By now, anti-psychiatry’s narrative has nearly become a cultural meme,1 attracting a large cult following on the internet. The narrative, of course, is that (1) there is an “epidemic” of mental illness afflicting this country (ie, “…an astonishing rise in the incidence of severe mental illness” in the US”)2; and (2) this epidemic has been fueled by (allegedly) harmful psychiatric medications, such as antidepressants and antipsychotics.2 I have challenged this false narrative in two previous columns3,4 pointing out, for example, that rates of psychiatric disability determinations are an invalid indicator of disease incidence or prevalence, and are subject to considerable manipulation and bias. At the risk of being repetitious and appearing a bit obsessed, I return to the issue now, in light of an important new study.
The recently-released (2016) National Survey on Drug Use and Health (NSDUH) is well-worth every psychiatrist’s attention.5 The NSDUH is an annual survey of the civilian, non-institutionalized population of the United States aged 12 years old or older, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). On the one hand, the 2016 survey gives the lie to the “epidemic” narrative, showing that—for the most part—rates of serious psychiatric illness in adults (18 or older) have remained fairly stable over at least the past decade. On the other hand, it raises a red flag with respect to young adults, age 18-25. More on this shortly.
Before presenting some of the data, it’s important to define two key terms. The survey defines “any mental illness” (AMI) as “any mental, behavioral, or emotional disorder in the past year that met DSM-IV criteria (excluding developmental disorders and substance use disorders).” It defines “serious mental illness” (SMI) as “any mental, behavioral, or emotional disorder that substantially interfered with or limited one or more major life activities.” AMI and SMI are not mutually exclusive categories; adults with SMI are included in estimates of adults with AMI. (“Co-occurring mental health issues and substance use disorders” were evaluated separately and are not discussed here).
So—here are the key findings relevant to the bogus “epidemic” narrative:
2. The percentage of adults with SMI in 2016 (4.2%) was similar to the percentages from 2010 to 2015, though higher than the percentages in 2008 and 2009 (3.7% in both years, statistically significant at the .05 level).
If we go back to the NSDUH data from 2002, we find that 8.3% of adults in the US were found to have serious mental illness during the 12 months prior to being interviewed.6 Thus, if anything, the rate of SMI in recent years appears to be lower than that from 15 years ago. There is no signal from these data that the incidence or severity of mental illness is spiking to epidemic proportions. (Recall that the standard definition of “epidemic” is “The occurrence in a community or region of cases of an illness (or an outbreak) with a frequency clearly in excess of normal expectancy).”7
1. Cf. Dr. Marcia Angell: “It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it.” Angell M: The Epidemic of Mental Illness: Why? The New York Review of Books. June 23, 2011.
2. Whitaker R. Psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Psychology and Psychiatry, Volume 7, Number I, Spring 2005.
3. Pies RW. The bogus “epidemic” of mental illness in the US. Psychiatric Times. June 18. 2015.
4. Pies RW. The astonishing non-epidemic of mental illness. Psychiatric Times. Nov. 1, 2016.
5. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
6. Epstein J, Barker P, Vorburger M, Murtha C. Serious Mental Illness and Its Co-Occurrence with Substance Use Disorders. 2002.
7. UCLA School of Public Health. Accessed at: http://www.ph.ucla.edu/epi/bioter/anthapha_def_a.html
8. Pratt LA, Brody DJ, Gu Q. Antidepressant use in persons aged 12 and over: United States, 2005–2008.
9. Pope GC, Ellis RP, Ingber MJ. Principal inpatient diagnostic cost group model for Medicare risk adjustment. Health Care Financ Rev. 2000 Spring; 21:93–118.
10. Warner R, de Girolamo G. Schizophrenia. World Health Organization, 1995.
11. Frisher M, Crome I, Martino O, et al. Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005. Schizophr Res. 2009;113:123-128.
12. Sohler N, Adams BG, Barnes DM, et al. Weighing the evidence for harm from long-term treatment with antipsychotic medications: a systematic review. Am J Orthopsychiatry. 2016;86:477-485.
14. Ghaemi SN. Classic study of the month. The FDA analysis of antidepressants and suicide. The Psychiatry Letter. April, 2015.
15. Carroll BJ. Adolescents with depression. JAMA. 2004;292:2578.
16. Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry. 2006;163:1898-1904.
18. Torrey F. American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System. Oxford University Press, 2013.
19. Frances, A.J. Setting the record straight on antipsychotics. Psychology Today. Feb 16, 2016.
20. Kim et al: Patterns of utilization and outcomes of inpatient psychiatric treatment in Asian Americans Asian. Am J Psychol. 2014;5:35–43.
For further reading:
. Goff DC, Falkai P, Fleischhacker WW, et al. The long-term effects of antipsychotic medication on clinical course in schizophrenia. Am J Psychiatry. 2017;174:840-849. doi: 10.1176/appi.ajp.2017.16091016. Epub 2017 May 5.