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Mental health problems and Millennium Development Goals: A few more associations.

Posted by plosmedicine on 30 Mar 2009 at 23:47 GMT

Author: Debjani Das
Position: Seniour House Officer
Institution: Royal Cornhill Hospital, Aberdeen AB25 2ZH, United Kingdom
Additional Authors: Soumitra Shankar Datta
Submitted Date: October 29, 2005
Published Date: October 31, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We agree with the authors of the article titled 'Achieving the millennium development goals: does mental health play a role' (1). We would like to mention some more probable associations of mental health agendas, which would influence the goals of the program.

Goal 1: Achieve universal primary education
The importance of education cannot be over-emphasised. Mental health problems in the child, or the child's carers, are often important in the assessment of school absenteeism. School refusal may be associated with poor coping with chronic illness, masked depression, substance-related problems, abnormal illness behaviour or family dysfunction. School absence patterns can be used to screen large numbers of children for unmet health needs (2). Mental health promotions should be part of any large educational program.

Goal 3: Promote gender equality and empower women
Domestic violence can be difficult to study and there might be limitations on the quality of data available (3). Screening for substance abuse and depression in an inner-city emergency department population may help to identify individuals at high risk of interpersonal violence (4). Thus mental health screening of 'at-risk' populations might act as a proxy markers for domestic and intimate partner violence. Reduction in domestic violence would be a big step towards achieving gender equality.

Goal 6: Combat HIV/AIDS, malaria and other diseases
The interaction of mental health problems and physical illnesses can be bi-directional. The focus on bio-medical interventions at the cost of effective behavioural interventions, to combat HIV epidemic has been questioned by Odutolu (5). Lifestyle modifications for those who are already infected may be of paramount importance in prevention of rapid spread of HIV infection, especially in high-risk populations as injecting drug users (6).

Mental health assessments and interventions are needed, even in non-psychiatric settings. Somatic symptoms are the leading cause of outpatient medical appointments. At least 33% of somatic symptoms are medically unexplained. These symptoms are chronic or recurrent in 20% to 25% of patients (7). Meta-analysis of medically unexplained symptoms namely functional somatic syndromes, anxiety and depression have been found to have some associations (8). Thus promoting mental health should be an integral part of general health care delivery.

1 Miranda JJ, Patel V.(2005) Achieving the millennium development goals: does mental health play a role? PLoS Med. 2(10):e291.
2 Weitzman M, Klerman LV, Lamb G, et al.(1982) School absence: a problem for the pediatrician. Pediatrics 69(6):739-746.
3 Latta RE, Goodman LA. (2005) Considering the interplay of cultural context and service provision in intimate partner violence: the case of Haitian immigrant women. Violence Against Women 11(11):1441-1464.
4 Lipsky S, Caetano R, Field CA and Bazargan S (2005) The role of alcohol use and depression in intimate partner violence among black and Hispanic patients in an urban emergency department. The American Journal of Drug and Alcohol 31(2):225-242.
5 Odutolu O. (2005) Convergence of behaviour change models for AIDS risk reduction in sub-Saharan Africa. The International journal of health planning and management 20(3):239-252.
6 Agdamag DM, Kageyama S, Alesna ET, Solante RM, Leano PS et al. (2005) Rapid spread of hepatitis C virus among injecting-drug users in the Philippines: Implications for HIV epidemics. Journal of medical virology 77(2):221-226.
7 Kroenke K. (2003) Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int Journal of Meth Psy Res 12(1):34-43.
8 Henningsen P, Zimmermann T, Sattel H. (2003) Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosomatic medicine 65(4):528-533

No competing interests declared.