Psychiatric News July 15, 2005
Volume 40 Number 14
© 2005 American Psychiatric Association
p. 10
Mental Illness Treatment Still Elusive for Many
Joan Arehart-Treichel
Over the past two decades, NIMH has supported various epidemiological
efforts to measure the prevalence of mental illness and its treatment in the
United States. The latest effort is the National Comorbidity Survey
Replication.
In the past decade, the use of mental health treatment in the United States
has dramatically increased. Still, many Americans are not receiving minimally
adequate care for mental illness.
That's one of numerous findings from the National Comorbidity Survey
Replication (NCS-R), published in the June Archives of General
Psychiatry in four papers. The NCS-R is a follow-up of the National
Comorbidity Survey, whose results provided an overview of Americans' mental
health a decade ago.
The lead author of the NCS-R was Ronald Kessler, Ph.D., a professor of
health care policy at Harvard Medical School. Other researchers, including
psychiatrists, were involved as well.
Although results from the survey are extensive, five major findings stand
out:
- Almost half of all Americans (46 percent) will meet criteria for a
DSM-IV disorder sometime in their lifetime.
"The public and policymakers need to realize that the high prevalence
is not surprising," Harold Pincus, M.D., executive vice chair of
psychiatry at the University of Pittsburgh and one of the survey authors, told
Psychiatric News. "All you have to do is think about the people
you know—family, friends, neighbors, coworkers—and how many of
them go through some significant emotional turmoil over the course of their
lives."
- Mental disorders usually have their onset in childhood or adolescence. Such
early onset, the researchers wrote, is "opposite the patterns found for
almost all chronic physical disorders.... Whatever else we can say about
mental disorders, then, they are distinct from chronic physical disorders
because they have their strongest foothold in youth."
- Although mental disorders are widespread in the U.S. population, the most
serious ones are concentrated among a relatively small proportion of cases. Of
cases that occur during a 12-month period, about 22 percent can be classified
as serious, 37 percent as moderate, and 40 percent as mild. Twelve-month cases
were classified as serious if they had any of the following: a suicide attempt
with serious lethality intent; work disability or substantial limitation due
to a mental or substance disorder; positive screen results for nonaffective
psychosis; bipolar I or II disorder; substance dependence with serious role
impairment; an impulse-control disorder with repeated serious violence; or any
disorder that resulted in 30 or more days out of role in the year.
- While the vast majority of people with lifetime psychiatric disorders
eventually receive treatment, the delay in doing so can be long, on average
six to eight years for mood disorders and from nine to 23 years for anxiety
disorders.
- Survey respondents who had a mental disorder that met DSM-IV
criteria during the preceding 12 months were asked about any mental health
treatment they had received during that time. Only 41 percent reported
receiving treatment, and only about one-third of those were classified as
having received at least minimally adequate treatment. Minimally adequate
treatment was defined as receiving either pharmacotherapy (two months or more
of an appropriate medication plus four or more visits to some type of
physician) or psychotherapy (eight or more visits with a health care
professional lasting on average at least 30 minutes).
Pincus said that he was surprised at "how few people had minimally
adequate care— even those seen by psychiatrists, and even those with
pretty significant conditions."
Philip Wang, M.D., Ph.D., told Psychiatric News that he was
surprised by this finding as well. Wang is an assistant professor of
psychiatry at Harvard Medical School and one of the survey authors.
"[M]ental disorders... are distinct from chronic physical disorders
because they have their strongest foothold in youth."
The irony, Wang said, is "that despite the fairly dramatic increase
in the use of mental health treatments that has occurred over the past decade,
the adequacy of treatments received by individuals really hasn't
improved."
Nonetheless, while increased use of mental health treatments does not
appear to have benefited the public as a whole, undoubtedly individual
patients have improved because of them, Kenneth Wells, M.D., believes. Wells
is a professor in residence in psychiatry at the University of California at
Los Angeles and one of the survey authors.
"The NCS-R study offers some new exploratory data that, along with
other research studies, stand to have an impact on the mental health field and
need to be further validated in order to understand the greater implications
of the findings," Darrel Regier, M.D., said in an APA press release
issued in conjunction with publication of the NCS-R results. "It is
important to note that new findings typically need replication and
validation."
Regier is director of the APA Division of Research and the American
Psychiatric Institute for Research and Education.
"The findings reported here are the first of what promises to be a
bountiful harvest," Thomas Insel, M.D., and Wayne Fenton, M.D., wrote in
an editorial accompanying publication of the results. "The NCS-R is one
element in a coordinated program of new psychiatric epidemiological studies
that will be completed over the next several years." Insel is director
of the National Institute of Mental Health (NIMH); Fenton is director of the
Division of Adult Translational Research and associate director for clinical
affairs at NIMH.
The NCS-R was based on interviews of a nationally representative sample of
Americans conducted from 2001 to 2003. More than 9,000 subjects aged 18 and
older were interviewed using the World Mental Health Survey version of the
Composite International Diagnostic Interview, which generates diagnoses of
mental disorders in accord with DSM-IV.
The study was funded by the NIMH, National Institute on Drug Abuse,
Substance Abuse and Mental Health Services Administration, Robert Wood Johnson
Foundation, and John W. Alden Trust.
Abstracts of the four survey papers from the NCS-R are posted online
at
<http://archpsych.ama-assn.org/cgi/content/abstract/62/6/593>,
<http://archpsych.ama-assn.org/cgi/content/abstract/62/6/603>,
<http://archpsych.ama-assn.org/cgi/content/abstract/62/6/617>,
and
<http://archpsych.ama-assn.org/cgi/content/abstract/62/6/629>.
Arch Gen Psychiatry 2005 62 593[Abstract/Free Full Text]
Arch Gen Psychiatry 2005 62 603[Abstract/Free Full Text]
Arch Gen Psychiatry 2005 62 617[Abstract/Free Full Text]
Arch Gen Psychiatry 2005 62 629[Abstract/Free Full Text]
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