Survey finds broad need for better mental health care

Washington -- Most Americans will meet the diagnostic criteria for one or more mental health disorders at some time in their life but many never seek treatment, according to a large mental health tracking survey, the first conducted in a decade.

Of those who do seek help, twice as many are seen by primary care physicians or nurses as are seen by psychiatrists, said researchers who reported the results of the National Comorbidity Survey Replication, or NCS-R, in the June issue of the Archives of General Psychiatry.

A key finding of the household survey of more than 9,000 English-speaking adults is that mental disorders are highly prevalent and are chronic, said Thomas R. Insel, MD, director of the National Institute of Mental Health, which funded the survey along with support from foundations and pharmaceutical companies.

But the good news is that most cases are mild, said Ronald Kessler, PhD, professor of health care policy at Harvard Medical School and the study's lead investigator. Some resolve on their own and a lifestyle change may alter others, he added. "For example a snake phobia is a mental disorder, but if you live on the 35th floor of a Manhattan high-rise, it's not likely to get in the way of your life very much."

However, many of the disorders do get in the way, said the researchers, who used diagnostic criteria set out in the fourth edition of the American Psychiatric Assn.'s Diagnostic and Statistical Manual. "We need to do a better job at figuring out which mild or moderate disorders that exist today are likely to become seriously debilitating in the future," said Dr. Kessler. "We need to know which disorders to go after because clearly we can't treat one-quarter of the population."

While the results of the survey support what the APA has said for years -- that mental disorders are real medical conditions, they are common, and they have a great impact on individuals, families and societies -- the organization is awaiting the release of the data to closely examine the findings.

"It is important to note that new findings typically need replication and validation," said Darrel A. Regier, MD, MPH, director of the APA's Division of Research.

The researchers also corroborated findings from a 2004 World Health Organization study that mental illnesses are chronic disorders of young people.

Problems start early

Unlike most disabling physical diseases, mental illnesses begin very early in life, said Kathleen Merikangas, PhD, an NIMH senior investigator and a researcher on the survey. Half of all lifetime cases begin by age 14 and three-quarters by age 24. The onset of these disorders during adolescence and young adulthood interferes with the successful completion of significant educational, occupational and social milestones and can cause lifelong disabilities, she said.

People do eventually seek treatment, said Philip Wang, MD, DrPH, assistant professor at Harvard Medical School's Dept. of Health Care Policy, but only after a considerable delay, often 10 years or more. And many turn to Internet support groups for help.

While the NCS-R is a follow-up survey to the National Comorbidity Survey published 10 years ago, it also examined the type and severity of several disorders, something the earlier survey did not attempt.

The researchers looked at four classes of disorders: anxiety, which included panic and posttraumatic stress disorder; mood, such as major depressive and bipolar disorders; impulse control disorder, including attention-deficit/hyperactivity disorder; and substance abuse disorder.

Based on data from the respondents, the 12-month prevalence for any disorder was 26%, with 18% of respondents reporting an anxiety disorder, 9.5% reporting a mood disorder, 9% reporting an impulse control disorder and 4% reporting substance abuse.

Of those cases, 22% were judged to be serious, 37% moderate in severity and 40% mild.

The survey also found that while 55% of respondents met the criteria for only one, 22% met the criteria for two diagnoses and 23% met criteria for three or more.