My dictionary would suggest the word “epidemic” is appropriate when discussing some that is “excessively prevalent” or “characterized by very widespread growth.” Is mental illness really growing as much as some critics claim?
It’s with some interest to examine the claims of those who say we’re in some sort of “epidemic” of mental illness. But owing to their sloppy premise, loose research efforts, and illogically connecting dots that have little to do with one another, I find it a hard claim to swallow.
In fact, research shows that prevalence rates for mental illness have actually declined somewhat from 1994, making it hard to understand where some are coming from about this “epidemic” nonsense.
Bruce Levine, over at Salon, borrows much of his beginning argument for his article from a 2011 New York Review of Books review by Marcia Angell (which he at least attributes):
Severe, disabling mental illness has dramatically increased in the United States. “The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007 — from one in 184 Americans to one in 76. For children, the rise is even more startling — a thirty-five-fold increase in the same two decades,” as Marcia Angell summarizes in the New York Times Book Review.
Angell also reports that a large survey of adults conducted between 2001 and 2003 sponsored by the National Institute of Mental Health found that at some point in their lives, 46 percent of Americans met the criteria established by the American Psychiatric Association for at least one mental illness.1
The problem is, neither Angell nor Levine — as skeptical researchers should — ask, “What are some alternative explanations for this data that might offer a ‘best fit’ model for this data?”
It’s not hard to find one right away — the relaxing of medical criteria in order to qualify for SSDI. If the programs relax their criteria in order to qualify, then it’s not surprising to see an uptick in the number of people who take advantage of that change.2
Worse is that neither author has bothered to put these kinds of statements or numbers into any sort of context. What does it mean when we say “46 percent of Americans met the criteria established … for at least one mental illness”? Is that better or worse than it was, say a decade earlier?
Levine believes this is proof of an epidemic. Sadly, he (and the original book reviewer) failed to note what the DSM-III-R (the DSM-IV’s predecessor) numbers were.
Based on nearly 100 fewer diagnoses between the two editions, a study conducted by some of the same researchers back in 19943 found an even higher prevalence rate:
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder.4
Hmmm… New study found 46 percent lifetime rate, old study found a 50 percent lifetime rate for qualifying for a mental illness diagnosis. As you can see, the rate has actually decreased since 1994.
Which is exactly the opposite of what Levine is arguing.
The 2005 Kessler et al. study5 that reported on 12-month prevalence rates actually found a similar decrease:
Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%.
Hmmm… 30 percent in the older study, and 26 percent in the newer study — a similar 4 percent decline.
And that’s the problem, in my opinion, with what passes for journalism today. It took me all of about 20 minutes to research this data (and this without anyone providing research citations — thanks folks!) and see that when you put this data in context, it actually makes a case that is in direct contradiction of Levine’s “epidemic” argument. And these aren’t tiny pilot studies conducted on a convenience sample of college students. These are studies with thousands of subjects.
Finally, one obvious explanation for the rise in people being treated for mental illness is because we’ve come a long way in the past two decades in helping to eradicate some of the stigma, ignorance, prejudice and discrimination that has traditionally been associated with mental illness. When people learn their concern is actually a real illness and there are treatments that work for it, they’re more likely to seek them out.
The data from research studies don’t lie. So don’t always believe the hype — especially when it flies in the face of such data.
Read the full Salon article: How our society breeds anxiety, depression and dysfunction
Read our previous discussion of the “epidemic” hype: An Epidemic of Mental Disorders?
- Ronald C. Kessler, PhD; Patricia Berglund, MBA; Olga Demler, MA, MS; Robert Jin, MA; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602. doi:10.1001/archpsyc.62.6.593. [↩]
- In other words, it would be astounding and counter-intuitive to find that numbers of people would go down for a “free government money” program after they government relaxed the criteria for it. [↩]
- Kessler RCMcGonagle KAZhao SNelson CBHughes MEshleman SWittchen HUKendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;518- 19 [↩]
- The newer study found, “Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%).” [↩]
- Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Ellen E. Walters, MS. Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617-627. doi:10.1001/archpsyc.62.6.617. [↩]