Over the last year, we have seen high profile suicides that have gripped our attention—from Kate Spade, to Anthony Bourdain, to, most recently, the tragic death of Parkland shooting survivor Sydney Aiello. It is often recognized, correctly, that suicide is highly linked to mental illness, particularly depression. That, in and of itself, is ample reason for us to think carefully about mental illness and its consequences, but before I tackle the issue of suicide, I want to comment, more foundationally, on why mental health should matter, and be more central to our attention in health.
The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Yet when we think of health, we tend to prioritize physical well-being, at the expense mental health. Instead, we should tackle mental health the same way we tackle physical health—with an eye towards preventing disease by addressing the foundational forces that cause us to be sick or well. We must do so for three key reasons—there are others, of course, but I here focus on three, in the interest of making a succinct, and hopefully persuasive, case.
Mental disorders account for a significant portion of the global disease burden
About 15 percent of the world’s diseases are mental illnesses. The challenge of mental disorders is especially acute in the US, where an estimated one in five adults—about 44 million people—experience mental illness each year. Depression is one of the most common mental illnesses, affecting an estimated 300 million people around the world. Depression is so widespread that the WHO has projected that, by 2030, it will be the leading cause of the global disease burden.
Mental illness may be even more common than we think. Many mental health challenges are likely underreported. There are a number of reasons for this. They include differences of opinion within the mental health field about the characteristics of these disorders, as well as changes to how we study them across populations and cultures. We also have a long way to go before we create a culture where stigma no longer prevents people with mental illness from getting assistance. 38 percent of Americans have said they are “definitely or probably” unwilling to have a person with mental illness move next door to them, 58 percent said this about having someone who is mentally ill work closely with them; and 68 percent said it about having someone who is mentally ill marry into their family (Figure 1). These attitudes make it likelier that many people with mental illness will remain under the radar, making it hard to accurately assess their true numbers.
Figure 1. Stigma by the numbers
Source: Dingfelder SF. Stigma: Alive and Well. Monitor on Psychology. 2009; 40(6): 56.
Mental disorders are shaped by contemporary social conditions
Health—both physical and mental—is a product of the social, economic, and environmental conditions in which we live. Our minds, just like our bodies, are shaped by a complex array of factors, including where we live, our genetics, our childhood experiences, and our access to material resources. Income, for example, is one of the most significant influences on health, and is linked to a number of common mood-anxiety disorders. From 2009 to 2013, 8.7 percent of people with annual incomes below the federal poverty line reported experiencing “serious psychological distress,” compared with the lower levels of psychological distress reported by individuals with higher annual incomes (Figure 2).
Figure 2. Inequality and mental health
Source: Cohn J. Mental Illness is a Much Bigger Problem for the Poor, New Study Shows. The Huffington Post. May 28, 2015. Accessed February 14, 2017.
Mental illness has also been linked to social conditions like discrimination, which can undermine the health of often-targeted groups like immigrants, racial minorities, and the LGBT population. For example, state laws allowing businesses to discriminate against same-sex couples have been linked with a 46 percent increase in mental distress among this group. And, when mental illness does strike, racial and ethnic disparities in care access can prevent members of marginalized communities from receiving treatment. These realities suggest the importance of addressing mental health not just at the level of treatment, but by engaging with the broader socioeconomic forces that do so much to shape our lives.
Early childhood is a critical time for preventing mental illness
Mental illness tends to have an earlier onset than other chronic conditions, and the burden of mental illness falls heavily on the young. As of 2011, up to 50 percent of children and adolescents living in the US met diagnostic criteria for at least one mental health disorder before reaching age 18 (Figure 3).
Figure 3. Percent of youth who meet criteria for a mental disorder diagnosis
Source: New data on mental illness among US youth. Monitor on Psychology. 2011; 42(2): 10.
It is important to note that, if mental illness is not treated early, it can increase the risk of other disorders throughout life. People with mental illnesses tend to have higher mortality rates than people without them, which can be linked to co-occurring physical challenges like heart disease, diabetes, and HIV. Mental disorders also drive mortality risk through their link to suicide, which claims over 800,000 lives around the world each year. The lifelong threat of mental illnesses points to the importance of addressing these diseases early, while the brain is still developing and interventions stand a better chance of taking hold. This means creating the conditions for health before a child even leaves the womb. Prenatal substance use can lead to low, and very-low, birth weight or premature birth, potentially harming mental health. Very-low birth weight (less than three pounds.) has been linked with an up to 4.5 times higher risk of psychiatricproblems, and low birth weight (less than five pounds.) has been linked with a 2.5 times greater risk of adult psychiatric problems. Exposure to toxic substances in early life, such as lead, can also threaten mental health—higher blood lead levels have been associated with higher risk of major depressive disorder and panic disorder in young adults. By preventing these hazardous childhood exposures, we could do much to improve mental health.
If we break an arm, or develop an infectious disease, it will be difficult for anyone to mistake our condition for good health. If, however, we struggle with mental illness—such as depression, anxiety, or post-traumatic stress disorder (PTSD)—it is possible that our disease will present few outward symptoms. At the same time, the stigma that is still too-often attached to mental illness can make those who develop a disorder less likely to seek the help they need. Given these challenges, and the reasons I have listed, it is critical that we address mental health with as much energy and insight as we apply to physical concerns. Our health deserves nothing less.