Lecture 1: Defining wellbeing and mental health

5 main steps to evidence based medicine

• defining a clinically relevant question

• searching for the best evidence

• critically evaluate the evidence

• applying the evidence

• evaluating the performance of EBM

meta-analyses & systematic reviews

bringing together a number of separate studies and synthesizing their results

advantages: transparent, less bias, comprehensive, protocol driven, critical appraisal, resolve for conflicitng results, identifying gaps in current research, reliable basis for decision making

disadvantages: only published studies, quality of included studies, conflict of interest, findings may not be applicable to certain settings, language bias

randomised controlled trials (RCTs)

the gold standard in clinical trails - double blind and patients randomly assigned to treatment or placebo

active control: compare standard care to new treatment

placebo control: ‘sham treatment’ indistinguishable from active treatment

Pope & McNally (2002)

shows why RCTs are so important

cohort study (longitudinal)

recruit and follow participants with a common characteristic over time

case-control studies

study group is defined by the outcome (presence of disorder). identify group of cases and group of controls from same pop. questionnaires, interviews, medical records etc

advantages: cost effective, no long follow up, can be used to study outcomes or rare diseases, examining multiple exposures simultaneously

disadvantages: risk factors are collected retrospectively and can give rise to recall and observer bias, selecting a suitable control group

cross-sectional survery

data is collected on the whole study population a singe point in time to examine the relationship between disease and other variables of interest.

descriptive: frequency and distribution of a disorder in a defined population

analytical: investigate the correlation between a risk factor and a health outcome. cannot determine possible causality bc the risk factors and outcomes are measured at the same time

adv: quick, cheap, no long follow-up, multiple outcomes & exposured to be studied, data only collected once, measure prevalence of disorder

disadv: difficult to determine whether the exposure or outcome came first, bias, difficult to interpret correlation, can’t study rare conditions

hierarchy of evidence

systematic reviews and meta-analyses

randomised controlled trials

cohort (longitudinal) studies

case-control studies

cross-sectional surveys

case studies and case reports

mental health risk factors

conflict, discrimination, compromised environment, gender, economic adversity, socially marginalised groups

mental health and poverty

less financial resources to maintain living standards, fewer education and employment opportunities, less access to health care, stigma and discrimination

hedonistic view on wellbeing

subjective wellbeing: positive mood, avoidance of pain and negative mood, high life satisfaction (Ryan & Deci, 2001)

eudaimonic view on wellbeing

psychological wellbeing: self-actualisation, personal growth (Ryan & Deci, 2001)

wellbeing framework

dynamically contructed through circumstances, activies, psychological resources, interpersonal relations, and locality

individual, family, community, and society

Steel et al., 2014

females more likely to experience mood or anxiety condition. males more likely to experience alcohol or substance abuse

anxiety and depression in COVID

signfiicant increase of depression and anxiety. biggest pandemic countries = biggest disorder prevalence. greater increase in women and younger children

defining a mental health disorder

personal distress, maladaptive behaviour, statistical outlier, violation of social norms

classifying mental disorder advantages

provides us with common nomenclature, enables us to structure info, enables us to identify causes and treatments of disorders, insurance reimbursement, recognition and validation of problems

classifying mental disorder disadvantages

stigma of having a disorder, labelling change in self-concept

categorical classification

presence/absence of a symptom pattern. qualitative differences between normal and abnormal

dimensional classification

symptoms vary on a continuum, differences are quantitative rather than qualitative