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Study Shows Mental Illness Often Begins in Youth,
Treatment Delays Worsen
Issues
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One-half of all lifetime cases of mental illness begin by age 14, and despite effective treatments for the disorders, there are long delays between the onset of symptoms and seeking treatment, according to the largest survey ever of the nation’s mental health,published in the June 6 issue of the Archives of General Psychiatry. These treatment delays—which can span decades—lead to more severe and difficult-to-treat illnesses and to co-occurring disorders. And, once people do get treatment, few receive care that meets “minimally accepted standard” for mental health treatment, researchers say. The landmark study, called the “National Comorbidity Survey Replication,” was led by Harvard University, the National Institute of Mental Health (NIMH) Intramural Research Program and the University of Michigan. Based on interviews with 9,282 randomly selected American adults, this survey is an expanded follow-up to the 1990 “National Comorbidity Survey,” designed to measure the severity and prevalence of mental illness, and the quality of treatment. “There are many important messages from this study,” said NIMH Director Thomas Insel, M.D. “But perhaps none as important as the recognition that mental disorders are the chronic disorders of young people in the U.S.” In fact, anxiety disorders often begin in late childhood, mood disorders in late adolescence and substance abuse in the early 20s, with three-quarters of all lifetime cases beginning by age 24. Treatment Delays Harm the Public Health They also found that disorders that emerge in childhood are associated with the longest delays in treatment,even though childhood disorders are often more serious than those that strike later in life. Researchers say children are less likely to receive timely treatment because they rely on parents or other adults to recognize symptoms, but adults often miss the signs unless they are extreme.The authors also found long delays in treatment among minorities compared to non-Hispanic whites.
These findings suggest a need for increased awareness and outreach efforts—especially considering the dangers associated with untreated disorders that strike at a young age:school failure, teenage childbearing,unstable employment, early marriage, and marital instability and violence. According to the researchers, early treatment is simpler and could prevent“enormous disability” later. It also halts the development of co-occurring disorders, which are particularly difficult to get under control, especially as they accumulate. “The pattern appears to be that the earlier in life the disorder begins, the slower an individual is to seek therapy,” said Ronald Kessler, Ph.D., the leader of the study and professor of health care policy at Harvard Medical School. “It’s unfortunate that those who most need treatment are the least likely to get it.” Disorders Common in U.S. The “main burden of illness,” they said,falls on those with severe disorders,which is about 6 percent of the population. NIMH and its partners in the study define a “severe disorder” as one that limits daily activities, or involves work disability, a suicide attempt with“serious lethal intent,” or psychosis. Survey respondents with severe disorders reported a mean of nearly three months a year during which they could not perform normal daily activities. Although eight out of 10 people who have a mental disorder will eventually seek care, according to the survey, the episodes can increase in severity and frequency, and grow resistant to treatment when left untreated for extended periods. Unfortunately, nearly half of those who have one mental disorder have one or more additional disorders, the researchers found. And the severity of each illness is “strongly” related to comorbidity—meaning that the more disorders you have, the more severe each may be. This striking finding supports a growing belief among some researchers that the distinctions between professionally recognized diagnoses are actually fuzzier than originally believed. Prevalence by Disorder
However, the most prevalent lifetime disorders are major depressive disorder at about 17 percent, followed by alcohol abuse at 13 percent, specific phobia at12.5 percent and social phobia at 12 percent. In terms of severity, over a year-long period, 22 percent of all reported cases were serious, more than one-third were moderate and 40 percent were mild. Researchers Recommend Early Intervention The good news is that a higher proportion of people who received mental health treatment increased to 17 percent—from 13 percent a decade ago—which some attribute to public awareness campaigns, direct-to-consumer advertising and a decrease in stigma. The study’s lead researchers are also calling for a focus on early interventions for children and prevention efforts that concentrate on halting the onset of multiple disorders. “Widespread failure to disseminate proven interventions may, in fact, explain why the large unmet need for treatment of mental disorders persists in the U.S. despite earlier efforts to address this problem," said Kessler. Researchers also see a need for increased outreach efforts,including “voluntary screening programs to detect early onset of mental disorders," a recommendation made by Kathleen Merikangas, a lead NIMH collaborator in the study. Similar studies are being performed in 28 other countries, as part of a global initiative on examining the prevalence of mental disorders.
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