Building Bridges from UM to the Local and Global Community:
The Role of Public Mental Health Research
English Text│Brian Hall
The University of Macau (UM) is dynamic and rapidly developing into an outstanding research institution. We have now seen our university enter the ranks of the top 300 world universities and we are now ranked 39th among the top 100 new universities under the age of 50 in the world. But how does this expansion and development link to the local Macao community? How can the university address local priorities and challenges? How can public health research fulfill the promise of a university relevant and focused on addressing the needs of local people while also addressing global challenges and leaving a global footprint? Below I articulate the relevance of mental health to this development agenda and outline some specific targets for research already underway.
What Is Public Mental Health?
A movement to establish interdisciplinary research is growing in Macao, as is true around the world. This is an encouraging phenomenon given that most problems worth addressing require utilising the skills of many people with different knowledge, expertise and backgrounds. This research format allows researchers to speak together and offer different perspectives. While valuable, true integration of multiple disciplines and perspectives can incubate a new field of scientific inquiry and development. Transdisciplinary approaches build upon the strengths of many, and leverage these strengths to develop meaningful solutions to seemingly intractable problems.
This leads to team science. I have the privilege to be working towards the goal of promoting health and wellbeing in Asia, which is a monumental challenge and one only accomplished through collaborative team approaches. Global mental health is a transdisciplinary field as it seeks to combine knowledge and methods utilised in anthropology, sociology, psychiatry, public health, epidemiology, communication, and public policy, to build an evidence base for the study and treatment of poor health around the world.
What Is Health?
The World Health Organization (WHO) defines health as ‘…. a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.’ Embedded within that definition is physical health, along with mental and social wellness. These definitions are positively framed and formulate a picture of health and wellness from a holistic perspective – that a person can live a life imbued with meaningful connectedness to society. Although this definition separates health and mental health, from the perspective of most people in the world these are interconnected and interrelated phenomenon.
My own approach is to conceptualise health broadly to include physical, mental, sexual, and behavioural dimensions. A common mantra for the field, stated first by Dr Brock Chisholm, the first director-general of the WHO, and later popularised through publication in the British medical journal The Lancet, ‘There is no health without mental health.’
The Global Burden of Disease
Mental disorders are serious and debilitating conditions, which in many cases require intervention. Poor mental health is a worldwide public health issue and mental health has been recognised as being a major contributor to the global disease burden. The WHO identifies an important health metric called the Disability Adjusted Life Year (or DALY). One DALY is equivalent to one healthy year of life lost due to a health condition. According to the Global Burden of Disease report, mental, neurological and substance-use disorders account for 28 per cent of DALYs around the world, surpassing cardiovascular disease and cancer.
The most common mental disorders are anxiety and depression. Although it may be argued that poor mental health does not directly lead to loss of life, it contributes to overall lower quality of life, and may in some cases lead to suicide, which is the third leading cause of death among adolescents. Poor mental health is an area of urgent need around the world, but the burden of mental health and poor health is still generally not well known across most of Asia. It is an important priority to characterise these issues and develop strategies to improve health. Intervention delivery in many parts of the world is lacking due to the identified treatment gap. Many more people desperately need intervention than there are available trained mental healthcare providers. We need to do more.
Developing a Research Agenda with Global Impact and Local Significance
UMDepartment of Psychology The Global and Community Mental Health Research Grouphoused in the Department of Psychology at UM, is a group comprised of students and faculty from diverse backgrounds including public health, medicine, social work, anthropology, psychology and epidemiology. The group is dedicated to addressing the pressing mental health and public health needs of East and Southeast Asia. We are engaged in several large research projects, and are developing several initiatives, which will link UM to the region in the public health arena.
In mainland China, we engaged in a large population representative epidemiological study of 765 adults to characterise the health problems facing both local residents and internal Chinese migrants. Our data showed that depression, alcohol misuse, sexual health and infectious disease, and sleep problems are prevalent and should be targets for potential treatment intervention. The data also showed that only a very small percentage of people identified with mental health problems sought care or were identified as having these conditions by their healthcare provider, suggesting a meaningful treatment gap.
In Hong Kong, we engaged in research focused on understanding the prevalence and determinants of common mental disorders (ie, anxiety and depression) following the Umbrella Movement among a population representative sample of over 1000 adults. Our data showed that the prevalence of depression and anxiety exceeded levels reported during the SARS flu epidemic in 2009, indicating that social unrest in Hong
Kong is a major contributor to poor health. This is among the first studies to document this association.
In Macao, we collected data from several important communities. We are examining the various threats to the health of our local migrant communities from Southeast Asia and mainland China. Migrants provide needed labour to sustain the lifestyles of local people and their efforts directly or indirectly contribute to the economic expansion of Macao. Therefore, their health and welfare is of concern to all us. Our team is engaged in fieldwork with these communities to understand their experiences living and working in Macao and to understand Macao residents’ perspectives on labour migrants. Key issues involving access to needed healthcare and housing have emerged along with poor mental health. Additional studies are planned to quantify the prevalence of these conditions and develop interventions to improve their health.
We collected survey data on a large sample of the Macao elderly; our data suggests that community-level trust and social relationships significantly contribute to less depression symptoms in this group. These results may have important policy-level implications and pathways to intervention development. According to our data, programmes that expand or link elders’ to social networks and supports might be a useful strategy to reduce depression in this community. The prevalence of depression was actually meaningfully high, but follow-up studies are needed to validate our results.
Several large-population level surveys have also been conducted on levels of depression among Macao adults. The results from one study of over 1,000 local residents indicated that the prevalence of depression in Macao is high and of concern. We hope these results, once made available, will help to encourage policy-level planning towards addressing these identified issues. The mental healthcare system in Macao may not be fully able to redress these concerns, but UM can help to improve this condition through education, community engagement, and training local clinicians. Our group is now planning a large longitudinal epidemiological study of the determinants of health issues in Macao to begin within the next year.
The Pearl River Delta is a dynamic and changing landscape. Research that is relevant to local society provides important linkages between the university and local communities. As our university continues to grow, our global presence will be felt; conducting research that may assist in improving the health of local Macao people and residents is an important step towards our continued relevance in the local society.
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