Study: U.S. Leads In Mental Illness, Lags in Treatment


By Rick Weiss

  One-quarter of all Americans met the criteria for having a mental
illness within the past year, and fully a quarter of those had a
"serious" disorder that significantly disrupted their ability to function
day to day, according to the largest and most detailed survey of the
nation's mental health, published yesterday.

Although parallel studies in 27 other countries are not yet complete,
the new numbers suggest that the
United States is poised to rank No. 1
globally for mental illness, researchers said.

"We lead the world in a lot of good things, but we're also leaders in
this one particular domain that we'd rather not be," said Ronald Kessler,
the Harvard professor of health care policy who led the effort, called
the National Comorbidity Survey Replication.

The exhaustive government-sponsored effort, based on in-depth interviews
with more than 9,000 randomly selected Americans, finds that the
prevalence of
U.S. mental illness has remained roughly flat in the past
decade -- a possible glimmer of hope given that previous decades had
suggested the rates were gradually rising.

But the rest of the news from the survey -- which did not include some
of the most serious disorders, such as schizophrenia, for which patients
are often institutionalized -- is mostly discouraging.

Less than half of those in need get treated. Those who seek treatment
typically do so after a decade or more of delays, during which time they
are likely to develop additional problems. And the treatment they receive
is usually inadequate.

Younger sufferers are especially overlooked, the survey found, even
though mental illness is very much a disease of youth. Half of those who
will ever be diagnosed with a mental disorder show signs of the disease
by age 14, and three-quarters by age 24. But few get help.

Many factors contribute to these failings, the reports conclude,
including inattention to early warning signs, inadequate health insurance
and the lingering stigma that surrounds mental illness.

"The system has to get its act together to get its quality of care up,"
Kessler said.

Thomas Insel -- chief of the National Institute of Mental Health, which
funded the $20 million study -- said the nation needs to recognize that
mental illness is a chronic condition that requires expert medical
attention just as heart disease, Alzheimer's and diabetes do.

He said he was disappointed to learn from the survey that despite the
availability of effective treatments for many mental illnesses, including
depression and anxiety, about a third of people in need rely solely on
nonprofessional sources such as Internet support groups and spiritual

"You wouldn't rely on your priest for treatment if you had breast
cancer," Insel said. "Why would you go to your priest for a major
depressive disorder? These are real medical and brain disorders, and they
need to be treated that way."

Mental health surveys have been conducted nationwide since the 1940s,
but they offered only crude measures until 10 years ago, when the first
National Comorbidity Study was performed. That highly structured survey
asked questions specific enough to provide an accurate diagnosis for a
wide range of mental disorders.

The study's 10-year follow-up, described in four reports in the June
issue of the Archives of General Psychiatry, goes further by measuring,
for the first time, the severity and persistence of people's mental
illness and the quality of their treatment.

The survey, conducted by the
University of Michigan, included 9,282
households selected at random in 34 states. Nearly 300 trained
interviewers traveled about 8 million miles over a year and a half. They
knocked on doors at all hours of the day and night to ensure they would
not systematically miss alcohol abusers who spend their days at bars,
people with depression who can go weeks hardly able to pull themselves
out of bed and people with social phobia who only rarely answer the doorbell.

The interview notes were uploaded to a central repository for analysis
by psychiatrists and other health professionals at
Harvard Medical School.

The survey focused on four major categories of mental illness: anxiety
disorders (such as panic and post-traumatic stress disorders); mood
disorders (such as major depression and bipolar disease); impulse control
disorders (such as attention-deficit/hyperactivity disorder); and
substance abuse.

Almost half of Americans meet the criteria for such an illness at some
point in their lives, the survey found. Most cases are mild and probably
do not require treatment. But every year about 6 percent of adults are so
seriously affected that they cannot perform even routine activities for
periods averaging three months. Because schizophrenia, autism, and some
other severe and relatively common disorders were not included, actual
prevalence rates are somewhat higher, Kessler said.

Comorbidity -- the simultaneous occurrence of two or more illnesses --
is common, the survey found. Nearly half of people with one mental
disorder met the criteria for two or more. That's a problem because
mental health services are usually geared toward one illness or another.

"Our findings highlight the importance of integrating treatments, of
treating the people instead of the disorder," said NIMH investigator
Kathleen Ries Merikangas.

The fraction of the population treated for mental illness over a
12-month period has grown to 17 percent from 13 percent a decade ago -- a
sign, perhaps, that advertisements for antidepressants and other drugs
are working, and the stigma of being treated is decreasing.

But most of those affected receive either no help or are being treated
by nonmedical providers or nonspecialists, whose care typically fails to
meet minimal standards of adequacy, Kessler said.

It is not clear why Americans have such high rates of mental illness,
but cultural factors clearly play a role. Immigrants quickly increase
their risk of mental health problems, especially if they do not live in
native ethnic communities. Minorities also tend to have lower levels of
mental health problems despite lower economic status, suggesting that the
social support they provide each other is protective.

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