Most Will Be Mentally Ill at Some Point, Study Says
By BENEDICT CAREY
More than half of Americans will develop a mental illness at some point in their lives, often beginning in childhood or adolescence, researchers have found in a survey that experts say will have wide-ranging implications for the practice of psychiatry.
The survey is the most comprehensive in a series of censuslike mental health studies undertaken by the government. The findings of those studies are frequently cited by researchers, advocacy groups, policy makers and drug manufacturers to emphasize the importance of diagnosing and treating mental illness.
The earlier, less comprehensive surveys, which were published in 1984 and 1994 and which also found a high prevalence of mental illness, came under attack on the ground that they defined mental illness too broadly. Now, experts say, the new findings are sure to renew debate about whether mental illness can be reliably distinguished from garden-variety emotional struggles that are part of any life.
Dr. Thomas Insel, director of the National Institute of Mental Health, the primary sponsor of the study, said in a conference call with reporters, "The key point to remember is that mental disorders are highly prevalent and chronic."
The study, Dr. Insel added, "demonstrates clearly that these really are the chronic disorders of young people in this country."
On the other side are psychiatrists who say they believe that the estimates are inflated. "Fifty percent of Americans mentally impaired - are you kidding me?" said Dr. Paul McHugh, a professor of psychiatry at Johns Hopkins University.
While the new survey was carefully done, Dr. McHugh said, "the problem is that the diagnostic manual we are using in psychiatry is like a field guide and it just keeps expanding and expanding."
"Pretty soon," he said, "we'll have a syndrome for short, fat Irish guys with a Boston accent, and I'll be mentally ill."
The report comes amid debate about whether adults and children should be screened for mental disorders, and where the line between illness and health should be drawn. The answers will have an enormous effect on who receives treatment and which disorders are covered by insurance.
The $20 million survey, which in addition to the government financing received some support from health research foundations and pharmaceutical companies, appears in a series of four papers in the June issue of The Archives of General Psychiatry. The investigators arranged face-to-face interviews with a broad cross section of 9,282 Americans ages 18 and over, and the interviewers asked the participants whether they had experienced periods of extended sadness, alcohol or drug abuse, irrational fears or a host of other symptoms. If so, the interviewers probed more pointedly about the episodes, asking how long they lasted and how they affected the participants' behavior.
People who described symptoms that met criteria outlined in the American Psychiatric Association's Diagnostic and Statistical Manual were classified as having had a mental disorder.
As expected, the researchers found that the most common problems were depression, affecting about 17 percent of the people at some point in their lives, and alcohol abuse, affecting 13 percent. Phobias were also common, including social phobia, a form of extreme anxiety that affected 12 percent. More than a quarter of those interviewed had had a mental disorder in the last year.
Of those people who had suffered from a mental illness at some point in their lives, most developed the problem at a young age. Mood disorders like depression typically first struck people in early adulthood, in their 20's or early 30's. But impulse-control problems like attention deficit hyperactivity, and anxiety problems like phobias, usually started far earlier, often by age 11.
Dr. Ronald C. Kessler, a professor of health care policy at Harvard Medical School, was the lead author of the survey, and was joined by a team of researchers from other universities and from the National Institute of Mental Health. Dr. Kessler said the rates of illness found should not be surprising.
"If I told you that 99 percent of Americans have had a physical illness, you wouldn't blink an eye," he said in an interview. "The fact is that there is a very wide range included here, with the equivalent of many psychiatric hangnails. We don't want to demonize those, but we don't want to trivialize them, either, because we know in many cases they lead to serious problems later on."
The investigators also asked the study participants about treatments, and found mixed results. Although people were more likely to find care than they were 10 years ago, only a third of the treatments met even minimal standards for effectiveness, said one co-author, Dr. Philip S. Wang, an assistant professor in the department of health care policy at Harvard.
Can you believe this crap? I can't believe these morons spent 20 million dollars on this study to come up with an end result that makes no practical sense in the end. What does it really tell us when we find out that 25% of all people meet criteria for some mental illness? Those criteria are so screwy that you can get any well adjusted person to meet the requirements. For instance, the diagnosis for alchol abuse under DSM criteria is something like "have you ever drank more than you intended?" "Have you ever intended not to drink or to cut back and failed?" "Has drinking ever negatively impacted your other daily life activities?" If you answered yes to that in any measure you already meet alcohol abuse criteria and maybe even alcohol dependence. All it's based on is that you have intended to cut back or stop and not done it and that it influences your life somehow. So if you go out drinking the night before an exam or before work and then decide to blow it off, congrats, you're alcohol dependent. A few years ago they removed physical symptoms from the criteria, so no longer do you need to get the shakes if you don't drink or feel poorly if you don't drink. It's just idiocy.
Don't even get me started on the depression criteria. Feel down for 2 weeks or more? Gained or lost weight? Don't get as much pleasure in what you used to? Feh.