Rate of Mental Illness Is 'Staggering'
25% of Americans Have Mental Disorder at Some Point, Though Many Untreated,
Researchers Say
June 1, 2004 -- A World Health Organization study released Tuesday shows that rates of most mental illness are far higher
in the U.S. than in any other country in the world.
At the same time, the study indicates that money used to treat mental health problems in
the U.S. and abroad is not being spent in the most effective way possible.
Overall, the survey of more than 60,000 adults in 14 countries showed a 27% rate of mental
disorders in the U.S. population for a list of diseases. That list includes: depression, anxiety, eating disorders, and substance
abuse. The U.S. rate was substantially higher than that of any other country measured, including other industrialized nations
such as Belgium, which showed a 12% illness rate.
Ukraine had the second highest overall rate of mental illness at 21%. Its 6.4% rate of substance
abuse, including alcoholism, was the world's highest and the only measure to exceed U.S. mental illness figures, according
to the study, published in today's issue of The Journal of the American Medical Association.
High Rates Underestimated
Despite evidence that one in four U.S. adults experiences mental illness at some point,
researchers still consider the figure an underestimate. They acknowledge that many people remain reluctant to tell surveyors
about their mental health history, mainly because of the stigma attached to mental diseases. Underestimates could be even
more severe in foreign nations, where patients are unaccustomed to discussing emotional issues or even giving information
to pollsters, as they were asked to do for this study.
"These numbers are absolutely staggering," says Ronald C. Kessler, PhD, a professor of health
care policy at Harvard Medical School in Boston, and one of the study's co-researchers. "When we get to the bottom of the
situation, my guess is it is going to be doubly staggering," he tells WebMD.
Among the study's findings are an 18% rate of anxiety disorders and a 10% rate of mood disorders
in the U.S. Both figures are above that of any other country, but range far beyond what is found in places such as Shanghai,
which showed just a 2.4% rate of anxiety and a 1.7% rate of depression.
Kessler says that researchers still aren't sure whether mental illnesses are much more common
in the U.S. or if people are simply more comfortable discussing them with questioners. Discussions of mental illness are far
less common in many parts of the world than in the U.S., where drug companies frequently tout medications designed to treat
disorders.
"These are the kinds of health problems people don't jump up and say they have," he tells
reporters.
Kessler points to a 5.3% reported rate of anxiety disorders in Japan -- a figure he calls
"implausibly low." Japan also consumes the most benzodiazepines -- drugs used to reduce anxiety. That is more than any other
nation per person, he says.
The study also shows that the U.S. and other industrialized countries are doing a poor job
of spreading treatment to patients who most need it. Nearly half of all people with serious mental illness in the U.S. did
not receive any treatment in the last year. At the same time, 23% of people with "mild" mental disorders and even 8% of those
with mental problems that didn't quite meet official criteria for a mental illness -- called "subthreshold" problems -- got
care.
"The fact that many people with subthreshold disorder are treated while many with serious
disorders are not shows that unmet needs for treatment among serious cases is not merely a matter of limited treatment resources
but that misallocation of treatment resources is also involved," the researchers conclude.
Kessler maintains that putting more resources into early identification and treatment of
mental disorders could prevent more illnesses of all severities.
"The resources are already in the health care system to do that if we wanted to reallocate
the dollars," he says.
SOURCES: "Prevalence, Severity, and Unmet Needs for Treatment of Mental Disorders in the World
Health Organization World Mental Health Surveys," Kessler, R.The Journal of the American Medical Association, June
2004; vol 291: pp 2581-2590. Ronald C. Kessler, PhD, Professor of Health Care Policy, Harvard Medical School, Boston.
