Health conditions and role limitation in three European Regions: a public-health perspective

OBJECTIVE: To describe the distribution of role limitation in the European population aged 18-64 years and to examine the contribution of health conditions to role limitation using a public-health approach. METHODS: Representative samples of the adult general population (n=13,666) aged 18-64 years from 10 European countries of the World Mental Health (WMH) Surveys Initiative, grouped into three regions: Central-Western, Southern and Central-Eastern. The Composite International Diagnostic Interview (CIDI 3.0) was used to assess six mental disorders and standard checklists for seven physical conditions. Days with full and with partial role limitation in the month previous to the interview were reported (WMH-WHODAS). Population Attributable Fraction (PAFs) of full and partial role limitation were estimated. RESULTS: Health conditions explained a large proportion of full role limitation (PAF=62.6%) and somewhat less of partial role limitation (46.6%). Chronic pain was the single condition that consistently contributed to explain both disability measures in all European Regions. Mental disorders were the most important contributors to full and partial role limitation in Central-Western and Southern Europe. In Central-Eastern Europe, where mental disorders were less prevalent, physical conditions, especially cardiovascular diseases, were the highest contributors to disability. CONCLUSION: The contribution of health conditions to role limitation in the three European regions studied is high. Mental disorders are associated with the largest impact in most of the regions. There is a need for mainstreaming disability in the public health agenda to reduce the role limitation associated with health conditions. The cross-regional differences found require further investigation.The ESEMeD project is funded by the European Commission (contracts QLG5-1999-01042; SANCO 2004123 and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos/nIII (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKlin

The role of religious advisors in mental health care in the World Mental Health surveys

To examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups. Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity. 1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort "often" through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors. Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.United States National Institute of Mental Health [R01MH070884]; John D. and Catherine T. MacArthur Foundation; Pfizer Foundation; US Public Health Service [R13-MH066849, R01-MH069864, R01-MH092526, R01-DA016558]; Fogarty International Center [FIRCA R03-TW006481]; Pan American Health Organization; Eli Lilly AMP; Company Foundation; Ortho-McNeil Pharmaceutical, Inc.; GlaxoSmithKline; Bristol-Myers Squibb; Shire Pharmaceuticals; State of Sao Paulo Research Foundation Thematic Project Grant [03/00204-3]; Ministry of Health; National Center for Public Health Protection; Ministry of Social Protection; European Commission [QLG5-1999-01042, SANCO2004123]; Piedmont Region (Italy); Fondo de Investigacion Sanitaria; Instituto de Salud Carlos III, Spain [FIS 00/0028]; Ministerio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]; Departament de Salut; Generalitat de Catalunya, Spain; Instituto de Salud Carlos III [CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP]; Glaxo-SmithKline; United Nations Development Group Iraq Trust Fund (UNDG ITF); Grant for Research on Psychiatric and Neurological Diseases and Mental Health from the Japan Ministry of Health, Labor and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]; Lebanese Ministry of Public Health; World Health Organization (Lebanon); National Institute of Health/Fogarty International Center [R03 TW006481-01]; Astra Zeneca; Eli Lilly; Hikma Pharm; Janssen Cilag; MSD; Novartis; Pfizer; Sanofi Aventis; Servier; National Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]; National Council on Science and Technology [CONACyTG-30544-H]; Health and Social Care Research and Development Division of the Public Health Agency; Champalimaud Foundation; Gulbenkian Foundation; Foundation for Science and Technology; Ministry of Public Health; National Institute of Mental Health [U01-MH60220]; National Institute of Drug Abuse; Substance Abuse and Mental Health Services Administration; Robert Wood Johnson Foundation [044708]; John W. Alden TrustSCI(E)PubMedSSCIARTICLE3353-3675