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Mental disorder numbers outpace treatment.

Mental disorders, drug abuse or dependence, or a combination of the two afflict an estimated 28 percent of U.S. adults annually, a statistic that translates into about 44.7 million persons, according to the most recent analysis of the largest U.S. survey of mental illness to date. However, fewer than one-third of those suffering from these problems seek help from physicians, mental-health clinics, self-help groups, or other caregivers, federal researchers report.

The survey offers no clear guidelines for revamping the health-care system or ensuring accessibility to treatment for mental disorders, assert Darrel A. Regier and his colleagues. Regier, a psychiatrist, serves as director of the Division of Epidemiology and Services Research at the National Institute of Mental Health (NlMH) in Rockville, Md.

"One is left with the dilemma of deciding how a more equitable and efficient system may be developed:' the investigators say.

The Epidemiological Catchment Area (ECA) survey covers five communities: Baltimore; Durham, N.C.; Los Angeles; New Haven, Conn.; and St. Louis. Between 1980 and 1985, researchers interviewed 20,291 individuals; a year later, they conducted follow-up interviews with 15,849 members of that group.

Though the ECA survey concentrates on urban areas, it stands as the most comprehensive look at the prevalence and treatment of mental disorders nationwide.

Initial interviews revealed that 15.7 percent of those surveyed reported symptoms of a mental disorder or substance abuse in the month before their questioning (SN: 11/12/88, p. 311). During the one-year follow-up, an additional 12.3 percent of the sample either developed a new mental disorder or serious drug problem or experienced the return of a mental disorder that had not been present at the time of the first interview.

Phobias and abuse of or dependence on alcohol and illicit drugs account for much of the overall increase in prevalence, from 15.7 percent at one month to 28 percent at one year, the researchers report in the February ARCHIVES OF GENERAL PSYCHIATRY.

Phobias affected 10.9 percent of the participants at one year. Another 7.4 percent reported alcohol abuse or dependence, 5.4 percent reported dysthymia (mild depression), 5 percent cited severe depression, 3.1 percent suffered nonalcohol drug disorders, and 2.1 percent reported obsessive-compulsive disorder. Other disorders occurred in 8 percent of the population.

A mental disorder appeared simultaneously with substance abuse among 3.3 percent of the volunteers.

Over a one-year period, 14.7 percent of all participants -- the equivalent of about 23.1 million people in the United States -- received mental health services, the NIMH scientists say. Of that number, slightly more than half qualified as suffering from a current mental or substance abuse disorder. Most of the rest had a history of psychiatric problems.

Among those seeking help who met the criteria for a current psychiatric disorder, the majority of visits occurred at facilities specializing in mental or substance abuse treatment and among support networks of friends, relatives, and self-help groups, the researchers say

However, nearly half of those with active mental or substance abuse disorders who sought treatment spoke with a primary-care physician or with the staff at a hospital emergency room about their symptoms. This confirms previous reports that practitioners of general medicine often serve as gatekeepers to mental health care, the scientists assert.

Of those participants with a mental disorder, only 28.5 percent sought mental health services during the one-year study, Such treatment apparently continues to arouse much stigma and shame, the NlMH team contends.

Individuals suffering from schizophrenia, manic depression, and somatization disorder (multiple physical complaints associated with no biological cause) proved most likely to receive some type of mental-health treatment.

Regier and his associates are now analyzing ECA data to determine the characteristics of people most in need of outpatient and hospital treatment for mental disorders. They also plan to chart the typical duration and chances of recurrence for each mental disorder included in the survey

For now, the investigators conclude that mental-health services available in the United States often fail to provide rapid treatment for psychiatric disorders and early care to prevent the worsening of symptoms.
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Title Annotation:National Institutes of Mental Health survey results
Author:Bower, Bruce
Publication:Science News
Date:Feb 27, 1993
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