Lifetime Prevalence of Mental Disorders in Lebanon: First Onset, Treatment, and Exposure to War

While large-scale national psychiatric epidemiologic studies have been conducted in Western industrialized nations [1–3], studies in the Arab world have generally been limited to smaller populations [4–6]. In addition, while exposure to war as a risk factor for the development of mental disorders in military populations has previously been described [7,8], the effect of war upon first onset of a range of mental disorders in civilian populations at a national level has not been explored. Over the last quarter-century, advances in psychiatric diagnostic classification, the development of fully structured diagnostic interviews, and the refinement of household survey technology have led to greater understanding of the epidemiology of psychiatric illness in the Western hemisphere. With the publication of the Diagnostic and Statistical Manual, 3rd edition [9], the American Psychiatric Association truly operationalized the diagnostic criteria for psychiatric disorders. Based on these criteria, Robins and colleagues created the Diagnostic Interview Schedule (DIS)—the first fully structured diagnostic interview that could be administered by trained lay persons [10]. The DIS was administered to over 20,000 individuals in the Epidemiologic Catchment Area Study, a landmark community-based survey of mental health disorders conducted in selected neighborhoods in five United States communities [1]. Widespread dissemination of the Epidemiologic Catchment Area study results led to replication studies in other countries and the development of other structured diagnostic interviews. The most widely used of these is the World Health Organization Composite International Diagnostic Interview (WHO CIDI), developed to encourage cross-national research by integrating the validated methodological approach of the DIS with the WHO's International Classification of Diseases [11]. The sophisticated study of disasters—war is one type of human-made disaster—and their impact on mental health is also relatively recent [12]. More than 29 armed conflicts are occurring now around the globe involving 25 countries [13]. The public health response to large-scale public health emergencies and catastrophes requires consideration of the mental disorders (e.g., post-traumatic stress disorder, depression), distress (e.g., sleep disturbance, fear, changes in economic behaviors such as purchasing houses), and health risk behaviors (e.g., increased alcohol and smoking, evacuation behaviors) of those exposed [14,15]. Linked Research Article This Perspective discusses the following new study published in PLoS Medicine: Karam EG, Mneimneh ZN, Dimassi H, Fayyad JA, Karam AN, et al. (2008) Lifetime prevalence of mental disorders in Lebanon: First onset, treatment, and exposure to war. PLoS Med 5(4): e61. doi:10.1371/journal.pmed.0050061 In a survey of 2,857 adults in Lebanon, Elie Karam and colleagues found a lifetime prevalence of any DSM-IV psychiatric disorder of 25.8%.