CC BY
8UDC 616.895.8-008.
A COMPARATIVE ANALYSIS OF THE QUALITY OF MENTAL HEALTH SERVICES IN TOMSK REGION AND THE CRIMEAN REGION IN DEPRESSIVE DISORDERS
V. A. Verbenko, S. M. Dymshyts, N. A. Kornetov, V. V. Stroyevsky
Department of Psychiatry, Psychotherapy, and Drug treatment with the Course of General and Medical Psychology Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University Crimean Republic Institution "Clinical Psychiatric Hospital № 1"
Department of Psychiatry, Addiction and Psychotherapy of Faculty of Professional Development and Retraining of the Siberian State Medical University
Correspondence: 5/7, Lenin Avenue, Simferopol, 295006, Republic of Crimea, Russian Federation E-mail: vverbenko@mail.ru
SUMMARY
The depressive disorder is a widespread disease with severe burden and high suicide risk. Depression also affects general health, makes it difficult to perform routine activities, and influences social and professional life much more than chronic physical diseases. Despite the fact that the effective treatment of depression is well known, less than half people in the world suffering from depression can get it (in some countries the number is as low as 10%). The investigation results show the need for providing training programs for primary care medical specialists in the Crimean Autonomy, using Russian and international experience in reducing the suicidal death rate.
СРАВНИТЕЛЬНЫЙ АНАЛИЗ КАЧЕСТВА ОКАЗАНИЯ ПСИХИАТРИЧЕСКОЙ
ПОМОЩИ ПАЦИЕНТАМ С ДЕПРЕССИВНЫМИ РАССТРОЙСТВАМИ В ТОМСКОЙ ОБЛАСТИ И РЕСПУБЛИКЕ КРЫМ
В. А. Вербенко, С. М. Дымшиц, Н. А. Корнетов, В. В. Строевский
РЕЗЮМЕ
Депрессивное расстройство является распространенным заболеванием с тяжелым бременем и высоким риском суицида. Несмотря на то, что эффективное лечение депрессии хорошо известно, менее половины людей в мире, страдающих от депрессии могут получить его (в некоторых странах это число >10%). Результаты данного исследования показали, необходимость проведения учебных программ по распознаванию депрессии для медицинских специалистов первичного звена в Республике Крым, используя российский и международный опыт в снижении смертности в результате суицида.
Ключевые слова: депрессивные расстройства, депрессия, суицид, самоубийство, первичная медицинская сеть, социальная психиатрия
The depressive disorder is a widespread disease account. In the developing countries, losses effected
with severe burden and high suicide risk. Depression by disabilities are even greater [2]. Let us clarify
also affects general health, makes it difficult to some of the concepts related to the new estimations
perform routine activities, and influences social and of mortality and impaired functional capacities. In
professional life much more than chronic physical addition to the most complete and consistent set of
diseases. Depression aggravates any disease course calculations for the morbidity and mortality grouped
and reduces the length and quality of life. The by age, sex, region, new metrics has been introduced:
diagnostic experience in Eastern Europe and the years of life with account of disability (DALY). The
former Soviet Union have revealed a link between calculation formula includes the number of years
depression and suicide at periods of prolonged lived with disability, so that the burden of the disease
social stress under radical social changes. Narrow can be determined quantitatively [3, 4]. The DALY
departmental interests dominate the existing methodology serves as a quantitative means to pool
practice of social assistance; functionally it is information about disabilities, premature deaths
uncoordinated. There is no continuous, regulated and non-fatal outcomes in order to identify the gaps
interaction of psychological, educational, medical, between these situations. One DALY is comparable
genetic, psychological, obstetric, legal and other to one lost year of healthy life. The burden of the
forms of assistance in the city and region scope [1]. disease is measured as the gap between the present
In 1990, depression was the fourth most common health condition and the ideal situation in which
cause of life reduction in the world, with disabilities everybody lives up to the advanced age without
taken into account; the prognosis is that in 2020 it diseases and disabilities. Putting it with more details,
will be the second most common cause. In 1994, it DALY for a particular disease is the sum of life years
was established that in the industrialized countries lost because of premature mortality (PM) in one
about 1.5 million years of life are lost annually population group, and life years lost due to disability
because of depression, with disabilities taken into (YLD) for individual cases under each specific
2015, т. 5, №1 (17)
КРЫМСКИЙ ЖУРНАЛ ЭКСПЕРИМЕНТАЛЬНОЙ И КЛИНИЧЕСКОЙ МЕДИЦИНЫ
condition [5]. In the world, the depressive disorder covers 350 million people [6]. Depression varies from usual changes in mood and emotional reactions to short-term problems in daily life. Depression can be a serious health disorder, especially if it the case is advancing and takes a moderate or severe form. Depressive disorder leads to significant human suffering and brings activities at work, at school and at home to a low level. In the worst cases, it can often lead to suicide. Every year sees one million suicidal deaths [7]. Despite the fact that the effective treatment of depression is well known, less than half people in the world suffering from depression can get it (in some countries the number is as low as 10%). Obstacles to effective treatment include lack of resources, trained health-care providers, and social stigma associated with mental disorders [8].
