America Leads The World In Mental Illness

Via Washington Monthly. A June report published in the Journal of the American Medical Association reveals that America has a much higher percentage its population suffering from some sort of clinically diagnosed mental disorder than seemingly every other country in the world. Worse, according to this study, the United Sates leads in virtually every type of mental disorder:
	     Type of Disorder (%)
Country  Anxiety  Mood	Impulse  Substance  Total
USA	  18.2	 9.6	  6.8	    3.8     26.4
Ukraine     7.1    9.1	  3.2	    6.4     20.5
France	  12.0	 8.5	  1.4	    0.7     18.4
Columbia   10.0    6.8	  3.9	    2.8     17.8
Lebanon    11.2    6.6	  1.7	    1.3     16.9
Nether.     8.8    6.9	  1.3	    3.0     14.9
Mexico	   6.8	 4.8	  1.3	    2.5     12.2
Belgium     6.9    6.2	  1.0	    1.2     12.0
Spain	   5.9	 4.9	  0.5	    0.3      9.2
Beijing     3.2    2.5	  2.6	    2.6      9.1
Germany     6.2    3.6	  0.3	    1.1      9.1
Italy	   5.8	 3.8	  0.3	    0.1      8.2
Nigeria     3.3    0.8	  0.0	    0.8      4.7
Shanghai    2.4    1.7	  0.7	    0.5      4.3
In both the Anxiety and Impulse-Control sections, the American "lead" is outside the margin for error. Oy.

I am not going to pretend to know why this is the case, but feel free to make your own guesses. Ideologues from every angle will immediately have knee-jerk causes at hand. Admittedly, my first reaction was that this had something to do with sprawl, excessive mental pressure from commercialism, media sensationalism of tragic events, and excessive demands in the workplace in terms of productivity. However, I have no idea whether or not these are actually factors. At the very least, this is something that should be taken more seriously within our country. However, considering the attitude of our leaders, elected officials and national discourse toward health care, especially "touchy-feely" subjects such as mental illness that are surely the invention of do-gooder liberals, I doubt it will be. The Great Backlash narrative against a "PC" strawman simply will not allow this discussion to take place.

Tags: Misc (all tags)

Comments

13 Comments

how are we different?
What makes U.S. culture different?
by Carl Nyberg 2005-03-14 10:36AM | 0 recs
My knee-jerk reaction
Could it be lack of exercise?  High rates in the anxiety and mood categories could definately be related to our car and sofa based society.
by uptown 2005-03-14 10:40AM | 0 recs
There's also ths issue of diagnosis
There's a wide range of cultural differences in the practice of psychiatry.  I'm about to do a some say x, some say y point.  It's possible that American diagnostic criteria are too sensitive, and that they pick up a lot of people and then medicalize them.  It's also possible that other countries don't diagnose enough people, and that there are a lot of mentally ill people abroad who aren't being diagnosed.  (I would have said treated except that a lot of Americans with diagnosed mental illnesses aren't getting treatment.)  In this case, the truth may be somewhere in between.

There has been speculation that ADHD rates in the US are higher, because the kind of entrepeneurially minded people who are likely to pick up and emigrate to a new country are likely to carry some genetic vulnerability to the disorder.

by Abby 2005-03-14 10:45AM | 0 recs
Re: There's also ths issue of diagnosis
I'm convinced that Americans are grossly over-diagnosed and over-medicated, and it's absolutely dangerous.  ADHD is the poster child for the problem.  I'd wager it's over-diagnosed by a factor of 10 or more.

If there's a "real" factor at work, it's our work habits.  Compare the US workweek and the amount of vacation time we take compared to most of Europe.

On the other hand, I think the most seriously metally ill are under-treated.  Every yuppie has their Zanax or Vallium or whatever, but there's a lot of truly delusional people out there getting no treatment at all (because someone who is truly ill is likely unaware or in denial about their illness).

by fwiffo 2005-03-14 10:56AM | 0 recs
Re: There's also ths issue of diagnosis
Agreed on the over-diagnosed thing.
On your other statement though:
"If there's a "real" factor at work, it's our work habits.  Compare the US workweek and the amount of vacation time we take compared to most of Europe."
I would have to disagree, first of all France is also near the top of the list to, and they have their 33 hour work week, etc.  Also not to long ago Americans and the rest of the world were working a lot longer hours than we do now, and if long work weeks were the cause they would have had an epidemic on their hands.  Granted, at the time mentall illness was poorly understood, but I think we would have had more accounts of anxiety, depression and other mentall illness on record from those times if overworking were the problem.  
If anything I think our self-centered, couch potato society causes a lot of these problems.
by Freedom Fighter 2005-03-14 01:52PM | 0 recs
Perhaps...
...it's simply a statistical artifact.  Maybe U.S. psychiatrists and psychologists are more likely than their counterparts elsewhere in the world to diagnose the same disorder in comparable patients.  Maybe U.S. citizens are just more likely to show up in a psychiatrist's office than are citizens of other countries, so more mentally ill Americans will be found.  Or maybe we're just a sick society.  Who's to say?
by KTinOhio 2005-03-14 10:47AM | 0 recs
It's not easy running the world.
Very stressful.

