ASSESSING HEALTH PROBLEMS Self-reported illness, mental distress, and alcohol problems in a rural district in Vietnam

Background: Data on disease burden in the community is important for health planning and policy making. Several developing countries in epidemiological transition suffer the double burden of infectious diseases and increasing rates of non communicable diseases. While the health information system in these countries is still weak, population surveys are rarely conducted. Aims: To assess the occurrence of self-reported illness, mental distress, alcohol problems in different groups in rural Vietnam. Specifically, the aims were to (i) evaluate instruments for monitoring mental health and alcohol problems; (ii) describe and analyze self-reported illness; (iii) assess level of mental distress and alcohol problems; (iv) describe use of health services among people with mental distress, and people with illness reported. Methods: This work was conducted in a rural district within the framework of a longitudinal demographic surveillance system. Through household interviews, data were collected from 11,089 households comprising 48,919 individuals, on self-reported illness and use of health services during four weeks prior to the interview (paper I). A Vietnamese version of the SRQ-20 was tested and evaluated in 52 persons in a district hospital sample and 485 persons from the general population (paper II). The instrument was used to estimate the prevalence of mental distress in a community sample of 3,425 persons (paper V). The same procedures were applied to evaluate a Vietnamese version of AUDIT in a sample of 485 persons (paper III), then to estimate alcohol problems in a sample of 3,423 persons (paper IV). Main findings: The prevalence of self-reported illness was 48%. The most common reported symptoms were cough, fever, and headache (19-22%). Occurrence of illness was significantly lower in groups with higher education, especially among men. Selftreatment was very common (68-70%). Those who reported illness used more private health services than public health services. Use of district hospitals was significantly higher among employed people (paper I). The selected optimal cutoff points of SRQ-20 in hospital and community settings were 5/6 and 6/7, respectively (paper II). The prevalence of mental distress was 5.4% (7% in women and 4% in men). Men who were separated/divorced/widowed or who had unstable employment had higher prevalence of mental distress. 58% of those with mental distress had no treatment and only 5% of them sought health care at the health facilities where mental health services are available. The same pattern of use of health services as in the first study was found among people with mental distress who had used health services (paper V). The cut-off point 7/8 of AUDIT was found optimal (63-100% sensitivity and 76-87% specificity) (paper III). The prevalence of alcohol problems was 25.5% in men and 0.7% women. Separated/divorced/widowed and high educated women had significantly higher prevalence of alcohol problems (paper IV). Conclusions: The surveillance system is a valuable tool for assessment of health problems and use of health services, which is important for health planning and prevention. The SRQ-20 and the AUDIT were confirmed to be valid in Vietnam. High level of alcohol problems among men underlines the need for public health intervention. Low utilization of public health services and treatment gap in mental health indicates the importance of monitoring quality of health services as well as reporting health information from both private and public health services. ISBN 91-7140-776-6 LIST OF PUBLICATIONS This thesis is based on the following papers: I. Kim Bao Giang and Peter Allebeck. Selfreported illness and use of health services in a rural district in Vietnam-findings from an epidemiological field laboratory. Scandinavian Journal of Public Health,2003: Suppl.62: 52-58. II. Kim Bao Giang, Peter Allebeck, Gunnar Kullgren, Nguyen Van Tuan. The Vietnamese version of Self-Reporting Questionnaire-20 (SRQ-20) in detecting mental disorders in Vietnam: a validation study. International Journal of Social Psychiatry, 2006:52(2):175-184. III. Kim Bao Giang, Fredrik Spak, Truong Viet Dzung and Peter Allebeck. The use of AUDIT to assess level of alcohol problems in rural Vietnam. Alcohol & Alcoholism, 2005: 40(6), 578–583. IV. Kim Bao Giang, Peter Allebeck, Fredrik Spak, Hoang Van Minh, Truong Viet Dzung. Alcohol use and alcohol-related problems in rural Vietnam: an epidemiological survey using AUDIT. (Accepted for publication by Substance Abuse and Misuse) V. Kim Bao Giang, Truong Viet Dzung, Gunnar Kullgren and Peter Allebeck. Prevalence of mental distress and use of health services in a rural district in Vietnam. (Manuscript)