A mental health perspective in Spain: an unknown emerging problem
Dra. María Emilia Rodríguez Rodríguez Adults Psychiatrist from Mental Health Center of Requena
First Sight
• Mental health included in Public medical system
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Patient centered healthcare system•
Psychiatrists, clinical psychologists and social workers• Family Doctor´s Consultation à Mental Health à screening
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First visit•
Relax group•
Other specific group (chronic pain, mindfulness, bereavement..)Evaluation
• Clinical interview
• Psychopathology
• Initial diagnosis and feedback with the patient
• Codification for statistic use and to name the therapeutic process we initiate
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The ICD (WHO), chapter 5 (mental disorders)• 70% of the first visits are diagnosed in any of the stress related pathologies!
Neurotic vs psychotic
• F40-‐F48 Neurotic, stress-‐related and somatoform disorders
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F40 Phobic anxiety disorders•
F41 Panic disorder [episodic paroxysmal anxiety]•
F42 Obsessive -‐ compulsive disorder•
F43 Reaction to severe stress, and adjustment disorders•
F44 Dissociative [conversion] disorders•
F45 Somatoform disorders•
F48 Other neurotic disordersAnxiety
• A feeling of worry, nervousness, or unease about something with an uncertain outcome
• Feeling of danger or unfortune
• Worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing
• A future-‐oriented mood state in which one is not ready or prepared to
attempt to cope with upcoming negative events (anxiety vs fear)
Diagnostic Criteria
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A. A period of at least six months with prominent tension, worry and feelings of
apprehension, about every-‐day events and problems
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B. At least four symptoms out of the following list of items must be present, of which at least one from items 1 to 4Autonomic arousal symptoms
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1. palpitations or pounding heart, or accelerated heart rate•
2. sweating•
3. trembling or shaking•
4. dry mouth (not owing to medication or dehydration)Depression
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Many people think that depression just means a person is very sad•
Medical illness, negatively affects how you feel, the way you think and how you act.•
Feelings of sadness and/or a loss of interest in activities once enjoyed•
Many symptoms in the body as well as mood problems•
Can decrease a person’s ability to function at work and at home•
Depression can affect anyone—even a person who appears to live in relatively ideal circumstancesSeveral factors can play a role in depression:
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Biochemistry: Differences in certain chemicals in the brain may contribute to symptoms of depression.•
Genetics: Depression can run in families. For example, if one identical twin hasdepression, the other has a 70 percent chance of having the illness sometime in life.
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Personality: People with low self-‐esteem, who are easily overwhelmed by stress, or who are generally pessimistic appear to be more likely to experience depression.•
Environmental factors: Continuous exposure to violence, neglect, abuse or poverty may make some people more vulnerable to depression.A Little of Statistics
• Depression affects an estimated one in 15 adults (6.7%) in any given year.
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And one in six people (16.6%) will experience depression at some time in their life.• The estimated percentages of prevalence-‐year and prevalence-‐life for anxiety disorders were 10.6% and 16.6% respectively (Spain)
• Women are more likely than men to experience depression or anxiety
disorders
What do we know about mental health in scientists, researchers
and postgraduate students?
In the USA
• In an article published in Nature Biotechnology and directed by the
researcher of the University of Kentucky (USA) Nathan Vanderford,
it seems that, in the doctoral students studied there are six times
more likely to develop anxiety or depression compared to the rest
of the population
In Belgium
Doctoral students, in
comparison with other work groups with high training, suffer more frequently
symptoms of deterioration in their mental health
3,659 doctoral students from Flemish universities
Quantify the frequency with which students claim to
have experienced in the last few weeks one of twelve
traits considered as signs of stress and, potentially,
psychiatric problems
41% of PhD students felt under constant pressure,
30% were depressed or unhappy and 16% felt useless
Half of the students claimed to live with at least two of the
twelve traits evaluated in the test
.STRIKING RESULTS
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Compared doing a doctoral thesis with other populations (a group of general population, another of workers and one of students), all of them with a high educational level (from students of university degree to doctorates)•
People who were doing a doctoral thesis had much more frequently signs of deterioration in their mental health
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32% of the doctoral students who experienced at least four of the twelve symptoms versus 12% -‐15% of people belonging to the control groupsSTRIKING RESULTS
• The development of these symptoms is independent of the discipline in which the doctorate is carried out
• Gender: women who do their PhD are 27% more likely to suffer psychiatric problems than men.
• Thesis director: positive or negative influence
• Family conciliation 52% more likely to develop a
psychiatric problem
A ROAD TRIP TO SPAIN
A postgraduate situation
• Economical crisis
• Obtain a contract of work in public calls
• The way in which projects are financed
• Economical support
• Unemployment in population who had completed his PhD
studies in 2014 was 8.2%
What about mental health in Spain?
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There are no studies in university students or scientific population•
In academic environment mental health is not a priority à doesn´t exist counselling or any psychological support•
Difficulties to access to a specialist (waiting lists, availability of time, time incompatibility)•
Fear and stigma: diagnosis, treatments•
System limit: psychologist in primary medical consultation for stress related problemsStress prevention
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Healthy style of lifeà time to relax and rest, time to enjoy with family and friends, practice sports (moderate activity), eat a varied diet•
In work: adopt a proactive and positive vision towards solving problems and challenges•
Developing a thesis requires a combination of technical, intellectual and emotional skills for the achievement of optimal results in contexts of considerable demand, long-‐term processes and with consequences for the professional and academic futureStress-‐related diseases treatment
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The first recommended treatment is the counselling (expert patient, specialized nursing)•
In low degrees affections, group interventions may be useful (includes relax techniques group, mindfulness)•
If anxiety or depression are importantà psychological intervention: CBT therapy•
No response, high intensity of symptoms or other specific diagnosis would be beneficiated with a psychiatric intervention•
Resistance to visit a psychiatrist because of medicationà secondary effectsFinal reflection
• Another study by Duke University, 83% of the population will suffer some type of mental disorder throughout their lives
•
so it is important to be clear about the factors that can trigger it, in order to fight against those percentages in a future• The first step is to locate the most prone sectors and it seems that
universities and research centers are a perfect place to start
Discussion: Risk factors for scientists (I)
• Not good future prediction
• a lonely work
• the work invades other vital areas
• long-‐term job, results are not always as expected
• a high-‐performance environment
• high intensity with which research activity tends to develop
Discussion: Risk factors for scientists (II)
• initial symptom of stress is generally ignored
• Personality traits that include anxiety, high self-‐demand and perfectionism
• the stress leads to the appearance of symptoms that produce suffering
• mental health system cannot always give an adequate response to these problems
• stigma surrounding psychopharmacological treatment
Bibliography
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Levecque, K., Anseel, F., De Beuckelaer, A., Van der Heyden, J., & Gisle, L. (2017).Work organization and mental health problems in PhD students. Research Policy, 46(4), 868-‐879.
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The ICD-‐10 Classification of Mental and Behavioural Disorders: ClinicalDescriptions and Diagnostic Guidelines 1st Edition ISBN-‐13: 978-‐9241544221 ISBN-‐10: 9241544228
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GHQ-‐12: General Health Questionnaire, short versión•
Informe Nacional RIO 2016: ESPAÑA Observatorio de Investigación e Innovación (RIO)Resources
• http://www.guiasalud.es/egpc/ansiedad/pacientes/00_introduccion.html
