When most people think of mental illness, they think of serious, lifelong conditions such as schizophrenia, chronic depression, post-traumatic stress disorder and bipolar disorder. Yet the truth is, in our lifetime fully half of us will experience some form of mental health problem.
A new report from the U.S. Centers for Disease Control and Prevention (CDC), put together after lengthy nationwide surveys, shows a new picture of mental health in America. The report sheds light not only on the prevalence of mental disorders in the country, but on the enormous economic costs they are exacting.
According to the CDC report, Mental Illness Surveillance Among Adults in the United States, the economic burden of mental illness in the country is substantial, totaling about $300 billion annually. It's a significant public health concern, not only because 25% of adults in the U.S. suffer from mental illness at any particular time, but also because it's associated with a host of other chronic physical health problems such as diabetes, obesity, cancer and cardiovascular disease.
Because the CDC reports that half of all American adults will develop at least one mental illness sometime during their lives, it recommends that increased efforts are taken to monitor and treat these problems.
How Widespread is Mental Illness?
It's not just an American problem - nearly 40 percent of Europeans suffer each year from disorders such as depression, anxiety, dementia or insomnia. A study done at Dresden University in Germany states that mental disorders have become the largest health challenge of the 21st century in Europe. Researchers covered 30 European countries and more than 500 million people over three years, looking at 100 different mental and neurological illnesses, and found that 165 million suffered from at least one of the illnesses.
According to the World Health Organization, mental illness results in more disability in developed countries than any other group of illnesses, including cancer and heart disease. The CDC found that the most common mental problems in the U.S. are depression and anxiety disorders.
Who Is Most Affected?
The prevalence of mental disorders isn't evenly distributed around the country. The map graphic included in the CDC report shows a handful of states that are most heavily affected by psychological distress, generally in the Southeast. For example, the rate of depression in Mississippi is 13.7 percent, compared to only 4.3 percent in North Dakota. People living in urban areas are more likely to suffer mental illness than those living in rural areas.
Ileana Arias, principle deputy director of CDC, says the levels of mental illness in the U.S. are unacceptable. “The report’s findings indicate that we need to expand surveillance activities that monitor levels of mental illness in the United States in order to strengthen our prevention efforts,” said Arias. She added that mental illness is frequently considered an issue of weakness or a moral issue, rather than a health condition no different than other diseases, which creates further obstacles for people seeking help.
And in fact, only about half of Americans who are diagnosed with major depression receive any treatment at all, according to the National Institute of Mental Health (NIMH). Even fewer - only about one-fifth - receive care that is in line with current mental health practice guidelines. There was also a racial divide; African Americans and Mexican Americans had the lowest rates of depression care, even though the rate and severity of depression is similar among all ethnic and racial groups.
Gender and Age Differences
Women have about twice the rates of depression than men, and the medical community is still trying to figure out exactly why. Jill Goldstein, a professor at Harvard Medical School and researcher into women's health, believes that sexual differentiation in the brain causes higher rates of depressive disorder in females. "Sex differences exist in every tissue of the body; disruption in the amygdala, hippocampus, hypothalamus, and white matter lead to the sex differences seen in depression, mood disorders, endocrine dysfunction, and heart rate, " Goldstein said.
In addition, different biological processes such as menstruation, pregnancy, postpartum period and menopause create hormonal changes in women that can greatly affect their mental health. Dr. Peter Schmidt, Chief of the Section on Behavioral Endocrinology at NIMH, says that a woman has a 20 percent chance of developing depression some time in her life, compared to a 12 percent chance for men. This could be due not only to biological differences, but also social aspects. Women may be diagnosed with depression more than men, partly, because they are more likely to self-report and seek help.
Schmidt also notes that a past history of mental illness is a risk factor for depression. "If a woman or a man has had a previous episode of depression, they are at an increased risk for developing subsequent episodes."
This relationship has also been demonstrated in children. George Slavich with the UCLA Cousins Center for Psychoneuroimmunology found that people who had had childhood trauma or adversity, including the loss of a parent, may become more sensitive or susceptible to mental disorders later in life. Slavich's research team says that people who experience early adversity or depression can develop negative beliefs about themselves or the world, which then activate in the face of difficulties later in life. It's also possible that early trauma actually influences biological systems, perhaps by lowering the threshold for psychological stress.
The By-Products of Mental Illness
Mental illness is not only closely associated with a host of physical health problems, but could actually be causing many diseases. Schmidt says that as researchers studied this relationship, they found that mental disorders, particularly depression, preceded the actual medical events by six to eight years or longer. "That truly is what people are now starting to focus try to see whether treating the depressions at that would decrease the risk in these individuals from subsequently developing a medical illness," he says.
Mental illness is also linked with increased use of alcohol and tobacco products. And people suffering from mental disorders tend not to get help; their use of medical care is lower, as well as their adherence to treatment therapies. "Depression at this time is second only to heart disease as a leading source of disease-related disability in the western world, and it is predicted to become one of the leading sources of disability worldwide over the next 20 years," Schmidt says.
The rates for intentional and unintentional death or injury is also much higher for people suffering from mental illness, whether chronic or recent. Homicides, suicides, and motor vehicle accidents are all two to six times higher among people with mental illness than in the general population. Approximately 8.4 million adults in the U.S. had serious thoughts of suicide in the past year, 2.2 million made suicide plans, and one million attempted suicide.
Only a small percentage of people who are suicidal receive treatment, says Leslie Citrome, MD, in Medscape Psychiatry. Although suicide is a leading cause of death, a global survey of more than 100,000 suicidal adults showed that only two-fifths had received treatment - and those who had actually attempted suicide were more likely to receive care than those who had only ideated or planned it.