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Mental disorders represent a worldwide public health concern

Interview with Professor Danuta Wasserman, President of the World Psychiatric Association


 

Professor Danuta Wasserman has several aims for her presidency of the World Psychiatric Association. She wants to boost the mental health and well-being of patients, psychiatric staff, and the public worldwide.



23rd WPA World Congress of Psychiatry in Vienna


Professor Danuta Wasserman from Sweden is the new president of the World Psychiatric Association (WPA). She assumed this important position at the WPA Congress of Psychiatry in Vienna in September this year after being chosen for President-Elect in 2020. The Norwegian Psychiatric Association congratulates her and is looking forward to collaborating with her and the WPA in the years to come.


The World Psychiatric Association is a global association representing 147 psychiatric societies in 123 countries and bringing together more than 250,000 psychiatrists.


At the Congress of Psychiatry in Vienna, Professor Wasserman presented her Action Plan for the next three years.


- One in every eight people in the world live with a mental disorder.


Still, levels of public expenditure on mental health are low. This is a great concern.


Her thoughts on the need for change are clear:


- Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to a variety of shortcomings in clinical trials, e.g., publication bias and weak control conditions such as waiting lists.


Professor Danuta Wasserman gives a speech at the WPA World Congress of Psychiatry in Vienna (2023). Image by WPA.
Professor Danuta Wasserman gives a speech at the WPA World Congress of Psychiatry in Vienna (2023). Image by WPA.

The need for a paradigm shift in research


Professor Wasserman is an experienced researcher, and she draws the WPA membership organizations attention to the very important study performed by Falk Reichsenring and colleagues. They performed an umbrella review of recent meta‐analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults.


- They selected meta‐analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. Reichsenring and his fellow researchers searched PubMed and PsycINFO and individual records of the Cochrane Library for meta‐analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment‐as‐usual (TAU), or psychotherapies vs. pharmacotherapies head‐to‐head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. The work is very thorough.


One hundred and two meta‐analyses, encompassing 3,782 RCTs and 650,514 patients, were included in the study. Depressive disorders, anxiety disorders, post‐traumatic stress disorder, obsessive‐compulsive disorder, somatoform disorders, eating disorders, attention‐deficit/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder were covered. What were the findings?


- Across disorders and treatments, most effect sizes for target symptoms were small and risk of bias often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted.


According to Professor Wasserman, a paradigm shift in research seems to be required to achieve further progress.


How to achieve better mental health


Professor Wasserman believes implementation of evidence-based prevention and self-help in addition to adoption of healthy lifestyles will be important in the future. She wants to dedicate a group to do an evaluation of the influence of healthy lifestyles on mental health. The research group will perform meta-analyses and systematic reviews, give advice for randomized controlled trials, promote different types of healthy lifestyle evaluation studies, and encourage the use of qualitative studies.


The professor´s aim for WPA´s work for the next three years is to boost the mental health and well-being of patients, psychiatric staff, and the public. She bases her aim on several of the UN´s Sustainable Development Goals (SDG).


- The WPA has an obligation to play an important role in contributing to the achievement of the SDGs. Most notably, the third SDG, “Health and Wellbeing”, includes decreasing suicide rates as an indicator of progress. Such a reduction should be a high priority for the WPA. Mental health stigma and discrimination due to age, race, ethnicity, nationality, religion, gender, sexual orientation, and other factors remain widespread. The tenth SDG, “Reducing Inequality” is another important goal for the WPA, to ensure that no one is left behind. The seventeenth SDG, “Partnership between Governments, Associations, the Private Sector and Civil Society”, deserves the WPA's attention to secure better public mental health.


Concerns for psychiatrists


Professor Wasserman also has ambitions for supporting and encouraging fellow psychiatrists around the world.


- We will create a specialist platform in the form of webinars where experts will share their insights into clinical psychiatry, public mental health, and etichs. We hope this will be a welcome addition and inspiration to psychiatrist in their busy working life. The “E-journal Club” where young psychiatrist can discuss recent scientific articles in psychiatry will be continued.


To make short, reader-friendly materials to psychiatric staff, patients, and their families to help them understand and manage specific psychiatric disorders based on the content of the webinars, is also on Professor Wasserman´s agenda.


Hopes for the future


The new President believes the action plan will make WPA a significant contributor to the field of psychiatry and public mental health worldwide in the years to come.


- Hopefully we can boost the mental health, healthy lifestyles, and health of patients and the public and improve patient care worldwide.


My sincere wish is also that we can, last but not least, improve the health and healthy lifestyles of psychiatrists and psychiatric staff. □



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