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Will the Rates of Psychiatric Disorders Go Up, Down, or Stay the Same?

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All of us have the right to decent and productive work in conditions of freedom, equity, security and human dignity. For persons with mental health problems, achieving this right is particularly challenging. The importance of work in enhancing the economic and social integration of people with mental health problems is highlighted in this monograph.

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In India, people are increasingly using new media technology (e.g., smartphones, tablets, laptops, and desktops for Internet access), with increasing frequency to text message, E-mail, blog, as well as access social networking websites (like Facebook, Twitter, WhatsApp, Instagram etc.) for business, entertainment, and to stay in touch with family and friends and simultaneously acquiring information about national and world events from other traditional sources of mass media (like television, newspaper, magazines, books, movies, radio etc.). Mass media have a strong effect on our expectations for family, parents, and children, creating standards for our way of life, affection, worship, and society

In simple words, we view reality in terms of our own experience that is influenced by primary groups (Family and Friends); secondary groups (School, religious institutions, and government), and mass media. While the influence of the primary group is waning and the secondary groups are time limited, the influence of mass media is increasing as it is a pervasive and permanent fixture of our lives. The influence of mass media increases when the number and strength of the other sources of influence decrease. There is no longer debate about the impact of the media on the thinking, behavior, and emotions of the general population. In addition, the effects may be pro-social or even anti-social. Mass media serve as socializing agents that aids in construction and perpetuation of perceptions and learned behaviors. Serving as a central source of information, mass media not only reflect public attitudes and values but also take part in shaping them. The effects of mass media are partly unintentional due to news and entertainment programs. However, the media also do this intentionally for monetary gain (by advertisements), achieving social good (sponsored programs), or political purpose (biased or “paid” news). Media have played a role in breaking down misconceptions and myths about homosexuality, leprosy, and HIV/AIDS. It is hoped that it can do the same for psychiatric disorders. The media contribute to mental illness stigma through the exaggerated, inaccurate, and comical images, they use to portray persons with psychiatric disorders as well as providing incorrect information about mental illness. Two mass communication theories, cultivation theory, and social learning theory work in tandem to influence the construction and perpetuation of mental illness stigma. Cultivation theory proposes that those who spend more time “living” in the virtual world of television may perceive the “real world” as per the imagery, principles, and portrayals depicted on the small screen. People who spend a lot of time watching television are likely to assume a television worldview of mental illness.

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The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM‐5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning (Endicott J, Cohen J, 1981)

Because the functional impact of symptom‐defined disorders depends on factors extrinsic to those disorders, such as self‐efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment. The determination of illness severity has important clinical implications. Depending on the disorder, severity affects decisions to seek treatment, the type and intensity of treatment, and whether to continue or stop treatment (Zigmond AS, Snaith RP., 1983). Severity also impacts expectations in the fulfillment of role function and disability status. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice.

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As has been noted, in spite of the importance of a separate mental health budget within the overall health budget, 32% of countries included in the ATLAS study reported not having a specific governmental budget for mental health. Of those that actually reported having one, 36.3% spent less than 1% of their total health budget on mental health. Countries categorized on the basis of income levels differ considerably in terms of the proportion of their governmental budget for mental health to their total health budget

The poorer countries have small health budgets, from which they spend a lower percentage on mental health, resulting in very few resources being available. Poor provision of mental health care results in poor outcomes, avoidable relapses and insufficient rehabilitation.

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Endicott J, Cohen J, Nee J et al. Hamilton depression rating scale. Arch Gen Psychiatry 1981

Kearns NP, Cruickshank CA, McGuigan KJ et al. A comparison of depression rating scales. Br J Psychiatry 1982;141:45‐9.

Cameron IM, Cardy A, Crawford JR et al. Measuring depression severity in general practice: discriminatory performance of the PHQ‐9, HADS‐D, and BDI‐II. Br J Gen Pract 2011;61:e419‐26

Zimmerman M, Martinez JH, Young D et al. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 2013;150:384‐8.

Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983

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