Psychiatric Illness in Younger Populations
Thus far, we have reviewed data primarily derived from adult populations. But what about children and adolescents? Is there really an “epidemic” of mental illness in such younger populations, as some have claimed?
** Recently, Dr. Mark Olfson and colleagues looked at rates of severe mental impairment among young people who receive mental health care in the United States. Based on survey data involving more than 50,000 subjects six to 17 years of age, the authors found that the percentage of young people with relatively severe mental health impairment actually declined from 12.8% in 1996–1998; to 11.9% in 2003–2005; to 10.7% in 2010–2012.
It’s interesting to note that this decline in serious mental impairment coincided with increasing prescription of antidepressants in this younger population. Though no firm conclusions can be drawn from this temporal association, there is no “signal” from the Olfson et al data suggesting that antidepressants are driving up rates of serious mental impairment in younger populations.
Of course, individual responses to these medications can vary considerabl, and all patients need to be carefully monitored for adverse reactions or side effects—particularly younger patients.
Other data in younger psychiatric populations also undermine the “epidemic” narrative. For example, Dr. E. Jane Costello and colleagues reviewed epidemiologic studies of children born between 1965 and 1996. All the studies reviewed used structured diagnostic interviews to make formal diagnoses of depression.
Twenty-six studies were identified, generating nearly 60,000 observations on children who had received at least one structured psychiatric interview. The authors concluded that there is no evidence for an increased prevalence of child or adolescent depression over the past 30 years, and that
“…public perception of an ‘epidemic’ may arise from heightened awareness of a disorder that was long under-diagnosed by clinicians.”
Similarly, Dr. Kathleen R. Merikangas and colleagues reported on results from the National Comorbidity Study-Adolescent Supplement (NCS-A), which examined lifetime prevalence data of mental disorders in a nationally representative sample of U.S. adolescents.
This study, too, found no evidence of substantially increased rates of major depression, compared with earlier NCS data.
^^Finally, with respect to bipolar disorder in younger populations, a recent review by Goldstein and Birmaher found no evidence of increasing prevalence of bipolar spectrum disorders over time, as ascertained by rigorous semi-structured interviews.
There is very little credible evidence to support the claim that serious psychiatric disorders are on the rise, much less that there is a “raging epidemic” of mental illness in the U.S.—either in adult or younger populations.
On the contrary, rates of serious mental illness appear to be either declining or stable in this country. Relatively stable rates also apply with respect to the incidence and prevalence of, for example, major depression and schizophrenia.
The actual occurrence rates of mental illness cannot be reliably inferred from changes in medication prescription rates; office-based diagnosis or treatment rates; or rates of putative “disability” attributed to mental illness. Only the uniform application of specific clinical criteria over long periods of time, and/or the use of structured clinical interviews, can yield reliable information on incidence and prevalence.
There is no credible epidemiological evidence that psychotropic medication per se has led to rising rates of serious mental illness or increased rates of any specific psychiatric disorders in the general population.
And, of course, absent a demonstrable “epidemic” of mental illness in the U.S., the speculative claim that there is a “biological cause” for the epidemic is nonsensical on its face.
Notwithstanding these conclusions, we need to investigate why office-based diagnosis and treatment is increasing for some psychiatric disorders.**
We also need better prospective methods of tracking incidence and prevalence of psychiatric illness in this country.
Equally urgent, we need to ensure that those with serious psychiatric illness—who often do not receive any professional care at all– have access to care and treatment by mental health professionals.