U.S. poised to rank No. 1 for mental illness, study suggests

One-quarter of all Americans met the criteria for having a mental illness within the past year, and fully a quarter of those had a "serious" disorder that significantly disrupted their ability to function day-to-day, according to the largest and most-detailed survey of the nation's mental health, published yesterday.

Although parallel studies in 27 other countries are not yet complete, the new numbers suggest that the United States is poised to rank No. 1 for mental illness globally, researchers said.

"We lead the world in a lot of good things, but we're also leaders in this one particular domain that we'd rather not be," said Ronald Kessler, the Harvard professor of health-care policy who led the effort.

The government-sponsored survey, based on in-depth interviews with more than 9,200 randomly selected Americans, finds that the prevalence of mental illness in the United States has remained roughly flat in the past decade — a possible glimmer of hope, given that previous decades had suggested the rates were gradually rising.

But the rest of the news from the survey — which did not include some of the most-serious disorders, such as schizophrenia, for which patients are often institutionalized — is mostly discouraging.

Less than half of those in need get treated. Those who seek treatment typically do so after a decade or more of delays, during which time they are likely to develop additional problems. And the treatment they receive is usually inadequate.

Younger sufferers are especially overlooked, the survey found, even though mental illness is very much a disease of youth. Half of those who will ever be diagnosed with a mental disorder show signs of the disease by age 14, and three-quarters by age 24, the survey shows. But few get help.

Many factors contribute to these failings, the reports conclude, including inattention to early warning signs, inadequate health insurance and the lingering stigma that surrounds mental illness.

"The system has to get its act together to get its quality of care up," Kessler said.

Thomas Insel, chief of the National Institute of Mental Health, which funded the $20 million study, said the nation needs to recognize that mental illness is a chronic condition that requires expert medical attention just as heart disease, Alzheimer's and diabetes do.

Mental-health surveys have been conducted nationwide since the 1940s. But they offered only crude measures until 10 years ago, when the first National Comorbidity Study was performed. That highly structured survey asked questions specific enough to provide an accurate diagnosis for a wide range of mental disorders.

The study's 10-year follow-up, described in four reports in the June issue of the Archives of General Psychiatry, goes further by measuring, for the first time, the severity and persistence of people's mental illness and the quality of their treatment.

The survey focused on four major categories of mental illness: anxiety disorders (such as panic and post-traumatic stress disorders); mood disorders (such as major depression and bipolar disease); impulse-control disorders (such as attention-deficit/hyperactivity disorder); and substance abuse.

Almost half of Americans meet the criteria for such an illness at some point in their lives, the survey found.

Most cases are mild and probably don't require treatment. But every year about 6 percent of adults are so seriously affected that they can't perform even routine activities, for periods averaging three months.

It's not clear why Americans have such high rates of mental illness, but cultural factors clearly play a role.

People who move here from abroad quickly increase their risk of mental-health problems, especially if they do not live in native ethnic communities.

Minorities tend to have lower levels of mental-health problems despite their lower economic status, suggesting that the social support they provide each other is protective.