Mental health often overlooked.

In 2001, the World Health Organization (WHO) estimated that 450 million people worldwide had a mental or neurological disorder. Twenty-five percent of the population can expect to experience one or more disorders within their lifetime. Mental illness is universal, affecting people in all nations and from every background, but poor people in developing countries lack access to many of the most basic resources for effective treatment.

WHO's definition of mental health disorders is broad, encompassing a wide range of problems of both the mind and brain. It includes autism, Alzheimer's disease, schizophrenia, depression, sleep disorders, addiction and substance abuse, bipolar affective disorder, panic and anxiety disorders, mental retardation, and epilepsy. (Although epilepsy occurs because of an electrical mix-up in the brain, and retardation and autism are developmental problems, people with these conditions are often discriminated against and prevented from fully participating in normal social activities.)

Overall, mental disorders account for almost a third of global disability (the number of healthy life years lost to a disability) from all diseases. Depression is by far the most debilitating--more than 120 million people are affected worldwide. Currently, depression represents 12 percent of the global disability burden, and by 2020 its share is expected to rise to 15 percent, second only to heart disease.

Although the incidence of depression is highest during middle age, experts recognize that the elderly and children aren't immune to mental health problems. The prevalence of some disorders--dementia and Alzheimer's--rises with age. In the United States, one in ten young people suffers from impairment of psychological development or from behavioral, emotional, and depressive disorders. Roughly 18 percent of children and adolescents in Ethiopia have a mental disorder, while in India the figure is 13 percent. More than 20 percent of young people in Germany, Spain, and Switzerland are afflicted with depression, anxiety, or other mental problems.

Rural isolation and poverty can make things worse. In remote regions, mental and general health care facilities and counselors are nonexistent or too expensive. Rural women--who also suffer from economic hardship--are more than twice as likely to suffer from depression than the general population. Often the mentally ill, who carry the extra burden of being poor, wind up incarcerated. In the United States, there are five times as many prisoners with mental illness as there are patients in state mental hospitals.

Changing societal norms can also bring out psychological problems as people are separated from their traditional social safety nets of family and community. For instance, eating disorders--an increasingly common problem among girls (and more and more boys) in affluent nations--have spread to developing countries as cultural definitions of female beauty change. Dependence on a cash economy, overcrowding, pollution, and increased violence in cities can also exacerbate mental disorders.

Mental illness strikes men and women differently. Almost 10 percent of women have a depressive episode every year, compared with fewer than 6 percent of men. Men, however, are more likely to have substance abuse problems and antisocial personality disorders. Severe mental disorders, such as schizophrenia, show no clear gender preference.

Mental illness often exacerbates and in some cases leads to other health problems. Patients with untreated mental disorders who also suffer from other chronic conditions--such as cancer, HIV/AIDS, heart disease, or diabetes--are less likely to experience an improvement in their overall health. And addictions to drugs, tobacco, or alcohol--which WHO also classifies as mental health disorders--can increase the severity and duration of mental illness. Studies show that the mentally ill are about twice as likely as others to smoke. Alcohol abuse is on the increase in many of the world's developing regions, especially among indigenous groups which previously had little exposure to intoxicants.

Suicide is the most tragic outcome of mental illness. Nearly one million people end their lives each year, and an estimated ten million to twenty million people try to kill themselves. Suicide--usually preceded by severe depression or schizophrenia--is a leading cause of death in young adults (fifteen to thirty-four years of age) in China and most of Europe. in the United States, farmers in the upper Midwest--a region plagued by economic hardship and loss of small farms--are 1.5 to two times likelier than other groups of men to commit suicide. There is a strong correlation between violence against women and contemplation of suicide. WHO found that Japanese victims of domestic violence were more than thirty times as likely to commit suicide as women who were not abused. Battered women in the United States are five times more likely to commit suicide.

Available treatment methods for mental illness vary regionally and among socioeconomic classes. Use of psychotropic drugs--mostly in industrial nations--is rapidly increasing. Antidepressants are the third most often prescribed drug, with sales of over $13 billion worldwide. The number of Americans taking medicines to treat their depression has risen by more than two-thirds over the last decade. Unfortunately, many are not supplementing their drug therapy with counseling or other interactions with mental health professionals.

In developing nations, however, therapeutic drugs for mental illness are usually unavailable to the general population. As a result, many people end up hospitalized--often in crowded, unsanitary asylums where they are neglected and abused--for conditions that could be treated with drugs, therapy, or both. Human rights commissions in India and Central America found that at least one-third of the "inmates" in these hospitals were people with epilepsy or retardation, who need not be hospitalized.

Few nations have adequate mental health programs, and many lack even the most basic or rudimentary services. WHO recommends that all nations provide treatment for mental illness as part of primary health care, launch public awareness campaigns to break stereotypes about mental illness, support community care of affected individuals, develop the human resources necessary to provide mental health care, and support research on mental illness.

SELECTED MENTAL HEALTH PROBLEMS

DEPRESSION

Twenty percent of cases never go into remission; recurrence rate after first episode is as high as 60 percent.

SCHIZOPHRENIA

Found equally in women and men; affects twenty-four million people worldwide.

SUBSTANCE ABUSE

Dependence on tobacco, alcohol, and illicit drugs affects millions of people and is a rising problem in developing nations.

EPILEPSY

Caused by excessive electrical activity in the brain--not dementia--it affects about fifty million people worldwide.

OBSESSIVE COMPULSIVE DISORDER 

Characterized by uncontrollable anxious thoughts or rituals; more common than schizophrenia, bipolar disorder, or panic disorder and affects about 2 percent of the U.S. population.

EATING DISORDERS

Between 5 percent and 20 percent of people with anorexia nervosa, a disease characterized by an intense fear of weight gain, die as a result of complications. Other disorders, including bulimia nervosa and binge-eating, are becoming more common among young women and girls in non-Western nations, such as Japan, Brazil, and South Africa.

This material is excerpted from Vital Signs 20002 and reprinted with permission from the Worldwatch Institute, www.worldwatch.org.