June 1, 2004 -- A World Health Organization study released Tuesday shows that rates of most mental illness are far higher in the U.S. than in any other country in the world.
At the same time, the study indicates that money used to treat mental health problems in the U.S. and abroad is not being spent in the most effective way possible.
Overall, the survey of more than 60,000 adults in 14 countries showed a 27% rate of mental disorders in the U.S. population for a list of diseases. That list includes: depression, anxiety, eating disorders, and substance abuse. The U.S. rate was substantially higher than that of any other country measured, including other industrialized nations such as Belgium, which showed a 12% illness rate.
Ukraine had the second highest overall rate of mental illness at 21%. Its 6.4% rate of substance abuse, including alcoholism, was the world's highest and the only measure to exceed U.S. mental illness figures, according to the study, published in today's issue of The Journal of the American Medical Association.
High Rates Underestimated
Despite evidence that one in four U.S. adults experiences mental illness at some point, researchers still consider the figure an underestimate. They acknowledge that many people remain reluctant to tell surveyors about their mental health history, mainly because of the stigma attached to mental diseases. Underestimates could be even more severe in foreign nations, where patients are unaccustomed to discussing emotional issues or even giving information to pollsters, as they were asked to do for this study.
"These numbers are absolutely staggering," says Ronald C. Kessler, PhD, a professor of health care policy at Harvard Medical School in Boston, and one of the study's co-researchers. "When we get to the bottom of the situation, my guess is it is going to be doubly staggering," he tells WebMD.
Among the study's findings are an 18% rate of anxiety disorders and a 10% rate of mood disorders in the U.S. Both figures are above that of any other country, but range far beyond what is found in places such as Shanghai, which showed just a 2.4% rate of anxiety and a 1.7% rate of depression.
Kessler says that researchers still aren't sure whether mental illnesses are much more common in the U.S. or if people are simply more comfortable discussing them with questioners. Discussions of mental illness are far less common in many parts of the world than in the U.S., where drug companies frequently tout medications designed to treat disorders.
"These are the kinds of health problems people don't jump up and say they have," he tells reporters.
Kessler points to a 5.3% reported rate of anxiety disorders in Japan -- a figure he calls "implausibly low." Japan also consumes the most benzodiazepines -- drugs used to reduce anxiety. That is more than any other nation per person, he says.
The study also shows that the U.S. and other industrialized countries are doing a poor job of spreading treatment to patients who most need it. Nearly half of all people with serious mental illness in the U.S. did not receive any treatment in the last year. At the same time, 23% of people with "mild" mental disorders and even 8% of those with mental problems that didn't quite meet official criteria for a mental illness -- called "subthreshold" problems -- got care.
"The fact that many people with subthreshold disorder are treated while many with serious disorders are not shows that unmet needs for treatment among serious cases is not merely a matter of limited treatment resources but that misallocation of treatment resources is also involved," the researchers conclude.
Kessler maintains that putting more resources into early identification and treatment of mental disorders could prevent more illnesses of all severities.
"The resources are already in the health care system to do that if we wanted to reallocate the dollars," he says.