Common Mental Disorders Depression - New Zealand Doctor

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12-month period amongst adults attending general practice. Substance use disorders were found to be more common in men than women (17% vs 8%). Depressive disorders (depression and dysthymia) and anxiety disorders were approximately twice as common in women compared with men (22% vs 12% and 26% vs 12%, respectively). 1 Mäori The New Zealand Mental Health Survey found that mental disorders were common among Mäori with at least half (50.7%) of adults experiencing at least one disorder over their life before interview and 29.5% experiencing at least one disorder in the previous 12 months. 29 These findings are consistent with evidence from the MaGPIe study that showed a relatively high prevalence of common mental disorders among Mäori primary care patients. 43 Many disorders experienced within the previous 12 months were considered serious (29.6%) or moderately serious (42.6%), and analyses of comorbidity found that multiple disorders were common, suggesting that such disorders have a considerable impact among Mäori. 29 Anxiety disorders were the most common disorder (lifetime 31.3%; previous 12 months 19.4%), and mood and substance disorders were also common, especially major depressive disorder (lifetime 15.7%; previous 12 months 6.9%). Alcohol disorders were the most prevalent substance use disorder (lifetime 24.5%; previous 12 months 7.4%). Drug disorders were also common (lifetime 14.3%; previous 12 months 4.0%), particularly marijuana abuse and dependence. 29 Disorders were more prevalent among Mäori women than men (previous 12 months 33.6% vs 24.8%), partly due to an increased rate of anxiety and mood disorders. Disorders were also more prevalent among young people, with a disorder occurring in the previous 12 months in about one-third of 15- to 44-year-olds. When the relationship between household income and mental disorder was examined, the prevalence rates for mental disorder were highest among Mäori with the lowest income and supported the view that socioeconomic position contributes to mental disorders among Mäori. 29 Pacific peoples The New Zealand Mental Health Survey found high rates of mental disorders among Pacific adults, with an overall prevalence of 25% for the previous 12 months compared with 21% for the total New Zealand population. 34 There were also higher rates of suicidal ideation (4.5%) and attempts (1.2%) for the previous 12 months than among the general population. Only 25% of Pacific people who had experienced a serious mental disorder had visited any health service for mental health reasons, compared with 58% for the general population. The prevalence of mental disorders was lower among Pacific people born in the Pacific Islands than among those born in New Zealand. 44 6 Identification of Common Mental Disorders and Management of Depression in Primary Care
Chapter 1 Background Asians There have been few studies of the prevalence of mental disorders among Asian ethnic groups in New Zealand. The limited evidence suggests that the prevalence of mental disorders among Asians does not differ significantly from that of the general population. 39 However, there are indications of high levels of depression among older Chinese immigrants and of a high prevalence of post-traumatic stress disorder among Cambodian refugees. 39 Young people The most prevalent childhood and adolescent mental disorders among young people in New Zealand are anxiety disorders, mood disorders, conduct disorder and substance abuse. 45 The overall and gender-specific prevalence of various disorders changes over time (see Table 1.2), with an overall increase up to the age of 18 years. In childhood and early adolescence, males are at greater risk, with higher rates of conduct disorder, attention-deficit hyperactivity disorder, and depressive disorder (depression and dysthymia) in boys. In adolescence, the rates of depression/dysthymia and anxiety disorders increase dramatically in females. However, the rate of substance abuse is higher in males. 45 New Zealand rates of mental disorders for young people are commonly taken from two long-term South Island studies of a 1972 to 1973 birth cohort of 1037 children (Dunedin Health and Development Study 46 ) and a 1977 birth cohort of 1267 children (Christchurch Health and Development Study). 45,47 The Dunedin study found that in 11-year-olds there was an 18% 1-year prevalence rate of mental disorders in their cohort, rising to 35% in 18-year-olds. Prevalence in 18-year-olds in the Christchurch study was similarly high at 42%. A limitation of these epidemiological data on the prevalence of mental disorders is that the extent of functional disability is not described. The disorders identified are likely to range from relatively mild and adolescent-limited conditions, to severe and chronic illness. The data from these studies should therefore be taken to represent an upper limit estimate of the number of young New Zealanders with significant psychiatric problems. 48 Overall, the studies showed that rates stabilised from the age of 18–21 years and new cases began to decline. 49 Childhood anxiety commonly precedes adolescent depression 51 and studies comparing anxiety and depression have revealed a common genetic predisposition for these disorders. 53 In the presence of both anxiety and depression, there is an increased risk of developing a comorbid substance disorder and treatment responsiveness is reduced. 54 Forty percent of 18-year-olds met the criteria for more than one disorder. 45 Identification of Common Mental Disorders and Management of Depression in Primary Care 7
