McNeil Family Professor of Health Care Policy, Ron C. Kessler, PhD, was featured on the National Academy of Sciences’ Facebook page for World Mental Health Day. Kessler spoke about how common mental health diseases are today. To avoid bias, he conducted a community-based epidemiological survey to estimate the number of people suffering from mental health. Kessler explains his process and the need for more treatment for mental health in his feature below:
October 10 is World Mental Health Day. Just how common mental disorders are may come as a surprise. The earliest attempts to estimate this number relied on treatment data that were downwardly biased because stigma and financial hardship deter many sufferers from seeking help. To avoid this bias, I conducted the first community-based epidemiological survey of mental disorders among U.S. adults in 1990-1992 and then replicated and extended that study throughout the world over the next 25 years. These surveys consistently show that one-fourth of adults in developed countries experience significant mental health problems each year. This high prevalence coupled with the high impairment of these conditions led the Global Burden of Disease Study to conclude that mental disorders account for more global impairment than any other class of non-communicable diseases and more than all communicable diseases combined.
The good news is that the vast majority of people with mental disorders can be treated effectively with existing therapies. The bad news is that so many evidence-based therapies now exist, each highly effective only among a subset of patients, that therapeutic success usually requires trial-and-error. So while 70-85% of patients with major depression eventually recover after repeated therapeutic trials, only 30% remit after their first trial irrespective of treatment type. Tragically, such therapeutic delays are intolerable for many patients, especially those struggling with hopelessness. Fully half of the 121 daily suicides in the U.S. occur among individuals who were treated for a mental disorder in the prior 12 months.
We have to do a better job of selecting optimal first line treatments. Lives depend on it. Recent research in personalized psychiatry has yielded promising results showing that a wide range of clinical features, patient characteristics, and biomarkers predict the treatments that are optimal for specific patients. My colleagues and I recently launched the Precision Treatment of Mental Disorders (PTMD) Initiative to build on these findings, collecting detailed clinical, personal, and neurocognitive data from thousands of patients throughout America at the beginning of anxiety or mood disorder treatment and documenting therapeutic responses in fine-grained symptom-tracking surveys. This continually-updating benchmark database will be used to guide pragmatic trials in matching future patients with optimal personalized treatments based on therapeutic outcomes of prior patients just like them. Coupled with advances in therapeutic development, initiatives such as PTMD offer hope that future treatments will be more timely and effective.
For information on prevalence and unmet need for treatment of mental disorders in the World Health Organization World Mental Health (WMH) Surveys visit:
https://www.hcp.med.harvard.edu/wmh/ (WMH web site)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100460/ (Barriers to treatment)