The prevalence and treatment of mental illness
The first large survey of mental illness and its treatment in the
United States since the early 1990s shows that almost half of adults
at some time, and nearly a quarter in any given year, have had a psychiatric
disorder. More of them are getting treatment today than in the early
1990s, but the treatment is still usually delayed and inadequate. Let’s
take a closer look at the results below.
The study, called the National Comorbidity Survey Replication, was conducted
in 2001–2003. Interviewers questioned more than 9,000 adults. At
some time in their lives, nearly 46% had at least one psychiatric disorder.
The rate was highest for anxiety disorders (29%). Next came impulse control
disorders (25%). Twenty-one percent had had a mood disorder and 15% had
been dependent on or an abuser of alcohol or other drugs.
Within the larger categories named above, the most common individual
psychiatric disorders were major depression (17%), alcohol abuse (13%),
social anxiety disorder (12%), and conduct disorder (9.5%). It is important
to note that different disorders often went together, especially anxiety
and depression. And, about 28% of the population suffered more than one
Some of these illnesses were not short lived. In the previous year,
26% of participants had had a psychiatric disorder. Again, anxiety disorders
were the most common (18%), followed by mood (9.5%) and impulse control
disorders (9%). The research also found that disorders began early in
life — in half of cases before age 14 and in three-fourths of cases
before age 24.
Twenty-two percent of disorders were severe (i.e. involving a suicide
attempt, psychosis, serious violence, or inability to function normally)
and 6% of the population had a severe psychiatric disorder in the previous
The time frame for seeking treatment varied. About 80% of people with
a psychiatric disorder had eventually sought treatment, but often after
a long delay. Major depression and panic disorder were usually treated
fairly quickly, but fewer than 7% sought treatment for social anxiety
disorder, post-traumatic stress disorder, and attention deficit disorder
within the first year. And nearly half of those with impulse control
or drug problems had never sought help at all.
The type of provider varied as well. About 17% of the interviewees,
including 41% of those with a psychiatric disorder, said they had used
mental health services in the previous year. General medical professionals
provided treatment for 23%; psychiatrists for 12%; other mental health
professionals such as social workers and psychologists for 16%; counselors
or spiritual advisers for 8%; and complementary and alternative practitioners
for 7%. (The total is more than 41% because some people received treatment
from more than one source.)
A comparison with the original National Comorbidity Survey, conducted
in 1991–1992, showed that Americans have been increasing their
use of mental health services. Treatment has become more widespread because
of greater public awareness, more effective diagnosis, less stigma, more
outreach programs, and greater availability of medications. Most important,
according to the survey researchers, has been the growing willingness
to prescribe psychoactive medications, especially antidepressants.
Still, nearly 60% of people with psychiatric disorders were getting
no treatment. And the overall rate of mental illness did not change between
1991–92 and 2001–2003. According to survey researchers, one
reason may be that many physicians lack the time and training.
Some researchers point out that the problem may not be as serious as
it seems. People often recover spontaneously from psychiatric disorders,
as they do from physical illnesses. And, sometimes there is no reliable
treatment. Survey researchers also suggest that we need more outreach
and education for the public and physicians, and more effort to treat
substance abuse and impulse control disorders.
December 2005 Update
Back to Previous