Another obstacle is inaccurate assessment. Even in some developed countries people suffering from depression do not always obtain a correct diagnosis, while other people, without depressive disorder, get such diagnosis and prescriptions of antidepressants.
The burden of depression and other mental health disorders is increasing on the global scale. In May 2012, the World Health Assembly adopted a resolution that appealed for a comprehensive and coordinated response to mental disorders at the national levels [9].
Apart from subjective sufferings, depression gives a significant impact on social and occupational functions, physical health and mortality. The depressive disorder impact is especially high for physical health. It can affect the course and outcome of severe chronic disabling illnesses, such as heart diseases, diabetes and cancer. Depressive disorder is widespread in situations of the primary medical service (above 10%) and usually it is not diagnosed, while there is a need for therapy with adequate doses of antidepressants. Primary-care physicians should be aware of the common risk factors for depressive disorders, with account of gender, neuroticism, psychosocial stressful events, and know the circumstances that create negative childhood experiences. In primary care, depressive symptomatology should be considered in patients along with several medical problems. It is important to pay attention to unexplained physical symptoms, - they are often multiple, and to various kinds of chronic pain or frequent use of medical services. The programs aimed at improving and follow-up of depressive patients using modern and safe antidepressants and providing further observation have been recognized as cost-effective [10, 11]. If depression is detected and treated ineffectively, we can expect growth of unemployment, alcoholism, drug abuse, aggravation of all illnesses, an increase of mortality and the number of suicides [12].
Broader social effects include greater dependence on social security benefits and the inevitable impact on self-esteem and self-confidence. We can see worsening of social adaptation, including a reduction in the communication ability, with advance of the disease. Disturbed personal relationships during the depressive episode often go on after the episode, spreading over longer periods of time and causing changes in social functioning, particularly in individuals with relapsing disorder. Stigma associated with general mental health problems [13] and having its specific influence on opinions and moods in the society can prevent people with depression from obtaining adequate aid [14].
MATERIAL AND METHODS
The study was conducted jointly by the Crimean Republic institution "Clinical Psychiatric Hospital № 1", the Department of Psychiatry, Psychotherapy, and Drug Treatment with The Course of General and Medical Psychology of the "Medical Akademy named after S.I. Georgievsky" and the Department of Psychiatry, Addiction and Psychotherapy of the Faculty of Professional Development and Retraining of the Siberian State Medical University. The study used the official data on suicidal mortality within the period since 2004 to 2010 in the Crimean Region and the Tomsk region. The comparative analysis was used as the main method.
RESULTS AND DISCUSSION
As mentioned above, the depression has a direct relationship with suicides, which indirectly reflects the situation with the disease in general. This study presents a comparison of suicide incidence in Tomsk Region (Russia) and the Crimean Region, within the period since 2004 to 2010. Based on the official data of these regions, a comparative analysis of suicidal mortality rate for 100 000 of population was made. The results are shown in Figure 1. Figure 1 shows that the downward trend in suicidal mortality in the Crimean Region since 2004 to 2010 is not as pronounced as in the Tomsk region. The Department of Psychiatry, Addiction and Psychotherapy of the Faculty of Professional Development and Retraining (Tomsk, Russia) headed by Professor N. A. Kornetov have designed Educational Program Modules for Depressive disorders (Russian Version), which comprises the training in diagnostic and therapeutic tactics at depressive disorders for various medical specialists of primary care. The program includes different educational forms. In the Siberian region, it is known as Recognition of Depression (REDEP). This program provides interdisciplinary conferences with supervision experts of the prominent World
Psychiatry Association, training in diagnostic skills, round tables with neurologists, cardiologists, gastroenterologists etc., educational courses for social workers, psychologists, psychiatrists. The program has been applied mainly in form of subject courses on depression for urban population of Tomsk region, they were provided three times a year during
one month for over 9 years. The monitoring of the mortality ratio of suicides (MRS) per 1000 000 of population in Tomsk has shown a gradual decline of this indicator: 2004 - 22.5; 2005 - 22.3; 2006 -18.5; 2007 - 12.4; 2008 - 9.6; 2009 - 7.2; 2010 - 3.8.
