A quick recap
In 2 previous articles on the bogus epidemic of mental illness in the US,8,9 the following conclusions were reached:
• There are no credible epidemiologic data showing that, in adults, the incidence or prevalence of schizophrenia, bipolar disorder, or MDD in the US has substantially increased over the past 2 or 3 decades, using DSM-III/IV or closely related criteria.
• Based on 2010 data, “National levels of psychological distress in adults have remained relatively stable for more than a decade.”10
• The prevalence of serious mental illness (SMI) in adults—conventionally defined by the National Institute of Mental Health as a psychiatric disorder “. . . resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities”—changed very little in this country between roughly 2000 and 2010.10
We are now in a position to update some of these findings:
• In 2014, there were an estimated 9.8 million adults aged 18 or older in the US with SMI during the past year. This number represented 4.2% of all US adults. This figure is not significantly different from SMI rates determined in 2008 (3.7%) or 2012 (4.1%).11
• Using a standardized measure called “serious psychological distress” (SPD)—based on the Kessler-6 (K6) scale—3.8% of US adults aged 18 to 64 years experienced SPD in the past 30 days, during the first 9 months of 2015. This compares with SPD rates of 3.2% in 2012, 4.0% in 2013, and 3.4% in 2014. In the period from 2001 to 2004, 30-day SPD prevalence rates were approximately 3.1% of the US adult population. In short, there has been no significant increase in SPD in the period from 2001 to 2015.12
• The percentage of adults who had a past-year major depressive episode (MDE) remained stable between 2005 and 2014. The percentage of adults with a past-year MDE with severe impairment also remained stable between 2009 and 2014.13
• The percentage of adults aged 18 or older with any mental illness has remained essentially stable from 2008 to 2014 as shown in the Figure.13
The trends reported here are simply not consistent with the claim that current psychiatric treatments are worsening the severity of psychiatric illness, or increasing its frequency in this country—much less creating an “epidemic” of mental illness. That said, this review has been limited to persons 18 years or older and has covered principally the past 15 years. And, as always, our instruments of measurement, including household surveys, are imperfect and may miss cases of mental illness that have not occurred within the specified period of 30 days or a year. Moreover, there may be an increased incidence or prevalence of specific psychiatric disorders that is not being captured by non-diagnostic categories such as “serious mental illness” or “serious psychological distress.”
Let me be clear: “stable” rates of mental illness should occasion no joy. We must do much more than achieve a kind of stalemate in the battle against psychiatric disorders. Yet it is misleading and unfair to suggest that psychiatry is laboring under a “failed paradigm” (to use the term made famous by historian Thomas Kuhn14). First, there is no one paradigm that defines all of psychiatry or that dictates practice on the part of all psychiatrists. Perhaps that is part of the problem: psychiatry is still a relatively young field, still struggling to find the right “model” for understanding and treating mental illness.15 The present state of affairs does not represent a failed paradigm, so much as the daunting complexity of psychiatric illnesses; our incomplete knowledge of their causes; and, perhaps most important, the many barriers to appropriate and comprehensive mental health care in this country.
Acknowledgments: I wish to thank Peter Kramer, MD, for his helpful comments on an early draft; and Ronald C. Kessler, PhD, for pointing out some sources of epidemiological data. The views expressed here, however, are my own.
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2. http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html. Accessed September 22, 2016.
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7. http://www.treatmentadvocacycenter.org/component/content/article/2085-anatomy-of-a-non-epidemic-a-review-by-dr-torrey. Accessed September 22, 2016.
8. http://www.psychiatrictimes.com/blogs/couch-crisis/there-really-%E2%80%9Cepidemic%E2%80%9D-psychiatric-illness-us. Accessed September 22, 2016.
9. http://www.psychiatrictimes.com/blogs/bogus-epidemic-mental-illness-us. Accessed September 22, 2016.
10. http://archive.samhsa.gov/data/2k12/MHUS2010/MHUS-2010.pdf. Accessed September 22, 2016.
11. http://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml. Accessed September 22, 2016.
12. https://www.cdc.gov/nchs/data/nhis/earlyrelease/er_spd_access_2015_f_auer.pdf. Accessed September 22, 2016.
13. Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50. September 2015. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm. Accessed September 22, 2016.
14. Bentall R. Psychiatry’s failed paradigm. Washington Post. January 4, 2010. http://voices.washingtonpost.com/shortstack/2010/01/rcent_decades_have_seen_dramat.html. Accessed September 22, 2016.
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