Page 1: Identification of Common Mental Dis
Page 4 and 5: Statement of intent Evidence-based
Page 6 and 7: Endorsements Te Ao Maramatanga New
Page 8 and 9: 3.6 Clinical features of common men
Page 10 and 11: List of figures 3.1 When to refer a
Page 13 and 14: About the guideline Foreword The Ne
Page 15 and 16: About the guideline Guideline devel
Page 17 and 18: About the guideline Paediatric subg
Page 19: About the guideline Royal New Zeala
Page 22 and 23: Algorithm 1 Management of depressio
Page 24 and 25: Algorithm 2a Management of severe d
Page 26 and 27: Algorithm 2c Management of mild dep
Page 28 and 29: • limited access to psychiatrists
Page 30 and 31: Asian peoples About 7% of the New Z
Page 34 and 35: Table 1.2 Prevalence of common ment
Page 36 and 37: 1.4 Etiology of common mental disor
Page 38 and 39: The ‘hopelessness theory’ 94 co
Page 40 and 41: Sexuality Data from the Christchurc
Page 42 and 43: Since those who are affected by sui
Page 44 and 45: 2.3 Managing depression: the steppe
Page 46 and 47: to informed consent. 152 There is a
Page 49 and 50: 3 Recognition and assessment of com
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Page 70 and 71: Good practice points Management of
Page 72 and 73: Box 4.1 Whänau Ora The concept of
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Page 76 and 77: Exercise There was insufficient evi
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Chapter 5 Recognition and assessmen
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6 Management of depression in adult
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Chapter 6 Management of depression
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Recommendations continued... Women
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during pregnancy, of which up to 6%
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Secondary care evidence Based on ev
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Advice for women It may be helpful
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Social networks appear to be an inf
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eastfeeding, or not breastfeeding,
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This evidence comprised two recent
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There is also some evidence that th
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8 Special issues: older adults/ kor
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Chapter 8 Special issues: older adu
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9 Models of care 9.1 Introduction V
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Chapter 9 Models of care were reduc
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Chapter 9 Models of care • networ
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Chapter 9 Models of care service as
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Quality improvement collaboratives
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NZGG has been funded to develop sum
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Appendix A: Guideline development p
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Appendix B: Evidence and recommenda
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Appendix C: Assessment of suicide r
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Appendix D: Assessment tools for co
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Anxiety Anxiety is often comorbid w
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Appendix F: Self-management resourc
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Information about mental disorders
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Dysthymia Dysthymia is a chronic lo
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Glossary, abbreviations and acronym
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References 1. The MaGPIe Research G
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References 38. Tse S, Tong K, Hong
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References 72. Kendler K, Kuhn J, P
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References 107. Halligan SL, Murray
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References 143. Dejesus RS, Vickers
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References 179. Shaffer D, Scott M,
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References 215. Garralda ME, Bowman
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References 249. Zwaanswijk M, Verha
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References 283. Linde K, Berner M,
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References 318. Henkel V, Mergl R,
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References 353. Rush AJ. STAR*D: wh
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References 386. Ward E, King M, Llo
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References 417. Kirsch I, Deacon BJ
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References 451. Zigmond AS, Snaith
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References 486. Appleby L, Warner R
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References 520. Irwin M, Artin KH,
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References 557. Agnew F, Pulotu-End
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