But seriously: we have a toxic culture in which maximum consumption is the primary concern. We're bombarded with messages which are calculated to instill in us an urgent sense of "needing" even the most trivial or poisonous things.

As to how we compare, I'm not familiar enough with other cultures to say anything with confidence. In my limited experience, however, societies where people actually have needs and goals which reflect a pursuit of survival and fulfillment -- rather than base consumption and accumulation of wealth -- tend to have a smaller proportion of people all scared and lonely and confused about their place in the universe.

by catastrophile 2005-03-14 10:49AM | 0 recs
obiously...
we need more substance disorders... I am doing my part each night Grabbing a pint of beer
by pacified 2005-03-14 01:04PM | 0 recs
Suburbuan-Exurban Consumer-Crazed Money Culture
Gosh, what could it be?  Gosh, does the fact that 50% of our adult population is OBESE tell anyone anything?  Could it possibly be the empty, shallow, "no-there-there" culture of the suburbs-exurbs which  is totally and completely based on mass consumption of cheap goods, overwork, hours in the car every day, neighborhoods with no sidewalks?  No, couldn't be?
by Matty 2005-03-14 04:19PM | 0 recs
Two comments
  1.  Russia is not on the list.  i would bet it leads the US in both depression and substance abuse.  I have read that the latter is so bad in Russia they cannot staff the army.

  2.  This is a very competitive, unnurturing society.  Every male is supposed to be a little frontiersman on his own with no tears allowed from the time he is 2.  Women are idealized and also demonized.  Very conflicted culture.  And the competition just gets worse, with a very few winners who take all and very few losers.  No social fabric, no safety net.  Just a lot of gibberish about "family values" while the family is unbdermined econimically by the GOP.
by Mimikatz 2005-03-14 04:29PM | 0 recs
Russia and The Ukraine
I think that The Ukraine offers some indication of what Russia would be like. Check out that lead in substance disorders!

That said, the US can't staff its military, either. And hiding the problem is a key part of our coping strategy. Democracy Now touched on that this morning. One reason that there are 5,500 deserters out there, living below the radar, is that the military doesn't want to go after them in a big way. They don't have the manpower to do so, and if they did, it would only publicize the problem, and vastly increase the number of folks who would desert.

Of course, the US staffing problems are due to sobriety, rather than drunkeness. Details, details....

by Paul Rosenberg 2005-03-15 05:55AM | 0 recs
No Diagnosis, no coverage for therapy
One explanation for the seemingly high incidence of mental illness in the US is the way psychotherapy is covered by health insurance. Most people want to use their insurance to pay for therapy. In order for that to happen, the therapist must assign a DSM IV psychiatric diagnosis and it must be one of the diagnostic categories insurers will pay for. Lots of people seeking therapy are not "ill" but are what used to be called "the worried well". However there is no diagnostic code for "worried well", so we get what appears to be high rates of mental illness. That and the pervasive use of psychiatric drugs of all kinds and BINGO! it looks like Americans are a crazy lot.
by DrCheryl 2005-03-15 02:59AM | 0 recs
Measurement, Reality & Table Wine
It's surely a sign of maturity to question if a measurement is accurate, or merely reflective of differences in diagnostic and reporting methods. But it's also a sign of maturity to be able to read, draw inferences, and, you know, like, click on links.

So, when you read that something was published in JAMA, which is (rumor has it) peer reviewed, it just might be a good idea to cool it with the speculation and investigate a little bit.  And what would you find? This:

Objective  To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative.

Design, Setting, and Participants  Face-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia.

Main Outcome Measures  The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview.

So, we can effectively remove all those speculations that get the US off the hook. The data are for real. Oh, and the sample sizes ["Sample sizes range from 1663 (Japan) to 9282 (United States)"] mean that the MOEs are narrower than we're commonly accustomed to.

The study itself notes a variety of problems with the data, which are not unusual in this kind of work. It's one reason that multiple studies are usually required before people feel confident in drawing broad conclusions--though more specific findings are on much sounder footing.  

That said, you don't need studies like this to know that the French and Italians have less problems with substance abuse than we do. They drink a lot more table wine, and have much lower levels of alcoholism. This accords with the ancient wisdom--moderation in all things--and the commonsense observation that temperance is generally more effective (and healthy) than abstinene.

Now, clearly one cannot generalize from one category to another--as the data in the table show. What is remarkable about the US is that we score so high in so many of the categories, which obviously have different causal modalities.  (Maybe if they didn't drink so much table wine, the French would be as anxious as us?)  But surely this calls for more self-examination. And surely, this is precisely what we lack, and why we have the political leadership we do.

by Paul Rosenberg 2005-03-15 05:48AM | 0 recs

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