Thus, the mortality ratio of suicides in 2010 compared to that in 2004 in Tomsk reduced by 74.7%.
Crimea Tomsk
2004
2005
2006
2007
2008
2ода
2010
Figure 1. Comparative analysis of mortality ratio of suicides (100 000) in Tomsk region (Russia) and the Crimean
region.
CONCLUSIONS
1. A theoretical synthesis of the data on the incidence of depressive disorders and suicidal mortality was performed been done in this study.
2. By a comparative analysis, significant differences in suicidal mortality rates for the period since 2004 to 2010 in the Crimean Region and Tomsk region were revealed.
3. The data has shown the need for providing training programs for primary care medical specialists in the Crimean Region, using the experience of the Tomsk colleagues, in order to reduce the suicidal death rate.
REFERENCES
1. World Bank. World Development Report. Investing in health. / Oxford University Press. - 1993. - P. 66-67.
2. Murrey C.J.L., Progress and directions in refining the global burden of disease approach: a response to Williams / Murrey C.J.L., Lopez A.D. Health Economics. 2000. - N 9. - P. 69.
3. Murrey C. J. L., The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factor in 1990 and projected to 2020. / Murrey C.J.L. Lopez A.D., Cambridge, MA, Harvard School of Public Health on behalf of the World Health Organization and World Bank (Global Burden of Disease and Injury Series, Vol.1.). -1996. - P. 139-143.
4. Murrey C.J.L. Global Health Statistic. Cambridge. / Murrey C.J.L., Lopez A.D. MA, Harvard School of Public Health on behalf of World Health Organization and World Bank (Global burden of Disease an Injury Series Vol. II). -1996. - P. 66-73.
5. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Third Edition, revised. / American Psychiatric Association, Washington, DC. - 1987.
6. Alexandrovsky Y.A. Border Mental Disorders: Instructions for Doctors. Fourth Edition. / M.: GEOTAR-Media. - 2007. - P. 720.
7. Lam R.W. Depression. / Lam R.W., Mok H. Oxford University Press. 2008. - P. 116.
8. Bajorec T, Stockman T. Psychiatry: pocket tutor. / Bajorec T, Stockman T. London: JP Medical. - 2012. - P. 258.
9. Sartorius N. Fighting stigma: theory and practice / World Psychiatry. - 2002. - Vol. 1. World Bank. World Development Report. Investing in health. / Oxford University Press. - 1993. - P. 66-67.
10. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Third Edition, revised. / American Psychiatric Association, Washington, DC. - 1987.
11. World Psychiatry Organization. Informational brochure, 2012. - N 369 (October). - 2012. - P. 25.
12. Cassano P., Fava M. Depression and public health: an overview / Cassano P., Fava M.J. Psychosom. Res. 2002 - Vol. 53. № 4 - P. 849-857.
13. Lespérance F. Depression in patients with cardiac disease: a practical review / Lespérance F., Frasure-Smith N. J. Psychosom. Res. 2000. - Vol. 48. - N 4-5. - P. 379-391.
14. Kornetov N.A. International standards of diagnostics and therapy of depressive disorders in general medical practice / Pharmacotherapy in neurology and psychiatry (lections for practical doctors). M.: "Human's Health". - 2002. - P. 117-128.
15. Bridges K. Somatic presentation of depressive illness in primary care. / Bridges K, Goldberg. D. Jour. Roal. Coll. Gen Pract Occas Pap. 1987. - Sep., № 36. - P. 9-11.
