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    • "Part of the problem is that there is no such object as a " gold standard " measure of mental health. For example , while Kessler et al. (2005) provide strong evidence that the National Comorbidity Study (NCS) provide results similar to the earlier Epidemiologic Catchment Area (ECA) Study and to clinical results, Kessler et al. (2004) acknowledge that there is no " gold standard " to compare to the NCS, and Grant et al. (2007) argue that the NCS underestimates substance dependency because of the nature of the screening questions. "
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    ABSTRACT: I present an improved methodology for estimating local prevalence rates using classical econometric methods. I provide information on the variation within national mental health surveys associated with ICD versus DSM coding. Conditional on the validity of national survey responses, I estimate precise and statistically significant models associated with binary measures of mental health diagnoses. I also present estimates from polychotomous discrete choice allowing for covariance in errors. Focusing on binary discrete measures, empirical results from NCS-R and NSADMHP are qualitatively similar though very different from NHIS. I speculate that, to a significant degree, this occurs because both NCS-R and NSADMHP rely on popular screening tools to mechanically diagnosis sample participants, while NHIS relies on self-diagnosis. I also discuss the effects on local prevalence estimates caused by unobserved community-specific effects. Finally, I use the results to make policy statements about the provision of public mental health services in central Virginia; the results document a severe shortage of services for people who are unlikely to be able to afford services in the private market.
    Health Services and Outcomes Research Methodology 09/2014; 14(3). DOI:10.1007/s10742-014-0120-2
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    • "Consider the following example: the two most recent surveys for alcohol use disorders revealed a 12.5% prevalence of alcohol dependence in Latvia (Snikere et al., 2011) and <0.5% in Italy (de Girolamo et al., 2006, using standard survey methodology—Composite International Diagnostic Interview CIDI; see Rehm et al., 2005, 2012, for background on methodology and a European overview of prevalence rates). Even if we allow for methodological problems with the Italian estimate, as it was based on the World Mental Health survey (Grant et al., 2007), which at the time asked dependence questions only if the respondent had previously answered affirmatively to the abuse criteria, other evidence from Italy would suggest prevalence of alcohol dependence at most 1/5 to 1/10 that of Latvia (Scafato et al., 2005). If we look at the per capita consumption of the two countries for 2010, we find a recorded consumption of 6.1 for Italy and 9.8 for Latvia, with unrecorded consumption being estimated at an additional 1.4 for Italy and 1.8 for Latvia (http ://www.who.int/substance_abuse/activities/gisah/en/). "
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    ABSTRACT: The aim of the study was to explore whether the concept of heavy substance use over time can be used as definition of substance use disorder. Narrative review. Heavy use over time clearly underlies the neurobiological changes associated with current thinking of substance use disorders. In addition, there is evidence that heavy use over time can explain the majority of social problems and of burden of disease (morbidity and mortality). A definition of substance use disorders via heavy use over time would avoid some of the problems of current conceptualizations, for instance the cultural specificity of concepts such as loss of control. Finally, stressing the continuum of use may avoid the high level of stigmatization currently associated with substance use disorders. 'Heavy substance use over time' seems to be a definition of substance use disorders in line with results of basic research and epidemiology. Additionally, it reduces stigmatization. This approach should thus be further explored.
    Alcohol and Alcoholism 08/2013; 48(6):633–640. DOI:10.1093/alcalc/agt127 · 2.09 Impact Factor
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    • "Additional data on AD for Italy, Southern Europe, and the European Union (EU) were obtained from the World Mental Health Survey (ESEMeD/MHEDEA 2000 Investigators, 2004; [18]). These data likely underestimate the true population prevalence of AD, as questions used to measure AD in the World Mental Health Survey were only asked of those respondents who scored positively on questions relating to alcohol abuse [19]. To correct for this undercoverage, data from the World Mental Health Survey were combined with data from the German Mental Health Survey, where both dependence and abuse were assessed independently [20,21]. "
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    ABSTRACT: Background The tradition of consuming alcohol has long been a part of Italian culture and is responsible for a large health burden. This burden may be reduced with effective interventions, one of the more important of which is treatment for Alcohol Dependence (AD). The aim of this article is to estimate the burden of disease in Italy attributable to alcohol consumption, heavy alcohol consumption, and AD. An additional aim of this paper is to examine the effects of increasing the coverage of treatment for AD on the alcohol-attributable burden of disease. Methods Alcohol-attributable deaths and the effects of treatments for AD were estimated using alcohol-attributable fractions and simulations. Deaths, potential years of life lost, years lived with disability, and disability adjusted life years lost were obtained for 2004 for Italy and for the European Union from the Global Burden of Disease study. Alcohol consumption data were obtained from the Global Information System on Alcohol and Health. The prevalences of current drinkers, former drinkers, and lifetime abstainers were obtained from the GENder Alcohol and Culture International Study. The prevalence of AD was obtained from the World Mental Health Survey. Alcohol relative risks were obtained from various meta-analyses. Results 5,320 deaths (1,530 female deaths; 3,790 male deaths) or 5.9% of all deaths (4.9% of all female deaths; 6.3% of all male deaths) of people 15 to 64 years of age were estimated to be alcohol-attributable. Of these deaths, 74.5% (61.3% for females; 79.8% for males) were attributable to heavy drinking, and 26.9% (25.6% for females; 27.5% for males) were attributable to AD. Increasing pharmacological AD treatment coverage to 40% would result in an estimated reduction of 3.3% (50 deaths/year) of all female and 7.6% (287 deaths/year) of all male alcohol-attributable deaths. Conclusions Alcohol was responsible for a large proportion of the burden of disease in Italy in 2004. Increasing treatment coverage for AD in Italy could reduce that country’s alcohol-attributable burden of disease.
    Substance Abuse Treatment Prevention and Policy 06/2013; 8(1):21. DOI:10.1186/1747-597X-8-21 · 1.16 Impact Factor
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