Columbia Mailman School’s Global Mental Health Program (GMHP), a collaborative effort between seven schools at Columbia, is led by a partnership of investigators in the departments of epidemiology and psychiatry. Their goal is to support faculty in advancing the field of global mental health by building research ties and in low and middle-income countries, offering training opportunities, and raising awareness about mental illnesses.
GMHP’s work is taking place at a time of increased global attention on mental health. Mental health research in low and middle-income countries tends to be very small and localized, making it difficult to establish standard treatments. To address this, GMHP is working with the WHO to build data coordinating centers in low and middle-income countries to accumulate a base of evidence around treatment for mental disorders. GMHP also offers many resources for Epidemiology faculty, including connecting them with a network of other researchers, highlighting their research, and helping to recruit research assistants for studies. GMHP also hosts regular symposia and other events. For more information, visit http://www.cugmhp.org/
In research news: Dr. Steven Stellman, professor of clinical epidemiology, is research director of the World Trade Center Health Registry, a cohort study of 71,434 survivors of the 9/11 disaster in New York City. Four recent or pending publications co-authored by Dr. Stellman focus on mental and physical health of Registry cohort members, with emphasis on “comorbidity” or multiple illnesses.
A paper titled “Chronic Physical Health Consequences of Being Injured During the Terrorist Attacks on World Trade Center on September 11, 2001” published in American Journal of Epidemiology, reported on 14,087 people who were present on the morning of 9/11 or shortly afterwards and followed-up for incident chronic diseases during the first six years after the attacks. Persons with multiple injuries and PTSD had a 3-fold higher risk of developing heart disease than those with no injury and no PTSD, and injured persons with or without comorbid PTSD in general had a higher risk of developing respiratory and other chronic diseases.
In a paper to be published in the Journal of Traumatic Stress, 10 to 11 years after 9/11, one in five enrollees had either PTSD or depression, and half of those had both mental health conditions, indicating that comorbidity is the rule and not the exception. This has important implications for treating clinicians who need to be alert to possible multiple mental health diagnoses in disaster victims.
An analysis to be published in CDC Morbidity Mortality Monthly Report found one in ten of the flooded enrollees from Hurricane Sandy were injured during evacuation or in the first week after returning home, most with multiple injuries. Injury risk increased with depth of flood-water in the home, and was greatest in those who attempted cleanup or repair of heavily damaged homes.
A third new study, published in Preventive Medicine and titled “Posttraumatic Stress Disorder and New-onset Diabetes Among Adult Survivors of the World Trade Center Disaster” explored the temporal relationship between 9/11-related PTSD and 2,143 cases of new-onset diabetes in 36,899 Registry enrollees. There was a 28% increase in diabetes among enrollees with PTSD compared to those without this condition.
Dr. Silvia Martins, associate professor of epidemiology, was awarded a NIDA- NIH 5-year R01 grant to use detailed information from the National Survey on Drug Use to identify effects of state-level variations in aspects of medical marijuana laws on the prevalence of illegal marijuana use and marijuana disorders. This is the first study to examine the direct effects of medical marijuana laws on marijuana acquisition patterns and prices. The research team includes several colleagues in the Department of Epidemiology: Drs. Deborah Hasin, Sandro Galea, Magdalena Cerda, and Katherine Keyes, and Dr. Melanie Wall from Biostatistics.
Dr. Martins, with colleagues in Columbia Psychiatry and Brazil, has been awarded a grant to examine quantitatively the patterns and social determinants of alcohol and drug use of adults in Rio de Janeiro and also conduct qualitative interviews of vulnerable subgroups of drug users
To address population health and health inequalities, Dr. Magdalena Cerda is studying the potential merits and shortcomings of targeted vs. universal public health interventions, centering on the impact these approaches may have on social inequalities in health. Since fundamental cause theory suggests that there are structural conditions like segregation that influence population health, the question then arises: can either universal or targeted intervention reduce social differences in health if we do not also target fundamental causes? Applying simulation techniques, Dr. Cerdá and colleagues found support for the use of universal rather than targeted prevention strategies to improve population-level health, however, to reduce inequalities, it was necessary to eliminate residential segregation. Her findings suggest that it is not possible for public health prevention strategies to address social inequalities in health without first addressing fundamental causes of health.
Dr. Christina Hoven, professor of epidemiology and psychiatry, is a leading author on a multinational study study to evaluate the efficacy of school-based preventive interventions of suicidal behaviors developed and tested in the Saving and Empowering Young Lives in Europe project. Responses from 11,100-plus adolescent pupils in 10 European Union countries will provide much-needed empirical evidence of the effectiveness of a universal school- based public health intervention. The findings to be published in The Lancet represent the first European multi-country randomized control study on the prevention of suicidal behaviors in adolescents.
Dr. Hoven was also a contributor on the World Health Organization Report, “Preventing Suicide: a Global Imperative,” the first WHO publication of its kind. The report aims to increase the awareness of the public health significance of suicide and suicide attempts and to make suicide prevention a higher priority on the global public health agenda.