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1 in 4 Report Mental Illness Symptoms

Posted on: Thursday, 5 January 2006, 00:00 CST

By Kristen Gerencher

SAN FRANCISCO - Maintaining mental health often takes a backseat to prevention of conditions such as heart disease and diabetes, but a comprehensive new survey suggests mental disorders are just as widespread and potentially hazardous.

The burden of mental illness is substantial in the United States, with one in four people saying they had symptoms over a one-year period, according to a report called the National Comorbidity Survey Replication.

About 41 percent of those afflicted sought treatment, but many failed to get adequate care, the survey said. Nearly 23 percent received treatment from a general practitioner, 12 percent from a psychiatrist and about 7 percent from a complementary or alternative medical provider.

Some mental health experts hope the results will galvanize doctors to ramp up detection efforts while spurring lawmakers, employers and insurers to put mental-health care back on the national agenda. A bill that would require insurers to cover mental- health benefits equally, known as mental-health parity, has stalled in Congress.

The survey should help doctors recalibrate baselines that make treatment more effective, said Dr. Darrel Regier, director of research for the American Psychiatric Association, which represents 35,000 psychiatrists.

"This is an exhaustive set of characteristics of people in the community with a very detailed set of questions that will help us get a much better sense of what impairment is associated with different diagnostic criteria and symptom scales," Regier said.

"That ultimately will help us reset what the diagnostic criteria are just the way [other medical data] helps set what blood pressure is ideal, what's normal and not normal."

The annual total economic cost of mental illnesses is estimated to be $79 billion, including direct loss of productivity and that which results from premature deaths, incarceration and people who provide family care, according to the President's New Freedom Commission on Mental Health, which sets goals for improving mental- health care.

Most mental illness begins in childhood or the teen years, with the median age of onset for anxiety and impulse-control disorders at 11, substance use at 20 and mood disorders kicking in around age 30 on average, according to the report. Half of all lifetime cases start by age 14 and three out of four by age 24.

Anxiety disorders were most prevalent, with 18.1 percent of the population experiencing one over the 12 months leading up to the survey, followed by mood disorders at 9.5 percent and impulse- control disorders at 8.9 percent. Substance-use disorders affected 3.8 percent of the population.

Of the cases, about 40 percent were classified as mild, but 37 percent were moderate and 22 percent were serious, meaning the person may have tried suicide or had substantial work limitations because of the disorder.

In most instances, the conditions are chronic and while cures are rare, prompt treatment can "greatly decrease" the number of premature deaths, said Dr. Russell Scheffer, a pediatric psychiatrist at Children's Hospital of Wisconsin in Milwaukee.

Early detection and treatment is especially crucial for children, who aren't able to learn and succeed at school if they're weighed down by the disorders, he said.

"If there are services available and people choose to use them, we do very well with the majority of our psychiatric illnesses," Scheffer said. "Between the medications and the psychotherapy we utilize, patients get a lot better."

Diagnosing children is sometimes difficult since they're still developing, but parents with concerns should consult their pediatrician and their child's teachers, he said.

The report should erase any doubt that mental disorders are real and debilitating, not to mention expensive to other areas of health care if treatment isn't prompt, Scheffer said.

"Patients with psychiatric illnesses have up to a 20 percent shorter life expectancy," Scheffer said, noting that suicide explains only part of the statistic. "Things like diabetes, hypertension, cardiovascular disease are the leading causes of premature death in patients with mental illness."

It's not uncommon to have more than one mental disorder at the same time. More than half - 55 percent - of people with a disorder had only one while 22 percent had two diagnoses and 23 percent met the criteria for three or more diagnoses, the study said.

Though there's nothing to be ashamed of, mental illness still has a social stigma that can deter people from getting needed care and add to their problems, Regier said.

"Many times people try to self-treat or medicate for a very adverse set of feelings," he said. "It's not unusual that they would develop an addiction as well. That does make for a more complicated approach you have to deal with."

As with any other medical issue, putting off needed treatment often complicates it once it happens, Scheffer said. "Take bipolar disorder or schizophrenia or depression. The more episodes you have, the longer you're ill, the harder it is to treat."

Some people are fortunate to go through one episode and never have it recur, he said. "Many people who have one major depression in their life ... don't get treated and it may resolve on its own and they never have another one. But if you have two or three episodes ... you're into what I would consider a chronic category."

Early detection in children is often hindered by mental-health care that falls through the cracks between schools, juvenile justice services and child welfare, said Tom Bornemann, director of mental health programs at the Carter Center, a nonprofit human rights group in Atlanta.

"What really is the challenge here is the fragmentation in our system," he said. "We don't have a system. We have a bunch of systems that don't communicate well with one another and are often working with the same person."

"The way we're organized works against us," Bornemann added. "It's almost a conspiracy against effectiveness."

He called the lack of broad access to mental-health benefits an "abomination," adding that research suggests the additional costs of adding comparable coverage would run in the 1 percent to 4 percent range.

While the advent of new antidepressants called selective serotonin reuptake inhibitors or SSRIs helped ease some patients' struggles in the last decade, other developments on the pharmaceutical side haven't been as positive.

The Food and Drug Administration added black-box warnings to antidepressants last year after the agency found slightly higher suicidal tendencies in children taking the medications, sparking debate about whether the move causes more harm than good for young patients in need of treatment.

More generally, some patients have to switch drug therapies frequently because of a lack of effectiveness or side effects such as weight gain that cause other health problems.

"Right now a lot of treatment-matching occurs on a trial-and- error basis, so you have a lot of discomfort consumers have to go through," Bornemann said.

But treatments are inching toward refinement. Promising technologies that harness genomics to help match patients with the right drugs and new imaging techniques to increase understanding of brain mechanisms are on the horizon, Regier said.

Mental-illness research is going in much the same direction as that for heart disease and cancer by "adding biomarkers and genomics and functional imaging so you see how neurotransmitters like serotonin are actually functioning in people with depression and what's changing in their brain as they get better," he said.

Overall, people concerned they may have a mental disorder shouldn't be afraid to talk to their doctors and be their own best advocates if insurance is a barrier, Scheffer said. "An evaluation doesn't mean you've committed yourself to medication. It's getting information."

The study was sponsored by the U.S. government and is based on interviews of more than 9,200 people from 2001 to 2003, none of whom were homeless or institutionalized.

Source: Charleston Gazette, The

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