The Epidemiology Survey And Study Of Preventive And Curative Strategies On Mental Disorders At Tibet In China

Background: Great of resaults of epidemuology shows that an increased tendency of prevalence rate of mental disorders was finding out in variaty area. After two epidemiological investigations in 1982 and 1993 in whole China, many epidemiological investigations on mental disorders had carried out in different minority regions in China. The prevalence is difference between these areas. Nowadays, it had been paied more and more attention to the mental health of population. Mental health service had been offered from many general hospitals in China. However, there was neither psychiatric department in general hospital nor special mental hospital in Tibet. It is the only region that no mental health service in China. There are also no epidemiological investigation on mental disorsers and epilepsy in Tibet.Objective: The purpose of this study was to investigate the prevalence of mental disorders and epilepsy, and the requirement of mental health in Tibet. Our targets were finding out preventive and curative strategies on mental health and building up the mental health service institution and prevention and cure net in Tibet.Methods: The methods of this survey were conformed to that used in the 1982 and 1993 psychiatric epidemiological survey in China. We used multi-stage randomization and cluster sampling method according to the national ratio of Tibeten population. Four representative area of Tibet were choosed to be the sample frame sections. The doubtful cases were screened out first by mental health screening schedule and other screening schedules, then, these cases were re-interviewed face-to-face with SCID-I, and positive cases were diagnosed according to DSM-IV, ICD-10 and CCMD-3. 10% negtive cases were sampled randomly to re-interview with SCID-I too. All positive cases were evaluated their social function and their mental or intellective disability.Results: 1. Excluding neuroses and alcohol-related disorders,the general lifetime prevalence of mental disorders was 13.40‰, and the point prevalence was 12.09‰. This result was similar with the results in 1982 and 1993 (p=0.643 and P= 0.743). However, the point prevalence of mood disorder and alcohol use disorder observably higher than 1982 and 1993 (p=0.000). Alcohol use disorder was the most serious problem in Tibet (point prevalence 40.65‰), and the prevalence of male and female also higher than other survey's reports in China. Neuroses were the secend serious problem in Tibet. The prevalence of neuroses was higher than 1993 (p=0.001). The prevalence of epilepsy was higher than 1983 (p=0.013) and other nations in China. The prevalence of schozophrenia and mental retardation in Tibet were no difference compered with 1982 and 1993.2. The male's prevalence for alcohol use disorder extremely higher than female (p=0.000). While female's prevalence for neuroses, depression and dysthymia was higher than male's (p=0.000 to p=0.023).3. Rarely mental disorder patients ever had saw doctor and got treatment in Tibet. Nearly all patients had seeked help from Lamafirst in Tibet. Only 3 epilepsy patients had got treatment in our survey. None of schizhophrenia and mood disorders patient ever had got treatment. So, most schizophrenia patients became chronic and disability. The prevalence of mental disability and intellectual impairment was 7.63‰ and 2.78‰ respectively.4. The survey of requirenment for mental health in Tibet shows that there were more than 1.9 ten thousands mental disorders patients, but there were fewer medicines or services could be obtained in Tibet. Many patients had to seek help from other provinces.5. According to our results, it was an urgent business to establish mental health institution and offer to mental health service in Tibet. Our emphases of preventive and curative works among mental disorders should be the alcohol-related disorders, neuroses, mood disorders (especially depression) and schizophrenia in Tibet. Epilepsy and mental retardation should be the emphases of preventive and curative for children's mental health. The mental health center established in general hospital should be the main form in Tibet, also the psychiatric outpatient service and theitinerant medical teams should be suffice for the demand of large patients who lived in pasturing and country area in Tibet.Conclusions: The general prevalence of mental disorders and epilepsy in Tibet were higher than native and other nations in China. The most serious mental disoders were alcohol use disorder and neuroses in Tibet. The prevalence of mood disorders and epilepsy also were high in Tibet, the prevalence of other mental disorders were similar with other regions. Many patients became disability in Tibet. The mental health institution, medicine and professional were hardly lack and urgently needed. The mental health center established in general hospital, the psychiatric outpatient service and the itinerant medical teams could be sufficed for the demand of large patiets who lived in different area in Tibet.