Progress: Illicit Drug Use and Mental Disorders
There are two major activities involved in this work:
estimating epidemiological parameters associated with burden of disease for mental disorders, including prevalence/incidence, duration, disability and mortality; and assessing mental disorders and illicit drug use as a risk factor for disease, injury and disability, using
comparative risk assessment.
Epidemiological parameters
Disability will be estimated using the disability-adjusted life year (DALY), which is a standardized metric that can be used to quantify loss of healthy years of life due to dying prematurely or to living with the health consequences of diseases or injuries (The GBD Study Operations Manual, 2008). Parameters required to calculate DALYs include incidence (annual and cumulative), prevalence (point, period, 12-month and lifetime), remission (proportion of patients fully remitted), duration (average period of illness prior to remission) and mortality.
Comparative Risk Assessment
The Global Burden of Disease study will also investigate risk factors for diseases and injuries. Any entity that raises the probability of disease/injury incidence or death can be treated as a risk factor. Risk factors need to be potentially modifiable; evidence of causal effect can be established; relatively specific definition of risk factor exposure; and sufficient data exists on risk factor exposure and risk factor disease relationships.
Illicit Drug Use and Dependence
The National Drug and Alcohol Research Centre is investigating drug dependence and use for the following drug types:
Injecting drug use is also being investigated as a risk factor for disease, injury and disability.
Click here for official case definitions of dependence on each of the drug types.
Discussion papers for each drug type are available by clicking the links above, as well as on the publications section of this website.
Defining illicit drug use
Estimates of the contribution that illicit drug use makes to the burden of disease need to be made because there is evidence that it produces substantial loss of life and disability. “Illicit” drug use includes the non-medical use of a variety of drugs that are prohibited by international law, namely: amphetamine-type stimulants, cannabis, cocaine, heroin and other opioids, and MDMA (ecstasy). Around the globe, there is also considerable illicit (extra-medical) use of pharmaceutical drugs such as benzodiazepines, anabolic steroids and other pharmaceuticals.
In the GBD exercise, we will use the term “illicit drugs” in preference to other terms (such as “extra-medical drug use” or “drug use” or “illegal drug use”) for ease of communication with a range of audiences. More generalist audiences may not be familiar with more technical terms specific to the drug literature; and also because the term “illicit” is widely used to refer to this group of drugs.
Drugs not included in the GBD estimates
Mental Disorders
The Queensland Centre for Mental Health Research is investigating the following mental disorders:
Disorders not included in the GBD estimates
A thorough and systematic review was conducted to search for studies reporting epidemiological data on personality disorders. Click
here for search results. Following removal of duplicates in the first phase and culling articles that did not meet the inclusion criterion in the second phase, some 50 potential articles were available for further investigation. From these, only eight large-scale epidemiological studies were identified, all conducted within developed countries. Hence only limited data was found for the epidemiology of personality disorders, with particular concern surrounding lack of data for developing countries.
A general overview and a tabulated selection of epidemiological data was presented at two Mental Disorders Research Group
meetings. The following summary topics included:
- Various studies reported significant levels of comorbidity in personality disorders
- The issue of limited quality epidemiological papers was discussed
Other issues were raised in relation to various methodological concerns, such as rater reliability and self-reported measures.
One other strategy suggested was to examine the World Mental Health Survey Initiative on Personality Disorders. Whilst 45 papers were retrieved (via PubMed) using the keyword "World Mental Health Survey" and "Personality Disorders", no articles were identified pertaining to personality disorders. Researchers involved with the World Mental Health Survey (WMHS) were contacted to ascertain whether estimates for personality disorders could be derived from the collected data. In brief, researchers concluded that the WMHS was unlikely to produce estimates that could be used to establish parameters for personality disorders.
The review concluded with a decision to suspend Personality Disorders pending further consultation with various experts on the subject matter.
Overall Progress Reports
Click on the links below to view overall progress reports. For progress of work for a particular disorder, click on the appropriate link above.
Progress Document - March 2008
The National Drug and Alcohol Research Centre
Illicit Drug Use Disorders Progress Flowchart - July 2008
Illicit Drug Use Disorders Progress Flowchart - January 2009
The Queensland Centre for Mental Health Research
Mental Disorders Progress Flowchart - July 2008
Mental Disorders Progress Flowchart - January 2008