Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study

Abstract

Background: Epidemiological models are frequently utilised to ascertain disease prevalence in a population; however, these estimates can have wider practical applications for informing targeted scale-up and optimisation of mental health services. We explore potential applications for a conflict-affected population, Syria.

Methods: We use prevalence estimates of major depression and post-traumatic stress disorder (PTSD) in conflict-affected populations as inputs for subsequent estimations. We use Global Burden of Disease (GBD) methodology to estimate years lived with a disability (YLDs) for depression and PTSD in Syrian populations. Human resource (HR) requirements to scale-up recommended packages of care for PTSD and depression in Syria over a 15-year period were modelled using the World Health Organisation mhGAP costing tool. Associated avertable burden was estimated using health benefit analyses.

Results: The total number of cases of PTSD in Syria was estimated at approximately 2.2 million, and approximately 1.1 million for depression. An age-standardised major depression rate of 13.4 (95% UI 9.8-17.5) YLDs per 1000 Syrian population is estimated compared with the GBD 2010 global age-standardised YLD rate of 9.2 (95% UI 7.0-11.8). HR requirements to support a linear scale-up of services in Syria using the mhGAP costing tool demonstrates a steady increase from 0.3 FTE in at baseline to 7.6 FTE per 100 000 population after scale-up. Linear scale-up over 15 years could see 7-9% of disease burden being averted.

Conclusion: Epidemiological estimates of mental disorders are key inputs into determining disease burden and guiding optimal mental health service delivery and can be used in target populations such as conflict-affected populations.

Keywords: Conflict; depression; global mental health; policy & systems; post-traumatic stress disorder; service planning.

Fig. 1.

Age-specific prevalent cases, in millions, for PTSD and major depression in Syria, 2015.

Fig. 2.

(a) Age-specific YLD rates per 1000 population (with 95% UI) for PTSD in Syria, 2015. (b) Age-specific YLD rates per 1000 population (with 95% UI) for major depression in Syria, 2015.

Fig. 3.

HR requirements for linear scale-up of anxiety and depression packages of care, in FTE per 100 000 population, 2015–2030.

Fig. 4.

(a) Avertable burden (DALYs) of moderate-to-severe depression – three possible scenarios: (1) current treatment coverage; (2) scale up to 30% target coverage; (3) scale up to optimal (100% of moderate–severe cases) target coverage. (b) Avertable burden (DALYs) of moderate-to-severe PTSD – three possible scenarios: (1) current treatment coverage; (2) scale up to 30% target coverage; (3) scale up to optimal (100% of moderate–severe cases) target coverage.