There are many ailments that a physician can easily diagnose and health officials can track. For example, the cause of an infection can usually be determined by the presence of an infectious pathogen. The diagnosis of type 1 diabetes is easy to establish. The same can be said for asthma, strep throat, or hemophilia. Sure there are gray areas in medicine, but for the most part, the diagnosis of common diseases is usually fairly cut and dry. The same can not be said of mental illness.
The diagnoses (even the definition) of mental illnesses are based on subjective judgements, which automatically weakens even the best studies designed to quantify it. This is even harder to diagnose and study in children because it relies heavily on parent-reported symptoms. Here s how Kathleen Merikangas, chief of the National Institute of Mental Health s in-house genetic epidemiology research program describes it: Right now we have all these different agencies doing surveys, each using a different method. It s a nightmare. We need to do better.
Difficulty in diagnosing and tracking mental illness is nothing new. We recently discussed this issue in relation to autism. There is clearly lot of confusion amongst the public, health officials and physicians about the state of mental illness in this country and headlines like the one in today s New York Times only serve to highlight this.
The title is very attention grabbing: Severe Mental Illness Found to Drop in Young, Defying Perceptions. But does this actually reflect the essence of the study? Maybe not.
The article describes a recent study in the New England Journal of Medicine that claims severe mental illness in young people has dropped. Although the study group was very large (it analyzed 53,622 youths aged 6 to 17) the methods relied exclusively on questionnaires, which are notoriously unreliable. Worse still, the questions were answered by parents rather than the children and young adults.
Here s how it worked: Parents submitted answers to questions about their kids that ranged from Is your child having fun? to Is your child getting along with other kids?. Parents reported a 0-4 rating (0 meaning not a problem, 4 indicating it s a big problem) to each of 13 questions. Scores to each question were cumulated, and any child s sum that was over 16 was categorized as severely impaired.
The researchers concluded that over the past 12 years, the percentage of children in this severe category fell to 10.7 percent from 12.8 percent in the period from 1996 to 2012. The study s lead author Dr. Mark Olfson of Columbia University said The finding is robust and real and challenges the prevailing stereotype that young people are somehow more vulnerable to mental problems.
Yet the conclusions are not only not universally accepted, but actually contradict conclusions of previous studies. For example, one study reported that ADHD diagnoses have risen, and another concludes that as many as 20 percent of young people have a serious mental, emotional or social condition. The new study s finding also differ from the opinions of many public health authorities.
Perhaps the most confusing part of all of this is that the study s conclusions are not about the decrease in severe mental illness but are about youth s usage of mental health services an indirect measurement of severe mental illness (at best), and this adds even more uncertainty to the findings.
From the study: Outpatient mental health treatment and psychotropic-medication use in children and adolescents increased in the United States between 1996 1998 and 2010 2012. They also found that relative to other groups, the severely mentally ill displayed the greatest relative increase in use of mental health services.
ACSH s Nick Staropoli explains When we look at this study's results, the parent-reported survey can reasonably be interpreted in a different way: that more children with severe mental issues are receiving treatment than have in the past. Parents may simply be reporting lower scores on the mental illness test for their children because their children are more likely to be receiving treatment for their mental illness. Its a classic case of causation and correlation.
He continues Regardless of the explanation, the results of this study are interesting and do help shed some important light on the fact that we are struggling to properly diagnose and accurately report the prevalence of mental illness in our society. However, the New York Times sensational headline and exaggeration of tenuous results is more misleading than informative.