The first large survey of mental illness and its treatment in the United States since the early 1990s shows that almost half of adults at some time, and nearly a quarter in any given year, have had a psychiatric disorder. More of them are getting treatment today than in the early 1990s, but the treatment is still usually delayed and inadequate. Let's take a closer look at the results below.
The study, called the National Comorbidity Survey Replication, was conducted in 2001–2003. Interviewers questioned more than 9,000 adults. At some time in their lives, nearly 46% had at least one psychiatric disorder. The rate was highest for anxiety disorders (29%). Next came impulse control disorders (25%). Twenty-one percent had had a mood disorder and 15% had been dependent on or an abuser of alcohol or other drugs.
Within the larger categories named above, the most common individual psychiatric disorders were major depression (17%), alcohol abuse (13%), social anxiety disorder (12%), and conduct disorder (9.5%). It is important to note that different disorders often went together, especially anxiety and depression. And, about 28% of the population suffered more than one psychiatric disorder.
Some of these illnesses were not short lived. In the previous year, 26% of participants had had a psychiatric disorder. Again, anxiety disorders were the most common (18%), followed by mood (9.5%) and impulse control disorders (9%). The research also found that disorders began early in life — in half of cases before age 14 and in three-fourths of cases before age 24.
Twenty-two percent of disorders were severe (i.e. involving a suicide attempt, psychosis, serious violence, or inability to function normally) and 6% of the population had a severe psychiatric disorder in the previous year.
The time frame for seeking treatment varied. About 80% of people with a psychiatric disorder had eventually sought treatment, but often after a long delay. Major depression and panic disorder were usually treated fairly quickly, but fewer than 7% sought treatment for social anxiety disorder, post-traumatic stress disorder, and attention deficit disorder within the first year. And nearly half of those with impulse control or drug problems had never sought help at all.
The type of provider varied as well. About 17% of the interviewees, including 41% of those with a psychiatric disorder, said they had used mental health services in the previous year. General medical professionals provided treatment for 23%; psychiatrists for 12%; other mental health professionals such as social workers and psychologists for 16%; counselors or spiritual advisers for 8%; and complementary and alternative practitioners for 7%. (The total is more than 41% because some people received treatment from more than one source.)
A comparison with the original National Comorbidity Survey, conducted in 1991–1992, showed that Americans have been increasing their use of mental health services. Treatment has become more widespread because of greater public awareness, more effective diagnosis, less stigma, more outreach programs, and greater availability of medications. Most important, according to the survey researchers, has been the growing willingness to prescribe psychoactive medications, especially antidepressants.
Still, nearly 60% of people with psychiatric disorders were getting no treatment. And the overall rate of mental illness did not change between 1991–92 and 2001–2003. According to survey researchers, one reason may be that many physicians lack the time and training.
Some researchers point out that the problem may not be as serious as it seems. People often recover spontaneously from psychiatric disorders, as they do from physical illnesses. And, sometimes there is no reliable treatment. Survey researchers also suggest that we need more outreach and education for the public and physicians, and more effort to treat substance abuse and impulse control disorders.
December 2005 Update