An epidemic or a plague of common mental disorders?
2019; Wiley; Volume: 140; Issue: 5 Linguagem: Inglês
10.1111/acps.13108
ISSN1600-0447
Autores Tópico(s)Health disparities and outcomes
ResumoActa Psychiatrica ScandinavicaVolume 140, Issue 5 p. 391-392 Invited EditorialFree Access An epidemic or a plague of common mental disorders? Toshi A. Furukawa, Toshi A. Furukawa [email protected] orcid.org/0000-0003-2159-3776 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JapanSearch for more papers by this author Toshi A. Furukawa, Toshi A. Furukawa [email protected] orcid.org/0000-0003-2159-3776 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JapanSearch for more papers by this author First published: 25 October 2019 https://doi.org/10.1111/acps.13108Citations: 3AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Many articles in psychiatric journals start their introduction by focusing on the gravity of mental disorders. Thus, for example, one article may start like 'Depression is the leading cause of disability around the world. The number of people living with depression increased by around 18% between 2005 and 2015, and now affects 322 million people or about 4% of the world's entire population', just to quote one recent case of mine 1. Similar tonality can be easily found in other academic articles and popular books, touting such sensational words as 'epidemic' 2, 3, 'plague' 4, or 'pandemic' 5. What good evidence is there for such claims, however verisimilar and alarming they may sound? It has been repeatedly pointed out that prescriptions of antidepressants have doubled in the high-income countries between 2000 and 2015 6 and currently more than 10% of adult populations are prescribed antidepressants in such countries as USA or Australia. The proportion of people with diagnosable mental disorders actually receiving treatment has also increased from approximately 20–33% in the 1990s in USA 7 or from 37% to 46% in the 2000s in Australia 8. These facts would certainly be contributing to the impression of an epidemic or a plague. However, we must remember that, on the one hand, antihypertensive and antidiabetic drug consumption has similarly doubled and that cholesterol-lowering drug consumption has quadrupled in the same 15 years 6 and that, on the other hand, there appears to be serous overdiagnosis and overprescribing in the case of depression 9. Have the prevalences of depression and anxiety increased? – this is the question, and the question is not easy to answer because, logically speaking, it requires large-scale surveys, repeated over the years, with similar enough methodologies. It is then no wonder that the literature has reported mixed and conflicting findings. We must remember that, in some cases, the degree of variability of estimated prevalences across countries is beyond reasonable explanation even when the studies had apparently used similar methodologies: For example, a report from the World Mental Health Survey Initiative summarized that the annual prevalence of depression is only 3.0% in Germany or Italy but it reaches 5.9% in France and 8.3% in USA 10. Should the figure in Germany rise to 5.9% in the next survey, could we argue that the prevalence has doubled in the meantime? Richter and his colleagues in this issue 11 set out to answer this challenging yet extremely important question by systematically reviewing epidemiological surveys that used the same methodology in the same geographical region repeatedly. They found 42 such studies, which compared prevalences of various conditions including depression, distress, alcohol dependence, and general mental illness, between two time points of, on average, 9.9 years apart. The pooled OR was 1.18 (95% confidence interval: 1.07–1.31). The authors concluded that the prevalence of adult mental illness has only modestly increased. The heterogeneity among the studies was extremely high, with I-squared of 96%. The subgroup analyses indicated strong effect modification (relative OR close to 0.5 or 2.0) because of the survey methodology (clinical diagnosis vs self-report symptoms), target mental condition (general mental illness vs substance dependence), decades (1980s vs. 2000s or later), or study quality (low vs high). In view of the extreme heterogeneity and the existence of apparent effect moderators, probably the overall OR of 1.18 is not very informative. I wonder what the estimates may have been if limited to clinical diagnosis of depression in Western countries after 2000s based on moderate to high quality scores. In the discussion, the authors point out the similarity of their findings with those from the latest Global Burden of Disease study. The latter reported 13.5% increase in the ten years between 2007 and 2017 in the total years lived with disability (YLD) because of mental disorders (excluding substance use disorders): When standardized for age, however, the increase disappeared and the change was − 1.1% 12. By way of reference, it is good to remember that the all-cause YLD increased by 17.0% in raw counts and by − 0.9% when age-adjusted during the same 10 years. Given Richter et al.'s new study 11 and other corroborating evidence, we can probably summarize: The prevalence of common mental disorders may be increasing modestly in the recent decades, but this increase is mainly driven by population aging and growth. The question remains however: Why has increasing provision of mental health services including antidepressant prescriptions not apparently had an impact on the annual prevalence of common mental disorders in these decades? Is it possible there still is great treatment gap and/or quality gap (one can easily imagine that 10% increase in under-quality care would have minimal impact on disease prevalence), or that the increase in mental healthcare provision was only enough to curtail the rapid increase in mental ill-health that would have taken place had it not been for increased mental health care? Declaration of interest TAF reports personal fees from Mitsubishi-Tanabe and MSD, and a grant from Mitsubishi-Tanabe, outside the submitted work; TAF has a patent 2018-177688 pending. References 1Furukawa TA, Cipriani A, Cowen PJ, Leucht S, Egger M, Salanti G. Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. Lancet Psychiatry 2019; 6: 601– 609. 2Whitaker R. Anatomy of an epidemic: magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Random House; 2010. 3Tucci V, Moukaddam N. We are the hollow men: The worldwide epidemic of mental illness, psychiatric and behavioral emergencies, and its impact on patients and providers. J Emerg Trauma Shock 2017; 10: 4– 6. 4Torrey EF, Miller J. The invisible plague: the rise of mental illness from 1750 to the present. New Brunswick, NJ: Rutgers University Press; 2001. 5Kramer M. The increasing prevalance of mental disorders: a pandemic threat. Psychiatr Q 1983; 55: 115– 143. 6 OECD. Health at a Glance 2017: OECD Indicators. Paris: OECD Publishing; 2017: p 2017. 7Kessler RC, Demler O, Frank RG et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 2005; 352: 2515– 2523. 8Whiteford HA, Buckingham WJ, Harris MG et al. Estimating treatment rates for mental disorders in Australia. Aust Health Rev 2014; 38: 80– 85. 9Mojtabai R. Clinician-identified depression in community settings: concordance with structured-interview diagnoses. Psychother Psychosom 2013; 82: 161– 169. 10Bromet E, Andrade LH, Hwang I et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med 2011; 9: 90. 11Richter D, Bruen A, Whittington R. Is the global prevalence of adult mental illness increasing? Systematic review and meta-analysis. Acta Psychiatr Scand. 2019; 140: 393– 407. 12James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789– 1858. Citing Literature Volume140, Issue5November 2019Pages 391-392 ReferencesRelatedInformation
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