over-consumption of medicaments, and other reasons. Epidemiological research has made important contribution to the resolution of the problems that arise in connexion with depressive disorders. New and further intensive investigations are necessary and should lead to the development of instruments for the diagnosis of depressive disorders and to identify the biological and psychosocial factors involved in the aetiology of depression and influencing its course, treatment and outcome.
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In the context of an ongoing WHO research programme in depression, a total of 573 patients consulting psychiatrists in Canada, Iran, Japan and Switzerland were assessed with the WHO/SADD schedule which proved to be a simple and reliable instrument for standardized recording of clinical data. The results indicated that the "average" depressive patients seeking care in culturally different settings have many clinical features in common. A screening instrument, developed in the same study, has been shown to be effective in selecting depressive patients among in- and out-patient populations.
A selective review of findings about the frequency of anxiety, fears, and phobias is presented. It is stressed that caution is necessary in considering the findings of the review because of the ambiguity of the concept anxiety, and numerous methodological problems which beset studies and make comparisons difficult.
1. Primary prevention of psychiatric disorders from the point of view of WHO was discussed. 2. It was emphasized that in contrast to developed countries malnutrition and infection-induced secondary mental deficiencies are still prevalent in the developing world. 3. Some of the relevant WHO projects were briefly reviewed.