In Brief

Half of all lifetime cases of mental illness begin by age 14 and, despite the availability of effective treatments, many patients do not seek and receive treatment until long after the first onset of symptoms, according to research reported in the June issue of the Archives of General Psychiatry (Vol. 62, No. 6, pages 593-602).

The National Comorbidity Survey Replication (NCS-R), supported by the National Institute of Mental Health (NIMH) and led by sociologist Ronald Kessler, PhD, a professor of health-care policy at Harvard Medical School, surveyed 9,282 English-speaking U.S. adults about their mental health.

The study found that mental disorders are quite common: About a quarter of the general population reported that they had symptoms sufficient for diagnosing a mental disorder during the previous 12 months.

"The study shows it is doubtlessly the case that an enormous number of people in this country are in a huge amount of psychological pain," Kessler says. "It is much greater than the pain caused by physical disorders."

The study also indicated that long delays between initial diagnosis and treatment are common for nearly all mental disorders. The median delay across disorders is nearly a decade; the longest delays are 20 to 23 years for social phobia and separation anxiety disorders.

The study is a replication of the 1990 National Comorbidity Survey, which estimated the prevalence of mental disorders in a nationally representative sample. NCS-R includes detailed measures of how and when people experience mental illness and what kind of treatment they receive. The goal of the research is to significantly improve estimates of mental disorders, as well as reduce the degree to which they affect individual families and the burden they place on employers and the U.S. economy, says Thomas Insel, MD, NIMH director.

"These studies confirm a growing understanding about the nature of mental illness across the life span," Insel says, referring to the finding that half of all lifetime mental illnesses start before age 14. "There are many important messages from this study, but perhaps none as important as the recognition that mental disorders are the chronic disorders of young people in the U.S."

The research also underscores a shortfall in treatment, notes Geoffrey M. Reed, PhD, the APA Practice Directorate's assistant executive director for professional development. "This study makes clear that we should be providing more mental health services, rather than fewer, and that we need to do a better job of getting those treatments into the community to young people who need them," says Reed. "The period from adolescence into early adulthood is extremely important in terms of making life choices and establishing behaviors that have a major impact across the entire life span. An untreated mental disorder during this period is likely to affect a person's functioning in an adverse and cumulative way for that person's whole life."

--K. KERSTING